Osteoporosis: Risk factors, diagnosis & treatment

By: Nutrition expert- Vidula Kozarekar, Mumbai.

Email id: vidula708@gmail.com

Osteoporosis is a disease that weakens bones to the point where they break easily- most often, bones in the hip, backbone (spine), and wrist. Osteoporosis is called a “silent disease” because you may not notice any changes until a bone breaks. All the while, though, your bones had been losing strength for many years.

Bone is living tissue. To keep bones strong, your body breaks down old bone and replaces it with new bone tissue. Sometime around age 30, bone mass stops increasing, and the goal for bone health is to keep as much bone as possible for as long as you can. As people enter their 40s and 50s, more bone may be broken down than is replaced.

A close look at the inside of bone shows something like a honeycomb. When you have osteoporosis, the spaces in this honeycomb grow larger, and the bone that forms the honeycomb gets smaller. The outer shell of your bones also gets thinner. All of this makes your bones weaker (1).

Causes and risk factors of Osteoporosis: (1)

Although osteoporosis can strike at any age, it is most common among older people, especially older women. Men also have this disease. White and Asian women are most likely to have osteoporosis. Other women at great risk include those who-

  • Have a family history of broken bones or osteoporosis
  • Have broken a bone after age 50
  • Had surgery to remove their ovaries before their periods stopped
  • Had early menopause
  • Have not gotten enough calcium and/or vitamin D throughout their lives
  • Had extended bed rest or were physically inactive
  • Smoke (smokers may absorb less calcium from their diets)
  • Take certain medications, including medicines for arthritis and asthma and some cancer drugs
  • Used certain medicines for a long time
  • Have a small body frame

The risk of osteoporosis grows as you get older. At the time of menopause, women may lose bone quickly for several years. After that, the loss slows down but continues. In men, the loss of bone mass is slower. But, by age 65 or 70, men and women are losing bone at the same rate.

Common form of osteoporosis: (2)

 1) Primary Osteoporosis:

Type I: It is also called as postmenopausal osteoporosis.

Type II: Type II or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1.

2) Secondary Osteoporosis:

Secondary osteoporosis may arise at any age and can affect men and women equally.

This form results from chronic predisposing medical problems or disease, or prolonged use of medications such as glucocorticoids, when the disease is called steroid induced or glucocorticoid-induced osteoporosis.

What is Osteopenia? (3)

Osteopenia is a clinical term used to describe a decrease in bone mineral density (BMD) below normal reference values, yet not low enough to meet the diagnostic criteria to be considered osteoporotic.

Consider it a warning. Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life. That way you will be less likely to break a wrist, hip, or vertebrae (bone in your spine) when you are older.

Diagnosis of Osteoporosis: (4)

  • Several methods are available for the assessment of bone mass.
  • The method that is most widely used is the Bone density scan (DEXA scan).
  • A bone density scan is a quick and painless procedure that involves lying on your back on an X-ray table so an area of your body can be scanned.
  • A bone density scan compares your bone density with the bone density expected for a young healthy adult or a healthy adult of your own age, gender and ethnicity.

Nutrition considerations: (5)

  • Get enough calcium every day

The best food sources of calcium are: Milk, Cheese, Yogurt and Fortified soy beverages. Calcium-fortified orange juice, some vegetables, fruit, beans and meat alternatives also contain calcium.

  • “What if I’m not getting enough calcium from food?”

Take a calcium supplement. The two most common types are calcium citrate and calcium carbonate. Calcium citrate supplements can be taken any time. Calcium carbonate supplements are better absorbed when taken with meals. Don’t get more than 500-600 mg of calcium at a time from supplements.

  • Get enough vitamin D every day

Vitamin D helps your body use and absorbs calcium. Aim for a total of 800-2000 IU of vitamin D for the day. Fish, milk and egg yolks are the best food sources of vitamin D.

  • Get enough vitamin B12 every day

Vitamin B12 helps with bone formation. Older adults tend to have low levels of this vitamin. Aim to get 2.4 micrograms (mcg) of vitamin B12 every day from fortified foods or a supplement containing vitamin B12.

The best food sources of vitamin B12 are: Eggs, Milk and milk products, Meat, fish, shellfish and poultry. Some breakfast cereals, “veggie meats” and soy beverages are fortified with vitamin B12.

  • Enjoy at least 7 servings of vegetables and fruit every day!

Vegetable and fruit have potassium, magnesium and vitamin K which can help to keep your bones strong and healthy. Vitamin K may also help in preventing fractures.

  • Eat the right amount of protein

Protein, from animal or plant sources, is needed for proper bone health, but eating too much protein may increase the amount of calcium that your body loses.

  • Watch out for high sodium foods

Eating too much sodium can make bones less dense. Read food labels to keep your sodium intake to less than 2300 mg (equal 1 tsp of salt) a day.

  • Drink coffee in moderation

The recommended total amount of caffeine for a day is 400 milligrams. That’s about four regular-sized (250 mL or 8 oz) cups of coffee a day. Any more than this can decrease the amount of calcium your body keeps. Remember that colas and energy drinks also contain a lot of caffeine.

  • Enjoy your cup of tea

Green and black teas (regular and decaffeinated) contain natural plant compounds called polyphenols. These compounds seem to help keep bones strong especially in people who drink tea often. Don’t forget that tea has caffeine and the recommended amount is up to 400 mg per day.

  • Drink alcohol sensibly

Drinking too much alcohol on a regular basis is a risk factor for fractures. Men should have no more than 3 drinks per day for men, and women no more than 2 drinks a day. One standard drink is:

142 mL (5 oz) glass of 12% wine

 341 mL (12 oz) bottle of 5% beer, or

 43 mL (1 ½ oz) shot of 40% spirits

  • Keep active

Eating well and being active go hand in hand for good bone health. Weight bearing activities, such as walking and dancing, help build and maintain bone mass. Keep active by doing strength (such as lifting weights), flexibility (stretching) and endurance (such as swimming) activities too.

Conclusion:

Osteoporosis is a common and silent disease until it is complicated by fractures that become common. These fractures are responsible for lasting disability, impaired quality of life, and increased mortality, with enormous medical and heavy personnel burden on both the patient’s and nation’s economy. Osteoporosis can be diagnosed and prevented with effective treatments, before fractures occur.

References:

  1. https://www.nia.nih.gov/health/osteoporosis
  2. https://www.nhp.gov.in/disease/musculo-skeletal-bone-joints-/osteoporosis#:~:text=Adults%20are%20advised%20to%20workout,No%20excess%20consumption%20of%20alcohol.
  3. https://www.ncbi.nlm.nih.gov/books/NBK499878/
  4. https://www.nhs.uk/conditions/dexa-scan/what-happens/
  5. https://www.saskatoonhealthregion.ca/locations_services/Services/Falls-Prevention/Documents/Community%20Toolkit/Resources%20Section/DC%20Osteoporosis.pdf

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