URBANA — If you're at risk for osteoporosis — and a lot of aging Americans are — consider reaching for the milk before you reach for the medicine, a new University of Illinois study suggests.

Study authors Karen Plawecki, director of the UI dietetics program, and UI nutrition Professor Karen Chapman-Novakofski, said doctors can be quick to prescribe bone medications because they think people won't change their diets.

But they encourage people to try pumping up their daily intake of calcium and Vitamin D first.

Osteoporosis — a condition of bone thinning and weakening due to mineral loss, primarily calcium — is projected to soar in the U.S. as baby boomers age.

A surgeon general's report found 10 million Americans have osteoporosis and another 34 million have low bone density. And the projections aren't pretty if current trends don't change: Half of all Americans over age 50 will be at risk for suffering bone fractures due to osteoporosis by 2020, and by 2040 the number of hip fractures could double or triple.

A family of drugs called bisphosphonates — among them Boniva and Fosamax — do build bone density, but they also come with expense and potential side effects and can even leave bones less structurally sound, according to Chapman-Novakofski.

In 2007, the Food and Drug Administration warned of the possibility of severe and sometimes incapacitating bone, joint and/or muscle pain in patients taking bisphosphonates, and last year the FDA warned long-time use of bisphosphonates may be linked to an atypical thigh fracture.

Plawecki and Chapman-Novakofski — who based their report published in the journal Nutrients on reviews of 219 articles in scientific journals — would like to see medication considered only when diet and supplements don't work.

Getting enough calcium is necessary for the heart, muscles and nerves to work the way they should, and low calcium significantly contributes to the development of osteoporosis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Sufficient Vitamin D in the diet also plays a role in preventing osteoporosis because it's needed to help the body absorb calcium.

Diet and exercise count

We all need the most calcium in our diets during our early years, between ages 9 and 18, when the recommended daily requirement is 1,300 mg. per day.

Women over 50 need 1,200 mg. of calcium a day, and men need 1,000 mg. a day from ages 51-70 and after that, 1,200 mg. a day, according to the Institute of Medicine Food and Nutrition Board.

Everybody from ages 1-70 needs 600 IU of Vitamin D a day and then 800 daily IU from age 71 and beyond.

Many women fall short of their calcium requirements, but they can easily get enough without gaining weight, Plawecki says. Three glasses of 1 percent or skim milk a day add up to 900 milligrams of calcium, and the last 300 milligrams can easily be obtained through other calcium-rich and fortified foods, she said.

Calcium-rich foods include dairy products, cheese, nuts, tofu, broccoli, kale, kidney beans, chick peas, watercress, sardines, salmon, oranges and apricots.

Many breads, crackers, cereals and snack food and beverages such as hot chocolate and sports drinks are also fortified with calcium, Chapman-Novakofski said.

Plawecki advises following a "portfolio" diet that includes a number of nutrients to minimize the risk of bone loss. And watch that sodium, which comes from processed meats, cheese and packaged foods as well as the salt shaker.

Studies have associated high-sodium diets with increased calcium loss.

Calcium is best absorbed when the recommended level per day isn't consumed all at once. It's best absorbed in doses of 500 milligrams or less at a time, Plawecki said.

Can you take in too much calcium? The body's total tolerable limit is 2,000 milligrams, and more ups the risks for kidney stones, she said.

But if you're just eating a balanced diet, this won't likely be a concern.

"It's really hard to get to 2,000 with food," Chapman-Novakofski said.

To cut osteoporosis risk, Chapman-Novakofski and Plawecki advice focusing on both diet and exercise. Specifically:

— Eat a diet rich in fruits and vegetables, low on sodium and with adequate calcium and protein.

— Exercise, using a varied routine. Combine aerobic, strength, balance and flexibility exercises.

— If you smoke, quit.

Where people tend to make the biggest mistake is failing to pay attention to what they eat, said Plawecki.

She and Chapman-Novakofski advise reading package labels. Those foods that are identified as a good source of calcium contain at least 100 milligrams per serving, and those identified as an excellent source contain 200 milligrams and up, they said.

"Be aware of what you eat," Plawecki advises.

When diet isn't enough

Dr. Sangiv Jain. a physical medicine and rehabilitation physician at Carle, says he advises patients first to try getting enough calcium and Vitamin D to decrease their osteoporosis and fracture risk.

"Regardless of whether they start a medication or not, they need a good supply of calcium and Vitamin D in their life," he said.

In fact, without enough of those nutrients, bone medications won't be as effective, he adds.

When should medications be considered?

Once a bone density scan identifies a patient as being in the osteoporosis range, he said, he looks at the patient's other risk factors, for example, has the patient suffered a fragility fracture — one that wouldn't have occurred if bone health was better.

If a patient is taking in enough calcium and Vitamin D and still suffers a fragility fracture, medication might be advisable, Jain said.

Bone mass is built during childhood and adolescence, and then begins a slow decline in our 20s. So it's important not only to get enough calcium and Vitamin D when we're young but to maintain enough in our diets later, Jain said.

"I hope that women talk to their daughters about it, so they start young," he said.

For more information, including calcium-rich recipes, see the a UI osteoporosis website at http://urbanext.illinois.edu/osteoporosis.