01/06/2014 12:40 pm ET Updated Mar 06, 2014

How to Keep Your Bones Healthy and Strong -- Part 2

In Part 1 of this series I discussed what factors contribute to bone health and various ways to assess the health of your bones. Now I will discuss the available treatments for osteoporosis and how to keep your bones healthy and strong naturally.

Treatment for Osteoporosis:

Pharmaceutical: In my opinion the drugs currently available for the treatment of osteoporosis are one really bad class of drug. Their side effects are many and serious and the longer these drugs are in use the more side effects keep coming to light. Even before all the newer evidence of problems, any drug that comes with a warning from its manufacturer not to take it unless you can remain upright for at least 30 minutes gives me pause.

The most common osteoporosis drugs are the bisphosphonates -- Fosamax, Boniva and Actonel being the most popular. Besides merely irritating the gastrointestinal tract, bisphosphonates can cause esophageal ulcers, esophageal cancer, osteonecrosis of the jaw (death of the bone in the jaw,) fever, bone pain, eye inflammation, kidney problems and osteomalacia (an abnormal softening of the bones). Now it is being shown that the new bone formed as a result of these drugs is actually weaker bone (more brittle than healthy bone) and so bones are breaking anyway and in places other than where osteoporotic bones typically break.

How about an osteoporosis drug that is only required once a year? Sounds too good to be true, doesn't it. Well, you know what they say about things that sound too good to be true. And Reclast is no exception. Besides having to be administered by intravenous infusion performed in a doctor's office at a cost of around $1,000, Reclast has been shown to produce abnormal heart rhythms.

Diet: As discussed above, the key here is to ensure an adequate amount and proper balance of nutrients that support health bone formation. Everyone talks about getting enough calcium, and although calcium is of major importance, it is just one part of the equation. And just how much calcium is enough? Do we all need the same amount? More calcium is not necessarily better. The recommended daily amount of calcium seems to always be rising -- 800 milligrams, 1,000 milligrams, 1,200 milligrams, 1,500 milligrams. More and more and more.

But what happens to all that calcium if your body can't use it? Here's where our friend phosphorus comes in. If there's not sufficient phosphate to balance the calcium, the calcium will precipitate out of the body fluids. If it precipitates in the kidneys it can form kidney stones -- on the teeth it forms tarter and when it deposits in the eye, a cataract may form, and so on. These are all signs of an imbalance in the calcium phosphorus ratio and taking more calcium will just make matters worse.

The other big question is what form of calcium to ingest. I believe that food, of course, should be where we get all of our nutrients from, including calcium. Non-dairy sources are by far the best (despite the overwhelming influence of the Dairy Council).

The best dietary sources of calcium are green leafy vegetables. Arugula (the hands down winner,) watercress, turnip greens, collard greens, mustard greens and spinach. All of these have two to five times the amount of calcium as dairy sources, in milligrams of calcium per 100 calories. (Don't be misled by the amount of calcium per "serving.") Broccoli, okra and cabbage also contain significant amounts of calcium as do some nuts, especially almonds and hazelnuts and sesame and sunflower seeds.

Calcium supplementation is big business. If you aren't getting enough calcium through the food you are eating, a calcium supplement will be necessary. The most common form of calcium supplement is made from calcium carbonate. This is the least expensive form of calcium and also the least absorbable -- which means in the long run it may not be so inexpensive after all. My preferred form of calcium supplementation is calcium lactate. Contrary to what it sounds like, this form of calcium is not from dairy and is safe for those with milk allergy and lactose intolerance. It converts most readily into the ionized form of calcium utilized by the body. Other good forms are calcium supplement are citrate, gluconate and ascorbate.

Some recent studies have suggested that vitamin K (a nutrient usually associated with blood clotting) may play a role in bone health. This relationship is still not well understood but luckily many of the high calcium foods mentioned above are also high in vitamin K.

Vitamin D is necessary for the absorption of calcium in the body. It plays so many critical functions throughout the body that as a result it has become today's "it" nutrient. However, its role in maintaining healthy bones cannot be overemphasized. Vitamin D is made in our bodies by the action of UV radiation from sunlight on the cholesterol in our skin. People who live in northern climates, or who don't get much sun exposure, need to take in more vitamin D. Good dietary sources of vitamin D are fatty fish, like salmon and mackerel, egg yolks and beef liver.

Vitamin D is, unfortunately, not found to any great extent in the vegetable world. One exception is mushrooms, which contain small amounts. Vitamin D supplements are widely available and vitamin D3 is the preferred form. How much you should take depends on your specific need as determined by the blood test referred to above. Everyone should have their vitamin D level checked.

Exercise: Weight bearing exercises are essential to building bone. There has to be some stress exerted on the bone to stimulate the bone forming cells. Swimming, although a great overall form of exercise, unfortunately does little to strengthen bones. The same goes for gliders and elliptical machines.

Walking, running, tennis, even dancing, all effect bones in a positive way. Equally important are resistance type exercises like weight lifting (free weights or weight machines) or stretch bands.
The focus of an exercise program to improve bone health should include, in addition to weight bearing and strengthening exercise, some to increase flexibility and improve balance. This can be accomplished with activities such as stretching, yoga and tai chi. The important thing to remember is to exercise safely and within your current level of fitness. You will find not only your bones getting stronger but you will experience an improved overall sense of well-being.