Common questions about osteoporosis. (Ask the Expert).

Q: What kind of doctor should I see about getting an osteoporosis evaluation?

A: A variety of specialists treat osteoporosis, including endocrinologists, rheumatologists, gynecologists, internists and other primary care physicians. The most important criterion is their knowledge about osteoporosis, bone density testing and osteoporosis medications. Thus, a knowledgeable, interested internist might be a better choice than an uninterested gynecologist.

Q: I've always been active but I don't want to risk breaking another bone. How can I exercise safely if I have osteoporosis?

A: Very few bones are broken while in controlled exercise programs. I favor first working with a physical therapist. Even if you've had fractures, you need a well-directed exercise program as part of your rehabilitation and prevention program. You most likely will need to participate in a weight-bearing exercise, 30 to 40 minutes a day, three to four times a week. This could consist of walking, using a treadmill, a Stairmaster or elliptical machines. We have the greatest amount of information on the fracture-preventing benefits of walking, however. If you're using weights, don't focus on increasing the pounds; focus on the number of repetitions. I tell my patients I'd rather they lifted 10 pounds, 10 times, than 100 pounds, once. And make sure you work with a certified exercise trainer at your health facility, if you join one, who understands the physical ramifications of the disease.

Also keep in mind that pre- and postmenopausal women respond differently to exercise. Most older postmenopausal women don't do enough exercise to actually increase their bone density, but they can still do enough to improve their coordination, agility and balance. Thus, they fall less and fracture less.

Elliott N. Schwartz, MO

Co-Medical Director

Foundation for Osteoporosis Research and Education

Oakland, CA

Q: I've been diagnosed with osteoporosis, but have never had any fractures. What lifestyle changes should I make to cope with the disease?

A: If you had a bone density test and someone said you have a low value, then you should do the following: Get serious about improving your nutrition. So try to get 1,500 mg of calcium and 600 to 800 IUs of vitamin D daily, the National Institutes of Health's recommended intake amounts, which are what I prescribe to my patients. Also, do all you can to remain physically active, to walk vigorously, to do whatever you can. You also need to talk to your doctor about whether any interventions might be necessary. This might be a fine time to talk about either hormone therapy or the use of a SERM such as raloxifene (Evista), which would help protect the bones you have right now.

Robert P. Heaney, MD

Professor of Medicine Creighton University

Omaha, NE