Preventing Osteoporosis
An oft-overlooked aspect of daily health is abiding by the recommended daily nutrional values set by the USDA. Good nutrition (adequate calcium and Vitamin D) and exercise can increase peak bone mass in healthy people, and can delay the onset of bone problems later in life. Too few people actually measure their intake of specific nutrients, which contributes to a buffet of health-related issues, and therefore osteoporosis. (Epidemiology of this disease.) Vitamin D and calcium are more important to the body than many people think, and it's important to have enough in your diet. Some experts believe that phytoestrogens, which naturally occur in plants and are structurally similar to estradiol, contribute important things to one's health, but recent research reveals that they do not deliver the effects that boosters hoped for them or naturally occurring estrogen. There is also a theory - getting serious credence recently - that an low-acid diet can help maintain bone health. Zinc in the diet may also help. Research has not shown any significant effect on the consumption of soy products or caffeinated beverages on the development of osteoporosis, although experts have hypothesized connections. Research has been unable to find a connection with dietary boron and magnesium either.
Diagnosis of osteoporosis will likely include a physical examination complete with x-rays. The physician may notice a loss of height, which is compounded by a "dowager's hump". This hump or curve of the spine is an indicator that bones are less dense than they need to be to fight off the manifestation of osteoporosis, and a bone density test will be the ultimate confirmation.
Making a concerted effort to incorporate more calcium and vitamin D into the diet as one ages is an easy preventative. The current recommended daily level is 400 IU (International Units), but some experts suggest that increasing it to between 800 and 1000 IU per day will help maintain bone health. Supplements can help maintain optimum calcium and vitamin D levels if the patient doesn’t get enough in the diet. One other treatment of which some experts are wary is the oscillating plate. (The idea is you stand on the plate every day for a few minutes and that stimulates formation of new bone.) Some health experts advocate prophylactic bisphosphonate treatment to those at high risk.
Mineralization, microarchitecture, and rate of turnover or remodeling are important processes in bone sturcture and metabolism. The most accurate bone density test is DEXA (dual-energy x-ray absortiometry), which uses minimal amounts of radiation and is general done on the spine and hip in about 10 to 15 minutes. Ultrasound bone density of the heel is a quicker and less expensive test, but not widely available or accepted as an accurate screening test.
The 2004 U.S. Surgeon General General Report on osteoporosis suggested at least 30 minutes of weight-bearing exercise per day to significantly reduce one's likelihood of developing osteoporosis.
Although popular magazines focus on calcium and vitamin D, healthy bones require a number of nutrients. Milk is a great food because it contains small amounts of many nutrients. People who suffer from lactose intolerance can attempt to find dairy products with reduced lactose. A serving of milk or yogurt contains about 350 mg of calcium, and fortified products contain even more. Other sources of calcium include dark-green leafy vegetables like kale and turnip greens. A prevention diet can incorporate tofu, canned fish and fortified cereals. It has been suggested that a high protein diet is bad for bone mineralization, but a report in the American Journal of Clinical Nutrition found that was not the case.
Doctors have developed that Osteoporosis Risk Assessment Instrument (ORAI) for estimating risk of osteoporosis. You can see an on-line version here:
http://depts.washington.edu/osteoed/tools.php?type=orai
A Canadian study found the ORAI was very effective. It correctly identified the women at risk for low bone density and therefore eliminated the need for many needless DEXA scans.
The World Health Organization developed the FRAX tool to evaluate risk of fracture. More is at http://www.shef.ac.uk/FRAX/
Similar is the QFracture project.
The QFracture Score is a recently developed system for estimating risk
of fracture due to low bone density over the next 10 years. It was
developed in the UK and it’s supporters are trying to get it used
everywhere. The score takes into account the subject’s age, BMI,
tobacco and alcohol use, and other medical conditions.
Some professionals expressed the concern that the system should
include other conditions COPD and vitamin D deficiency) and medicine
used (e.g. SSRI antidepressants). It is also true that the QFracture system has not been
proven to reduce the number of fractures in large populations, but
that is largely because it is so new.
There is a website for finding your QFracture score at http://www.qfracture.org/
Another system is the Simple Calculated Osteoporosis Risk Estimation (SCORE). An on-line version is here: http://depts.washington.edu/osteoed/tools.php?type=score
Exercise is important throughout the life cycle to ensure healthy, strong bones, increased muscle strength, coordination, and balance. Because bone is living tissue just as muscle is, exercise helps strengthen bones, purge the body of toxins, and maximize physical capabilities.
The best exercise for prevention of osteoporosis is the weight-bearing kind. Resistance from weight training, dancing, climbing stairs, and any cardiovascular activity helps build and maintain strong muscles and a strong, hearty foundation for our bones. According to the Surgeon General, at least 30 minutes of physical activity a day will help us be on our way to having healthy, strong bones.
There is also some evidence that beta-blockers, commonly used for hypertension, help prevent the decline in bone density. However, no one suggests these drugs be administered solely for this use. The bone effects are pleitropic.
The AAOS has a page on What Is Your Risk for Osteoporosis?
An exercise plan for people with osteoporosis.
Sources for Material on this Page: The Centers for Disease Control on Calcium and Bone Health, Washington University webpage on osteoporosis and bone physiology, National Institutes of Health
Last updated: Aug 25, 2012
