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Most people know calcium strengthens bones. But there are more than a dozen other ways to fight osteoporosis, the silent, bone-thinning condition that can lead to fractures, back and neck pain, and a loss of up to 6 inches of height over time.

Both men and women can get osteoporosis, but it's more common in women, especially after menopause. About one in five women over age 50 in the United States have it.

Taking preventive measures is key, as many people with osteoporosis will get bone fractures before they even know they have the disease.

Start early
If you know you are at higher risk of osteoporosis, you can start fighting it early, says Sabrina Strickland, MD, an orthopedic surgeon at the Women's Sports Medicine Center at the Hospital for Special Surgery in New York City.

"If your mother had it, you should be doing everything right from age 20 to 30," she says. "We make bone until we're 30, so that is when we need to eat right—ideally we maximize bone mass while we are making it."

Exercise
Exercise is one of the most important things you can do to prevent osteoporosis.

"A total lack of exercise is bad; astronauts and spinal cord–injury patients lose bone," says Kenneth Lyles, MD, professor of medicine at Duke University School of Medicine, in Durham, N.C.

These groups are limited in how much they can move and do weight-bearing exercises—those that work against gravity, such as walking, jogging, lifting weights, doing push-ups, or climbing stairs. Dr. Lyles tells patients to exercise five to six days a week—30 minutes of both aerobic and strengthening exercise two to three times a week.

White and Asian people, as well as those who are relatively thin, are at greater risk of bone thinning than other people in the population.

Cut back on salt
Whether salt impacts osteoporosis is uncertain, but there does seem to be a relationship between high sodium intake and bone loss, particularly for people with high blood pressure.

In general, salt increases the amount of calcium excreted in urine and sweat, which can spur bone loss if you are already calcium deficient. And research suggests that people with high blood pressure lose more calcium in their urine.

Dr. Lyles says this can pose a problem for the approximately 10% of the population that has an inherited metabolic disorder that causes their kidneys to excrete too much calcium.

Watch your soda intake
A high intake of cola—whether decaf, diet, or caffeinated—was linked to a greater risk of bone thinning in a large 2006 study. It is not clear, however, if soda actually causes bone loss. Some experts chalk up the link to the fact that people who drink a lot of soda likely consume less dairy.

Many sodas, including colas, contain phosphorus, a mineral that we need. But phosphorus intake has to be balanced with calcium—if not, it may up your risk of bone thinning.

In addition to phosphorus, the authors of the 2006 study say that ingredients in cola extract could have a detrimental effect on bone health.

Curb your caffeine
Dr. Strickland says caffeine can interfere with calcium absorption, so any substance containing caffeine—whether soda, coffee, or chocolate—should be limited.

Moderate intake—for example 300 milligrams of caffeine a day (which is about one cup of coffee or two cups of tea—is probably not a problem as long as you are getting enough calcium.

Don't smoke
"I tell all of my patients to stop smoking because it is terrible for your bones," says Dr. Strickland. Smoking impedes the healing of fractures and reduces the body's ability to make bone, she says.

"When you stop smoking, you are immediately increasing your bone strength and ability to recover from injury."

Watch your medications
Some medications can increase the likelihood of getting osteoporosis. One of the main culprits is anti-inflammatory corticosteroids such as prednisone, which cause bone thinning.

Proton pump inhibitors such as Prilosec and Prevacid (used to treat acid reflux) change the pH balance in the stomach, which can affect how well calcium is absorbed. Dr. Strickland says this is usually an issue with long-term (i.e. more than seven years) usage of these medications.

Antidepressants known as selective serotonin reuptake inhibitors and methotrexate are also associated with osteoporosis.

Limit alcohol
Up to two drinks a day may actually help prevent fractures, Dr. Lyles says, but more than that could reduce the absorption of calcium, deplete calcium reserves, and reduce the level of hormones such as estrogen that are involved in bone production.

Consuming too much alcohol can also put people at risk for falls and breaks.

Calcium
Adults should get 1,000 milligrams of calcium daily, according to the National Institutes of Health (NIH). And the recommendation goes up to 1,200 milligrams for women over 50 and men over 70.

Most people, with the possible exception of adolescent girls and the elderly, get enough calcium in their diet, according to a 2010 Institute of Medicine report.

Supplements are typically safe, but should be taken at the recommended dose and along with vitamin D. Too much can increase the risk of kidney stones or other problems.

Vitamin D
Vitamin D helps the body absorb, retain, and use calcium. Sunlight triggers vitamin-D production in the body, and dietary sources of the vitamin include fortified foods such as milk, orange juice, and breakfast cereals.

In general, it's hard to get too much vitamin D unless you overdo supplements. (Too much can harm the heart or kidneys). Aim for 600 international units (IU) daily and 800 IU if you are over 70, according to the NIH. The upper limit is 4,000 IU.

Oral bisphosphonates
Bisphosphonates are the most widely used osteoporosis medications, and include alendronate (Fosamax), a pill or liquid taken either daily or weekly; risedronate (Actonel), a daily, weekly, or monthly pill; and ibandronate (Boniva), a daily or monthly pill.

These medications are intended to prevent fractures in the spine, hips, and wrists among people with abnormal bone loss. Boniva, however, has only been proven to reduce spinal fractures.

The pills, which can cause heartburn and upset stomach, must be taken on an empty stomach. You can't eat for between 30 and 60 minutes after taking them, depending on the medicine.

Injectable bisphosphonate
Zoledronic acid (Reclast) is an injectable bisphosphonate given once a year as an intravenous infusion. (It can also be given biannually to prevent osteoporosis in postmenopausal women.) The infusion can produce flu symptoms immediately after administration, Dr. Lyles says.

Bisphosphonates increase the risk of two rare complications—spontaneous femur fractures and osteonecrosis (bone death) in the jaw.

These complications occur in between one in 10,000 and one in 100,000 patients, Dr. Lyles says, usually after using the medications for two years. Doctors usually stop prescribing these medications after five years.

Raloxifene
Raloxifene (Evista) can reduce the risk of spinal fractures by 50%. The drug doesn't, however, appear to prevent fractures not in the spine.

Intended for use in postmenopausal women, it may decrease the risk of breast cancer and heart disease, but it also raises the risk of blood clots. It typically isn't the first line of defense for osteoporosis, Dr. Lyles says.

Denosumab
Denosumab (Prolia) is the newest osteoporosis drug on the market.

This medication prevents bone breakdown as well as bisphosphonates, but through a different mechanism, Dr. Lyles says. It is given by injection (not infusion) twice a year.

Side effects can include back and muscle pain, eczema, and skin infections. Unlike bisphosphonates, however, denosumab has not been associated with osteonecrosis of the jaw.

Calcitonin
Calcitonin (Fortical, Miacalcin) is less effective than bisphosphonates, but it slows bone thinning and could reduce the risk of spinal fractures.

Calcitonin may help reduce pain caused by spinal compression fractures. It can be injected or taken nasally (using a nasal spray). The most common side effects are nasal irritation (with the spray) and nausea (associated with the injectable form).

Parathyroid hormone
Parathyroid hormone is a naturally occurring hormone that stimulates new bone formation.

A synthetic version, teriparatide (Forteo), is approved for people who have severe osteoporosis and a high risk of fractures. The once-daily injection can be self-administered and is taken for two years, but is usually given only to people who don't respond to other medication.

At about $750 a month, it's pricey, Dr. Lyles says. Side effects include joint pain, headache, dizziness, and nausea. Many patients are also so tired after taking the shot that they discontinue use, Dr. Lyles adds.

Hormone therapy
Women would have great bones if they never hit menopause, Dr. Strickland says. If hormone therapy—usually estrogen taken by itself or in combination with progestin—were looked at strictly through the lens of bone strength, she adds, everyone should take it.

A wider lens has to be used, however. Hormone therapy is rarely prescribed to women unless they cannot take other medications because it can increase the risk of breast cancer and heart disease.

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