Osteoporosis And Osteoporotic Fractures:
Experiencing an osteoporotic fracture can be a debilitating event. It may lead to hospitalization, requiring long-term care, or, in some instances, even death. Osteoporosis is a severe thinning of the bone. It is most common in non-Hispanic white and Asian women. African American and Hispanic women are at risk, but the risk is considered lower. Osteoporosis can also affect men and is most common in non-Hispanic white males.
A DXA scan (dual-energy x-ray absorptiometry) is the most common diagnostic test for determining osteoporosis. A DXA scan measures the density of a bone. A diagnosis of osteoporosis is determined by comparing an individual’s scan results, assigning a T-score, and comparing that score to a T-score of a healthy individual. A young, healthy adult is assigned a T-score of zero. A T-score of -2.5 or lower defines osteoporosis. Osteopenia is considered less severe than osteoporosis and is characterized by a T-score of -1 to -2.5.
Risk Factors:
Contributing factors to osteoporosis can include increased age, insufficient calcium and vitamin D intake, poor nutrition, a sedentary lifestyle, chronic heavy drinking, and a lack of early detection. Medications such as glucocorticoid steroids, selective serotonin reuptake inhibitors, thiazolidinediones, which are a type II diabetes medication, antiepileptic medicines, proton pump inhibitors that lower stomach acid, and some cancer medication can contribute to an increased risk of developing osteoporosis.
Osteoporotic fractures can occur anywhere in the body. However, they are most common in the hip, spine, and wrist. A person who has decreased bone density may suffer a fracture after a fall, or they could experience a wedge or spinal compression fracture attempting to lift a heavy item. Prevention and early management are key to avoiding complications from an osteoporotic fracture later in life.
Bone Metabolism:
Bones are constantly being rebuilt and remodeled depending on the conditions that are placed on them. Bone is primarily made of hydroxyapatite minerals and a matrix of type 1 collagen. Bone remodeling consists of three phases: resorption, reversal, and formation. Osteoclasts are cells that remove bone. Bone removal is considered the resorption phase. Reversal then occurs when mononuclear cells form on the surface of the bone. Finally, bone formation occurs when cells called osteoblast, responsible for new bone growth, deposit new bone, resulting in bone formation. Microdamage can occur when bone encounters a force significant enough to stress it. The continuous cycle of bone reabsorption and formation results in bone renewing its microstructure. This cycle is how bone remodels to adapt to external forces.
Bones also serve as a buffering system in the body. The body must contain a strict pH balance. If the body becomes too acidic, osteoclast cells activate, and bone reabsorption occurs. Hydroxyapatite contained in bone is an alkaline mineral. The release of this alkaline mineral aids in balancing extracellular pH; however, this happens at the cost of bone breakdown. The ability of osteoblasts to form new bone decreases in an acidic environment. Renal and respiratory diseases, gastroenteritis, diabetes, aging, and menopause can all contribute to an acidic environment.
Traditional Treatment Recommendations:
Traditional recommendations for the prevention and management of osteoporosis management include adequate calcium and vitamin D intake. The recommendation for calcium intake is 1,000 mg per day for adults aged 19 to 50. Women over 50 and men over 70 should have a calcium intake of 1,200 mg daily. Additionally, vitamin D intake of 600 IU is recommended for children aged 1 year to adults aged 70, and 800 IU is recommended for adults over 70. If osteoporosis levels are severe enough, a physician may recommend pharmacological treatments. Medications can be classified as antiresorptive, preventing bone reabsorption, or anabolic medications that increase bone growth. Additional medications may consist of bio-identical or synthetic hormones and hormone modulators. However, pharmaceuticals can have significant side effects.
Nutrition And Mineral Balancing:
While vitamin D and calcium are standard recommendations for bone health, several other lesser-known vitamins and minerals contribute to healthy bones. Magnesium, silicon, boron, vitamin C, and vitamin K all support bone health. Magnesium supplementation can increase bone density. Magnesium is present in almonds, cashews, and peanuts. Silicon helps in the mineralization process, and low levels of silicon contribute to poor bone health. Whole grains, cereals, carrots, and green beans contain silicon. Boron increases calcium and magnesium retention. Boron is present in prunes, raisins, dried apricots, and avocados. Vitamin C supports collagen formation and aids with fracture healing. Vitamin K helps transport calcium to the bones and helps avoid calcium accumulating in the arteries. However, vitamin K coagulates blood and should be avoided when taking warfarin. Additionally, type I collagen supplementation is associated with increased bone mineral density at the lumbar and femoral neck.
Physical Activity:
There are non-pharmacological ways to prevent and minimize osteoporosis. Physical activities that involve weight-bearing aerobic exercises such as walking, jogging, stair climbing, and tennis help reduce bone loss. However, note that walking alone will not significantly increase bone density. Adding a mechanical challenge to the bone, such as wearing a weighted vest with activity, can increase the load placed on the bone, thereby challenging it to remodel and increase density. Resistive strength training is another form of exercise that can help retain bone mass. Like aerobic activity, for bone to be maintained or even gained with resistive training, the mechanical stress placed on bone must be greater than the forces that occur with daily activity.
Osteoporotic fractures most often occur due to a fall. Fall prevention strategies such as balance and strength training can help prevent falls from happening in the first place. Exercises that strengthen the core, support the spine, and improve posture serve a dual purpose because they not only strengthen the body but they also can improve balance. Individuals at a higher risk for falls can incorporate strength training in an aquatic environment while also working on balance. Before participating in activities involving high impact and loading, a physician should be consulted to assess an individual’s fracture risk so that activity modifications can be made if necessary.
Conclusion:
Early prevention and proactive strategies for bone health are the best way to avoid an osteoporosis diagnosis. However, if an osteoporosis diagnosis is received, focusing on bone preservation and minimizing further bone loss through dietary interventions and lifestyle modifications can help reduce fracture risk. Navigating an osteoporosis diagnosis doesn’t have to be done in fear. Maintaining an active lifestyle throughout aging is achieved one step at a time.
References:
1.Arnett TR. Extracellular pH Regulates Bone Cell Function. The Journal of Nutrition. 2008;138(2):415S418S. doi:https://doi.org/10.1093/jn/138.2.415s
2.Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed Research International. 2018;2018(4840531):1-10. doi:https://doi.org/10.1155/2018/4840531
3.Branch NSC and O. Bone Mineral Density Tests: What the Numbers Mean. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published May 5, 2023. https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-mean
4.Branch NSC and O. Bone Health and Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published May 8, 2023. https://www.niams.nih.gov/health-topics/bone-health-and-osteoporosis
5.Hadjidakis DJ, Androulakis II. Bone Remodeling. Annals of the New York Academy of Sciences. 2006;1092(1):385-396. doi:https://doi.org/10.1196/annals.1365.035
6.König D, Oesser S, Scharla S, Zdzieblik D, Gollhofer A. Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women—A Randomized Controlled Study. Nutrients. 2018;10(1):97. doi:https://doi.org/10.3390/nu10010097
7.National Institute of Arthritis and Musculoskeletal and skin diseases. Calcium and vitamin D: Important for bone health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published May 5, 2023. https://www.niams.nih.gov/health-topics/calcium-and-vitamin-d-important-bone-health
8.National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published December 2022. https://www.niams.nih.gov/health-topics/osteoporosis
9.Price CT, Langford JR, Liporace FA. Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet. The Open Orthopaedics Journal. 2012;6(1):143-149. doi:https://doi.org/10.2174/1874325001206010143
10.Snow CM, Shaw JM, Winters KM, Witzke KA. Long-term Exercise Using Weighted Vests Prevents Hip Bone Loss in Postmenopausal Women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000;55(9):M489-M491. doi:https://doi.org/10.1093/gerona/55.9.m489
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