Prevention of osteoporosis

Bone is a living tissue that is continuously renewed through processes of formation and elimination of bone tissue, releasing minerals (bone resorption), transferring the calcium ion from the bone matrix to the blood. Any alteration or change that causes an increase in bone resorption favors a decrease in bone mass.

Osteoporosis literally means "porous bone" and is caused by a decrease in the two main components of bone: calcium salts and protein matter. Osteoporosis is the main risk factor for brittle bone fractures, causing severe pain, physical limitations, impaired quality of life and reduced life expectancy in some cases.

Osteoporosis is a disease that occurs more frequently in women after menopause. It is also very frequent in both sexes after the age of 70; however, some of the risk factors that cause it, such as lifestyle and eating habits, could be modified from childhood to avoid or reduce its effects.

Osteoporosis risk factors

Genetic: genetic factors condition between 50 and 80% of the remodeling of bone mass and bone mineral density. Likewise, the risk of osteoporosis is higher in daughters or sisters of women who have suffered from the disease.

Age: between 35 and 40 years of age in both sexes, a discrete loss of bone mass begins; in women, after menopause, a more acute loss begins to occur, which subsequently decreases and becomes more moderate, similar to that which occurs in the male sex. After the age of 70 years in both sexes, the risk of suffering fractures due to osteoporosis increases significantly.

Menopause: Menopause is the main cause of osteoporosis in women. As a result of this process, the levels of estrogens, sex steroid hormones that intervene in the transport of minerals such as calcium, phosphorus and magnesium through the membranes of bone, kidney and intestine cells, are reduced. By decreasing intestinal absorption of these minerals, their urinary excretion increases and concentrations in the bone decrease, increasing the risk of osteoporosis.

Sedentary lifestyle: the lack of mobility in individuals causes bone mass losses, even in those who consume high levels of calcium. When sedentary during the period of bone growth (from birth to age 30), the risk of osteoporosis increases at other stages of life.

Smoking: smokers of both sexes are at greater risk of osteoporosis.

The consumption of alcoholic beverages: excessive alcohol consumption increases the elimination of calcium, causing a decrease in bone density; moreover, regular drinkers suffer loss of balance and fractures more frequently.

Diseases that cause osteoporosis: among the diseases that cause osteoporosis are celiac disease, diabetes mellitus and renal failure.

Diet: diets poor in calories, protein and micronutrients such as calcium, vitamin D, phosphorus and potassium increase the risk of osteoporosis. When deficits occur in stages of bone growth (from birth to age 30), the risk of osteoporosis increases at other stages of life.

Health impact of osteoporosis

Osteoporosis is called "the silent epidemic of the 21st century" because bone loss is gradual and is not detected until it is very advanced or the first fracture has occurred; these can happen by simple blows or falls, called fragility fractures, occur mainly in the spine, wrist and hip, causing the same symptoms as the rest of the fractures: intense pain, inflammation, functional disability and deformity.

The most frequent fractures occur in the spine, as a consequence of an effort when carrying a weight, bending, making a sudden turn or for no apparent reason; they are characterized by causing intense pain, which tends to reduce after 2 or 3 weeks of rest and may disappear after 2 or 3 months, only in a few cases they may become chronic pain.

About 50% of vertebral fractures do not cause symptoms. The most serious fractures are those of the hip, generally occurring as a result of a fall, reducing the patient's quality of life and sometimes also limiting their life expectancy, especially when they occur in people with other conditions or at a very advanced age.

Nutritional factors related to bone mass

Energy intakes: to ensure bone health, energy restrictions that cause losses in body weight, muscle mass and bone mass are not recommended. Even a slight excess of weight that increases the mechanical load and favors bone density would be preferable.

In addition, in the case of postmenopausal women, adipose tissue can be a useful source of endogenous estrogen reserves to counteract the decline in hormone production.

Protein intakes: Bone health can be affected by both deficits and excesses of this macronutrient. Ensuring adequate protein levels is essential to supply the amounts of amino acids required for the construction of the bone matrix and the maintenance of muscle mass; however, if protein levels are excessive, the production of acids that favor the mobilization of calcium from the bone and its urinary elimination increases. 1.2 to 1.6 grams of high quality protein per kilogram of body weight is recommended to maintain the balance between calcium and protein intake.

Carbohydrate intakes: Carbohydrates should guarantee between 50 and 60% of the total energy provided by the diet. It is recommended that more than 85% of the energy provided by carbohydrates should come from the intake of complex carbohydrates, such as whole grains, legumes, vegetables and tubers. The energy intake from simple carbohydrates (sugar, honey and foods containing them) should be less than 10% of the total energy provided by carbohydrates. Excessive consumption of simple carbohydrates can cause insulin levels in the blood to be so high that they inhibit the reabsorption of calcium at the renal level, which increases its urinary elimination.

Fat intakes: fats should ensure between 30 and 35% of the total energy provided by the diet. Excessive consumption of fat, mainly saturated fat, can cause the formation of complexes with calcium and other minerals in the intestine, which favor their loss through the feces. However, the consumption of omega-3 polyunsaturated fatty acids is recommended because of their protective effects against bone loss.

Dietary fiber: the recommended intake of fiber is between 20 and 25 grams per day, these amounts favor the intestinal microbiota, contributing to improve calcium absorption; however, it is suggested that a daily intake of more than 50 grams could interfere in calcium absorption, reducing its levels in the bones.

Calcium requirements: Calcium salts constitute about 60% of bone tissue, contributing together with other nutrients to the prevention of osteoporosis. Therefore, from early childhood, adequate intakes of calcium and other nutrients should be ensured in order to reduce the risk of fractures and other associated health disorders.

Main sources of calcium in the diet:

• Milk and its derivatives.

• Fortified foods.

• Small fish when consumed including the bones, such as canned sardines and whole fried anchovies.

• Some vegetables and legumes.

Factors that favor calcium absorption:

• Adequate levels of vitamin d in the body.

• The increase of the demands during the periods of gestation, lactation and growth.

• When the hydrogen potential (ph) is acidic.

• Slower intestinal transit speed.

• Adequate protein intakes.

• Lactose.

• Moderate intakes of saturated fatty acids and polyunsaturated fatty acids.

• Maximum reduction of saturated fatty acid levels in the diet.

• Excess phosphorus and protein in meals (excessive consumption of soft drinks and meats).

• Low levels of vitamin d in the body.

• Reduced estrogen levels after menopause.

• Very accelerated intestinal transit speed.

• Very high levels of oxalates; contained in spinach, beets, parsley, peanuts, chocolates and tea infusion.

• Very high levels of phytic acid; contained in cereal husks.

• Excess fats in the diet; mainly saturated fats; contained in fatty, processed meats and in very fatty dairy products such as highly processed cheeses and butters.

• Consumption of medications such as tetracyclines and antacids.

Vitamin d requirements: Together with calcium and other substances, it contributes to the prevention of osteoporosis by prom