What You Need To Know About Osteoporosis

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What You Need To Know About Osteoporosis

OsteoporosisDue to the prevalence of osteoporosis worldwide, this disorder is considered a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease (Cooper et al, 1992).

Approximately 30% of all postmenopausal women have osteoporosis in the United States and in Europe. At least 40% of these women and 15–30% of men will sustain one or more fragility fractures in their remaining lifetime (Randell et al, 1995). In Canada, approximately 1 in 4 women have osteoporosis. By the year 2041 about 25% of the population will be over the age of 65 (Brown & Josse, 2002). Aging of populations worldwide will be responsible for a major increase of the incidence of osteoporosis in postmenopausal women (Reginster & Burlet, 2006).

About Osteoporosis

Osteoporosis is a progressive skeletal disorder in which the bones gradually become brittle and weak resulting in compromised bone strength. This can cause changes in posture and increase the risk for fragility fractures. The World Health Organization defines osteoporosis as bone mineral density (BMD) 2.5 standard deviations (SD) or more below the average value for a young healthy women (a T-score of <-2.5 SD).

There are two forms of osteoporosis, primary and secondary. Primary osteoporosis may occur in two types: Type I osteoporosis (post-menopausal) is an accelerated decrease in bone mass that occurs when estrogen levels decrease after menopaouse, and Type II osteoporosis (age-related) is the inevitable loss of bone mass that occurs with an increase in age.

Secondary osteoporosis may develop at any age and may be related to many different causes such as genetic (congenital), hypogonadal states, endocrine pathologies, deficiency states, inflammitory diseases, iatrogenic, hematologic and neoplastic pathologies. In addition, long-term use of some medications—especially corticosteroids—can thin the bones. Sometimes, it is not the condition that causes osteoporosis, but the drug used to treat other health problems.

Most people think of osteoporosis as being an old person’s disease but recent studies suggest this is not always true. Younger people, especially female athletes, anorexics and chronic dieters, are being diagnosed with this disease.

Many women think they don’t have to start worrying about osteoporosis until menopause, but that’s not true. The more bone you build early in life by leading a healthy lifestyle, the better you’ll be able to withstand bone loss later on.

Bone density is highest at around age 30 and thereafter begins to decline. If young athletes (and non-athletes) do not accumulate sufficient bone mass during childhood and early adulthood they are at increased risk for osteoporosis. Other risk factors include a small frame or low body weight, Caucasian or Asian background, early onset of menopause, physical inactivity, low calcium intake, smoking, excessive use of alcohol, and a family history of osteoporosis.

It is important to recognize if you are at an increases risk for developing osteoporosis based on the predisposing factors and communicate with your primary care physician. You may need to have you bone density measurement and change your lifestyle accordingly. Another reason to get your bone mineral density measured is that osteoporosis can operate silently for decades. Your first symptom may be a fragility fracture and preventative management may reduce the risk for progressive bone loss and fragility fractures.

Predisposing factors for Osteoporosis:

  • Previous history of bone fractures
  • Family history of osteoporosis
  • Smoking
  • A diet low in calcium and vitamin D
  • Excessive alcohol of caffeine consumption
  • Small body size and low body mass index
  • Estrogen deficiency
  • Female gender
  • Sedentary lifestyle
  • Long-term use of certain medications, such as corticosteroids
  • Having Caucasian or Asian heritage
  • Early menopause
  • Eating disorders such as anorexia

Recommendations to help prevent osteoporosis

Calcium: Men and women should supplement their diet with 1200mg and 1500mg (in divided doses) of calcium per day respectively. Calcium in the form of calcium citrate is the easiest to digest and absorb. Good dietary sources of calcium include reduced-fat dairy products, kale, broccoli, sardines and canned salmon with bones, and calcium-fortified products like orange juice, soy milk, and tofu.

Vitamin D and other nutrients: Vitamin D is important in the absorption and utilization of calcium. Food sources include cold water fish such as salmon and sardines. Your skin also produces vitamin D from sun exposure. The recommend dose is 1000 IUs per day. Other important nutrients include magnesium, boron, potassium, folic acid and vitamins C, E and K.

Soy Foods: Soy foods such as tofu, soy beans and soy nuts have a positive effect on bone mass due to their high content of isoflavones which have an estrogen-like effect in the body.

Physical activity: There is a plethora of evidence that suggests regular exercise is essential for maximizing peak bone mass and reducing subsequent bone loss. Exercise is not only good for your cardiovascular health but is an excellent way to increase bone mass, slow bone loss and reduce the likelihood of falls. Thirty to sixty minutes of weight bearing exercise such as walking or jogging, five to six times a week is highly recommended. Strength training three times per week with weights will also help increase bone mass. Tai chi has been shown to improve balance, reduce the risk of falls and hip fractures in the elderly, and even slow bone loss in postmenopausal women. Yoga is another option for improving balance and flexibility.

Falls: Preventing falls and accidents in the home is important especially
in the older population. Studies have shown that regular exercise to improve strength and balance is the most effective strategy for preventing falls, but other steps can also help: Wear low-heeled shoes with non-slip soles. Fall-proof your home by keeping floors free of clutter, securing loose rugs, improving lighting, and adding grab bars and non-skid mats where helpful. Be cautious with drugs that can cause dizziness like sedatives and some antidepressants. And get your vision checked regularly and corrected as needed.

Avoid smoking: Smoking interferes with the body’s ability to use calcium, reduces estrogen levels in the body and increases the risk of hip fractures.

Reduce alcohol and caffeine intake: Alcohol decreases the amount of bone building cells in the body. Too much alcohol can also impair balance and coordination leading to a higher risk of falls and fractures. Caffeine causes increased loss of calcium in the urine. Tea has less caffeine than coffee, and research shows that people who regularly drink black or green tea have higher bone mineral densities than those who consume these beverages less frequently.

Reduce salt and soda pop intake: Diets high in salt and pop increases the loss of calcium in the urine.

Brown, JP and Josse RG. 2002 clinical practice guidelines for diagnosis and management of Osteoporosis in Canada. CMAJ 2002; 167(10 suppl): S1-S34.

Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992 Nov;2(6):285–9

Randell A, Sambrook PN, Nguyen TV, Lapsey H, Jones G, Kelly PJ, Eisman JA. Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporosis Int 1995;5:427–32.
Reginster JY. Burlet N. Osteoporosis: A still increasing prevalence. Bone 2006;38: S4-S9

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