Bone health after 40: an integrated guide to maintain strength and prevent osteoporosis
Chapter 1: Understanding the Fundamentals: What happens to the bones after 40?
After 40 years, bone tissue begins to collapse faster than recovering. This is a natural process associated with age -related changes in the hormonal background and a decrease in the effectiveness of the cells responsible for bone regeneration.
- Bone regeneration and remodeling: The bones are constantly in the process of remodeling, where the old bone tissue is removed (resorption) with osteoclasts, and the new bone tissue is formed (osteogenesis) osteoblasts. Up to 30 years, the formation process prevails over the destruction process, which leads to an increase in bone mass. After 30 years, the balance shifts, and destruction begins to occur faster, especially after 40 years.
- The influence of hormones: Hormones play a key role in maintaining bone health. In women, menopause leads to a sharp decrease in estrogen levels, which accelerates the loss of bone mass. In men, a decrease in testosterone levels occurs gradually, but also affects bone density. Estrogen and testosterone are facilitated by the activity of osteoblasts and the absorption of calcium.
- Spick bone mass: The maximum bone mass is achieved at the age of 20-30 years. The higher the bone bone mass, the greater the reserve of bone strength, and the later the signs of osteoporosis will appear. Factors affecting the peak bone mass: genetics, nutrition, physical activity, hormonal background and general health in youth.
- Osteopenia and osteoporosis: Stages of reducing bone density: Osteophenia is a condition characterized by a decrease in the mineral density of bones, but not as pronounced as with osteoporosis. This is an intermediate stage between healthy bones and osteoporosis. Osteoporosis is a disease characterized by a significant decrease in bone density and a violation of their microarchitecture, which leads to increased fragmentation and risk of fractures.
- Types of osteoporosis: There are various types of osteoporosis:
- Primary osteoporosis: The most common type associated with age -related changes and hormonal factors. There are postmenopausal (type I) and senile (type II) osteoporosis.
- Secondary osteoporosis: It is caused by other diseases or medication, for example, glucocorticoids, anticonvulsants, some antidepressants. Causes of secondary osteoporosis: endocrine diseases (hyperthyroidism, hyperparathyroidism, diabetes mellitus), diseases of the gastrointestinal tract (celiac disease, crown disease), rheumatological diseases (rheumatoid arthritis), and oncological diseases.
Chapter 2: Risk factors for osteoporosis after 40
Understanding risk factors allows you to take preventive measures and reduce the likelihood of osteoporosis.
- Unhanged risk factors:
- Age: The risk of osteoporosis increases with age.
- Floor: Women are more susceptible to osteoporosis, especially after menopause.
- Genetics: Heredity plays a significant role in determining the density of bones. If your parents or close relatives had osteoporosis or fractures associated with the fragility of bones, your risk increases.
- Breed: Representatives of the Caucasian and Asian rash of osteoporosis are higher than that of representatives of the Negroid race.
- Body structure: People with a thin physique and slight weight have a higher risk of osteoporosis.
- Changed risk factors:
- Deficiency of calcium and vitamin D: Insufficient consumption of calcium and vitamin D leads to a decrease in bone density.
- Insufficient physical activity: The absence of a bone load reduces their strength.
- Smoking: Smoking negatively affects bone tissue and reduces the level of estrogen.
- Excessive drinking: Alcohol abuse violates the process of bone formation and reduces calcium absorption.
- Some diseases and drugs: As described above in the section “Types of osteoporosis.”
- Low weight: BMI less than 19 kg/m2 increases the risk of osteoporosis.
- Frequent falls: Falls increase the risk of fractures, especially in people with osteoporosis.
- Highly sodium diets, caffeine and phosphates: They can help remove calcium from the body.
- Assessment of risk factors: A regular assessment of risk factors allows you to timely identify a predisposition to osteoporosis and take prevention measures. Use online risk calculators of osteoporosis (for example, Frax) and consult a doctor.
Chapter 3: Food for the health of bones after 40: calcium, vitamin D and other important nutrients
Proper nutrition is the basis of bone health. Calcium and vitamin D are key elements, but other nutrients are important.
- Calcium: Bone building material:
- Recommended daily norm: For adults 40+, the recommended daily calcium rate is 1000-1200 mg.
- Calcium sources:
- Dairy products: Milk, yogurt, cheese – excellent sources of calcium. Choose low fat foods.
- Leaf green vegetables: Cabbage, spinach, broccoli contain calcium, but it is worse absorbed than from dairy products.
- Enriched products: Some products, such as soy milk, orange juice, cereals, are enriched with calcium.
- Fish with bones: Sardins, canned salmon with bones – good sources of calcium.
- Almond: Contains calcium, but also many calories.
- TOF: If it is prepared using calcium sulfate.
- Calcium factors affecting the assimilation: Vitamin D, magnesium, phosphorus, acidity of the stomach. Some products (for example, spinach, rhubarb) contain oxalates that bind calcium and prevent its absorption.
- Vitamin D: Assistant in the assimilation of calcium:
- Recommended daily norm: For adults 40+, the recommended daily vitamin D is 600-800 IU (international units).
- Sources of vitamin D:
- Sunlight: Under the influence of sunlight, the skin produces vitamin D. However, the effectiveness of the synthesis depends on the time of year, the latitude of the terrain, time of day, skin color and the use of sunscreens.
- Fat fish: Salmon, tuna, mackerel – rich sources of vitamin D.
- Egg yolks: Contain a small amount of vitamin D.
- Enriched products: Milk, cereals, juices are often enriched with vitamin D.
- Vitamin additives: In case of lack of vitamin D from food and sunlight, it is recommended to take vitamin additives.
- Factors affecting the level of vitamin D: The time of year, geographical position, lifestyle, skin color, health status.
- Other important nutrients:
- Magnesium: Participates in the formation of bone tissue and the absorption of calcium. Sources: green leafy vegetables, nuts, seeds, whole grains.
- Vitamin K: It is necessary for normal bone mineralization. Sources: green leafy vegetables, broccoli, Brussels cabbage.
- Phosphorus: It is important for the health of bones, but excessive consumption of phosphorus can disrupt calcium balance.
- Protein: It is necessary for the formation of bone tissue. Sources: meat, fish, poultry, eggs, legumes, nuts.
- Vitamin C: Participates in the synthesis of collagen, which is an important component of bone tissue. Sources: citrus fruits, berries, pepper.
- Zinc: It is necessary for the activity of osteoblasts. Sources: meat, seafood, nuts, seeds.
- Food additives: If necessary, after consulting a doctor, you can take food additives with calcium, vitamin D and other nutrients. It is important to observe the recommended dosages and take into account possible interactions with drugs.
Chapter 4: Physical activity to strengthen bones after 40: types of exercises and recommendations
Physical activity plays a key role in maintaining bone health.
- Types of exercises:
- Exercises with weight load: Exercises in which body weight exerts pressure on the bones, stimulate their strengthening. Examples: walking, running, jumping, dancing, strength training using weights or elastic tapes.
- Power training: Strengthen the muscles that support the bones. Examples: weight lifting, exercises with elastic ribbons, push -ups, squats.
- Exercise of equilibrium: Help to prevent falls. Examples: Standing on one leg, tai-chi, yoga.
- Exercises for stretching: Improve the flexibility and mobility of the joints. Examples: stretching the muscles of the legs, arms, back.
- Physical activity recommendations:
- Aerobic exercises: At least 150 minutes of moderate intensity or 75 minutes of high intensity per week.
- Power training: At least twice a week, working on all the main muscle groups.
- Exercise of equilibrium: Regularly, especially if there is a risk of falls.
- Start slowly and gradually increase the intensity and duration of the exercises.
- Consult a doctor before starting a new physical activity program, especially if you have any diseases.
- Choose the exercises that you like so that it is easier for you to adhere to regular training.
- Use the correct technique for performing exercises to avoid injuries.
- The influence of physical activity on the bone: Physical activity stimulates osteoblasts and contributes to the formation of new bone tissue. Exercises with weight load are most effective for strengthening bones.
- Physical activity and prevention of falls: Equilibrium exercises and strength training strengthen muscles and improve coordination, which reduces the risk of falling.
Chapter 5: Diagnostics of osteoporosis after 40: densitometry and other methods
Timely diagnosis allows you to identify osteoporosis in the early stages and begin treatment.
- Densitometry (Dexa scan):
- What is it: Dexa scanning (two-energy X-ray absorption) is the most accurate and widely used method for measuring the mineral density of bones.
- How is it: During Dexa scanning, a low dose of x-ray is used to measure bone density in the spine, thigh and, sometimes, in the forearm.
- Indications for DEXA scanning:
- Women over 65 years old.
- Men over 70 years old.
- Women in Postmenopauz under 65 years old with risk factors of osteoporosis.
- Men aged 50-69 years with risk factors of osteoporosis.
- People with fractures arose with a slight injury.
- People taking drugs that increase the risk of osteoporosis.
- People with diseases associated with osteoporosis.
- Interpretation of the results: The results of DEXA scanning are presented in the form of T-criteria and Z-criterion.
- T-criteria: Compares the density of the patient’s bones with the average density of the bones of healthy young people of the same sex.
- T -criteria -1.0 and higher: normal bone density.
- T -criterion from -1.0 to -2.5: osteopenia.
- T -criteria -2.5 and below: osteoporosis.
- Z-criteria: Compares the density of the patient’s bones with the average density of people of people of the same age and gender.
- T-criteria: Compares the density of the patient’s bones with the average density of the bones of healthy young people of the same sex.
- How often you need to conduct DEXA scan: The frequency of Dexa scanning depends on the age, risk factors and results of previous studies. It is usually recommended to carry out repeated scanning every 1-2 years with osteoporosis and every 2-5 years with osteopenia.
- Other diagnostic methods:
- Radiography: It can identify fractures and signs of osteoporosis, but less sensitive than Dexa scanning.
- Ultrasound densitometry: It measures the density of bones using ultrasound. A less accurate method than Dexa scan, but can be used for screening.
- Laboratory research: They can help identify the causes of secondary osteoporosis. These include: a blood test for calcium, vitamin D, thyroid hormones, parathyroid hormone, bone metabolism markers.
- Osteoporosis screening: Regular screening for osteoporosis is recommended for all women over 65 and men over 70, as well as people with risk factors.
Chapter 6: Treatment of osteoporosis after 40: drugs and other approaches
Treatment of osteoporosis is aimed at slowing the loss of bone mass and reducing the risk of fractures.
- Medicines:
- Bisphosphonates: The most commonly used drugs for the treatment of osteoporosis. Slow down the destruction of bone tissue and increase its density. Examples: Alendronate, Risedronate, Ibandronate, Zoledronic acid.
- Side effects: Heartburn, abdominal pain, bone pain, rare, but serious side effects, such as osteonecrosis of the jaw and atypical thigh fractures.
- Method of application: Bisphosphonates take on an empty stomach, washed down with a large amount of water, and do not lie down for 30-60 minutes after receiving.
- Selective estrogen receptor modulators (SMER): They have an estrogen -like effect on bone tissue, increasing its density and reducing the risk of vertebrae fractures. Example: Raloxifen.
- Side effects: Risk of thromboembolic complications.
- Paratyroid hormone (PTG): Stimulates the formation of new bone tissue. Example: Teripipidide.
- Side effects: Bone pain, dizziness, an increase in blood calcium.
- Method of application: Introduced subcutaneously daily for 2 years.
- Denosumab: Monoclonal antibody, which blocks the formation of osteoclasts and slows down the destruction of bone tissue.
- Side effects: Bone pain, risk of infections, osteonecrosis of the jaw.
- Method of application: Entered subcutaneously every 6 months.
- Romosozumab: Monoclonal antibody, which stimulates the formation of new bone tissue and slows down the destruction of the old.
- Side effects: The risk of cardiovascular complications, therefore, is not recommended for patients with a high risk of cardiovascular disease.
- Method of application: It is introduced subcutaneously monthly within 1 year.
- Bisphosphonates: The most commonly used drugs for the treatment of osteoporosis. Slow down the destruction of bone tissue and increase its density. Examples: Alendronate, Risedronate, Ibandronate, Zoledronic acid.
- Other approaches to treatment:
- Diet, rich in calcium and vitamin D: As described above in the section “Nutrition for the health of bones after 40”.
- Regular physical activity: As described above in the section “Physical activity to strengthen bones after 40”.
- Prevention of falls: Elimination of risk factors in the house (for example, carpets, slippery floors, poor lighting), the use of auxiliary tools (for example, cane), balance exercises.
- Refusal of smoking and moderate alcohol use: As described above in the section “Risk factors for osteoporosis after 40”.
- Choosing the treatment method: The choice of treatment for osteoporosis depends on the age, gender, risk factors, the degree of reduction in bone density and the presence of concomitant diseases. The decision on the prescription of drugs is made by the doctor based on the results of the examination.
- Monitoring of treatment: During the treatment of osteoporosis, it is necessary to regularly control the bone density using Dexa scanning and take blood tests to evaluate the effectiveness and safety of therapy.
Chapter 7: Prevention of falls: ensuring the safety of the house and outside it
Prevention of falls is an important part of the prevention of fractures.
- Risk assessment of falls: Evaluate your risk of falls, given the age, state of health, medication and risk factors in the environment.
- Safety at home:
- Eliminate obstacles: Remove carpets, wires, toys and other items that you can stumble about.
- Provide good lighting: Install sufficient lighting in all rooms and corridors. Use nightlines in the bedroom and bathroom.
- Use the handrails: Set the handrails in the bathroom, toilet and along the stairs.
- Non -slip coatings: Use non -slip mats in the bathroom and in the kitchen.
- Comfortable shoes: Wear comfortable shoes with non -slip soles.
- Adjust the height of the furniture: Choose the height of chairs and beds so that you are convenient to sit down and get up.
- Check your vision: Check your vision regularly and wear glasses or contact lenses, if necessary.
- Safety outside the house:
- Be careful on slippery surfaces: In winter, wear shoes with a non -slip sole and use a cane or crutches if necessary.
- Pay attention to the irregularities on the sidewalks: Avoid walking on uneven surfaces and pits.
- Use public transport with caution: Hold on to the handrails in buses and trams.
- Report security problems: If you notice dangerous areas on sidewalks or roads, inform the relevant services about this.
- Exercises to improve balance: Regularly perform exercises that improve balance and coordination.
- Medical examination: Consult a doctor about drugs that can increase the risk of falls and diseases that affect balance.
- Auxiliary means: Use auxiliary tools (cane, crutches), if necessary.
- Information of others: Tell your loved ones and friends about your risk of falls so that they can provide you with help and support.
- Help in the fall: Learn to fall correctly to reduce the risk of fractures. If you feel that you are falling, try to group and cover your head with your hands.
Chapter 8: Hormonal therapy and bone health after 40: Advantages and risks
Hormone therapy (GT) can affect bone health, but its use requires a thorough assessment of advantages and risks.
- Hormonal therapy and menopause: During menopause, a decrease in estrogen levels leads to an accelerated loss of bone mass. GT containing estrogen can slow down this loss and reduce the risk of fractures.
- Advantages of GT for bone health:
- Increase in bone density: GT increases the density of bones in the spine and thigh.
- Reduction of risk of fractures: GT reduces the risk of fractures of vertebrae, hips and other bones.
- RISKS GT:
- Breast cancer: Long -term use of GT can increase the risk of breast cancer.
- Stroke and thromboembolic complications: GT can increase the risk of stroke and thromboembolic complications.
- Gall bladder diseases: GT can increase the risk of gallbladder diseases.
- Making a decision on the GT: The decision on the use of GT should be made individually, after discussing with a doctor all the advantages and risks.
- Factors affecting the decision on the GT:
- The age of the start of GT: The appointment of GT in the early postmenopausal period can be safer and more effective.
- Type GT: There are various types of GT, including estrogen-containing and combined drugs (estrogen and progesterone). The choice of the type of GT depends on the presence of the uterus and other risk factors.
- Dose GT: You should use the minimum effective dose of GT.
- Duration of GT: The duration of GT should be limited.
- The presence of risk factors: It is necessary to take into account risk factors for breast cancer, cardiovascular diseases and thromboembolic complications.
- Alternatives GT: There are alternative methods of treatment and prevention of osteoporosis that are not associated with hormones, such as bisphosphonates, smirer, denosumab, teripipida and romososomab.
- Consultation with a doctor: Before starting GT, you need to consult a doctor and undergo an examination.
Chapter 9: Alternative methods of treatment and prevention of osteoporosis
Along with traditional methods of treatment and prevention of osteoporosis, there are alternative approaches that can be useful in addition to the main treatment.
- Phytoestrogens: Plant compounds that have an estrogen -like effect. Sources: soy, red