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Food to prevent osteoporosis: Osteoporosis Diet & Nutrition: Foods for Bone Health

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Osteoporosis Diet & Nutrition: Foods for Bone Health

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Food and Your Bones — Osteoporosis Nutrition Guidelines

The food that you eat can affect your bones. Learning about the foods that are rich in calcium, vitamin D and other nutrients that are important for your bone health and overall health will help you make healthier food choices every day. Use the chart below for examples of the different types of food you should be eating every day.

If you eat a well-balanced diet with plenty of dairy, fish, fruits and vegetables, you should get enough of the nutrients you need every day, but if you’re not getting the recommended amount from food alone, you may need to complement your diet by taking multivitamins or supplements.

Good-for-Your-Bones Foods

Food Nutrient
Dairy products such as low-fat and non-fat milk, yogurt and cheese Calcium. Some dairy products are fortified with Vitamin D.
Fish
Canned sardines and salmon (with bones) Calcium
Fatty varieties such as salmon, mackerel, tuna and sardines Vitamin D
Fruits and vegetables
Collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens and broccoli. Calcium
Spinach, beet greens, okra, tomato products, artichokes, plantains, potatoes, sweet potatoes, collard greens and raisins. Magnesium
Tomato products, raisins, potatoes, spinach, sweet potatoes, papaya, oranges, orange juice, bananas, plantains and prunes. Potassium
Red peppers, green peppers, oranges, grapefruits, broccoli, strawberries, brussels sprouts, papaya and pineapples. Vitamin C
Dark green leafy vegetables such as kale, collard greens, spinach, mustard greens, turnip greens and brussel sprouts. Vitamin K
Fortified Foods
Calcium and vitamin D are sometimes added to certain brands of juices, breakfast foods, soy milk, rice milk, cereals, snacks and breads. Calcium, Vitamin D

Leafy greens and other nutrient-rich foods are good for your bones.

More Examples of Bone Healthy Food

Recent research has found that olive oil, soy beans, blueberries and foods rich in omega-3s, like fish oil and flaxseed oil may also have bone boosting benefits. While additional research is needed before the link between these foods and bone health can definitively be made, the many overall health benefits of these foods make them excellent choices to add to your diet. Studies have also shown that a moderate intake of certain alcoholic and non-alcoholic beverages like wine, beer and tea may also be good for your bones. More research is also needed to better help us to better understand the relationship between these drinks and bone health.

More Tips for Eating for Good Bone Health

Beans (Legumes)

While beans contain calcium, magnesium, fiber and other nutrients, they are also high in substances called phytates. Phytates interfere with your body’s ability to absorb the calcium that is contained in beans. You can reduce the phytate level by soaking beans in water for several hours and then cooking them in fresh water.

Meat and Other High Protein Foods

It’s important to get enough, but not too much protein for bone health and overall health. Many older adults do not get enough protein in their diets and this may be harmful to bones. However, special high protein diets that contain multiple servings of meat and protein with each meal can also cause the body to lose calcium. You can make up for this loss by getting enough calcium for your body’s needs. For example dairy products, although high in protein, also contain calcium that is important for healthy bones.

Salty Foods

Eating foods that have a lot of salt (sodium) causes your body to lose calcium and can lead to bone loss. Try to limit the amount of processed foods, canned foods and salt added to the foods you eat each day. To learn if a food is high in sodium, look at the Nutrition Facts label. if it lists 20% or more for the % Daily Value, it is high in sodium. Aim to get no more than 2,300 mg of sodium per day.

Spinach and Other Foods with Oxalates

Your body doesn’t absorb calcium well from foods that are high in oxalates (oxalic acid) such as spinach. Other foods with oxalates are rhubarb, beet greens and certain beans. These foods contain other healthy nutrients, but they just shouldn’t be counted as sources of calcium.

Wheat Bran

Like beans, wheat bran contains high levels of phytates which can prevent your body from absorbing calcium. However, unlike beans 100% wheat bran is the only food that appears to reduce the absorption of calcium in other foods eaten at the same time. For example, when you have milk and 100% wheat bran cereal together, your body can absorb some, but not all, of the calcium from the milk. The wheat bran in other foods like breads is much less concentrated and not likely to have a noticeable impact on calcium absorption. If you take calcium supplements, you may want to take them two or more hours before or after eating 100% wheat bran.

Alcohol

Drinking heavily can lead to bone loss. Limit alcohol to no more than 2 – 3 drinks per day.

Caffeine

Coffee, tea and soft drinks (sodas) contain caffeine, which may decrease calcium absorption and contribute to bone loss. Choose these drinks in moderation.

Coffee/Tea

Drinking more than three cups of coffee every day may interfere with calcium absorption and cause bone loss.

Soft Drinks

Some studies suggest that colas, but not other soft drinks, are associated with bone loss. While more research will help us to better understand the link between soft drinks and bone health, here is what we know:

  • The carbonation in soft drinks does not cause any harm to bone.
  • The caffeine and phosphorous commonly found in colas may contribute to bone loss.
  • Like calcium, phosphorous is a part of the bones. It is listed as an ingredient in colas, some other soft drinks and processed foods as “phosphate” or “phosphoric acid.”
  • Some experts say that Americans get too much phosphorous, while others believe that it is not a problem as long as people get enough calcium. The harm to bone may actually be caused when people choose soft drinks over milk and calcium-fortified beverages.
  • Luckily you can help make up for any calcium lost from these beverages by getting enough calcium to meet your body’s needs.

More Information

To learn more about other foods that may be good for your bones, visit PubMed.gov, an online service of the US National Library of Medicine, to find research studies on nutrition and bone health.

Osteoporosis Diet: Top 5 Foods for Bone Health

As you age, maintaining a healthy, balanced diet full of nutrients is a critical part of body and bone health. Certain foods and supplements can help you prevent osteoporosis, along with a plethora of other health benefits. Boosting your diet with vitamin-rich foods will help you look and feel your best.

Best Foods for Osteoporosis

Calcium, vitamin C and Vitamin D are integral to preventing osteoporosis. Eating foods rich in those vitamins and nutrients will promote bone health and reduce your risk for many other conditions as you age. The following are a few of the best foods for bone health.

Dairy Products

Healthy sources of calcium and fat are important for bone health. Dairy products like milk, cheese, and yogurt are full of calcium. A few servings a day will boost your calcium intake.

Fruits & Vegetables

The produce aisle is packed with good-for-you nutrients. Some of the best fruits and vegetables for osteoporosis prevention include:

  • Leafy greens like kale, collard greens, spinach, and mustard greens
  • Figs
  • Broccoli
  • Oranges
  • Mushrooms

Prepare fruits and vegetables in a way that you enjoy, and eat a few servings a day to provide your body with the nutrients it needs to help keep your bones healthy and strong.

Lean Protein

Salmon and tuna are particularly high in vitamin D, which helps the body process calcium. Skinless chicken and other lean meats also provide a healthy dose of protein to support bone density and tissue growth. 

Eggs

Eggs are another great source of vitamin D. The egg yolks in particular are packed with vitamin D, but also contain cholesterol. Eat eggs in moderation with a variety of other vitamin D rich foods.

Nuts

Many types of nuts are a good source of healthy fats, protein, and nutrients like calcium and magnesium. Some ideal nuts for osteoporosis prevention include almonds, sunflower seeds, or pistachios. Eat a handful each day as a snack to promote bone health.

Fortified Foods

Certain foods are fortified with extra nutrients. Some breakfast cereals, orange juice, breads, and more have added calcium or vitamin D to help consume extra nutrients. If you are lactose intolerant, or don’t like certain other nutrient-rich foods, fortified foods can be a good alternative.

What are other ways to prevent osteoporosis?

Your diet is not the only way to prevent osteoporosis and encourage strong bones. Certain supplements can increase your vitamin consumption and make sure you are getting the recommended daily amounts. Read more about the recommended supplements and how they can aid in osteoporosis prevention.

Osteoporosis has a strong genetic component, and even those with a robust bone health diet can still be susceptible to developing the condition. It is important to elect for bone density scans, also known as DEXA scans, to analyze your bone structure and watch for any decrease in density. Find out more about how DEXA scans work and how often you should receive them by reading our blog.

Turn to Heiden Orthopedics for Osteoporosis Prevention

Osteoporosis prevention is an important part of getting older, and a few simple dietary changes along with regular bone density scans can help you stay happy and healthy for years to come. Heiden Orthopedics is your resource for bone health, so consult with us today to get started with preventive care, bone density scans, or other treatments.

Food for healthy bones – NHS

Credit:

A healthy balanced diet will help you build healthy bones from an early age and maintain them throughout your life.

You need sufficient calcium to keep your bones healthy and vitamin D to help your body absorb calcium.

Poor bone health can cause conditions such as rickets and osteoporosis and increase the risk of breaking a bone from a fall later in life.

You should be able to get all the nutrients you need for healthy bones by eating a balanced diet.

A good diet is only one of the building blocks for healthy bones, which also includes exercise and avoiding certain risk factors for osteoporosis.

Calcium

Adults need 700mg of calcium a day. You should be able to get all the calcium you need by eating a varied and balanced diet.

Good sources of calcium include:

  • milk, cheese and other dairy foods
  • green leafy vegetables, such as broccoli, cabbage and okra, but not spinach
  • soya beans
  • tofu
  • plant-based drinks (such as soya drink) with added calcium
  • nuts
  • bread and anything made with fortified flour
  • fish where you eat the bones, such as sardines and pilchards

Although spinach contains a lot of calcium, it also contains oxalate, which reduces calcium absorption, and it is therefore not a good source of calcium.

Vitamin D

Adults need 10 micrograms (400 International Units or IU) of vitamin D a day.

It’s difficult to get all the vitamin D we need from our diet and we get most of our vitamin D from the action of the sun on our skin.

From late March/April to the end of September, you can make vitamin D from sunlight by having short daily periods of sun exposure without sunscreen. However, everyone should consider taking a daily vitamin D supplement during the autumn and winter when we cannot make vitamin D from sunlight.

For babies and children, see vitamins for children.

At-risk groups

Some groups of the population are at greater risk of not getting enough vitamin D, and the Department of Health and Social Care recommends that these people should take a daily 10 microgram (400IU) vitamin D supplement all year round. These groups are:

  • people who are not often outdoors, for example if they are frail, housebound or living in a care home
  • people who usually wear clothes that cover up most of their skin when outdoors
  • people with dark skin such as those of African, African-Caribbean or south Asian origin

Good sources of vitamin D:

  • oily fish, such as salmon, sardines and mackerel
  • egg yolks
  • fortified foods, such as some fat spreads and breakfast cereals

If you’ve been diagnosed with osteoporosis, your doctor may prescribe calcium and vitamin D supplements as well as osteoporosis drug treatments if they have concerns that your calcium intake may be low.

Find out more about treating osteoporosis.

Menopause

Women lose bone more rapidly for a number of years after the menopause when their ovaries almost stop producing oestrogen, which has a protective effect on bones.

There are no specific calcium or vitamin D recommendations for the menopause, however a healthy balanced diet, including calcium, summer sunlight and vitamin D supplements, will help slow down the rate of bone loss.

Vegans

Non-vegans get most of their calcium from dairy foods (milk, cheese and yoghurt), but vegans will need to get it from other foods.

Good sources of calcium for vegans include:

  • fortified soya, rice and oat drinks
  • soya beans
  • calcium-set tofu
  • sesame seeds and tahini
  • pulses
  • brown and white bread (in the UK calcium is added to white and brown flour by law)
  • dried fruit such as raisins, prunes, figs and dried apricots

The vegan diet contains little, if any, vitamin D without fortified foods or supplements but, for everyone, sunlight on the skin in spring and summer is the main source of vitamin D. Remember to cover up or protect your skin before it starts to turn red or burn (see how to make vitamin D from sunlight).

Other vegan sources of vitamin D are:

  • fortified fat spreads, breakfast cereals and plant-based drinks such as soya drink (with vitamin D added)
  • vitamin D supplements

Read more about sources of calcium and vitamin D in the vegan diet.

During pregnancy and when breastfeeding, women who follow a vegan diet need to make sure they get enough vitamins and minerals for their child to develop healthily.

Read about being vegetarian or vegan and pregnant for more information.

If you’re bringing up your baby or child on a vegan diet, you need to ensure they get a wide variety of foods to provide the energy and nutrients they need for growth.

Read baby and toddler meal ideas for more information.

Too much vitamin A

Some research has suggested a link between too much vitamin A and an increased risk of bone fractures. As a precaution, people who regularly eat liver (a rich source of vitamin A) are advised not to eat liver more than once a week, or take supplements containing retinol (a form of vitamin A usually found in foods that come from animals).

People at risk of osteoporosis, such as postmenopausal women and older people, are advised to limit their retinol intake to no more than 1.5mg (1,500 micrograms) a day by eating less liver and liver products and avoiding supplements containing retinol (including those containing fish liver oil).

Page last reviewed: 8 April 2021
Next review due: 8 April 2024

Five Foods to Prevent Osteoporosis

Osteoporosis can strike at any age and occurs in both men and women, but it is most common in post-menopausal women. Bone is living tissue that constantly regenerates. Osteoporosis causes bones to become weak and brittle making you more susceptible to fractures. The most common fractures occur in the hip, wrist or spine.

Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.

May is National Osteoporosis Month. If you suffer from osteoporosis, try adding foods that are good for your bones and rich in nutrients like calcium, vitamins D, C, and K, as well as potassium and magnesium.

.Dairy products — Low-fat and non-fat milk, yogurt and cheese that contain calcium and are fortified with vitamin D, as well as fatty fishes like canned sardines, salmon (with bones), mackerel and tuna.

.Potassium — Spinach, beet greens, okra, tomato products, artichokes, plantains, potatoes, sweet potatoes, collard greens and raisins.

.Magnesium — Tomato products, raisins, potatoes, spinach, sweet potatoes, papaya, oranges, orange juice, bananas, plantains and prunes.

.Vitamin C — Red peppers, green peppers, oranges, grapefruits, broccoli, strawberries, Brussels sprout, papaya and pineapples.

.Vitamin K — Vegetables such as kale, mustard greens, turnip greens and Brussels sprout, okra, Chinese cabbage, dandelion greens, and broccoli.

If you think you have osteoporosis, make an appointment with a doctor at Flushing Hospital Medical Center’s Ambulatory Care Center by calling 718-670-5486.

For more health and lifestyle tips, follow us on Twitter @FHMC_NYC and like us on Facebook at www.facebook.com/FlushingHospital.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

What You Can Do Now to Prevent Osteoporosis

Did you know that that 50 percent of women in the U.S. age 50 or older will
break a bone due to osteoporosis?

Overall, about 54 million Americans have osteoporosis—a gradual thinning
out of the bones—or low bone density, which may lead to fracture.

Women typically start out with lower bone density than men, and loss of
estrogen over time can increase the risk for osteoporosis.

But there is good news: In some cases, osteoporosis can be preventable. The
sooner you start keeping your bones healthy, the better off you will be in
your 50s and beyond.

Kendall F. Moseley, M.D.

, endocrinologist and osteoporosis specialist at the

Johns Hopkins Metabolic Bone Center

, shares a few tips to keep your bones healthy and strong.

Keep Bones Healthy Through Your Diet

Get the Right Amount of Calcium

When it comes to calcium, more is not always better. You should strive to
hit the daily intake recommendation:

  • 1,000 mg for women 50 and younger
  • 1,200 mg for women 51 and older

With well-balanced nutrition, you may be able to get most of the necessary
calcium from your diet and fill in the rest with supplements. As a matter
of fact, you could be eating more calcium than you think!

Try calculating your daily intake by reading nutritional labels. Remember,
these labels are based on a daily allowance of 1000 mg, so if the label
says, “25% of daily calcium,” that means you’re getting 250 mg of calcium
per serving, just add a zero.

Don’t Forget Vitamin D

Vitamin D helps your body absorb calcium and use it to strengthen your
bones. When your skin is exposed to sunlight, your liver and kidneys are
responsible for making vitamin D. However, most of us can’t rely solely on
the sun to get our daily dosage for many reasons: indoor living, sunscreen,
skin tone, seasonal changes, etc. Non-fortified foods are also limited in
vitamin D.

Your goal should be:

  • 600 international units (IU) of vitamin D per day if you are 70 or
    younger
  • 800 IU if you are 71 or older

Because many women don’t hit the recommended dosage of vitamin D through
sun exposure and diet, supplements may be needed to meet this goal.

Protein Is Important for Bone Health, Too

Protein is in every cell in your body, including your bones. Studies have
shown that eating protein increases bone mineral density. The recommended
daily protein intake is 0.4 grams per pound of body weight. So, if you’re a
140-lb. woman, you need about 60 grams of protein per day. Protein can be
found in animal or nonanimal food sources.

Learn how your diet can help your bone health. View our infographic.

Exercise

Most of us know that exercise is good for fitness, but did you know it’s
great for bone health, too? Exercise helps stimulate the cells responsible
for building bones.

But not just any exercise will do. To promote bone health, try doing
weight-bearing and resistance exercises 3 or 4 days a week.

  • Weight-bearing exercises
    focus on carrying the weight of your body against gravity. Walking is a
    great weight-bearing activity, as are running, dancing, aerobics,
    hiking and tennis.
  • Resistance exercises
    use an opposing force, such as weights, an elastic band, or water, to
    strengthen your muscles and build bone. Having strong muscles and good
    balance may also help you avoid falls or minimize injury.

Build Healthy Life Habits

The choices you make, beginning as early as childhood, can affect your bone
health in the future. To protect it, consider making the following
adjustments to your lifestyle:

  • Quit smoking.
  • Limit alcohol consumption.
  • Maintain a healthy weight.
  • Eat a well-balanced diet.
  • Stay active.

Think you may not be hitting all the recommended daily nutritional values
for optimal bone health? Worried about other factors in your life that
might contribute to bone loss? Talk to your doctor about what you can do
now to help prevent osteoporosis and bone fractures in the future.

Osteoporosis Prevention With Calcium: Foods, Supplements, Daily Intake

What is calcium?

Calcium is a mineral that the body needs for good health. Calcium is found naturally in some foods and is added to others. It also is available as a nutrition supplement and is contained in some medicines like Tums®.

Why does the body need calcium?

Calcium is the healthy bone mineral. About 99% of the calcium in the body is stored in the bones and teeth. It’s the mineral that makes them hard and strong. The remaining 1% is needed for many activities that help keep the body functioning normally. Calcium helps blood vessels contract (narrow) and expand, makes muscles contract, helps send messages through the nervous system and helps glands secrete hormones.

Bones are constantly being remodeled every day, and calcium moves in and out of them. In children and adolescents, the body builds new bone faster than it breaks down old bone so total bone mass increases. This continues until about age 30, when new bone formation and old bone breakdown start occurring at about the same rate. In older adults, especially in post-menopausal women, bone is broken down at a faster rate than it’s built. If calcium intake is too low, this can contribute to osteoporosis.

How much calcium does an adult need to take in every day?

The amount of calcium needed for healthy bones and teeth is different by age. The National Institutes of Health suggests these levels of daily intake for adults:

Daily suggested calcium intake for adults

  • Adults 19-50 years: 1,000 mg.
  • Adult men 51-70 years: 1,000 mg.
  • Adult women 51-70 years: 1,200 mg.
  • Adults 71 years and older: 1,200 mg.
  • Pregnant and breastfeeding teens: 1,300 mg.
  • Pregnant and breastfeeding adults: 1,000 mg.

What are the best ways to get enough calcium?

The best way to get enough calcium every day is to eat a variety of healthy foods from all the different food groups. Getting enough vitamin D every day from foods like enriched milk or from natural sunlight is important to help the body absorb and use calcium from food.

Here are some easy guidelines for selecting foods high in calcium:

  • Dairy products have the highest calcium content. Dairy products include milk, yogurt and cheese. A cup (8 ounces) of milk contains 300 mg of calcium. The calcium content is the same for skim, low fat and whole milk.
  • Dark green, leafy vegetables contain high amounts of calcium. Broccoli, kale and collards are all good sources of calcium, especially when eaten raw or lightly steamed. (Boiling vegetables can take out much of their mineral content.)
  • A serving of canned salmon or sardines has about 200 mg of calcium. It’s found in the soft bones of the fish.
  • Cereal, pasta, breads and other food made with grains may add calcium to the diet. Look for cereals that are fortified with minerals, including calcium.
  • Besides cereal, calcium is sometimes added to fruit juices, soy and rice beverages and tofu. Read product labels to find out if a food item has added calcium.

The U.S. Department of Agriculture recommends that everyone aged 9 years and older eat three servings of foods from the dairy group per day.

1 serving of dairy equals:

  • 1 cup (8 ounces) milk.
  • 1 cup yogurt.
  • 1.5 ounces of natural cheese (such as cheddar).
  • 2 ounces of processed cheese (such as American).

Should I take a calcium supplement?

Calcium is best absorbed through the foods we eat and the beverages we drink. For most healthy patients, it’s important to eat a well-balanced diet instead of relying on supplements alone.

For those who can’t get enough calcium from food and beverages each day, taking a calcium supplement may be necessary. People who have lactose intolerance might have difficulty getting enough calcium through their diet alone. In addition, those with absorption problems due to gastrointestinal illness may not absorb enough calcium. Those who follow a vegan diet, or consume large amounts of protein and sodium might also not get enough calcium.

What type of calcium supplement should I take?

The amount of calcium the body will absorb from supplements depends on the form of calcium in the supplement, how well the calcium dissolves in the intestines and the amount of calcium in the body. The two most commonly used calcium products are calcium carbonate and calcium citrate.

Calcium carbonate supplements dissolve better in an acid environment, so they should be taken with a meal. Calcium citrate supplements can be taken any time because they do not need acid to dissolve. For this reason, people who might have problems absorbing medications could consider using calcium citrate instead of calcium carbonate. This would include those who take medications to decrease stomach acid (such as over-the-counter and prescription heartburn medications). Also, those who have had intestinal bypass surgery, or perhaps even those 65 years and older, may benefit from calcium citrate instead of calcium carbonate.

Calcium supplements in the form of gluconate, lactate or phosphate are also available, but they generally contain less absorbable calcium. It’s helpful to look for supplements that have the United States Pharmacopeia (USP) or consumerlab.com (CL) abbreviation on the bottle. This indicates that the products have met voluntary industry standards for quality.

The higher the calcium dose, the less it’s absorbed. For the maximum absorption, no more than 500 mg of calcium should be taken in a single dose. If you need more than 500 mg as a supplement, take the doses at least four hours apart. If you think you need a calcium supplement, ask your doctor or a dietitian to recommend one.

What happens if I take too much calcium?

Adults ages 19 through 50 should not get more than 2,500 mg calcium total per day (including food and supplements). Adults over age 50 should not exceed 2,000 mg total per day. Dietary calcium is considered safe, but too much calcium in the form of supplements might have some health risks. Too much calcium has the potential to increase the risk of kidney stones, constipation or even calcium buildup in your blood vessels, along with difficulty absorbing iron and zinc.

Are there any medications that interact with calcium?

Calcium can reduce the absorption of these drugs if taken at the same time:

  • Bisphosphonates (osteoporosis treatment).
  • Thyroid medication.
  • Certain seizure medications (phenytoin).
  • Certain antibiotics.
  • Iron supplements.

What happens when the body does not get enough calcium?

Children need calcium to build strong bones. Adults need calcium to maintain strong bones. Over time, inadequate calcium intake can cause osteoporosis, the brittle bone disease. People with osteoporosis are at high risk for broken bones, especially at the wrist, hip and spine. These fractures cause chronic (long-lasting) pain and disability, loss of independence, decreased quality of life and a higher risk of death.

Osteoporosis can cause the bones that make up the spine (the vertebrae) to break. This causes the spine to collapse in these areas, which leads to pain, difficulty in moving and gradual deformity. If the problem is severe enough, it causes a “dowager’s hump” to form, a curvature of the upper back.

Who develops osteoporosis?

According to the National Institutes of Health, half of all women over age 50 and a quarter of men older than age 50 will break a bone due to osteoporosis. Post-menopausal white and Asian women are at the highest risk for osteoporosis. About 25% of women with osteoporosis will develop a vertebral deformity, and 15% will break a hip. Osteoporosis also causes broken hips in men, although not as often as in women. Hip fractures are associated with an increased risk of death within the year after the bone break.

Risk factors for osteoporosis include:

  • Not enough calcium in the diet.
  • Age over 50.
  • Small, thin body build.
  • Family history of osteoporosis.
  • Being a white or Asian woman.
  • Smoking.
  • Use of certain medications such as breast cancer treatments, seizure medications, steroids.

What are the symptoms of osteoporosis?

Symptoms of bone loss do not occur until osteoporosis develops. Even then, in its early stages, osteoporosis may not cause any symptoms. Symptoms that develop as osteoporosis worsens may include:

  • Breaking bones easily.
  • Back pain.
  • Stooped posture.
  • Gradual loss of height.

How is osteoporosis diagnosed?

The outward signs of osteoporosis (height loss, easily broken bones, dowager’s hump) combined with a patient’s gender and age are strong signs that the patient has osteoporosis. A technology called dual X-ray absorptiometry (DXA) is the state-of-the-art technique for measuring bone mineral density (how much calcium is in the bones) and to diagnose osteoporosis.

How can osteoporosis be prevented?

To promote lifelong healthy bones and reduce calcium loss:

  • Eat a diet rich in calcium and vitamin D throughout your life.
  • Enjoy regular exercise, especially weight-bearing activity like walking or jogging.
  • Don’t smoke.
  • Go easy on the caffeine and alcohol.

The U.S. Preventive Services Task Force recommends a bone density screening by DXA in all women aged 65 years or older. They also recommended a screening test for women under the age of 65 who are at risk for fractures. This test shows the strength of the bones so that preventative measures against fractures can be started if necessary.

Calcium content of various foods

  • Yogurt, plain, low fat, 8 ounces 415 mg per serving.
  • Orange juice, calcium-fortified, 6 ounces 375 mg per serving.
  • Yogurt, fruit, low fat, 8 ounces 338–384 mg per serving.
  • Mozzarella, part skim, 1.5 ounces 333 mg per serving.
  • Sardines, canned in oil, with bones, 3 ounces 325 mg per serving.
  • Cheddar cheese, 1.5 ounces 307 mg per serving.
  • Milk, nonfat, 8 ounces 299 mg per serving.
  • Milk, reduced-fat (2% milk fat), 8 ounces 293 mg per serving.
  • Milk, buttermilk, 8 ounces 282–350 mg per serving.
  • Milk, whole (3.25% milk fat), 8 ounces 276 mg per serving.
  • Tofu, firm, made with calcium sulfate, ½ cup 253 mg per serving.
  • Salmon, pink, canned, solids with bone, 3 ounces 181 mg per serving.
  • Cottage cheese, 1% milk fat, 1 cup 138 mg per serving.
  • Instant breakfast drink, various flavors and brands, powder prepared with water, 8 ounces 105–250 mg per serving.
  • Frozen yogurt, vanilla, soft serve, ½ cup 103 mg per serving.
  • Ready-to-eat cereal, calcium-fortified, 1 cup 100–1,000 mg per serving.
  • Turnip greens, fresh, boiled, ½ cup 99 mg per serving.
  • Kale, fresh, cooked, 1 cup 94 mg per serving kale, raw, chopped, 1 cup 90 mg per serving
  • Tofu, soft, made with calcium sulfate, ½ cup 138 mg per serving ice cream, vanilla, ½ cup 84 mg per serving.
  • Soy beverage, calcium-fortified, 8 ounces 80–500 mg per serving.
  • Chinese cabbage, bok choi, raw, shredded, 1 cup 74 mg per serving.
  • Bread, white, 1 slice 73 mg per serving.
  • Pudding, chocolate, ready to eat, refrigerated, 4 ounces 55 mg per serving.
  • Tortilla, corn, ready-to-bake/fry, one 6″ diameter 46 mg per serving.
  • Tortilla, flour, ready-to-bake/fry, one 6″ diameter 32 mg per serving.
  • Sour cream, reduced fat, cultured, 2 tablespoons 31 mg per serving.
  • Bread, whole-wheat, 1 slice 30 mg per serving.
  • Broccoli, raw, ½ cup 21 mg per serving.
  • Cheese, cream, regular, 1 tablespoon 14 mg per serving.

Calcium and Bone Health – HelpGuide.org

healthy eating

Calcium is the key to lifelong bone health. Learn how to eat to strengthen your bones and prevent osteoporosis.

What are the health benefits of calcium?

Calcium is a key nutrient that many of us overlook in our diets. Almost every cell in the body uses calcium in some way, including the nervous system, muscles, and heart. Your body uses calcium to build healthy bones and teeth, keep them strong as you age, send messages through the nervous system, help your blood clot, your muscles contract, and regulate the heart’s rhythm.

If you don’t get enough calcium in your diet, your body will take it from your bones to ensure normal cell function, which can lead to weakened bones or osteoporosis. Calcium deficiency can contribute to mood problems such as irritability, anxiety, depression, and difficulty sleeping.

Despite these vital functions, many of us are confused about calcium and how to best protect our bones and overall health. How much calcium should you get? Where should you get it? And what’s the deal with vitamin D, magnesium, and other nutrients that help calcium do its job? This confusion means that many of us are not getting the recommended daily amount of calcium and approximately one in two women (and about one in four men) over the age of 50 will break a bone due to osteoporosis.

Getting enough calcium in your diet is not just important for older people. It’s also vital for children, teens, and young adults since we continue building bone mass into our mid-20s. From then on, we can lose bone mass without sufficient calcium in our diets. Whatever your age or gender, it’s vital to include calcium-rich foods in your diet, limit those that deplete calcium, and get enough magnesium and vitamins D and K to help calcium do its job.

The calcium and osteoporosis connection

Osteoporosis is a “silent” disease characterized by loss of bone mass. Due to weakened bones, fractures become commonplace, which leads to serious health risks. People with osteoporosis often don’t recover after a fall and it is the second most common cause of death in women, mostly those aged 60 and older. Men are also at risk of developing osteoporosis, but typically 5 to 10 years later than women. For most people, osteoporosis is preventable, and getting enough calcium in your diet is the first place to start.

How much calcium do you need?
Age Males Females
Newborn to 6 months 200 mg/day 200 mg/day
6 to 12 months 260 mg/day 260 mg/day
1 to 3 years 700 mg/day 700 mg/day
4-8 years 1,000 mg/day 1,000 mg/day
9 to 18 years 1,300 mg/day 1,300 mg/day
19 to 50 years 1,000 mg/day 1,000 mg/day
51 to 70 years 1,000 mg/day 1,200 mg/day
71+ years 1,000 mg/day 1,000 mg/day
Source: National Institutes of Health

Food is the best source of calcium

Doctors recommend that you get as much of your daily calcium needs as possible from food and use only low-dose supplements to make up any shortfall. Your body is better able to absorb calcium from food than it can from supplements. In fact, studies show that even though people who take calcium supplements have a higher average intake, those who get their calcium from food have stronger bones. Furthermore, using high-dose calcium supplements may increase your risk of kidney stones and heart disease.

Good food sources of calcium

Good sources of calcium include dairy products, leafy green vegetables, certain fish, oatmeal and other grains, tofu, cabbage, summer squash, green beans, garlic, sea vegetables and calcium-fortified foods such as cereals and orange juice.

Good food sources of calcium
Food Milligrams (mg) per serving
Yogurt, plain, low fat, 8 ounces 415
Mozzarella, part skim, 1.5 ounces

Cheddar cheese, 1.5 ounces

Cottage cheese, (1% milk fat), 8 ounces

Cheese, cream, regular, 1 tablespoon

333

307

138

14

Milk, nonfat, 8 ounces

Milk, reduced-fat (2% milk fat), 8 ounces

Milk, whole (3.25% milk fat), 8 ounces

Soymilk, calcium-fortified, 8 ounces

299

293

276

299

Ready-to-eat cereal, calcium-fortified, 1 cup 100-1,000
Sardines, canned in oil, with bones, 3 ounces

Salmon, pink, canned, solids with bone, 3 ounces

325

181

Tofu, firm, made with calcium sulfate, 1/2 cup

Tofu, soft, made with calcium sulfate, 1/2 cup

253

138

Turnip greens, fresh, boiled, 1/2 cup

Kale, raw, chopped, 1 cup

Kale, fresh, cooked, 1 cup

Chinese cabbage, bok choy, raw, shredded, 1 cup

Broccoli, raw, 1/2 cup

99

100

94

74

21

Source: National Institutes of Health

Calcium and whole milk dairy: The pros and cons

While milk and other dairy products contain a lot of calcium in a highly absorbable form, there may be some potential downsides.

Whole milk dairy products are often high in saturated fat. Many prominent health organizations recommend that you limit your saturated fat intake and choose low- or non-fat dairy foods, though an increasing body of research shows that eating whole-milk dairy products is linked to less body fat and lower levels of obesity. Low-fat and non-fat dairy products also tend to contain lots of hidden sugar to make up for the loss of taste, which can be far more detrimental to your health and weight than the saturated fat it’s replaced.

Milk can contain high levels of estrogen. Some studies show a possible link between the natural estrogens found in milk and breast, prostate, and testicular cancer. Part of the problem is modern dairy practices, where the cows are fed synthetic hormones and antibiotics, kept continuously pregnant, and milked over 300 days per year. The more pregnant the cow, the higher the hormones in the milk. Organic milk comes from cows that are grass-fed and not given synthetic hormones or other additives, although organic milk can still be high in natural hormones. Because both natural and synthetic hormones are found in the milk fat, skim milk has a much lower level.

Some people are lactose intolerant, meaning they are unable to digest lactose, a sugar found in milk and milk products. Symptoms range from mild to severe, and include cramping, bloating, gas, and diarrhea. Beyond the discomfort it causes, lactose intolerance can also interfere with calcium absorption from dairy.

Tips for upping your calcium intake

To boost your daily intake, try to include calcium-rich foods in multiple meals or snacks.

Tips for adding more calcium from dairy to your diet

  • Use milk instead of water when making oatmeal or other hot breakfast cereals.
  • Substitute milk for some of the liquid in soups such as tomato, squash, pumpkin, curries, etc.
  • Milk can be added to many sauces or used as the base in sauces such as Alfredo and Béchamel sauce.
  • Make whole-wheat pancakes and waffles using milk or yogurt.
  • Get creative with plain yogurt. Use it to make a dressing or a dip, or try it on potatoes in place of sour cream.
  • Add milk or yogurt to a fruit smoothie. You can even freeze blended smoothies for popsicles.
  • Enjoy cheese for dessert or as a snack. Try cheddar, mozzarella, Gouda, jack, Parmesan, or a type of cheese you’ve never had before.

Tips for getting more calcium from non-dairy sources

Greens can easily be added to soups, casseroles, or stir-fries. Opt for kale, collard greens, turnip greens, dandelion greens, mustard greens, beet greens, broccoli, and cabbage. Spice up these and other dishes with garlic, basil, thyme, oregano, and rosemary to add more nutrients.

Eat dark green leafy salads with your meals. Try romaine hearts, arugula, butter lettuce, mesclun, watercress, or red leaf lettuce (avoid iceberg lettuce as it has very little nutrient value).

Add extra servings of veggies to your meals, i.e. asparagus, fresh green peas, broccoli, cabbage, okra, bok choy.

Top salads or make a sandwich with canned fish with bones, such as sardines and pink salmon.

Use beans/legumes as part of your meals. They are wonderful in stews, chili, soup, or as the protein part of a meal. Try tofu, tempeh, black-eyed peas, black beans, and other dried beans. You can also snack on edamame.

Start your day with oats. Steel cut oats or rolled oats make a filling breakfast. For an added punch include cinnamon

Snack on nuts and seeds such as almonds and sesame seeds. You can also add these to your morning oatmeal.

Order or prepare sandwiches on whole grain wheat bread.

Beyond calcium: Other nutrients for healthy bones

When it comes to healthy bones and preventing osteoporosis, calcium alone is not enough. There are a number of other vital nutrients that help your body absorb and make use of the calcium you consume.

Magnesium

Why it’s important: Magnesium helps your body absorb and retain calcium to help build and strengthen bones and prevent osteoporosis. Since your body is not good at storing magnesium, it is vital to make sure you get enough of it in your diet.

How much do you need? For adult men, 400-420 mg daily. For adult women, 310-320 mg daily (more during pregnancy).

How to include more in your diet: Magnesium is found in nuts (especially almonds and cashews), seeds (pumpkin, sesame, flax, sunflower), whole grains, seafood, legumes, tofu, and many vegetables, including spinach, Swiss chard, summer squash, turnip and mustard greens, broccoli, sea vegetables, cucumbers, and celery. Reduce sugar and alcohol, which increase the excretion of magnesium.

Vitamin D

Why it’s important: Vitamin D helps the body absorb calcium and regulates calcium in the blood.

How much do you need? Up to age 70, 600 IU (international units) per day. Over 70, 800 IU per day.

How to include more in your diet: Your body synthesizes vitamin D when exposed to the sun. Spend at least 15 minutes outside in the sun each day and include good food sources of vitamin D in your diet, such as fortified milk, eggs, cheese, fortified cereal, butter, cream, fish, shrimp, and oysters.

Phosphorous

Why it’s important: Phosphorous works with calcium to build bones. But again, it’s important to get the balance right: too much phosphorous will cause your body to absorb less calcium and can even be toxic.

How much do you need? For adults, 700 mg a day.

How to include more in your diet: Good sources include dairy, fish (cod, salmon, tuna), pork, poultry, lentils, nuts, and whole grains.

Vitamin K

Why it’s important: Vitamin K helps the body regulate calcium and form strong bones.

How much do you need? Adult men, 120 micrograms daily. Adult women, 90 micrograms daily.

How to include more in your diet: You should be able to meet the daily recommendation for vitamin K by simply eating one or more servings per day of broccoli, Brussels sprouts, dark green lettuce, collard greens, or kale.

Vitamin C and vitamin B12

New research suggests that vitamin C and vitamin B12 may also play important roles in bone health and the prevention of osteoporosis.

Consuming foods rich in vitamin C may help to prevent bone loss. Good sources include citrus fruit, such as oranges and grapefruit, strawberries, kiwi, mango, Brussels sprouts, and green bell peppers.

Studies have also found a link between vitamin B12 levels and bone density and osteoporosis. Good sources of B12 include seafood such as salmon, haddock, and canned tuna, as well as milk, yogurt, eggs, and cottage cheese.

Other tips for building strong bones and preventing osteoporosis

In addition to adding calcium-rich foods to your diet, you can also minimize the amount of calcium you lose by reducing your intake of foods and other substances that deplete your body’s calcium stores.

Lower your salt intake. Eating too much salt can contribute to calcium loss and bone breakdown. Reduce packaged and convenience foods, fast foods, and processed meats which are often high in sodium. Instead of salt, try using herbs and spices to enhance the taste of food.

Limit the caffeine you consume. Drinking more than 2 cups of coffee a day can lead to calcium loss. The amount lost can have a significant impact on older people with already low calcium levels. You can buffer the effects to an extent by drinking coffee with milk.

Watch your alcohol consumption.  Drinking alcohol inhibits calcium absorption and disrupts your body’s calcium balance in a number of ways. Try to keep your alcohol consumption to no more than 7 drinks per week.

Beware of soft drinks. In order to balance the phosphates in soft drinks, your body draws calcium from your bones, which is then excreted. Opt for water or calcium-fortified orange juice instead.

Exercise is crucial to lifelong bone health

When it comes to building and maintaining strong bones, exercise is essential, especially weight-bearing activities such as walking, dancing, jogging, weightlifting, stair climbing, racquet sports, and hiking. Find something that you enjoy doing and make it a regular activity.

Calcium supplements: What you need to know

While food is the best source of calcium, making up any shortfall in your diet with supplements is another option. But it’s important not to take too much.

Calcium citrate is a highly absorbable calcium compound.

Calcium ascorbate and calcium carbonate are not as easily absorbed as calcium citrate.

Be smart about calcium supplements

Don’t take more than 500 mg at a time. Your body can only absorb a limited amount of calcium at one time, so it is best to consume calcium in small doses throughout the day.

Don’t take more than the recommended amount for your age group. Take into account the amount of calcium you get from food. And remember: more isn’t better; it may damage the heart and have other negative health effects.

Take your calcium supplement with food. All supplemental forms of calcium are best absorbed when taken with food. If it’s not possible to take your supplement with food, choose calcium citrate.

Purity is important. It’s best to choose calcium supplements with labels that state “purified” or, if you’re in the U.S., have the USP (United States Pharmacopeia) symbol. Avoid supplements made from unrefined oyster shell, bone meal, or dolomite that don’t have the USP symbol because they may contain high levels of lead or other toxic metals.

Be aware of side effects. Some people do not tolerate calcium supplements as well as others and experience side effects such as acid rebound, gas, and constipation. For acid rebound, switch from calcium carbonate to calcium citrate. For gas or constipation, try increasing your intake of fluids and high-fiber foods.

Check for possible drug interactions. Calcium, magnesium, and vitamin K supplements can interfere with other medications and vitamins you’re taking, including heart medicine, certain diuretics, antacids, blood thinners, and some cancer drugs. Talk with your doctor or pharmacist about possible interactions. Any medications that you take on an empty stomach should NOT be taken with calcium.

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D.

90,000 What foods will help protect against osteoporosis

Almonds are rich in minerals that are good for bones.
Photo: pixabay.com

To strengthen bones, not only calcium is needed, but also a wide range of vitamins and minerals.

Osteoporosis is a disease characterized by decreased bone density and increased fragility.This disease progresses over time, and treatment can take a long time. Fortunately, a well-formulated diet can be a good prevention against osteoporosis. Many people know about the need for calcium intake, but our skeleton also requires other elements. What kind of foods should be included in your diet, the MedikForum portal tells.

Citrus . Orange, tangerine, and lemon are well known for being high in ascorbic acid or vitamin C.In the body, vitamin C is used primarily for the proper functioning of the connective and bone tissues. It helps keep joints healthy, reduces the risk of injury from osteoporosis, and promotes better mineralization.

Fish . Fish, especially fatty ones, are rich in vitamin D and omega-3 fatty acids, which support joints and improve calcium absorption.

Almond . All nuts are good for the body, but almonds are best for protecting against bone problems.It contains high amounts of calcium, potassium, manganese and vitamin E, which strengthen bone tissue.

Potatoes . Potatoes are rich in magnesium and calcium, which support the work of calcium and vitamin D. The richest in these substances are sweet and white potatoes.

90,000 7 best products for the prevention of osteoporosis

Osteoporosis is an insidious age-related disease, its essence is a gradual decrease in bone density.It is often painless and asymptomatic and is detected only in the case of fractures. You have to take it seriously. To keep your bones strong, you need to pay attention to nutrition as well – especially foods high in calcium and vitamins.

Calcium is the most famous nutrient when it comes to the skeleton. Vitamins C, D, potassium and magnesium also play an important role. At the same time, nutrition that is aimed at preventing bone loss should be balanced and include many fresh gifts of nature and sources of protein.Nutritionists recommend 7 particularly healthy options.

1. Dark green products

There is a misconception that dairy products are the exclusive suppliers of calcium, but in fact this mineral can also be found in vegetables. For example, leafy vegetables are rich in calcium – chard, collard greens, basil, Chinese cabbage, spinach, lettuce. But that’s not all: leafy greens are also rich in vitamin K, thanks to which vitamin D is better absorbed, the sufficient content of which in the body reduces the threat of osteoporosis.

2. Potatoes

It is not very rich in calcium, but it contains large amounts of potassium and magnesium. These valuable substances work together to keep your bones healthy. A lack of magnesium can disrupt the balance of other vitamins. Potassium, on the other hand, has the ability to paralyze the negative effects of acids that otherwise leach bone calcium.

Any variety and type of potato is rich in potassium and magnesium. But we must remember that when frying, the lion’s share of valuable substances is lost, so it is advisable to boil or bake potatoes.

3. Citrus fruits

Everyone knows that citrus fruits are excellent suppliers of vitamin C. But few people know about the importance of this vitamin for bone mass, meanwhile, it plays an important role in preventing osteoporosis, because it is needed for the formation of collagen – a vital component of bones and cartilage.

It should be noted that vitamin C is more effective for the male skeleton. This, however, is not a reason to give up citrus fruits for women.The importance of these fruits for many processes in the body cannot be underestimated, including for maintaining the elasticity of the connective tissue, which means the smoothness and youthfulness of the skin. And don’t forget to fight cellulite! Only one single grapefruit, for example, can cover the full daily requirement of vitamin C.

4. Fish products

Many types of oily fish are rich in vitamins. Fish also contains beneficial omega-3 acids, which, by supporting bones, also heal joints and are important for the well-being of the heart and blood vessels.

Salmon is considered an excellent source of potassium, and canned salmon also contains calcium. If the bones of raw fish are thrown away, the soft bones of canned fish can be eaten, and after processing they retain a lot of calcium. The same can be said for sardines. Salmon fillets, canned or fresh mackerel and tuna are useful.

5. Almonds

It is not only rich in calcium and potassium, but also completely versatile.You can eat a handful of almonds for a snack, fry, crush and add to salads, or grind with salt and, having obtained delicious almond butter, spread it on whole grain bread. Of course, almonds are a fat nut, but one handful daily will add health and will not affect weight.

6. Natural sweeteners

Frequent substitution of natural sweeteners for refined table sugar is a good nutritional strategy. It can be considered a proven fact that sugar is hazardous to health.If we talk about its dangers specifically for osteoporosis, then sugar can weaken bones. For example, its substitute molasses is a natural sweetness. Try it in baked goods, or mix it into oatmeal or smoothies.

7. Foods fortified with vitamins

Fortification, or fortification of foods with vitamins, is a controversial issue in dietetics. However, dairy-free vegans are better off eating fortified foods.Everyone else should think about this on winter sunless days – they need sources of vitamin D, as well as vitamins that are found in fresh vegetables and fruits.

90,000 Prevention of osteoporosis with vitamins and exercise

Author: Female staff

Like the skeleton of a house, your skeleton keeps you active. Did you know that osteoporosis can be a hidden threat? Osteoporosis is a condition in which your bones become brittle and fragile.Since it can start early and doesn’t always alert you to symptoms, you may not even know you have it until something breaks. However, you can prevent osteoporosis with vitamins and exercise.

How to determine if you are at risk

The risk of osteoporosis is influenced by gender, age, body size, ethnicity and family history. While you cannot control these risks, there are other steps you can take to protect your health. Low estrogen levels, smoking and excessive alcohol consumption can contribute to the development of the disease.Even certain medications can increase your risk.

You can also find out if you are at risk by asking your doctor to get your calcium and vitamin levels checked. Or, if you are a postmenopausal woman over 50, ask your doctor about getting a bone density test. This exam can diagnose osteoporosis before a bone fracture occurs.

What to do about it

Get rid of the idea that osteoporosis is just part of aging. There are many things you can do, starting today, to avoid or slow down its progression.Above all, prevent osteoporosis with vitamins and exercise. So, get moving and get enough calcium.

Obtaining calcium

As a child, you probably heard that “drink milk” every day. Turns out that was good advice. Milk is a good source of calcium, a nutrient that helps strengthen bones.

A healthy diet should meet your calcium needs. Calcium is important for your body’s ability to absorb vitamin D, and you’ll also find it in yogurt, cheese, orange juice, cereals, and breads.

Take vitamin D

Eating right and spending time in the sun should provide enough vitamin D, but you may also need to take it in pill form. Be sure to check with your doctor before taking any supplements.

Exercise

Want to have a significant impact on osteoporosis at any stage in life? Rush! This doesn’t mean you need to go to the gym. Walking just 30 minutes a day is what the doctor ordered.No 30 minutes free? Break it down into ten minute segments when you find the time.

Don’t like to walk? Any weight-bearing exercise does the job. So yes, you are allowed to dance until you are healthy. Dance, jog, play basketball, walk – anything that makes you compete with gravity is good. Do you want to take it up a notch? Take something heavy. Adding strength training will have potential benefits regardless of your age.In a 2000 study, researchers found that high- to moderate-intensity resistance exercise had a positive effect on bone density. The best way to get all this work done is to bring a friend with you.

There’s nothing better than someone sweating in the last few minutes of your workout near you. Teamwork can help you stay committed when you feel like giving up. The Women’s Care Specialists can help you cope with osteoporosis. Call to find out more or make an appointment.

90,000 Prevention of osteoporosis – Prevention of diseases and healthy lifestyle – Budgetary institution of the Khanty-Mansiysk Autonomous Okrug – Ugra

PREVENTION OF OSTEOPOROSIS

Osteoporosis is the most common disease of the skeleton, characterized by a decrease in bone mass and a violation of the structure of bone tissue, leading to increased fragility of bones.This increases the likelihood of fractures, leads to changes in posture, decreased growth, chest deformities, back and bone pain, and difficulty breathing.

Timely started active prophylaxis can significantly affect the prevalence, progression and outcome of the disease. To prevent osteoporosis, the following guidelines must be followed:

BALANCED FOOD

It is known that one of the main minerals that have a significant effect on the formation and maintenance of the skeleton is calcium.The main sources of calcium are dairy products, legumes, spinach, greens, nuts, fish, and seafood.

Vitamin D is very important for improving the absorption of calcium in the gastrointestinal tract. Vitamin D enters the body along with such foods as fish, liver, eggs, and is also formed under the influence of ultraviolet rays. However, in the autumn-winter period, the number of sunny days is sharply reduced, so vitamin D should be taken additionally in the form of medications.

In addition, it is necessary to pay attention to the protein component of the diet. You need to consume 1-1.2 g of protein per 1 kg of body weight per day. At the same time, it must be remembered that excess protein intake increases the excretion of calcium in the urine. Harmful products for osteoporosis are coffee and table salt. So, caffeine increases the excretion of calcium in the urine in adults, and the consumption of four or more cups of coffee a day in women contributes to a decrease in bone mass. It is also necessary to limit the intake of salt to 1 level teaspoon per day, since table salt also increases the excretion of calcium in the urine and therefore reduces bone mineral density in adults.

MAINTENANCE OF NORMAL BODY WEIGHT

Watch your weight. It is important to note that overly thin women suffer from osteoporosis much more often than overweight women. This is due to the fact that the fat cell is able to synthesize hormones that stimulate the development of bone tissue.

REFUSE ABUSE OF ALCOHOLIC DRINKS AND SMOKING

PHYSICAL LOAD

Exercise is important for reducing bone loss, improving balance and preventing falls, as well as for rehabilitation after fractures.Physical activity should include walking, running, tennis and other outdoor activities. It is important to note that swimming does not help to strengthen the bone, since the weightless state of the body in the water does not lead to the necessary force on the bone structures.

FALL PREVENTION

Exercise to improve your balance:

  • feet on the same line (right in front of left or vice versa), hands on the belt; in this position we stand for 20-30 seconds;
  • feet together, hands on the belt, rise on toes; stand for 15-20 seconds;
  • hands on the belt, bend the left leg, lifting it off the floor, rise on the toe of the right leg; stand for 15-20 seconds.The same with the other leg.

Monitor your eyesight and hearing, regularly visit an ophthalmologist and ENT doctor.

Use additional walking devices (walkers, cane) if necessary.

HEALTHY LIFESTYLE

KEY TO YOUR HEALTH AND LONGEVITY!

90,000 7 effective methods for the prevention of osteoporosis

After 70 years of age, every person is susceptible to age-related osteoporosis.

If you do not belong to a risk group, this does not mean that this pathology does not threaten you – it is just that the chances of its development are reduced. Therefore, it is desirable for everyone to engage in the prevention of osteoporosis.

With reduced bone density, spinal fractures can occur even under the influence of their own body weight.

1. Healthy lifestyle

No matter how much has been said in this regard, maintaining health is the most important measure for the prevention of osteoporosis, starting from childhood and adolescence – at a time when bones must accumulate the greatest possible supply of minerals.Therefore, good nutrition and giving up bad habits can save you from many troubles in the future. So, even small doses of alcohol reduce osteosynthesis (the formation of new bone cells) and disrupt calcium absorption. Smoking causes prolonged spasm of the capillaries, thereby preventing minerals from reaching the bones, especially the spine. Coffee helps to remove calcium from bones and eliminate it from the body through the kidneys.

2. Power supply

Prevention of osteoporosis through diet is based primarily on calcium intake.Its lack of food during the period of active growth can affect the condition of the bones after many years.

In addition to calcium, food should be rich in magnesium and phosphorus – that is, a complex of minerals necessary for nourishing bones, as well as vitamin D. All this contains in excess of fermented milk products (especially various types of cheeses), egg yolk, liver, sea fish, fresh greens and sprouted cereals. Cereals, especially soybeans, also contain natural estrogen, an analogue of the female sex hormone estrogen, which prevents bone resorption (destruction).

Not only diseases and bad habits, but also a diet low in fat can interfere with the normal absorption of minerals. Therefore, women who are on diets for the sake of harmony run the risk of letting this insidious and serious disease into their body.
Excess salt in food can promote increased leaching of calcium from bones and excretion from the body in the urine. Therefore, if osteoporosis is already “knocking at your door”, the amount of salt consumed must be strictly controlled.

3. Preparations

If the intake of calcium with food does not reach the daily norm, it is necessary to introduce into the diet preparations containing easily digestible forms of calcium salts (gluconate, lactate and others). Taking such funds for osteoporosis is a treatment and prevention at the same time, since it is impossible to restore bones without a normal amount of minerals. It is advisable to choose preparations containing a balanced mineral complex, including potassium, phosphorus and magnesium – a complete set of substances needed by the bones will provide them with the best nutrition.

Women in the period of menopause are shown means containing estrogens – female sex hormones. Preferred are drugs with phytoestrogens – plant analogues of estrogen, which are able to compensate for its deficiency without negative consequences.
A promising area of ​​prevention is the use of bisphosphonates – drugs that suppress the activity of osteoclasts (cells that destroy bone tissue). These products are highly effective and easy to use (some of them only need to be taken once a month).

There are also dietary supplements with plant analogues of thyroid and parathyroid hormones, which have a beneficial effect on calcium metabolism. Since these funds are not drugs, the dose of the active substance in them is lower than the therapeutic one and does not have side effects on the body. They can be taken without a doctor’s prescription.

4. Physical education

Physical activity also helps maintain bone density. Moreover, it can be useless to devote time to physical education after osteoporosis has developed – physical activity is useful precisely for prevention, since muscle inactivity contributes to the demineralization of bones.So, bed rest for 3-4 months reduces the volume of bone mass by 10-15%. And regular physical education for the same period of time can compensate for the loss by only 1–2%.
Physical activity for the prevention of osteoporosis should be moderate. It can be not only sports training, but also dancing, fitness, aerobics … Moderate strength exercises on simulators are useful. The main thing is that physical activity is regular, because if you devote time to your health from time to time, you may not get the desired result at all.

A very effective preventive measure will be classes in special therapeutic exercises for osteoporosis (even if you are not sick with it).

5. Sunbathing

Everyone knows about the benefits of sunlight, and if you live in regions where there is little sun, it is advisable to travel at least once a year to a place where your skin can be saturated with sunlight and vitamin D. If this is not possible , there is an alternative – tanning under ultraviolet quartz lamps, but with all precautions and without fanaticism.

6. Treatment of chronic diseases

Those who suffer from pathologies that lead to impaired absorption of calcium or increased calcium excretion, it is necessary to take all measures to get rid of these diseases. Such diseases are hormonal disorders, some diseases of the liver, kidneys and gastrointestinal tract. If it is not possible to completely recover, substitution therapy with mineral preparations is prescribed. Also, replacement therapy is prescribed to those people who have to take medications – calcium antagonists * for a long time, for example hormones, phosphates, fluorides in large doses.

7. Medical supervision

Preventive measures aimed at preventing osteoporosis are undoubtedly necessary for everyone. But for those at risk of developing this disease, regular medical supervision is especially important. If the result of ultrasound densitometry shows that the bones begin to lose density, the doctor will tell you how to prevent osteoporosis and prescribe preventive treatment. Women over 40 need to have their bones checked once a year.

90,000 The role and place of calcium and vitamin D preparations for the prevention and treatment of osteoporosis | Lutsenko

INTRODUCTION

Bone tissue consists of inorganic components and an organic matrix. The latter consists of collagen proteins (90%), mainly of type I collagen, as well as non-collagen proteins [1]. Bone inorganic substances are mainly represented by phosphates and calcium, however, bicarbonates, sodium, potassium, citrate, magnesium, carbonate, phosphorus, zinc, barium and strontium are also present in significant amounts [2].Calcium and phosphorus form hydroxyapatite crystals with the formula Ca10 (PO4) 6 (OH) 2. Collagen and non-collagen proteins form a scaffold for hydroxyapatite deposition. This interaction provides strength and elasticity of bone tissue [3].

Calcium is one of the main macronutrients of the human body. 99% of calcium is found in bone tissue, the rest is found in extracellular fluid and other tissues. Calcium enters the body through the consumption of food, its greatest amount is found in dairy products.Calcium excretion occurs through the intestines, kidneys and skin, and therefore it is necessary to maintain its supply from the outside. The absorption of calcium from the intestine is a process that is influenced by many factors: food composition, age, the level of vitamin D in the blood, the genotype of the vitamin D receptor.Dietary fiber and oxalates (salts and esters of oxalic acid) reduce calcium absorption, and proteins (aromatic amino acids) and glucose increases. Table salt and caffeine increase urinary calcium excretion, as does high protein intake due to increased intestinal absorption [4].

For normal absorption of calcium in the intestine, a sufficient level of vitamin D in the blood is required. Hypovitaminosis D is widespread in the world, it is associated not only with a negative calcium balance and decreased bone mineralization, but also with muscle weakness, leading to a high risk of falls, which can lead to fractures, especially in people with osteoporosis [5].

This article describes the role of calcium and vitamin D in maintaining bone mineral density (BMD), as well as in the prevention and treatment of osteoporosis, data from studies on calcium and vitamin D intake, and basic approaches to correcting calcium and vitamin D deficiency.

CALCIUM

Adequate calcium intake is one of the many factors necessary to achieve the desired peak bone mass, as well as to continue to maintain it throughout life. In adolescence, the optimal calcium intake is about 1100 mg / day [6]. The peak bone mass is reached by the age of 25–30, after which the process of bone tissue metabolism is stabilized, and this balance is maintained until 45–50 years in women and up to 55–60 years in men [7]. Lack of calcium leads to stimulation of bone resorption.Long-term calcium deficiency almost always results in a decrease in bone mineral density (BMD), which may increase the risk of osteoporosis in old age [8].

In women, the need for calcium increases physiologically during pregnancy and lactation to ensure intrauterine development of the fetus, mineralization of the skeleton and growth of the child during breastfeeding [9]. During intrauterine development, the fetal bone tissue accumulates about 30 g of calcium.This process is most active in the third trimester of pregnancy. During lactation, 280–400 mg of calcium is excreted daily from the mother’s body with milk [10]. According to prospective studies, in healthy pregnant and lactating women, bone mass decreases rapidly, and after the cessation of breastfeeding, it recovers [11–13].

CALCIUM CONSUMPTION IN RUSSIA AND IN THE WORLD

According to studies conducted in the Russian Federation, the population of our country consumes an insufficient amount of calcium with food.In a study by the Federal State Budgetary Scientific Institution “Federal Research Center for Nutrition and Biotechnology”, it was demonstrated that the average calcium intake among people aged 18 years and older was 510-560 mg / day. The lowest values ​​were observed in women 18-30 years old, the highest – in men 45-55 years old. Among all age groups, men had higher calcium intake than women [14]. In a study within the framework of the Osteoscreening Russia program in the population of 6 regions, the average calcium intake among women was 683 mg, among men – 635 mg per day.For most people, calcium intake was ≤50% of the daily requirement, and only 9% of women and 6% of men received the required amount of calcium [15]. Similar data were obtained in a study that surveyed medical workers in 16 regions of the Russian Federation, aged 20 to 72 years: the average calcium intake was 529 mg per day, 90% of the study participants had a pronounced lack of calcium intake from food [16].

In the United States, more than 50% of women aged 51–70 and men and women over the age of 70 received inadequate dietary calcium, with women consuming less calcium than men [17].According to the results of the study by Novaković R. et al., In which the intake of calcium in the countries of Central and Eastern Europe was investigated, the average intake of calcium was 869 mg / day, the lowest was also noted among women. Of the 8033 surveyed, 5813 additionally received calcium-containing drugs, but among them only 73% of this combination allowed to achieve an adequate intake of calcium [18]. According to a systematic review of calcium consumption in the world, the lowest intake is observed in Nigeria (288 mg / day), the highest – in the Netherlands (1151 mg / day) [19].

CALCIUM CONSUMPTION AND URELINE DISEASE

With adequate dietary calcium intake, the risk of kidney stones is reduced. This may be because calcium binds to oxalates in the intestine, which decreases absorption and decreases urinary excretion. In 2013, the results of three prospective cohort studies were published, in which more than 226 thousand people took part: within the framework of these studies, calcium intake with food and in the form of supplements and the incidence of symptomatic nephrolithiasis were assessed every 4 years.The follow-up period was 20 years for two studies and 16 years for one. A total of 5270 cases of manifest urolithiasis were recorded. A higher intake of calcium (from both dairy and other foods) was found to be associated with a lower risk of kidney stones. The risk of urolithiasis did not depend on the level of vitamin D and oxalate intake [20].

CALCIUM SUPPLEMENTS AND CARDIOVASCULAR DISEASES

Bostick et al.a study was carried out among 34,486 thousand postmenopausal women, aged 55–69 years: among women who consumed more than 1.425 mg of calcium per day, mortality from coronary heart disease was 33% lower, compared with women who consumed less than 696 mg per day [ 21]. Various positive effects of calcium on the cardiovascular system have been proposed as a possible reason: a decrease in blood pressure, an effect on the concentration of lipids in the blood, and on body weight. However, the results of the systematic review indicate some inconsistency in the data, which does not allow for an unambiguous conclusion [22].According to a meta-analysis by Bolland MJ et al. in 2011, the use of calcium supplements (but not combination drugs with vitamin D) was associated with an increased risk of myocardial infarction [23]. Reviewed by Tankeu et al. (2017) presents data from 28 studies (published from 2003 to 2015) on the assessment of cardiovascular risk with the use of calcium salts both separately and with vitamin D, as well as with an increase in dietary calcium intake with a duration of observation of large cohorts from 3 to 13 years old.In 7 out of 28 studies, increased risks were noted when taking calcium supplements with vitamin D or only calcium salts in relation to myocardial infarction or stroke or heart failure [24]. Taking into account the available data on the possible negative effects of calcium salt supplementation on the cardiovascular system, it is necessary to strictly dosed prescription of calcium supplements to patients according to indications, and in combination with vitamin D.

CALCIUM PREPARATIONS AND OSTEOPOROSIS

Adequate calcium intake is important for the prevention and treatment of osteoporosis, as it helps maintain BMD, reduce the risk of hip fractures, especially in old age, and potentiate the antiresorptive effect of estrogens on bone tissue.However, according to several meta-analyzes, evidence of a reduction in fracture risk with dietary intake of calcium alone has not been confirmed [25–27]. In the first 5 years after menopause, calcium does not prevent rapid BMD loss. At the same time, women who received less than 400 mg / day of calcium with food had a greater benefit from an additional intake of 500-600 mg of calcium in the form of pharmacological supplements than people with a higher intake of dietary calcium [4].

Increasing calcium intake is the main approach to the prevention of bone loss, and when adequate dietary intake cannot be achieved through dietary intake, pharmacological calcium supplementation should be used [28].In total (due to food and pharmacological additives), the maximum allowable daily intake of calcium is 2000 mg. Such a dose did not lead to undesirable effects and therefore does not currently require a downward revision [29], although the data from studies on cardiovascular risks should probably be taken into account and in real clinical practice not to exceed the dose of calcium in preparations of 1000 mg.

VITAMIN D

Vitamin D is a fat-soluble vitamin that plays an important role in calcium homeostasis, maintaining bone health and reducing the risk of falls and fractures [30].To assess the status of vitamin D, it is recommended to assess the concentration of its metabolite – 25 (OH) D – in the blood. Deficiency of vitamin D – a decrease in the level of 25 (OH) D less than 30 ng / ml, deficiency – less than 20 ng / ml. The predominant location of the Russian Federation in northern latitudes is one of the reasons for the decrease in the level of 25 (OH) D – from November to March, the skin practically does not synthesize vitamin D [31]. In addition, the amount of food products that contain a sufficient amount of vitamin is very limited, mainly fish meat: salmon, sardines, tuna; also cod liver and mushrooms exposed to sunlight [32].In addition, a decrease in the bioavailability of the vitamin from food in patients with malabsorption or obesity may be the cause of the deficiency. Decreased synthesis of active metabolites of vitamin D in liver failure, chronic kidney disease, rickets, oncogenic osteomalacia, X-linked hypophosphatemia, autosomal dominant hypophosphatemia are also accompanied by vitamin D deficiency [33].

Pregnancy and lactation are often accompanied by a deficiency of vitamin D. In most cases, pregnant women have reduced concentrations of 25 (OH) D, indicating a deficiency or deficiency of vitamin D.The relationship between vitamin D deficiency in the mother and the development of various diseases in the child has been determined [34, 35]. In some cases, low 25 (OH) D levels in pregnant women remained low despite taking vitamin D supplements [36].

Older people with vitamin D deficiency are at increased risk of falls due to the development of myopathy. Clinical features of myopathy with vitamin D deficiency include duck gait, muscle mass loss or muscle atrophy, while maintaining sensitivity and deep tendon reflexes, while in some cases myopathy may not have any very specific manifestations.Muscle biopsies show atrophy of mainly type II muscle fibers, which are fast reaction fibers – they are activated first when it is necessary to prevent a fall [37]. This fact explains the increased propensity for falls among the elderly with vitamin D deficiency [38].

PREVALENCE OF VITAMIN D DEFICIENCY IN RUSSIA AND IN THE WORLD

Hypovitaminosis and vitamin D deficiency are widespread in the world: according to calculations, the number of people with vitamin D deficiency or deficiency is about 1 billion [39].The geographical features of the territory of the Russian Federation largely determine the high prevalence of vitamin D deficiency. Among Moscow postmenopausal women, only 3.2% had normal levels of vitamin D in the blood, and 70.3% had its deficiency. In addition, this study demonstrated seasonal fluctuations in this indicator [40]. However, in the work carried out in the North-West region of the Russian Federation, seasonal dependence among persons 18–70 years old was not revealed; hypovitaminosis and deficiency were found in 82% of the examined [41].

Worldwide, the highest prevalence of vitamin D deficiency and deficiency is noted among women living in the Middle East (81%), Asia (71.4%) and Australia (60.3%). In Europe, this figure was 57.7%, in Latin America – 53.4%. It has been shown that in individuals of the Caucasian race, for each degree of latitude north or south of the equator, the level of 25 (OH) D in the blood is 0.69 nmol / L lower [42].

VITAMIN D AND OSTEOPOROSIS

According to systematic reviews and meta-analyzes, vitamin D deficiency is associated with an increased risk of osteoporosis, osteoporotic fractures, falls, muscle weakness, general and cardiovascular mortality, and low physical activity in older people [43, 44].Thus, a pronounced decrease in the level of vitamin D increases the relative risk of hip fractures by 2.1 times, adjusted for age and body weight [45], and in elderly postmenopausal women, with a decrease in the concentration of vitamin 25 (OH) D ≤20 ng / ml, losses bone mass [33].

APPROACHES TO CORRECTION OF VITAMIN D DEFICIENCY

In the recommendations of the Russian Association of Endocrinologists and in the recommendations of the Russian Osteoporosis Association for osteoporosis, the doses of native vitamin D for prophylactic use in various age groups of the population are presented [31]:

  • for people aged 18–50 years, the prophylactic dose of vitamin D is 600–800 IU / day;
  • over the age of 50 years – 800-1000 IU / day;
  • during pregnancy and lactation, it is recommended to receive vitamin D at a dose of 800–1200 IU / day;
  • for diseases / conditions that are accompanied by impaired absorption or metabolism of vitamin D, it is recommended to take vitamin D in doses 2-3 times higher than the daily requirement of the age group (after rickets, osteomalacia; osteoporosis, chronic kidney disease, liver failure, malabsorption syndrome, hyperparathyroidism ; patients taking anticonvulsants, antifungal drugs, glucocorticoids, antiretroviral therapy, cholestyramine).

It is recommended to treat vitamin D deficiency with cholecalciferol in a saturating dosage. The most common treatment regimens are 50,000 IU weekly by mouth for 8 weeks or 7,000 IU per day for 8 weeks. In case of vitamin D deficiency, take saturating dosages for 4 weeks. To maintain optimal levels, it is recommended to take 1000–2000 IU daily [31].

With good patient compliance, long-term use of vitamin D alone or in combination with calcium helps to reduce the risk of extravertebral fractures, including hip fractures.In addition, a systematic review based on an analysis of 159 randomized clinical trials showed that regular vitamin D supplementation reduced mortality in the elderly [46].

According to the consensus of experts from the European Society of Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, and the International Osteoporosis Foundation, the prescription of calcium supplements in combination with vitamin D is recommended for people at high risk of calcium and vitamin D deficiency, as well as those who who is receiving treatment for osteoporosis [47].

COMBINATION OF PREPARATIONS OF CALCIUM AND VITAMIN D

If it is necessary to prescribe preparations of both vitamin D and calcium, then the use of combination preparations is preferable, since this can improve patient compliance. Currently, for the prevention and treatment of osteoporosis (as part of complex treatment), combined preparations of native vitamin D and calcium are widely used – they differ both in the doses of colecalciferol and calcium, and in the calcium salt they contain.Data on some calcium preparations used in the Russian Federation are presented in table. 1.

Table 1. Medicines containing various salts and doses of calcium, as well as vitamin D, recommended in the Russian Federation for the prevention and treatment of osteoporosis (in ascending order of doses of colecalciferol in one tablet)

Name of the drug

Composition of 1 tablet

Calcemin

Bayer Healthcare AG (Germany)

calcium (in the form of citrate and carbonate) 250 mg

colecalciferol (vit.D3) -50 IU

copper (in the form of oxide) -500 mcg

zinc (in the form of oxide) 2 mg

manganese (in the form of sulfate) 500 μg

boron (in the form of sodium borate) 50 μg

Calcemin Advance

Bayer Healthcare AG (Germany)

calcium (in the form of citrate and carbonate) 500 mg

colecalciferol (vit. D3) 200 IU

magnesium (in the form of oxide) 40 mg

copper (in the form of oxide) 1 mg

zinc (oxide form) 7.5 mg

manganese (in the form of sulfate) 1.8 mg

boron (in the form of sodium borate) 250 μg

Calcium-D3 Nycomed

(chewable tablets)

Representative office: TAKEDA (Japan)

calcium carbonate 1250 mg, which corresponds to 500 mg of elemental calcium

colecalciferol 200 IU

Calcium + Vitamin D3 Vitrum®

Unipharm, Inc. (USA)

calcium 500 mg

vitamin D3 (colecalciferol) 200 IU

Calcium-D3 Nycomed Forte (chewable tablets)

Representative office: TAKEDA (Japan)

calcium carbonate 1250 mg, which corresponds to 500 mg of elemental calcium

colecalciferol 400 IU

Complivit® Calcium D3 Forte (chewable tablets)

Pharmstandard-Ufavita, JSC (Russia)

calcium carbonate 1250 mg, which corresponds to 500 mg of elemental calcium

colecalciferol 400 IU

Natekal D3

Italfarmako S.p.A. (Italy)

calcium carbonate 1500 mg (corresponding to 600 mg calcium)

colecalciferol (vitamin D3) 400 IU

Natemille

Italfarmako S.p.A. (Italy)

calcium carbonate 1500 mg (equivalent to calcium 600 mg)

colecalciferol 1000 ME

Due to the fact that the recommended doses of calcium (downward) and vitamin D (upward) have been revised, a new combined drug Natemille (Italfarmaco S.p.A., Italy), which is dispersible in the oral cavity tablets, which allows you not to wash them down with water, taken 1 time per day. They contain 1.5 g of calcium carbonate, equivalent to 600 mg of elemental calcium, and 1000 IU of colecalciferol. This dosage form significantly increases the absorption of calcium. Natemille microcrystalline tablets, dispersed in the oral cavity due to prolonged contact with saliva, promote faster and more effective drug saturation, which increases the absorption of the drug and accelerates its entry into the systemic circulation [48].

Since the average intake of calcium with food in Russia is a little more than 600 mg, the use of this drug allows you to reach the recommended daily intake for most people, against the background of a sufficient dose of native vitamin D. In addition, the existing clinical guidelines indicate that for better assimilation, a single dose of calcium should not exceed 600 mg, which is ensured when taking the new drug Natemille. Previous research has shown that a single daily dose of calcium and vitamin D as a combination drug is preferred by more patients than a double dose [49].

If patients undergoing treatment for osteoporosis did not receive vitamin D supplementation before starting treatment, or if their level cannot be determined, it is recommended to prescribe a moderate loading dose of native vitamin D, 50,000 IU once. After that, the patient switches to the usual maintenance dose [31, 50]. The drug of choice is Natemille, 1 tablet a day. It is more physiological to take calcium supplements in the evening, after dinner.

CONCLUSION

Calcium and Vitamin D are important components of therapy for maintaining bone health, as proven by numerous studies.The lack of their consumption leads to the progression of many diseases, including various metabolic diseases of the skeleton. They are effective in reducing the risk of fractures (with established osteoporosis in combination with anti-osteoporotic drugs), falls and mortality in the elderly. The widespread lack of calcium intake with food and the high prevalence of insufficient levels of vitamin D dictate the need for their additional intake in the form of pharmacological drugs as prevention of osteoporosis and fractures in all age groups, as well as in combination with pathogenetic agents for the treatment of osteoporosis.

ADDITIONAL INFORMATION

Funding source . The search and analytical work was carried out with the support of the Federal State Budgetary Institution “NMIC of Endocrinology” of the Ministry of Health of Russia

Conflict of interest . The authors declare no obvious and potential conflicts of interest related to the publication of this article.

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Osteoporosis

FIRST STEPS IN COMBATING OSTEOPOROSIS

Step One is a nutritious diet rich in calcium.
1. In women over 50, the daily requirement for calcium increases:
if you are taking hormone replacement therapy, you need 1,000 mg of calcium per day;
if you are not taking hormone replacement therapy, then you need more calcium – up to 1,300 mg per day.

Remember that the primary and preferred source of calcium is low-fat dairy products. Especially rich in calcium: cheeses (Edam, Parmesan, Cheddar), cottage cheese, canned fish with seeds (young herring, sardines). So, a sandwich with hard cheese or sprats will help you fill up to a third of your daily calcium requirement. One liter of milk or kefir contains the daily calcium requirement. If you consume less calcium than is necessary for your age, then calcium should be taken additionally in the form of medications.To calculate your daily dietary calcium intake, you can use the following formula: Daily Calcium Intake (mg) = Dairy Calcium (mg) + 350 mg.

2. Vitamin D is important for better absorption of calcium in the gastrointestinal tract. According to the latest recommendations of the International Osteoporosis Foundation (IOF), the need for vitamin D per day is up to 400 IU (international units) at the age of 65 years and up to 600 IU – at an older age.
Vitamin D enters the body with food (fish, liver, eggs), and is also formed in the skin under the influence of ultraviolet rays.However, from October to March, most of the sunlight in our latitudes is absorbed by the atmosphere, so vitamin D should be taken additionally in the form of medications. Especially do not forget about this in old age.

3. Monitor your protein intake. Protein is necessary for the formation of the basis of bones, therefore, 1-1.2 g of protein per 1 kg of body weight should be consumed per day. However, excess protein intake tends to increase urinary calcium excretion.

4.Do not overuse coffee. Caffeine increases urinary calcium excretion in adults. Drinking 4 or more cups of coffee a day promotes bone loss in the spine and throughout the body.

5. It is necessary to limit the consumption of table salt to 1 teaspoon without top per day. Table salt increases urinary calcium excretion and decreases bone mineral density in adults.

Step two – maintenance of normal body weight.
Low body weight is one of the risk factors for osteoporosis.Therefore, check if you are underweight.
To do this, you need to calculate the body mass index (BMI):
BMI = Weight (kg) / Height2 (m).
Normal BMI is 20-25 kg / m2.
BMI below 20 kg / m2 can lead to osteoporosis.
In addition to determining body weight, its dynamics is no less important. It has been proven that an increase in body weight with its lack has a protective effect, and a decrease in normal body weight leads to an increase in the risk of fracture. Therefore, maintaining a healthy body weight is considered as another step towards the prevention of osteoporosis.

Step three – fighting bad habits.
1. Smoking cessation. Women who smoke are characterized by:
· relatively low body weight
· lower levels of sex hormones
· early age at menopause
· reduced intestinal calcium absorption
· increased risk of falls due to impaired neuromuscular conduction.
Therefore, smoking cessation is another measure of prevention of osteoporosis and fractures.

2.Alcohol has a negative effect on bone mass, as it inhibits bone formation and reduces the absorption of calcium in the intestine. Thus, refraining from taking alcoholic beverages is also the prevention of osteoporosis.

Step four – lifestyle change.
A sedentary lifestyle leads to osteoporosis. Regular exercise is good for strengthening your bones. The increased mechanical stress on the bones increases their density. Important to know: exercise is effective as long as you do it.Low-intensity exercise with only body weight (such as walking) is beneficial for improving overall health. Balance training activities, such as dancing, may be of additional value in osteoporosis. To achieve the effect, physical activity programs for osteoporosis should gradually increase in level of stress. Start with simple, low-intensity exercises. When choosing a program, heed the recommendations of the physiotherapy specialists.Avoid exercises that include flexion and rotation in the spine, regardless of the position in which they are performed (lying, sitting or standing), as well as jumping. Such movements can damage the vertebrae.
Examples of exercises for osteoporosis:
1. One leg bent at the knee, the other laid back, hands on the waist. Semi-squat as low as possible 4 times. Change the position of the legs.
2. Bent elbows, arms at shoulder level, spread arms and shoulders back, bringing the shoulder blades together.
3.Standing, hands in front of you in the castle. Raise your arms up in front of you, bend over, putting your leg back on your toe. Put your hands down through the sides. “Bicycle” with two legs.
4. “Horizontal scissors” (crossing of straightened legs).
5. Lying on your back, legs bent at the knees, raise the pelvis, hold the position for 5-7 seconds (keep the stomach drawn in), take the starting position.
6. Lying on your side, take your right leg straight at an angle of 30-45 degrees, holding for 5 – 7 seconds. Repeat on the other side.
7.Lying on the left side, the right leg is laid back, move it forward, describing a semicircle, then move it back (also through the descriptions of a semicircle). Repeat on the other side.
8. Alternately raise either the left or the right straight leg, holding for 5 – 7 seconds.
9. Lying on your stomach (hands along the body) tear off the shoulder girdle from the floor, holding for 5-7 sec.
10. Raising the head, shoulder girdle and both straightened legs, arms raised forward (boat) or spread apart (swallow).
11. Standing on all fours, raise alternately opposite leg and arm, hold for 5-7 seconds. Repeat by changing the position of the arms and legs.
12. Hands in support from behind. Raise the pelvis as high as possible, hold for 5-7 seconds. Lower.

Remember!
· Do not lift heavy loads. After a vertebral fracture, do not lift more than 4 kg
· When carrying objects, distribute the weight evenly in both hands. When lifting an object off the floor, bend your knees, keeping your back straight.Hold the object close to your body
Place your foot on a support while shoeing, avoiding bending in the spine, or use a long-handled shoehorn
Wash the floors with a mop, sweep with a long-handled brush
Avoid sudden changes in body position: do not abruptly get up from a supine position or bend down sharply
· Wear a semi-rigid corset if you are facing long and heavy loads
In the presence of osteoporosis of the spine, back massage and manual therapy are contraindicated.

Step Five – Fall prevention.
The fall is the immediate cause of the fracture. From 30 to 50% of older people fall several times a year, but only 3-5% of falls lead to fractures of various localization and only 1% – to a hip fracture. The percentage of older people prone to frequent falls increases with age, and after age 75, 90% of hip fractures are due to falls. Therefore, the priority is the measures aimed at reducing the risk of falling.

RISK FACTORS FOR FALLS:
– Difficulty maintaining balance
– Weak muscles that impair coordination
– Vision problems
– The presence of a disease
– Taking certain medications (drugs for lowering blood pressure, cardiovascular drugs, diuretics, sleeping pills)
– drinking alcohol (as this leads to a slow reaction, causes drowsiness, relaxation, dulls the feeling of danger

Tips for preventing falls
Pay attention to the situation in the house and make rational changes:
corridors, walkways and stairs keep free.
· Install handrails along the stairs.
· Secure carpets and loose wires.
· Get ​​rid of rocking chairs and clutter in your home.
· do not stand on stepladders or stools; When standing on a chair or other support, make sure it is strong and has a stationary device to keep from falling with your hands.
· Make sure that your home is well lit: place the switches in the apartment in the most convenient place for you: next to the bed, immediately upon entering the room.The night light should be in close proximity to the bed so that you can easily turn it on if you need to get up at night. Leave the night light between the bedroom and bathroom on overnight if necessary. Keep a flashlight on your bedside table.
· if you need to constantly remove household items from the shelf, then it should be at such a height that they can be removed from the shelf with both hands at the same time.
· Install handrails in the bathroom and toilet. Use a rubberized mat in your shower stall or bath.If you find it difficult to stand in the shower, use special plastic chairs with backs and non-slip legs. If you are used to taking a bath while seated, use non-slip rubber suction pads. Install a hot water restrictor to prevent scalding. Keep the bathroom or shower floor dry. You need to install two support handles in the bathroom, one to get in and out of the bathroom, and the other to help you get up from a sitting position.Do not use towel racks as support, they will not support your weight.
· Wear stable, low-heeled shoes. Do not go home without shoes: in socks or barefoot, choose comfortable non-slip slippers.
· Do not use slippery wax (varnish) on bare floors.
· Maintain order and remove unnecessary items from the floor.
· Do not move furniture to unusual places.
· Place frequently used items in an accessible place: not too low or high. All the necessary things should be at your fingertips.
· The bed should be so high that when you sit on the edge of it, your feet touch the floor.
· Use a cordless telephone to make it easier for you to answer calls.
· Do not keep small animals at home that could get under your feet and cause a fall.
· Place a rubber mat in front of the stove and in front of the sink in the kitchen.

Take control of your health – this will help reduce the risk of falls:
· Regularly see an ophthalmologist for vision correction and glasses, cataract and glaucoma treatment.
· Avoid sudden changes in body position, as this may cause dizziness, especially in persons with vascular diseases of the head and neck.
· If you suffer from diseases of the nervous system and joints, when walking, use assistive devices such as canes or crutches.
· If possible, reduce the intake of sedatives and sleeping pills.
· Ask your doctor about the side effects of the medicines you are taking, some of which may make you dizzy or drowsy.Ask your health care provider to replace your fall medications with safer alternatives.

When outside:
* stay away from icy road sections.
* In winter, walk along paths sprinkled with sand or salt.
* when the sidewalk is wet, if possible, walk on the grass.
* Avoid sudden movements or changing positions while walking.
* Wear low-heeled shoes with rubber soles.
* If you find it difficult to walk on your own, use a cane, even when walking for short distances.
* If you are using assistive devices (canes, walkers), they must be stable, with wide legs.

On the stairs:
* Landings must be well lit, with switches located on them.
* Install handrails on both sides of the ladder.
* Mark bottom and top rungs with bright tape.
* Make sure the stair carpet is securely attached.
* Treat the steps suitable for the porch with a waterproof non-slip coating.
* Install the handrails on the porch.

Failure to maintain balance is the main cause of falls.
How you maintain your balance can be easily checked using the test:
Slowly rising from a sitting position, hold for a while. If you are unable to complete this exercise, see your doctor to refer you to a physical therapy instructor. He will select the set of exercises you need.

Approximate set of exercises to improve coordination.

Repeat each exercise at least 8-10 times.
– Try standing on one leg for 15-20 seconds. Increase this time gradually. Then you can close your eyes while doing this exercise. In this case, it is necessary that, at least for the first time, someone backs you up from behind.
– Get on your toes and count to ten.
– Draw a large circle with your left thigh, then your right. At the same time, the shoulders and legs remain motionless.
Find like-minded people: do gymnastics, take walks together, exchange new information about osteoporosis and modern methods of dealing with it.If there are special osteoporosis schools in your area, visit them. Do not start gymnastics without first consulting your doctor!

Step Six – See Your Doctor Regularly

Once you have been diagnosed with osteoporosis, remember to consult your doctor regularly. Any treatment should be carried out under the guidance of a specialist, as today there are several groups of drugs for the treatment of osteoporosis. They vary in effectiveness, safety and ease of use.Therefore, before starting treatment, it is imperative to discuss all the pros and cons of prescribing a particular drug with a doctor who, taking into account your characteristics, will choose the drug that is optimal for you. The main goal of drug treatment is to improve bone quality and reduce the risk of new fractures. Therefore, it should be remembered that if you have already been diagnosed with osteoporosis, then, in addition to calcium and vitamin D (in any form), which all patients should take, you need to take medications for osteoporosis.
Long-term follow-up is indicated for osteoporosis – for 3-5 years. At the same time, densitometry is performed regularly (approximately once every 1-2 years) in order to assess the condition of the bones and the effectiveness of treatment. Other examinations are also carried out according to indications. Thus, by following the simplest recommendations, you can prevent further bone loss and avoid the formidable complication of osteoporosis – bone fractures.

Ten myths about osteoporosis
if the first.Osteoporosis is a natural stage in human aging.

– No. Osteoporosis is a disease, and diseases are not natural. All people age, but not everyone develops osteoporosis: one in two women and one in three men over the age of 70 suffers from it. Osteoporosis is a systemic disease of the skeleton in which bones lose their strength, become more fragile, and can easily break under low stress. For example, an elderly person may be fractured if he fell while slipping in the street, picked up a heavy bag from the floor, or simply turned over in bed and suffered a fracture.In theory, osteoporosis can break any bone in the body. But most often the bones of the distal forearm (arm from the elbow to the hand) and the proximal femur are fractured. In addition, the thoracic and lumbar vertebrae break. Vertebral fractures are more often not associated with trauma. Due to the decrease in the density and strength of the bone tissue, the vertebrae seem to “sag”, decreasing in height. A round, stooped back is formed, the so-called “old lady’s hump”.

The second myth.Osteoporosis is a female disease. He does not threaten men.

– No. Men also suffer from osteoporosis. But in women, it develops more often. A higher risk of osteoporosis in women is associated with lower overall bone mass and smaller bone size than men. In addition, women lose bone mass faster and in greater amounts due to menopause and longer life expectancy.

The third myth. Children do not have osteoporosis.

– It happens. Osteoporosis in children can develop against the background of chronic diseases of many internal organs: kidneys, thyroid gland, gastrointestinal tract, lungs, diabetes mellitus, etc.and may also be genetically predetermined (osteogenesis imperfecta, etc.).

Fourth myth. Osteoporosis is a silent disease. It does not appear until the fracture occurs.

– This is most often the case. The disease develops gradually, over the years. And a person does not feel anything until the first fracture. But with careful attention to yourself, you can notice signs of osteoporosis. This is a specific type of pain in the thoracic and lumbar spine.It is there when a person is standing: the fragile vertebra “bends” under the weight of our vertical position. In a lying or sitting position (with unloading of the spine), the pain weakens or disappears altogether. Patients come to us who say that they used to be able to do housework on their feet all day, but now their back hurts and they need to lie down during the day. Such symptoms are a sign of developing osteoporosis. Pain in osteoporosis is often confused with osteochondrosis. But with osteochondrosis, the pain in the supine position does not go away: on the contrary, it can intensify.If you notice signs of osteoporosis, you need to see your doctor. A fracture caused by osteoporosis is easier to prevent than treat.

The fifth myth. Osteoporosis is a hereditary disease. It is impossible to warn him.

– People whose blood relatives have osteoporosis have a higher risk of developing this disease. But this does not mean that the disease cannot be prevented or (most importantly!) Its harmful consequences – fractures – cannot be avoided. Let’s figure it out. There are risk factors for developing osteoporosis that a person cannot change.These include: heredity, female sex, age over 65, Caucasian race (in Afro-Caribbean women, osteoporosis is 2.5 times less common), early menopause in women, prolonged immobilization (immobility). But there are factors that directly depend on a person’s lifestyle. By changing them, osteoporosis can be delayed or avoided altogether. These factors are:
Exercise. Strengthen metabolic processes in bone tissue and increase bone mineral density.
Body weight.Fragile women have weaker bones and muscles and are more prone to fractures.
Smoking and alcohol abuse. It just breaks bones.
Insufficient intake of calcium and vitamin D cannot provide normal bone metabolism and leads to osteoporosis.
Tendency to falls: dizziness, unsteady gait, general weakness, etc. Falls are the most common cause of osteoporotic fractures.

Sixth myth. Prevention of osteoporosis should be carried out from early childhood.

– This is so. Proper nutrition and physical activity during childhood and adolescence are especially important. This is a time of intense bone growth and bone build-up (bone quality and density). Peak bone mass is reached by the age of 18 to 25. It is impossible to increase the bone mass further. You can only keep what has already been accumulated. But if we look at modern Russian children, we will see that these are children with less bone mass than, say, children 30 years ago. Those children drank milk because it was the only “children’s” drink.And they walked on the street, because there was nothing else to do. And many modern children prefer carbonated drinks to milk, which flush out calcium from the body. And they prefer to sit at the computer outdoors without getting enough sunlight and physical activity. It is clear that by the age of 50 they are more likely to develop osteoporosis.

The seventh myth. Drinking tea reduces the risk of osteoporosis.

– The purest myth. Tea is useful in itself and does not affect osteoporosis.There is also a lot of information that meat, salt and coffee increase the risk of osteoporosis. In reasonable amounts, these foods do not cause osteoporosis. No need to drink more than 3 cups of coffee a day and abuse salt, it will not be beneficial for the cardiovascular system.

The eighth myth. Almost the entire population of Russia is at risk of developing osteoporosis.

– This is not a myth. Bone strength is determined by calcium. Calcium is absorbed by the body when vitamin D is present in the body.The main amount of vitamin D is synthesized in the skin when exposed to sunlight. And in Russia from October to May – darkness! Another way of getting vitamin D into the body is with food, these are fatty fish, which are also few in Russia. Therefore, I recommend to all people over 2 years of age (pediatricians prescribe vitamin D for children of the first 2 years of life) from October to March, I recommend taking additional vitamin D supplements. Please discuss the dosages you need with your doctor!

The ninth myth. Osteoporosis is not a socially significant disease.

– Legally, the Government of the Russian Federation really does not yet classify osteoporosis as a socially significant disease. But in fact, the social significance of osteoporosis is great. What is it? With osteoporosis, bones become brittle and break easily. The most dangerous is a hip fracture. It cannot be treated without surgery. Elderly people with a hip fracture stop walking, and more than half of them die in the first 6 months from congestion caused by immobility. It can be myocardial infarction, congestive pneumonia, sepsis caused by pressure sores.Someone dies within a week, someone’s process stretches for a couple of years. Such an outcome can and should be avoided by timely detection of osteoporosis, prevention of fractures, and in the event of a fracture – by surgical treatment of it. All of this is completely real even now in Yaroslavl, but it will be much easier and more effective if the Russian Government recognizes osteoporosis as an important disease like, for example, diseases of the cardiovascular system.