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Osteoporosis: a Review of Bone Loss and Nutrition

written by Aruna Nathan, M.D.
on Sunday, 10th March ,2019

Osteoporosis, a Brief Overview.

Let’s talk about a process that we should think about when we’re young so we can try to prevent unfortunate events as we age.  First, here are a few important definitions. Osteoporosis is a decrease in bone mass leading to fragility of the bones and increased fracture risk. Osteopenia is its less severe sidekick and sarcopenia is loss of muscle mass.  Fragility fractures refer to hip fractures, wrist fractures and compression fractures of the spine that may occur spontaneously, and occur more frequently in those who have osteoporosis.

Osteoporosis is responsible for 1.5 million new fractures a year, 0.5 million hospitalizations per year, 800,000 ER visits per year and 180,000 nursing home visits per year.

Bones are not static - they are constantly forming and reforming.   In childhood and in our teens we have more bone forming activity, in our 20s, 30s and 40s this activity between bone formation and bone loss tends to maintain bone mass. After menopause in women, when estrogen and other gonadal hormone levels begin to decline there is slow bone loss, men also lose bone mass as they have lower levels of testosterone with age.  At this point, there is still ongoing formation and destruction of bone, but the net effect is of bone loss.

Since a great deal of healthy bone formation occurs in childhood, adolescence and early adulthood, a nutritious diet rich in calcium, vitamin D and other minerals like magnesium is essential, as well as frequent physical activity, are to be encouraged during these years. Furthermore, by maintaining these healthy habits we can prevent premature bone loss and thus decrease our overall risks for fragility fractures.

Sarcopenia is loss of muscle mass.  Just as with our bones, we tend to lose muscle mass as we age.  Being inactive increases this loss but being active and especially doing weight bearing exercises can help slow down this loss. Muscle health is in many ways related to bone health. Building muscles usually results in stronger bones and also helps with better posture and fall prevention, thus decreasing hip fractures and possibly vertebral compression fractures.

In addition to advancing age and family history there are other factors that may increase an individual’s overall risk for development of osteoporosis and thus fragility fractures.  These include nicotine or alcohol use, medications like glucocorticoids  (e.g. prednisone and Medrol) and proton pump inhibitors, medical conditions like rheumatoid arthritis, celiac disease, early menopause, low body weight and hypothyroidism. One of the most significant risk factors for fractures related to osteoporosis is past history of similar fractures. So for example, people with wrist fractures after a fall are at high risk of hip fractures in the future.

Fragility fractures are fractures that occur in bone that is weakened by osteoporosis.  The most common types are vertebral compression fractures (27%), wrist fractures (19%), and hip fractures (14%).  Hip fractures are the most devastating regarding a person’s future health. Nearly half the people cannot walk after a hip fracture and many individuals lose their ability to live independently.  

Osteoporosis also affects men and in general men are not tested and treated for this condition. Hip fracture outcomes are usually worse in men, who sustain 1/3 of hip fractures overall, thus men need to also be appropriately screened and treated for this condition.


Nutrition for Bone Health. Some important considerations.

1. Calcium rich foods should be part of each meal, best also to always try and get all your calcium through foods rather than pills or supplements. Your body needs about 1200 mg of calcium a day but you can eat closer to 1500 mg a day as not all the calcium is well absorbed. Only about 300-400 mg of calcium can be absorbed during each meal, thus it is important to eat foods high in calcium throughout the day.

2.Try to have varied sources of calcium-rich foods; each individual’s digestive system may have varying abilities to extract calcium from different foods.

Some examples of foods high in calcium are dairy, almonds, dark leafy greens (kale, Swiss chard, collard greens, bok choy), soy, figs, almond butter, canned salmon. Even broccoli, asparagus, okra, butternut squash contain calcium.

Adding lemon or lime helps release calcium more easily, especially from green leafy vegetables (raw as in salads or cooked as in steamed or sautéed).

In general, steamed or cooked greens release more calcium than raw greens, but it is important to eat both kinds for other nutrients.

3. In addition to calcium, you also need other minerals like potassium and magnesium for strong bones - nuts and seeds, whole grains, avocados, bananas, dragon fruit, acorn squash, sweet potato and salmon to name a few.

It is also important to remember that bone health also is linked to adequate protein intake, especially after the age of 60.  

4 Important to avoid or decrease consumption of certain foods for bone health It. Excess salt does cause loss of calcium.  Salt consumption in the standard American diet is close to 4000 mg a day; it is recommended to be between 1500 mg to 2000 mg. In fact, if you were to avoid processed foods completely and eat all home-made foods, consumption of sodium can be closer to 1000 mg. One of the reasons the calcium requirements are as high as they are, is that the average diet is very high is sodium from added salt.

Sodas and other drinks containing phosphoric acid, which also causes calcium loss through the urine.  Excess Caffeine intake affects the bones as well.  

5. Calcium Carbonate can be used to supplement if needed in addition to foods. Calcium Citrate is recommended for patients on proton pump inhibitors (examples,Omeprazole, Prilosec, Pantoprazole) and also medications like Zantac.

Stay tuned for a post later this week about exercises that are beneficial for all, and especially for those concerned about osteopenia and osteoporosis. 

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