Osteoporosis causes more than 2 million fractures annually, mainly in the hips, vertebrae and forearms. Its prevalence is highest in postmenopausal women, where it is estimated that approximately 21% of women aged 50-84 years have osteoporosis. Men over the age of 50 also have a high likelihood of osteoporosis.
What is osteoporosis?
According to the WHO and the Spanish Society of Rheumatology, “osteoporosis is a systemic skeletal disease characterised by low bone mass and deterioration of bone microarchitecture, which leads to increased bone fragility and susceptibility to fractures”.
Types of osteoporosis
The types of osteoporosis are classified as follows:
- Primary osteoporosis: this is the most frequent, representing 90% of cases, in both women and men. It is mainly characterised by an increase in bone resorption that affects the microarchitecture of the bone, although in some cases it may be due to alterations in bone formation. It is due to factors such as gonadal deficiency in both sexes, menopause, low calcium intake and low levels of vitamin D and hyperparathyroidism.
- Secondary osteoporosis: accounts for less than 5% of cases in women and about 20% in men. It is related to underlying conditions or diseases, such as chronic kidney disease, endocrine disorders (hyperthyroidism, hypogonadism, diabetes mellitus, etc.), hyperphosphataemia, alterations in calcaemia and serum vitamin D concentration, reduced mobility, long-term steroid treatment, prolonged gravitational weight loss (as occurs in astronauts on space flights), alcoholism, smoking, among others.
Symptoms of osteoporosis
Generally, people with osteoporosis are asymptomatic, and when a fracture occurs, the pathology is already present. The symptoms that arise are:
- Back pain, which in many cases is caused by a vertebral fracture.
- Fragility fractures.
- Reduction in height.
- Postural manifestations, such as stooping.
Management of osteoporosis
As the Spanish Society of Rheumatology states: “in both the prevention and treatment of osteoporosis, it is important to reduce risk factors, prevent falls and recommend optimal nutrition”. The recommendations in this regard are as follows:
- Give up smoking and avoid excessive alcohol consumption.
- Regular physical exercise, preferably weight-bearing exercise.
- Optimise body mass index.
- Adequate exposure to sunlight.
- In the prevention of falls, it is important to adapt to the patient’s environment, identify drugs that may increase their risk and correct vision deficits.
- Recommend nutrition that includes the 3 basic nutrients for bone health: calcium, vitamin D and protein.
Balanced diet
Diet recommendations are focused on foods that can help preserve bone mass. Examples include:
- Increase consumption of calcium-rich foods such as milk, skimmed dairy products, nuts and seeds, whole grains, green vegetables and sardines.
- Combine this with foods rich in vitamin D (oily fish, eggs and brown rice), and foods rich in vitamin C (citrus fruits, peppers, Brussels sprouts, watercress).
- Increase consumption of greens, fruit and vegetables.
- Consume pulses, including legumes.
- Preferably use seed or olive oils (sources of unsaturated fat rich in vitamin E).
- Moderate consumption of animal protein (meat, fish, eggs).
- Preferably consume fish, especially oily fish, due to its content of essential fatty acids (Omega-3).
- Limit consumption of animal foods rich in saturated fats.
- Reduce consumption of coffee, alcohol, fizzy drinks and sugar.
- Moderate salt intake.
Calcium and vitamin D supplementation
As we have read, calcium and vitamin D levels are crucial for good bone health and are recommended by various societies and the World Health Organisation. Let’s look at the reasons why and the amounts suggested.
- Calcium: it is the most abundant mineral in the body, with a content of 1.2kg. 99% of calcium is found in bones and teeth. Peak bone mass is one of the key factors determining bone mass and risk of fracture later in life, and calcium is a building block in obtaining it. Studies have shown that calcium supplementation is effective in reducing bone loss in women in the late postmenopausal phase (>5 years postmenopause), especially those with low habitual calcium intake (<400 mg/day).5 Intake recommendations range from 800 to 1000 mg/day.
- Vitamin D: is produced in the skin as a result of the action of ultraviolet light. Vitamin D promotes calcium balance by improving intestinal absorption of calcium and stimulates bone matrix formation and bone maturation. Deficiency may increase the risk of fractures, and in postmenopausal women, vitamin D combined with calcium supplementation has been shown to reduce the rate of bone loss and also improve muscle strength and balance, reducing the risk of falls.3,5 Recommended doses are between 400-800 IU/day of vitamin D.
There are also two other minerals of interest for bone wellbeing, magnesium and zinc, the former being involved in bone structure and the latter in bone formation and mineralisation. The intake of these two minerals should cover 300 mg/day for magnesium and 10-25 mg/day for zinc.
Prevention of falls
It is important that the specialist properly instructs the patient with osteoporosis about the risks of falls and fractures. Some tips for preventing falls are: avoid walking on uneven or damp ground without appropriate footwear, avoid walking in the dark at home, shoes must be suitable and fully support the foot, postural hygiene exercises, monitor the ascent and descent of stairs, adapt the bathroom to prevent slips, among others.
