How to prevent osteoporosis

31/07/2023

Currently, the global prevalence of osteoporosis in people over the age of 50 is around 1/3 – 1/5. The elderly with osteoporosis are at high risk of falls and bone fractures, which can lead to serious complications and increase the risk of death. In addition to taking medication, a combination of a healthy diet, regular exercise, and avoiding unhealthy habits is the key to preventing osteoporosis.

General Information about Osteoporosis

According to the National Institute of Arthritis and Musculoskeletal and Skin Disease – NIAMS of the National Institute of Health – NIH, osteoporosis is a bone disease that occurs when the bone mineral density and bone mass decrease, which can lead to decreased bone strength and may increase the risk of fractures. Osteoporosis is a “silent” disease because it often has no symptoms and even the patient may not know they have suffered from it until they break a bone. Osteoporosis is the leading cause of fractures in postmenopausal women and older men as well. Fractures can occur anywhere in the skeletal system, but they most commonly occur in the hip, spine, and wrist.

Osteoporosis can weaken bones and increase the risk of fractures. (Image: Freepik)

It is estimated that there are over 200 million people with osteoporosis worldwide, and according to statistics from the International Osteoporosis Foundation (IOF), one in three women over 50 will have an osteoporosis-related fracture, while the fracture rate in middle-aged men is 1/5. In the United States, the results of the National Health and Nutrition Examination Survey have shown that osteoporosis and bone loss are a major public health threat to nearly 54 million women and men in the United States aged 50 and older. Of the 54 million people in this middle-aged group, it is estimated that there are 10.2 million adults with osteoporosis, of which over 80% are women. In Vietnam, the overall prevalence of osteoporosis is 4.7%, and it is estimated that by 2050, the number of women with osteoporosis aged 50 and over could reach over 7 million, according to the Vietnamese Rheumatism Association.

Several risk factors can increase the risk of osteoporosis, including:

– Gender: Women are at a higher risk of developing osteoporosis than men due to lower peak bone mass and smaller bones. However, men are still at risk, especially after the age of 70.

– Age: As people age, the rate of bone loss accelerates and the rate of new bone growth slows down. Over time, bones can become weak, and the risk of developing osteoporosis increases.

– Body size: People with small or thin bones are at an increased risk of osteoporosis compared to people with larger bones due to lower bone density, while the rate of bone loss is similar to people with higher bone density.

– Race: White and Asian women are more likely to develop osteoporosis, whereas African-American and Mexican-American women are less likely. White males are also more susceptible than African-American and Mexican-American men to develop osteoporosis.

– Family history: Researchers find that the risk of osteoporosis and fractures may increase if the parents of the patient have a history of osteoporosis or fractures in middle age.

– Hormonal changes. A decrease in some hormones can increase the risk of osteoporosis, such as a decrease in estrogen levels in women after menopause. Estrogen regulates bone metabolism, promoting the activity of osteoblasts (bone-forming cells). When estrogen levels decrease, bone density also decreases, and bones are more likely to fracture.

– Diet: A diet low in calcium and vitamin D can increase the risk of osteoporosis and fractures. A diet excess or shortage of protein can also increase the risk of bone loss and osteoporosis..

– A healthy lifestyle is essential for maintaining bone strength. Low levels of physical activity and prolonged periods of inactivity can both lead to bone loss, increasing the risk of falls and fractures. Alcohol consumption and smoking are also among the risk factors to be concerned about for osteoporosis.

– Other complications of long-term medication consumption and health issues include conditions of endocrine, hormones, gastrointestine, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and loss of appetite.

Women have a higher risk of osteoporosis than men due to lower peak bone mass and smaller bones. (Image: Freepik)

Osteoporosis increases the probability of fractures in the elderly, which is particularly serious since the rate of recovery and repair at this age is quite slow, with many problems and complicated sequelae that can lead to death. For example, for patients undergoing hip fracture treatment, prolonged bed rest can increase the risk of infection, blood clots, stroke, and heart attack. A study by Panula et al. on patients over 65 years old with hip fractures showed that the 1-year mortality rate after surgery for hip fractures was 27.3% and the 4-year mortality rate was 79%, which is three times higher than the general population. Some of the main causes that have been statistically recorded by scientists include cardiovascular diseases, pulmonary embolism, and infections.

Preventive Measures for Osteoporosis

Time and age are things that humans cannot intervene in, but lifestyle and nutrition are things that they can change to have better health and to be able to “age” healthily and actively. Osteoporosis, a silent but very dangerous disease for the elderly, can also be prevented and managed with a healthy lifestyle and a well-established diet for bones and joints.

Appropriate Exercise Routine

Daily workouts play an important role in supporting the treatment of osteoporosis. Studies have shown that some physical activities that are good for bone health include strength training or resistance training. Regular exercise can help build muscle mass, increase strength, and improve coordination of the limbs, body parts, and balance, which are weaker in the elderly. This can help reduce the risk of falls in older adults. In addition, appropriate exercise can also help improve daily function and slow down the aging process, which can lead to dependence on caregivers.

According to the U.S. Department of Health and Human Services, adults of all ages should set the following exercise frequency goals:

  • At least 150 minutes (2.5 hours) per week of moderate-intensity exercise OR at least 75 minutes per week of vigorous-intensity exercise.
  • In addition, muscle-strengthening activities of moderate intensity should be performed at least twice a week.

For older people, these 150 minutes should include a combination of balance, aerobic, and strength-training exercises each week. Some suitable exercises for this population include:

  • Balance exercises: Walking on unstable surfaces (e.g., foam mats or wobble boards), Tai Chi, Walking backward, Step-ups, Lunges, Front-to-back weight shifting exercises
  • Weight-bearing exercises: Fast walking (3 to 4 miles/hour), walking or running, tennis, badminton, table tennis, handball, and other racket sports, climbing stairs, dancing, etc. These workouts provide force to the bones, pushing them to work harder and thereby developing their ability to withstand stress

Although exercise is fit for persons with osteoporosis, it should not place undue strain on the bones. If you have osteoporosis, you should avoid practicing intense exercises. To help prevent injuries and fractures, consult with a physical therapist or rehabilitation specialist to get specific exercises recommended to strengthen and support the back or sore muscles, or be provided instructions on how to move and perform daily activities safely, depending on the patient’s condition, and concurrently, created an exercise program that is suitable for the patient’s physical condition.

An appropriate exercise routine contributes to improving bone and joint health. (Image: Freepik)

Avoid bad habits

A healthy lifestyle is also very important to optimize bone health. It is recommended to:

  • Quit smoking and avoid second-hand smoke.
  • Moderate drinking, no more than one cup of beer per day for women and no more than two cups per day for men.
  • Get regular health checkups and ask your doctor about any factors that could influence your bone health or increase your risk of falls, such as drugs or other medical issues.

Nutrition

A balanced diet with adequate nutrition that supports the prevention and treatment of osteoporosis must be ensured:

  • At least 5 groups of 8 food groups: Cereal group (Rice, wheat flour); Legume group; Milk and dairy products group; Meat, fish, and seafood group; Egg and egg products group; Yellow, orange root vegetables, dark green leafy vegetables; Other vegetables and fruits group; Oils, fats of various types.
  • Plenty of fruits and vegetables.
  • Energy (calories) that is appropriate for age, height, and weight to maintain a healthy weight.
  • Supplement nutrients that support reducing bone loss, such as calcium, vitamin D, and vitamin K2.

Calcium, vitamin D, and vitamin K2 are important nutrients that help prevent osteoporosis and achieve maximum bone mass.

Some good sources of calcium that can be supplemented include low-fat dairy products, dark green leafy vegetables such as spinach, kale, broccoli, sardines, and salmon with bones, nuts, beans, soybeans, tofu, and calcium supplements.

If you do not supplement the recommended amount of calcium, your body will take calcium from your bones. This can result in bone loss, which can gradually weaken and hollow down your bones, leading to osteoporosis.

Age groups Men Women
Recommendation

(RDA) – mg

Maximum limit

(UL) – mg

Recommendation (RDA) – mg Maximum limit

(UL) – mg

20 – 49 years 800 2500 800 2500
50 – 69 years 800 2000 900 2000
Over 70 years 1000 2000 1000 2000
Pregnant women     1200 2500
Lactating women     1300 2500

However, the amount of calcium taken in will not be absorbed entirely into the bones 100%, and even the amount absorbed will be much lower if the diet lacks two important vitamins for bones, namely vitamin D and vitamin K2.

Vitamin D is essential for calcium absorption in the intestine. It can be produced in the skin after sunlight exposure. Some natural foods that contain enough vitamin D include fish that are high in omega-3, 6, and 9 fatty acids, such as salmon, sardine, tuna, fish oil, egg yolks, liver, milk, and cereals. If you supplement with insufficient amounts of vitamin D, your body can only absorb 10-15% of the calcium intake, while consuming enough, the amount of calcium absorbed from the intestine and blood will increase by 30 to 40%, according to a study by Hollick et. al.

Age groups Men Women
Recommendation

(RDA) – mcg

Maximum limit

(UL) – mcg

Recommendation

(RDA) – mcg

Maximum limit

(UL) – mcg

20 – 49 years 15 100 15 100
50 – 69 years 20 100 15 100
Over 70 years 20 100 20 100
Pregnant women     20 100
Lactating women     20 100

In the meantime, vitamin K2 is essential in transferring calcium from the blood to the bones. Furthermore, vitamin K2 aids in activating osteocalcin, an essential chemical generated by osteoblasts, which transports calcium from the blood to bone tissue, assisting in forming a strong skeletal system. However, osteocalcin cannot function unless it is activated by vitamin K2. Vitamin K2 not only serves to increase the amount of calcium carried from the blood to the bones via this approach, but it also helps to prevent calcium buildup and deposition on the blood vessel walls, which are the cause of many cardiovascular events.

According to the European Food Safety Authority EFSA, the recommended daily intake of vitamin K for adults to maintain healthy bones is 75 mcg per day, and for children from 6 months to 4 years old is 12 mcg per day. To get enough vitamin K2 for a healthy skeleton, natto, a Japanese fermented soybean, is a great option. As a tablespoon of natto contains 150 mcg of vitamin K2, which is twice the recommended amount. Furthermore, several more familiar folk foods also contain significant levels of vitamin K2, such as eel with 63 mcg of vitamin K2 per 100 grams of flesh, and chicken with 10 mcg of vitamin K2 per 100 grams of meat. Some formula milk for the elderly now also supplements bone and joint nutrients to compensate for the lack of nutrients due to the gradually declining ability to digest and consume food over time. Therefore, daily supplementation with bone-supporting formula milk is also one of the acceptable choices to supplement the natural sources of calcium and vitamins in milk, which is ideal for the physical condition of the elderly.

Conclusion

Thus, as can be seen, osteoporosis is a disease that appears to be quiet and dangerous, as the patient does not realize whether they suffer from osteoporosis until they have their bone density measured or experience an event that causes their bone breaks. Fractures in old age can cause many cardiovascular and infection complications. Patients must maintain a scientific diet, rich in bone-friendly substances such as calcium, vitamin D3, and K2, and an active and regulated lifestyle to prevent and manage osteoporosis. Encourage the elderly to “age in a healthy way”.

References:

  1. National Institute of Arthritis and Musculoskeletal and Skin Disease. Osteoporosis https://www.niams.nih.gov/health-topics/osteoporosis 
  2. Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017 Mar;4(1):46-56. doi: 10.5152/eurjrheum.2016.048. Epub 2016 Dec 30. PMID: 28293453; PMCID: PMC5335887.
  3. Wright, N.C., et al., The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res, 2014. 29(11): p. 2520-6.
  4. Thị Thanh Tú, N., Thị Dung, N. ., & Thanh Thủy, N. . (2022). MỘT SỐ ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG BỆNH LOÃNG XƯƠNG TẠI KHOA LÃO BỆNH VIỆN Y HỌC CỔ TRUYỀN TRUNG ƯƠNG. Tạp Chí Y học Việt Nam, 513(1). https://doi.org/10.51298/vmj.v513i1.2348
  5. Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, Kivelä SL. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011 May 20;12:105. doi: 10.1186/1471-2474-12-105. PMID: 21599967; PMCID: PMC3118151. 
  6. Holick MF. Vitamin D deficiency. N Engl J Med. 2007
  7. Maresz K. Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health. Integr Med (Encinitas). 2015 Feb;14(1):34-9.
  8. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to vitamin K and maintenance of bones (ID 123, 127, 128 and 2879), blood coagulation (ID 124 and 126), and function of the heart and blood vessels (ID 124, 125 and 2880) pursuant to Article 13(1) of Regulation (EC) No 1924/2006 on request from the European Commission. EFSA Journal 2009; 7 ( 9): 1228. [20 pp.]. doi:10.2903/j.efsa.2009.1228
  9. https://www.webmd.com/diet/foods-high-in-vitamin-k2 
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