Prevention of osteoporosis
Dr Z.Bonakdar
Rheumatologist
Assessing the risk of developing OP
• Family history:
Parental history of hip fracture
• Medical history:
Advanced age;
frailty;
hyperthyroidism;
hyperparathyroidism;
celiac and other malabsorption syndromes;
BMI < 20 kg/m2 or weight loss;
long-term glucocorticoids , > 3 months of prednisone ≥ 7.5 mg;
rheumatoid arthritis;
or chronic liver or kidney disease
• Gender risks:
For men, androgen deficiency (primary or secondary);
For women, estrogen deficiency, menopause age < 45 years, or
cessation of menstruation for 6-12 consecutive months
• Lifestyle:
Smoking (current or former),
daily alcohol > 3 units,
caffeine > 4 cups/day,
inadequate calcium / vitamin D intake,
lack of sunlight,
prolonged immobility / lack of weight-bearing exercise
Assessing the risk of falls and fracturing
within 10 years
• Previous fragility fracture (hip, vertebra, humerus, wrist)
or fall in the past year
• High risk of falling, physical frailty or significant weight
loss; poor strength, balance, gait, vision
Indication of BMD
Exercise for Osteoporosis
 Bone accretion occurs during adolescence and peak bone mass is normally
achieved after puberty and into the third decade of life
 Bone mass declines with age, about 0.3- 0.6% in cortical bone and 0.81.2% in trabecular bone annually
 At menopause, an acceleration of bone loss occurs over approximately 5
to 8 years, with an annual 2 to 3 percent loss of trabecular and 1 to 2
percent loss of cortical bone
 Over lifetime, women lose approximately 50 percent of trabecular and 30
percent of cortical bone, where as men lose two thirds of these amounts
 After 50 years of age, there is an exponential rise in fractures such that 40
percent of women and 13 percent of men develop one or more
osteoporotic fractures
 We lose so much muscle as we age that by the time we're 70, we only
have about 50% to 55% of our muscle mass left.
 If you persist with your weight training, even a 1% change in bone density
every year adds up to a 10% difference after ten years. That's a lot of
bone.
 If you have osteoporosis in your spine, don't lift more than 20 to 25
pounds with your arms or against your trunk, and avoid movements that
have you twisting your trunk or bending forward extensively.
Three types of exercise for osteoporosis are:
• Weight-bearing
• Resistance
• Flexibility
All three types of exercise for osteoporosis are needed to build
healthy bones.
Weight-bearing exercise for osteoporosis are:
• Walking
• Hiking
• Dancing
• Stair climbing
• Racquet Sports
Sports like bicycling and swimming are great for your heart and lungs.
However, these are not weight-bearing exercise for osteoporosis.
At least half an hour of moderate to vigorous exercise five times a week.
Walking four hours a week cause a 41% lower risk of hip fractures.
Resistance exercise for osteoporosis includes:
• Free weights or weight machines at home or in the gym
• Resistance tubing that comes in a variety of strengths
• Water exercises, any movement done in the water makes your muscles
work harder.
For best results, do resistance exercises two or three times a week.
Resistance helps with osteoporosis because it strengthens muscle
and builds bone.
• For best results, do resistance exercises two or three times a week. the
exercise more challenging by gradually adding weight or repetitions.
• Work all your different muscles -- including arms, chest, shoulders, legs,
stomach, and back.
• Give each muscle group time to recover.
Flexibility exercise for osteoporosis include these:
• Regular stretches
• T'ai chi
• Yoga
Flexibility is another important form of exercise for osteoporosis.
Having flexible joints helps prevent injury.
Tai Chi
• Tai chi a form of slow, graceful moves builds both coordination and strong
bones.
• A study reported in Physician and Sports medicine found that tai chi could
slow bone loss in postmenopausal women.
• The women, who did 45 minutes of tai chi a day, five days a week for a
year, enjoyed a rate of bone loss up to three and a half times slower than
the non tai chi group.
Yoga
• yoga can build bone health in your hips, spine, and wrists -the bones most vulnerable to fracture.
• Yoga also sharpens your balance, coordination, concentration,
and body awareness and thus helps prevent falls.
Body Vibration [WBV]
• In a study of healthy, postmenopausal women, a 24-week whole body
vibration program was shown to improve muscle strength, balance and hip
bone density.
• The Bone Mass Density (BMD) of the hip increased by 1% .
• Research indicates that the highest muscle reflex response may occur
between 30Hz and 40Hz.
• The duration of the vibration exercise programs was between 20-30
minutes.
Dynamic Motion Therapy (DMT)
Avoid a Slip, Fall, or Fracture
Diet and osteoprosis
Nutrition
 Calcium and vitamin D
prepubertal children 800 mg/day
adolescents 1300 mg/day
women and men 1000 mg/day
women and men over 50 years 1500 mg/day
women and men 400 IU/day
women and men over 50 years 800 IU/day
 Tea contains fluoride and phytoestrogens with positive role in bone health
 Excess caffeine > 4 cups should be avoided
 Excess dietary sodium > 2100 mg/day or 90 mmol/day should be avoided
Nutrition
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Excessive alcohol should be avoided
Cigarette smoking should be stopped
Excessive vitamin A should be avoided
High protein diet should be avoided
Vitamin K may be efficacious in slowing bone loss but has not been shown
to be superior to Ca and vitamin D
 Population with high phytoestrogen intakes have lower rates of fracture
 Multinutrient supplement 600 mg magnesium, 15 mg zinc, 120 mg
vitamin C, 80 mg vitamin K, 3 mg boron- all nutrients believed to be
important for bone health
You can get ample calcium from any of the following:
• Low-fat or fat-free dairy products
• Calcium fortified juices and food
• Sardines with bones
• Certain vegetables
• Soy products
• Calcium supplements
Types of calcium supplements include:
• Calcium carbonate, which is 40% elemental calcium.
• Calcium citrate, which is 21% elemental calcium. While lower in elemental
calcium than calcium carbonate, calcium citrate is easier to digest and
does not cause constipation as much as other types of calcium
supplements.
• Calcium gluconate and calcium lactate, which contain a low amount of
elemental calcium.
• Vitamin D can be obtained through minimal sun exposure (10 minutes a
day) and from your diet.
• Vitamin D is in foods such as salmon, tuna, and mackerel.
• Other foods with vitamin D, but in small amounts, include cheese, egg
yolks, and beef liver.
• You can also get vitamin D from fortified foods such as milk and some
cereals, orange juices, yogurts, margarines, and soy drinks.
Recommended calcium and vitamin D by age
Age
Recommended
Recommended
calcium intake
vitamin D intake
(milligrams a day)
(international units a day)
1-3 years
700
600
4-8 years
1,000
600
9-18 years
1,300
600
19-50 years
1,000
600
Males 51-70
1,000
600
Females 51-70 1,200
600
71 and older
1,200
800
Breakfast Foods
Average Calcium (mg)
• Cereal, calcium-fortified, 1 cup
100 - 1000
• Soy milk, calcium-fortified, 8 ounces
80 - 500
• Milk, 1 cup
300
• Yogurt, 1 cup
300 - 400
• Orange juice, calcium-fortified
200 - 340
Lunch, Dinner, and Snack Foods
• Canned sardines, 3 ounces
• Swiss cheese, 1 ounce
• Cheddar cheese, 1 ounce
• Canned salmon, 3 ounces
• Turnip greens, 1 cup
• Kale cooked, 1 cup
• Broccoli, raw, 1 cup
Average Calcium (mg)
320
270
200
200
200
90
90
High Calcium Intake Linked to Heart
Disease, Death
In contrast, a recent meta-analysis concluded that calcium supplements
without co-administered vitamin D were associated with an increase in the
risk of myocardial infarction by around 30 % .
Cardiovascular outcomes were not primary endpoints in any of the studies
and the association remains the subject of some controversy.
They found that women who consumed more than 1400 mg of calcium daily
had a higher rate of death from all causes (hazard ratio [HR], 1.40; 95% CI,
1.17-1.67) than women who consumed between 600 mg and 1000 mg daily.
Women who consumed more than 1400 mg of calcium daily also had a higher
risk of death from cardiovascular disease (HR, 1.49; 95% CI, 1.09-2.02) and
ischemic heart disease (HR, 2.14; 95% CI, 1.48-3.09) but not stroke.