You feel fine, and then you get the diagnosis: osteoporosis. It’s a complete surprise.

In the U.S., 54 million people have the bone disease osteoporosis or the low bone mass (osteopenia) that can put them at risk for it, according to the National Osteoporosis Foundation. The so-called ”brittle bone” disease happens when your body makes too little bone, loses too much existing bone or both.

And it’s not a minor problem. Osteoporosis can lead to loss of mobility, decreased independence and dangerous, even deadly fractures.

So, what to do when you get the diagnosis? Often, a doctor will simply say, “Vitamin D, Calcium, Exercise.” But it’s not so simple, and some more recent research tweaks those recommendations.

Senior Planet asked two bone health experts to weigh in. Here’s the rationale for your doctor’s basic RX—and the “yes, but….”

Calcium

BASIC ADVICE Getting enough calcium is a tried-and-true way to help moderate the bone loss. For men and women age 51 and over, most guidelines call for 1,200 milligrams of calcium daily, along with vitamin D. Many doctors simply follow guidelines.

YES, BUT… In an analysis published in late 2016, researchers from Johns Hopkins and elsewhere found that taking calcium supplements may increase the risk of dangerous plaque buildup in your arteries and with that, the risk of heart disease. Calcium from foods, on the other hand, appears to be protective.

That’s why Diane Schneider, MD, MSc, suggests that we get our calcium from food first. A former professor of medicine at UC San Diego, Schneider is the author of  ”The Complete Book of Bone Health” and co-founder of this bone health website. “If you consume dairy, it’s easy to get the 1,200,” she says. To get 1,200 mg from food, you’d need roughly a cup of yogurt, a cup of milk and about four ounces of cheese, for instance.

You can track your calcium intake from food by using smartphone apps.  One is the International Osteoporosis Foundation app. Tracking helps you to take only as much calcium supplement as you need to make up the difference between the 1,200 milligram RDA and what you’re getting in the foods you eat.

But Robert Recker, MD, professor of medicine and director of the Osteoporosis Research Center at Creighton University, Omaha, says the amount of calcium we get from foods varies a lot from day to day. He suggests being safe on the bone front by taking the  full 1,000 to 1,200 milligrams of supplement a day, but in two doses—500 to 600 mg twice a day, and each time with a meal. “If you take it all at once, your absorption efficiency goes down.”

Which approach should you take? Dr. Schneider’s protects arteries by relying on you to eat the right foods and stay on top of how much calcium you’re taking in day by day. Dr. Recker’s is failsafe bone protection, no matter how much or little calcium-rich foods you’re eating, but may not be as artery-protective.

And, no matter how much you boost calcium, it’s not going to help you gain bone, Schneider says, though it may help slow the loss. However, calcium may give you other benefits. For instance, while getting enough calcium doesn’t build bone density, in one study it did help study participants decrease the chances of having a fracture, Italian researchers recently reported.

For more on the calcium supplement-heart debate, go here.

Vitamin D

BASIC ADVICE Doctors should always recommend vitamin D along with calcium, because having enough D in your blood helps your body to aborb the calcium—good for the bones and the arteries. Scientists have been debating for years how much vitamin D we need to take for bone health. According to the Institute of Medicine, or IOM, people age 51 to 70 need 600 international units (IU) a day; once you reach 70, you need 800 IUs.

YES, BUT… Many doctors say that’s not enough, especially since after age 65, our bodies produce a quarter of the vitamin D than they did when we were in our 20s . The goal, they say, is to get enough D to achieve a specific blood level.

That might be easy—except doctors also disagree on what the blood level should be. The IOM says blood levels of 25-hydroxy vitamin D 20 nanograms per milliliter (ng/mL)  and above are generally adequate. However, Recker says the levels ideally should be at 40 ng/mL or higher. To maintain that, you may need 2,000 IUs a day, according to the Endocrine Society. Your doctor should advise you on the amount best for you.

Complicating the issue even more is geography and other factors. Our bodies produce vitamin D in response to the skin absorbing the sun’s UVB rays, and studies show that you probably produce little or no vitamin D between November and March if you live north of Georgia. You also make less D if you are homebound or work indoors everyday, always wear sunblock or have a dark complexion.  Any of these could make it even  more important that you check your blood levels of vitamin D and supplement accordingly.

The maximum, or safe upper tolerable limit of vitamin D, is 4,000 IUs of Vitamin D a day, according to the Institute of Medicine.

Exercise

BASIC ADVICE Doctors all agree that you need to do weight-bearing exercise to maintain bone health.

YES, BUT…  Weight training can help—yes, that means actually lifting weights—but Recker says you should do this under supervision. You can hire a personal trainer or ask your doctor to refer you to a physical therapist to learn how to exercise safely and reduce the risk of falls, which could lead to fracture.Exactly how much exercise should you do to strengthen your bones? According to the International Osteoporosis Foundation, you should try for four sessions a week—about three hours total—incorporating both aerobic exercise that is weight-bearing—such as brisk walking or jogging—  and strength training.

And don’t think you can just get used to your regular exercise routine and start coasting. Schneider says that once you’ve become accustomed to a routine—after doing it regularly for six or eight weeks, say—you need to change it up. Otherwise, your body gets used to it and your gains will stall.

While exercise can help preserve bone health, slowing the loss, one of its major benefits as you age is not actually building bone. “Exercise does more [bone building] for the growing teen or the premenopausal women than it does for postmenopausal women,” Schneider says. What it does do when you’re older, she says, is help you maintain your muscle mass and strength, which in turn can help you to avoid falls. And when you have osteoporosis, you really don’t want to fall and risk a fracture. Yoga can also be a help in the fall-prevention department. However, Recker suggests getting professional instruction so you learn proper technique.

What About Vitamin K?

Researchers have written about the role of vitamin K in bone health. K is a vitamin found in a range of foods and also in different forms; the form that has shown promise in some studies is menaquinone-7 (MK-7), which is plentiful in natto, a Japanese fermented product. However, other studies have found no benefit from increased intake of vitamin K, and currently most doctors do not recommend (or rule out) taking supplements.

Getting Tested—and Retested

Your osteoporosis diagnosis was likely made by either a screening with a bone density test, or was made when you suffered a bone break. These test results are known as your baseline test.

After you make lifestyle efforts to improve your bone health, your doctor may order a repeat bone density test in about two years. That’s a reasonable time, Recker says, to see if the bone health regime is working and you are slowing the bone loss. If you meet certain conditions, insurance may cover. For instance, Medicare will reimburse for a bone density test every two years, or more often if medically needed.

After a repeat test, your doctor may decide you need prescription medications to help your bone health.