Introduction to Osteoporosis
The important thing to remember in any discussion of osteoporosis is that it is a preventable condition. It is, of course, far easier to prevent than to treat. Osteoporosis translates into serious fractures. The most common osteoporotic fractures are those of the hip, spine, and wrist (in persons not diagnosed and treated before). With hip fractures, one-third of patients die within a year, but more devastating is the loss of personal independence in those surviving. Medical management usually involves hospital admission, surgery, and an extensive period of rehabilitation. By the time the sufferer gets back to the starting point, they are often a much-debilitated person who needs considerable medical attention. If a person has a urinary infection, you can give antibiotics, and with good management, they can and should be cured or controlled without bubonic trauma. So what is the result of all this fun and activity associated with osteoporosis? If we compare the length of life between healthy women 65 years of age and osteoporotic women 65 years of age, the latter have a 50-percent greater chance of mortality. It is also true that in an older woman, a hip fracture is a sentinel event, and the result may be death. So, it is preventable
Risk Factors for Osteoporosis
The two single most important risk factors are age and female gender. Women live longer than men and are greatly at risk, in particular those surviving to an old age. Dietary calcium deficiency during the growth spurt leads to lower peak bone mass and ultimately to an increased risk of developing osteoporosis. The use of corticosteroids during childhood is associated with a similar effect. The risks of fractures are determined by the pattern and severity of cortical bone loss, which in turn is dependent upon the rate at which the bone is lost. Rapid early postmenopausal bone loss is a powerful risk factor. Later in life the risks are more dependent on the rate of loss.
The absolute risk of a fracture is a function of the bone mass, the geometry of the bone and the presence of additional risk factors. In the clinical setting of primary prevention of steroid-induced osteoporosis in post-menopausal women, young age and HRT significantly reduce the number of patients necessary to treat in order to prevent one vertebral fracture. Osteoporosis and associated fractures impose a major public health burden due to costs and quality of life. The common goal, therefore, is to prevent osteoporotic fractures, and strategies may be divided into those for primary and secondary prevention. From the biomechanical perspective the strength of the bone is directly related to its cross-sectional area and to the modulus of elasticity. The vulnerability of osteoporotic bone is due to the preferential loss of volume in the outer cortex.
Preventive Strategies and Treatment Options
The findings of the present study suggest that high vegetable protein consumption is associated with a lower risk of osteoporosis. Thus, it is generally recognized that lifestyle, which includes nutrition, physical activity, and changing diet habits during the growth periods, is important for preventing osteoporosis. These findings suggest that prevention of osteoporotic fractures is closely related to adequate intakes of protein, calcium, and other nutrients. Prevention is especially important because few effective treatments exist. Owing to the inevitable progress of aging, an increase in the number of patients with osteoporosis is expected to occur in the near future. Major and established risk factors for fractures in osteoporotic patients include low bone mass, impaired bone quality, and tendency of falling. Therefore, the majority of preventive strategies and treatment options currently available are based on one or more of these three factors. The critical period for preventing osteoporotic fractures occurs in the years before and surrounding menopause, and the critical period for peak bone mass is childhood and adolescence. However, as previously mentioned, osteoporosis may have an onset prenatally, even before birth, because the intrauterine environment plays an important role in fetal programming. Limited data from recent studies have suggested that approximately 5 to 15% of peak bone mass is acquired by exercise during growth. With respect to osteoporosis prevention and management, a comprehensive and integrative systems biology approach is required and the understanding of the pathogenesis at the level of interacting molecular networks is providing new molecular targets for pharmacologic therapy, novel noninvasive diagnostic tools for assessing bone quality, and identification of pathways permitting the optimization of accumulation of peak bone mass.
An active lifestyle such as exercise and high physical activity programs during young adulthood and early adulthood has long been recommended to achieve high peak bone mass. Until now, a number of circumstances have made well-planned physical activity programs difficult to design and time-consuming. Competitive sports with only preoccupations regarding achievement increase the fracture risk. Especially, an association of type, intensity, duration, and timing of exercise remains unclear. The number of studies is also limited by menopausal status or later ages. Exercise should primarily resist passive skeletal aging. In addition, although mechanical utilization of bones is a major determinant of skeletal architecture, limited data suggest that nutritional factors can modify exercise-related gains during early growth and maturation. In particular, adequate dietary calcium is essential for the mineralization process and exercise proficiency. Assessment of dietary calcium intake during growing years is also critical. However, it does not seem to be advisable for recommendations about other nutritional factors such as vitamin D, magnesium, zinc, and other nutrients, because the effects of these nutrients on bone are generally modest. The health belief model is used to understand behaviors that are protective against a problem in order to develop and evaluate health education and promotion interventions. At this briefing, I would like to summarize selective nutrients, including vegetables known to have a positive effect on osteoporosis and related topics from an epidemiological perspective. It is usually accepted that intake of nutrient-rich food is important, but women may have difficulty meeting recommended daily allowances for vitamins and minerals. Strategies to increase the nutrient density of dietary intakes considering the energy intake linked with increasing rates of obesity are also needed.
Nutritional Interventions
Nutritional interventions, particularly employing mineral (calcium and phosphate, especially when coupled with vitamin D) and protein supplements, are considered as the most effective treatment regime available for preventing osteoporosis. Aside from controlling the amount of meat consumed, the rate of sodium excretion, and the calcium/phosphorous ratio in meals, control is also possible through direct quantitative intake of calcium and phosphate via tablet consumption. The prevention of osteoporosis is linked to preventing bone mass loss since bone analysis has indicated that calcium and the rate at which calcium enters the bone affect the density of the bones.
While having a sufficient dietary intake of calcium in a young age ensures that osteoporosis in old age can be prevented to a certain extent, it has been concluded that among patients with osteoporosis, an intake of 1,500 mg of calcium daily is required for treatment. Even though it has not been proven that the daily intake of 1,500 mg of calcium can prevent fractures, the risk of secondary osteoporotic fractures is not increased either. As phosphates are an integral mineral component of bone, the increased intake of phosphates raises the bone density and decreases the frequency of fractures. Suppose the levels of deoxypyridinoline and C-telopeptide, which are biochemical markers, do not change due to the calcium and phosphorous supplements, estrogen or bisphosphonate anti-resorptive treatment is an alternative option which causes these markers to decrease.
Physical Activity and Exercise
Maintaining or enhancing bone strength, balance, and flexibility through exercise is essential in preventing osteoporosis. Since bone is a living tissue, bone strength and mass improve with weight-bearing exercise, such as walking and weight training (also called resistance exercises, where you work against the force of weights, gravity, or both). Weight-bearing exercise also is referred to as strength training or physical conditioning. The muscles place stress on the bones of the arms and legs when exercising, thus the bones get stronger. The stronger and denser the bones are, the more difficult they will be to break.
For postmenopausal women, exercise can have a positive effect on signs and symptoms of menopause, including emotional instability and lack of confidence, and increase bone density. However, the amount of exercise that leads to reduced bone loss is not known. For healthy bones, walking, weight lifting, physical conditioning, and other exercises are all beneficial. While high-impact exercises and sports like running and basketball also increase bone strength in the lower half of the body, at least 30 minutes of exercise are needed at least three or four days per week. It is also crucial to ensure that your bone health exercises are good for your heart. High-impact weight-bearing and muscle-strengthening exercises are two kinds of exercises that are important for creating and sustaining healthy bones.
Conclusion
Osteoporosis is a condition that significantly impacts bone health and increases the risk of fractures. Early diagnosis and preventive measures can help manage and mitigate its effects, promoting better bone health and quality of life.
INTERNATIONAL HEALTH AND MEDICINE ORGANIZATION IHMO
