The answer is, there are studies that demonstrate that you can meet your calcium needs with milk and dairy products, even if you are diagnosed with lactose maldigestion (which can lead to intolerance if the load of lactose you consume overwhelms your ability to digest it). If you are a lactose maldigestor, try drinking milk with a meal. try smaller amounts and work slowy back up to larger amounts, your intestinal bacterial will adapt and help you digest the lactose. Try aged cheeses, they are very low in lactose. try yogurt, the cultures help you digest the lactose. Use lactose free or reduced milks. you can take an enzyme (lactase) capsule before consuming dairy. It is difficult to meet your calcium needs woithout dairy foods in your diet. Dairy foods are also a good source of 8 other nutrients, like potassium, vitamin D, phosphrous,protien and more. Dr. Bob Heaney an internation expert has written on protein and bone health. He indiocates if calcium intake is adequate, higher protein intake will not impact bone. you need protien for good bone health too, luckily dairy foods are a good source of both.

I work for the dairy industry, so do not just take my word for it, check health professional organizations point of view, like the American Dietetics Association, the American Academy of Pediatrics, or the National Medical Association. they have written on this issue.

Good luck and I hope these refereences are helpful to you.

Here are some references:

Suarez FL, Adshead J, Furne JK and Levitt MD. Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. American Journal of Clinical Nutrition . 1998;68:1118-22

Inman-Felton AE. Overview of lactose maldigestion (lactase nonpersistence). Journal of the American Dietetic Association . 1999; 98:481-9

McBean LD, Miller GD. Allaying fears and fallacies about lactose intolerance. Journal of the American Dietetic Association . 1998; 98:671-676

McBean LD, Miller GD. Allaying fears and fallacies about lactose intolerance. Journal of American Dietetic Association . 1998; 98:671-676

Suarez FL, Adshead J, Furne JK and Levitt MD. Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. American Journal of Clinical Nutrition . 1998;68:1118-22

Pribila BA, Hertzler SR, Martin BR, Weaver CM, Savaiano DA. Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy-rich diet. Journal of the American Dietetic Association. 2000;100:524-528

http://pediatrics.aappublications.org/cgi/content/full/118/3/1279

http://www.nationaldairycouncil.org/NationalDairyCouncil/Nutrition/Lactose/lactoseIntolerancePage1.htm

http://www.nationaldairycouncil.org/NationalDairyCouncil/Health/Handbook/

I suggest you read chapter 8 in the Handbook of Dairy Foods and Nutrition.

also check out this issue on web sites like WebMD.com, eatrright.org

Certainly a more difficult question to answer given what osteopenia represents. Since it is really a "pre-condition" it is very hard to pin a hard outcome like fracture risk. Osteoporosis is a T score less than -2.5. Osteopenia is really just a very arbitrary mostly research-defined value of T score between -1 and -2.5. Obviously, bone mineral density deficiencies only represent about 25% of the risk that predicts fractures at the hip and spine. That is very important to realize. There is nothing magical about a cut-off of -2.5. It is a continuum of risk with decreasingly important predicting power as you approach a T score of "0". If it takes literally years and thousands of people to find a fracture risk reduction benefit with fosamax and T score worse than -2.5 then it will take many more people to show the benefit in a T score that is -1 to -2.4, but...you can do it. The Fracture Intervention Trial. Mayo Clin Proc 2005 Mar; 80:343-9 showed a risk reduction with alendronate in osteopenia. However, some might argue is it worth it? You would spend a ton of money to prevent one fracture over a five year period (and it wouldn't even be the life-threatening hip fractures, rather a vertebral fracture).
However, I think there is a fair amount of evidence to support alendronate or other bisphosphonate therapy in osteopenia in the setting of high dose steroids, HIV-osteodystrophy and prostate cancer treatment protocols.
In summary, broad-stroke generalizations about treatment of osteopenia and fosamax run the risk of throwing the baby out with the bath water. Each physician should take the responsibility to understand guidelines in the setting of the patient sitting across from them.

responding to the above: re JRG: "Finally, it is unlikely to expect that most girls will consume greens, sea vegetables and collards." In the movie "Cool Hand Luke," Paul Newman has a line that goes something to the effect of "what we have here is a communication problem." Certainly sodas and other acid generating foods (such as animal protein as stated above) contribute to osteoporosis. This raises the question of what are we supposed to eat/what does the human biology call for: with our flat teeth for grinding rather than sharp scissors like teeth a& jqaw for tearing flesh, only four of 32 teeth for tearing meat, our lack of fangs and claws, our long small bowel like (other) predominantly herbivores/vegetarians, etc. it is pretty clear that if you speak to a comparative anatomist,the human body should be about 90% vegetarian. I did not discuss what teenagers like, I am talking about reawakening our culture to real preventive medicine that prevents and/or abolishes diseases because we do not ange our body which then pays us back with avoidable conditions like osteoporosis, osteopenia, high blood pressure, high cholesterol, heart attack, stroke, dialysis, most cancers, diverticulitis, appendicitis... all diseases that come from what we did that we should not have and all virtually entirely avoidable. If we can get leadership from the likes of people who have commented on this column, we could begin to get those teenagers to eat more brown rice/vegetables/beans/fruit/nuts and less of those foods that generate the ( avoidable) common scourges of our culture as above + more. Public health begins with leadership & education. Re GP: this is the natural approach to a high magnesium diet as sodas & animal proteins are low in magnesium. Re GP again: soymilk is a recent invention, and I don't recommend it. Rice milk is 1,000's of years old and is called "amasake" which is a not too sweet form of this product. For reasons I won't go into just now, I don't recommend wheat ( or rye) or dairy or much soy unless it is (limited) tamari, miso, tempeh, or occasional tofu. Dr GDM has vested interests which I feel are conflicts of interests, but the readers of this column are free to believe him or not. He seems a nice person. My position would be, read what I said in the first place. BLG speaks from her heart, but is wrong & the scientific data do not support her positions at all. However, she makes a powerful point that all patients are handmade-1 of a kind and need to be treated respectfully. Her situation is clearly different from the "walking well." JW, MD, has an interesting discussion regarding the arbitrary decisions that are made by physicians/panels/working groups/organizations and then called evidence-based medicine. It was only a few years ago that the decision to treat HIV was deferred until very serious numbers were present. That thinking has changed and HIV-positive patients are being treated earlier and earlier. Such will likely become the case with osteopenia as better medications/natural treatments (vitamin K2, strontium, high doses of Vit D3 to achieve blood levels of 25 hydroxy D3 of 50 +: lifeguards have levels of 100, and are not adversely affected). There is no vitamin D in foods unless supplemented: the calcium in supplemented orange juice or rice milk and vegetables is more readily absorbible than milk calcium because milk has higher phosphorus content which reduces calcium absorption. I hope this clears up some of the above. While this is an "opinion piece" everything I have said is simply an "invitation for your consideration." I have stuck to the science, whether it seems brutal or not, these are the facts. I invite you to our website, for more on disease prevention as a whole: www.thepmc.org. I have no vested/conflicts of interest. H. Robert Silverstein MD, FACC. Medical Director, the Preventive Medicine Center.