**5. Medical treatments and dietary recommendation for BMD alteration**

The goal of pharmacological therapy is to reduce the risk of fractures by acting on the main agents controlling bone remodeling, which has been affected by osteoporosis. The majority of osteoporosis treatment is antiresorptive (e.g., denosumab, bisphosphonates, estrogen agonist and antagonist, estrogens, and calcitonin), which reduces bone resorption. Otherwise, some anabolic treatments have been developed (e.g., teriparatide), which are dedicated for stimulating bone formation instead of repressing bone-resorbing cell functioning [75]. Both antiresorptive and anabolic agents improve BMD but with variated intensities and can be used for the treatment of one patient. In the work of [76], authors found that the treatment sequence played an important role in osteoporosis treatment. Based on their observation, they have concluded that initiating a treatment by anabolic treatment first followed by a potent antiresorptive treatment is more effective in improving BMD value. In contrary, using antiresorptive agents first, then when the BMD does not sufficiently increase, clinicals suggest to switch to teriparatide, which is not optimal utilization of anabolic treatments.

Besides medications, dietary habits contribute also to improve or deteriorate the bone. Vitamin D and calcium form part of the bone mineral matrix, assuring its strength, and one of the best ways to reach adequate intake of calcium and vitamin D is through healthy eating habits [77]. In a recent meta-analysis of the influence of foods rich in vitamin D on serum 25(OH)D levels, results have shown that those aliments lead to significant increase in serum 25(OH)D as well as BMD [78]. Together with vitamin D, increased calcium intake has been proven to improve BMD by 0.6–1% over 1 year [79]. However, in a recent study [80], dietary calcium intake has not show any association with BMD values in normal participants over 50 years of age, while it has shown a positive change in BMD in women undergoing osteoporosis medical treatment.
