Bones’ health support: Osteoporosis prevention

Bones’ health support: Osteoporosis prevention

I. Understanding osteoporosis: Quiet enemy of bones

Osteoporosis, often called a “quiet epidemic”, is a systemic disease of the skeleton, characterized by low bone mass and microarchitectural disorders of bone tissue, which leads to increased fragility of bones and, as a result, increased risk of fractures. This process develops gradually, often without any noticeable symptoms until a fracture occurs, usually in the thigh, spine or wrist.

IA Bone fabric: dynamic structure

Bone tissue is not inert material; This is a living, constantly remodeling fabric. This remodeling process, called bone metabolism, includes two main types of cells: osteoclasts and osteoblasts. Osteoclasts are responsible for the resorption of bone tissue (destruction), and osteoblasts – for the formation of new bone tissue. Under normal conditions, these processes are in balance, ensuring the maintenance of bone mass and structure.

IB mechanism for the development of osteoporosis: Balance violation

Osteoporosis occurs when the balance between resorption and bone formation is disturbed, and resorption prevails over the formation. This leads to a gradual loss of bone mass and weakening of the bone structure. As a result, the bones become porous and fragile, like a sponge, and are more susceptible to fractures even with minor injuries or loads.

IC types of osteoporosis: a variety of causes and factors

There are several types of osteoporosis, each of which has its own specific causes and risk factors:

• Primary osteoporosis: The most common type, which is divided into:

  • Postmenopausal osteoporosis (type I): Associated with a decrease in estrogens after menopause. Estrogen plays an important role in maintaining bone density, and its decrease leads to accelerated bone resorption. This type of osteoporosis is more common in women and usually affects the spine and wrists.
  • Senile osteoporosis (type II): Associated with age -related changes and a decrease in the function of osteoblasts. It is found in both men and women, usually after 70 years, and affects both spongy and compact bone. Most often lead to fractures of thigh and vertebrae.
  • Idiopathic osteoporosis: It is found in children and young people, the causes of which are unclear.

• Secondary osteoporosis: It develops as a result of other diseases, taking drugs or lifestyle. Examples include:

  • Endocrine diseases: Hyperthyroidism, hyperparathyroidism, Cushing syndrome.
  • Diseases of the gastrointestinal tract: Celiac disease, Crohn’s disease, ulcerative colitis.
  • Rheumatic diseases: Rheumatoid arthritis, ankylosing spondylitis.
  • Hematological diseases: Multiple myeloma, leukemia.
  • Taking drugs: Glucocorticoids (prenisolone), anti -confusion, proton pump inhibitors (with prolonged use), thyroid hormones (in excess doses).
  • Other factors: Chronic renal failure, anorexia, alcoholism, smoking.

ID risk factors of osteoporosis: determination of high -risk groups

The determination of risk factors of osteoporosis allows you to identify persons who require more thorough monitoring and the adoption of preventive measures. The main risk factors include:

• Age: The risk of osteoporosis increases with age, since over the years the bone mass is naturally reduced.
• Floor: Women are more susceptible to osteoporosis than men, especially after menopause due to a decrease in estrogen levels.
• Breed: People of the Caucasian and Asian race have a higher risk of osteoporosis than people of African origin.
• Family history: The presence of osteoporosis or fractures in a family history increases the risk of the development of the disease.
• Low body weight: People with a low body weight have a smaller bone mass and, therefore, a higher risk of osteoporosis.
• History of fractures: The presence of fractures, especially at the age of 50, is a strong predictor of the future risk of osteoporotic fractures.
• Insufficient consumption of calcium and vitamin D: Calcium and vitamin D are essential for bone health, and their deficiency can lead to a decrease in bone mass.
• Smoking: Smoking negatively affects bone density and increases the risk of fractures.
• Alcohol abuse: Excessive alcohol consumption can disrupt the formation of bone tissue and increase the risk of falls, which leads to fractures.
• Insufficient physical activity: The lack of physical activity, especially exercises with weight load, can lead to a decrease in bone mass.
• Certain diseases and drugs: As described in the IC section, some diseases and drugs can increase the risk of osteoporosis.

II. Diagnosis of osteoporosis: determination of the degree of bone mass

Early diagnosis of osteoporosis is extremely important to prevent fractures and improve the quality of life. Diagnosis usually includes an assessment of risk factors, physical examination and densitometry.

II.A. Densitometry (DXA): Golden standard for measuring bone density

Densitometry (DXA-Dual-Energy X-Ray Absorptiometry) is a gold standard for bone density. This is a non -invasive and painless method using low doses of x -ray radiation to measure the mineral density of bones (IPC) in the spine, thigh or wrist.

The results of DXA are usually expressed in the form of T-criteria and Z-criterion.

• T-criteria: Compares the PMC of the patient with an average IPC of healthy people of the same gender at the age of 20-29 years (the age of peak bone mass). It is used to diagnose osteoporosis in postmenopaus women and men over 50.

  • T -criteria ≥ -1.0: normal bone mass.
  • T -criteria from -1.0 to -2.5: osteopenia (reduced bone mass).
  • T -criteria ≤ -2.5: osteoporosis.
  • T -criteria ≤ -2.5 with one or more fractures: severe osteoporosis.

• Z-criteria: Compares the PMC of the patient with an average IPC of people of the same gender and age. It is used to diagnose osteoporosis in children, young people and women in prenopause. The Z -criteria below -2.0 requires further examination to identify possible causes of low bone mass.

II.B. Other diagnostic methods:

• Ultrasound densitometry: Uses ultrasonic waves to assess bone density, usually in the heel. This method is less accurate than DXA, but can be used for screening.
• Computed tomography (CT): It can be used to measure the MPC vertebrae, but is usually not a method of choice for diagnosis of osteoporosis due to a higher irradiation dose.
• Risk assessment of fractures (Frax): Frax is a tool developed by the World Health Organization (WHO) to assess the 10-year probability of thigh fractures and other basic osteoporotic fractures (spine, forearm, shoulder). It takes into account various risk factors, such as age, gender, body weight index, history fractures, family history, smoking, alcohol use, intake of glucocorticoids and the presence of rheumatoid arthritis. Frax helps to determine who needs DXA and treatment of osteoporosis.

II.C. Who needs to undergo densitometry:

Densitometry recommendations can vary depending on the country and medical organizations. However, as a rule, DXA is recommended for the following groups:

• Women aged 65 and older.
• Men aged 70 and older.
• Women in postmenopause younger than 65 years old and men aged 50-69 with risk factors of osteoporosis.
• People with fractures aged after 50.
• People taking drugs that can cause osteoporosis.
• People with diseases that can cause osteoporosis.
• People with signs of a decrease in bone mass, such as loss of growth or kyphosis (curvature of the spine).

III. Prevention of osteoporosis: an integrated approach to strengthening bones

Prevention of osteoporosis should begin in childhood and continue throughout life. An integrated approach, including proper nutrition, physical activity, rejection of bad habits and, if necessary, taking drugs, is the most effective way to strengthen bones and reduce the risk of fractures.

III.A. Bone health food: calcium and vitamin D – key components

Proper nutrition plays a vital role in the prevention of osteoporosis. The key nutrients for the health of bones are calcium and vitamin D.

• Calcium: It is the main building material for bones. Recommended daily calcium consumption varies depending on age and gender.

  • Children and adolescents (9-18 years old): 1300 mg
  • Adults (19-50 years old): 1000 mg
  • Men (51-70 years old): 1000 mg
  • Women (51-70 years old): 1200 mg
  • Adults (71 years and older): 1200 mg

  Good calcium sources include:

  • Dairy products (milk, yogurt, cheese)
  • Green sheet vegetables (cabbage, spinach, broccoli)
  • Fish with bones (sardins, salmon)
  • Enriched products (orange juice, breakfast flakes, soy milk, tofu)
  • Almond
  • CHIA and sesame seeds

  With insufficient intake of calcium with food, calcium supplements can be recommended. However, it should be remembered that excess calcium consumption (more than 2000 mg per day) can be harmful and increase the risk of developing cardiovascular diseases and kidney stones. It is important to consult a doctor before taking calcium additives.

• Vitamin D: It is necessary for the absorption of calcium in the intestines and maintaining bone health. Vitamin D is produced in the skin under the influence of sunlight. However, many people do not receive enough vitamin D from sunlight, especially in the winter months and in regions with high breadth.

  The recommended daily consumption of vitamin D is:

  • Adults (19-70 years old): 600 IU (international units)
  • Adults (71 years and older): 800 IT

  Good sources of vitamin D include:

  • Fat fish (salmon, tuna, mackerel)
  • Egg yolk
  • Enriched products (milk, breakfast flakes, orange juice)
  • Vitamin D supplements

  With insufficient intake of vitamin D with food and limited effects of sunlight, vitamin D additives can be recommended. The doctor can determine the required dose of vitamin D based on the level of vitamin D in the blood.

  It should be noted that both the deficiency and excess vitamin D can be harmful. It is important to consult a doctor before taking the additives of vitamin D.

• Other important nutrients: In addition to calcium and vitamin D, other nutrients, such as vitamin K, magnesium, phosphorus, zinc and copper, also play an important role in bone health. A variety of and balanced diet, rich in fruits, vegetables, whole grain products and low -fat protein, will help ensure the sufficient intake of these nutrients.

III.B. Physical activity: strengthening bones and muscles

Physical activity is an important component of the prevention of osteoporosis. Exercises with weight load and strength training are especially effective for strengthening bones and muscles.

• Exercises with weight load: These are exercises that make your bones work against gravity. Examples include:

  • Walking
  • Run
  • Dance
  • Climb the stairs
  • Tennis
  • Weightlifting
  • Jumping

  Exercises with weight load help to increase bone mass and density, especially in the spine and hips.

• Power training: Use resistance to strengthen muscles. Strong muscles help maintain bones and improve balance, which reduces the risk of falls and fractures. Examples of strength training include:

  • Heavy lifting
  • Using elastic resistance ribbons
  • Exercises with your own weight (push -ups, squats, attacks)

  It is recommended to perform weight load exercises and strength training at least 30 minutes a day, most days of the week. Before starting a new exercise program, it is important to consult a doctor, especially if you have any diseases.

• Exercises to improve balance: With age, the balance deteriorates, which increases the risk of falls. Exercises to improve equilibrium, such as tai-chi, yoga and exercises on a balancing board, can help improve balance and reduce the risk of falls.

III.C. Refusal of bad habits: protection of bones from destruction

• Smoking: Smoking negatively affects bone density and increases the risk of fractures. Refusal of smoking is an important step in the prevention of osteoporosis.
• Alcohol abuse: Excessive alcohol consumption can disrupt the formation of bone tissue and increase the risk of falls, which leads to fractures. The restriction of alcohol consumption can help protect your bones.

III.D. Prevention of falls: minimizing the risk of fractures

The falls are the main cause of fractures in people with osteoporosis. Taking measures to prevent falls can significantly reduce the risk of fractures.

• Improving the home environment:

  • Remove carpets and other items that you can stumble about.
  • Provide good lighting in the house, especially at night.
  • Install the handrails in the bathroom and toilet.
  • Use non -slip mats in the bathroom and in the kitchen.
  • Check your vision and hearing regularly.

• Using auxiliary means:

  • Use a cane or walker if you have any problems with equilibrium.
  • Wear shoes with a non -slip sole.

• Regular physical exercises:

  • Exercises to improve equilibrium and strengthening muscles can help prevent falling.

• Medication:

  • Some drugs can cause dizziness or drowsiness, which increases the risk of falls. Discuss your medicine with your doctor.

III.E. Medicinal therapy: slowing down bone weight and increase in bone density

In some cases, changes in lifestyle can be insufficient to prevent osteoporosis. In these cases, drugs can be recommended.

• Bisphosphonates: Are the most common drugs for the treatment of osteoporosis. They slow down bone resorption and increase bone density. Examples of bisphosphonates include alendronate, rizedronate, ibandronate and zoledronic acid. Bisphosphonates can cause side effects, such as heartburn, abdominal pain and rarely – jaw osteonecrosis and atypical thigh fractures.
• Denosumab: It is a monoclonal antibody, which also slows down bone resorption. It is introduced in the form of subcutaneous injection every six months. Denosumab can cause side effects, such as muscles and bones, skin reactions and rarely – hypocalcemia and jaw osteonecrosis.
• Selective estrogen receptor modulators (SMER): For example, Raloxifen, act like estrogen on bones, increasing bone density. SMER can cause side effects, such as tides and increased risk of thromboembolic complications.
• Paratyroid hormone (PTG): Teriparaphyde and abalparaatide are forms of PTG, which stimulate the formation of new bone tissue. They are introduced in the form of daily subcutaneous injections. PTH can cause side effects, such as dizziness, nausea and joint pain.
• Romosozumab: It is a monoclonal antibody that inhibits sclerostin, protein, which inhibits the formation of bone tissue. It is introduced in the form of monthly subcutaneous injections. Romososumab can cause side effects, such as joint pain and increased risk of cardiovascular complications.

The choice of a drug for the treatment of osteoporosis should be carried out by a doctor on the basis of individual risk factors and benefits.

IV. Life with osteoporosis: state management and improvement of the quality of life

Life with osteoporosis can be complex, but the state management and taking measures to prevent fractures can significantly improve the quality of life.

• Regular medical examinations: Regularly visit a doctor to control bone density and assess the risk of fractures.
• Taking drugs: Take medications in accordance with the doctor’s recommendations.
• Balanced nutrition: Adhere to a balanced diet rich in calcium and vitamin D.
• Physical activity: Continue to engage in physical activity adapted to your capabilities.
• Prevention of falls: Take measures to prevent falls in the house and outside it.
• Psychological support: Communicate with other people living with osteoporosis, and seek psychological support, if necessary.
• Training: Learn more about osteoporosis and ways to control it.

V. New directions in the study of osteoporosis: Hope for the future

Studies in the field of osteoporosis are ongoing, and new discoveries can lead to the development of more effective methods for the prevention and treatment of this disease. Some of the new areas of research include:

• Genetic research: The study of genetic factors affecting the bone mass and risk of fractures.
• Development of new drugs: The development of drugs that stimulate the formation of new bone tissue and slow down bone resorption.
• Using stem cells: Using stem cells to restore bone tissue.
• Development of new diagnostic methods: Development of more accurate and less invasive methods of diagnosis of osteoporosis.

Continuing studies in the field of osteoporosis give hope that in the future we will be able to more effectively prevent and treat this disease, improving the quality of life of millions of people around the world.