Closer Look at Osteoporosis – Risk Factors, Fractures, and Preventative Measures
May 10, 2011
Osteoporosis, literally translated means “porous bones.” It is a progressive bone disease that occurs due to a loss of bone mass and structural deterioration of bone tissue. More than 10 million Americans currently have the disease. In women over 45 years of age, osteoporosis accounts for more days spent in hospitals than many other diseases including diabetes, myocardial infarction and breast cancer. The development of the disease is linked to three compounding factors: deficient level of peak bone mass, a reduction in bone mass after age 30, and further loss after age 50. Therefore, the best preventative measure is to optimize peak bone mass by consuming adequate calcium and being physically active during childhood and young adulthood.
|Uncontrollable Risk Factors for Osteoporosis|
- Gender (women are at higher risk)
- A thin or small frame
- Ethnicity (whites and Asians are higher risk)
- Conditions such as type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, and hormonal disorders
- Menopause (greatest change in a woman's bone mineral density occurs five to seven years after menopause)
|Controllable Risk Factors for Osteoporosis|
- Smoking and/or excessive alcohol intake
- A sedentary lifestyle
- Diet low in calcium and vitamin D
- Long-term corticosteroid, proton pump inhibitor, and/or anti-inflammatory drug use
- Eating disorders (anorexia nervosa or bulimia)
- Excessively low caloric intake (frequent among young female athletes)
- Amenorrhea due to very low body fat and consequent hormonal disturbance
Osteoporosis causes bones to become frail and brittle, increasing the risk for fractures. The disease is asymptomatic prior to a fracture; changes in posture and/or back pain caused by distortions in the vertebrae may be the first sign of the disease. The vertebra, hip, and wrist are the sites with the greatest risk of fracture. Hip fractures are the most prevalent (73% of osteoporotic fractures in women, 61% among men) and are consistently associated with chronic pain, reduced mobility, disability, and an increasing degree of dependence. Vertebral fractures can lead to back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function. There are also psychological impacts on quality of life from fractures as a result of loss of self-esteem, distorted body image and depression.
- It is estimated that 1 in 3 women over 50 will experience osteoporotic fractures, as will 1 in 5 men
- Actually, the combined lifetime risk for hip, forearm, and vertebral fractures coming to clinical attention is around 40% - equivalent to the risk for cardiovascular disease
- Among white women, the risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a diagnosis of breast cancer
As noted earlier, exercise is a key preventative measure for osteoporosis. Not all exercise is suitable for individuals with osteoporosis however; the excessive bending encountered in yoga or Pilates can increase the risk of spinal compressions fractures and high-impact activities can increase the risk for all types of fracture.
|Exercise and Osteoporosis|
- Childhood and adolescence are the most valuable times to improve bone mass through exercise
- Weight-bearing exercise can help to strengthen and even reverse the deterioration of bone tissue for all sufferers, even the elderly(i.e. jogging, sporting activities, and weightlifting)
- Resistance training should focus on using body weight and axial loading; closed kinetic-chain options are favorable
- Greater quantity of leisure time spent engaging in sporting activities and/or household chores instead of sitting, is associated with a significant reduction in the risk for hip fracture
- Epidemiological evidence suggests that physical activity is associated with a significant reduction in risk of hip fractures for both genders
- Strengthening of the back musculature, particulalrly thoracic extension is associated with a reduced risk of vertebral fractures and kyphosis
Proper nutrition is the other chief preventative measure for osteoporosis. Adequate intake of calcium is crucial to maximize the positive effect of physical activity on bone health during childhood and young adulthood. If adequate levels of calcium are not consistently present in the diet, calcium and vitamin D supplementation may be warranted. Girls ages 9-18 are at the highest risk for inadequate intake and many consume only 50% of daily need. The most common supplements available are calcium carbonate and calcium citrate, which have been found to be equally beneficial. It is recommended to split the daily dosage to optimize total absorption. Calcium and vitamin D supplementation has been shown to reduce the rate of bone loss and also fracture rates in older male and female adults as well as the elderly. One study examining elderly adults, found higher dietary protein intake associated with a lower rate of age-related bone loss.
|Vitamin D fortified milk|
|Sardines (bones contain calcium)|
|Salmon, tuna, and herring (vitamin D)|
|Leafy green vegetables|
|Calcium-fortified cereals and drinks|
Lactose intolerance is associated with low bone mass and increased risk of fracture due to low milk (calcium) intake. Caffeine can decrease the absorption of calcium, but the effect is minimal below a quantity seen equal to three glasses of coffee each day. Chronic alcohol abuse is also directly associated with bone deterioration. Excess alcohol intake has a direct toxic effect on bone-forming cells.
|Foods Detrimental to Bone Calcium|
|>3 cups of coffee a day|