Postmenopausal osteoporosis - how do you prevent it?

Postmenopausal osteoporosis prevention requires comprehensive approach - diet, supplements, exercise, and sometimes medication. Strategies based on Persatuan Obstetrik dan Ginekologi Malaysia guidelines and Ministry of Health Malaysia Osteoporosis CPG 2022: (1) Calcium 1000mg daily (main sources: milk, yoghurt, small fish with bones like sardine/anchovy, calcium-sulfate-set tofu, dark leafy greens). Calcium supplements only if diet doesn't meet target. (2) Vitamin D3 800-2000 IU daily (blood level 30-50 ng/mL). (3) Vitamin K2 (MK-7) 90-180mcg daily - directs calcium to bone, not arteries. Calcium+K2+D3 single package (Solgar is common choice) very effective. (4) Weight-bearing and resistance training 2-3x weekly - brisk walking, stair climbing, dumbbell training. Exercise alone can boost bone density 1-2% per year. (5) Protein 1.2-1.5g per kg body daily. (6) Avoid: smoking, heavy alcohol (>2 drinks daily), excessive caffeine (>4 coffees daily), excessive salt. (7) For women with high risk or diagnosed osteopenia/osteoporosis, medications: (a) hormone therapy for selected women after individualised clinician review, if started within the first 10 years of menopause and for women under 60. (b) Bisphosphonate (alendronate, zoledronate) - first-line for osteoporosis. (c) SERM (raloxifene) - alternative for women who can't take hormone replacement therapy. (d) Denosumab or teriparatide injections for severe cases. Monitor with bone density scan every 2 years if treated. Discuss personal plan with Malaysian obstetrics and gynaecology specialist or endocrinologist.