Bone health after 50: Osteoporosis prevention
I. Introduction: understanding of osteoporosis and its effect on health at a late age
Osteoporosis, literally meaning the “porous bone,” is a systemic disease of the skeleton, characterized by a decrease in bone mass and a violation of bone microarchitectonics. This leads to increased fragility of bones and, therefore, to an increased risk of fractures. It is important to emphasize that osteoporosis often develops asymptomatic for many years, and a fracture may be the first sign of the disease. After 50 years, the risk of developing osteoporosis increases significantly, especially in women, due to hormonal changes associated with menopause. However, osteoporosis is not an inevitable consequence of aging. Active preventive measures and timely diagnosis can significantly reduce the risk of the development of the disease and its complications. Understanding risk factors, as well as available prevention and treatment strategies, plays a key role in maintaining bone health and an active lifestyle in old age.
II. Risk factors for the development of osteoporosis after 50 years:
The definition of risk factors is the first step towards the effective prevention of osteoporosis. These factors can be divided into modified (those that can be influenced) and unmodified (those that cannot be changed).
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Unmodified risk factors:
- Age: With age, the density of bone tissue is naturally reduced. Bone exchange, the process of constant destruction and restoration of bone tissue, slows down, and destruction begins to prevail over the restoration.
- Floor: Women are more at risk of developing osteoporosis than men. This is due to the lower initial bone density and a sharp decrease in estrogen levels during menopause. Estrogen plays an important role in maintaining bone density.
- Family history: The presence of osteoporosis or fractures in a family history increases the risk of the development of the disease. Genetic factors play a certain role in determining the density of bone tissue.
- Breed: People of the European and Asian race have a higher risk of osteoporosis than people of African origin.
- Previous fractures: A fracture in the past, especially a hip, vertebra or radial fracture, significantly increases the risk of subsequent fractures associated with osteoporosis.
- Early menopause (up to 45 years): The early cessation of menstruation leads to a long period of low estrogen levels, which negatively affects bone health.
- Some diseases: Certain diseases, such as rheumatoid arthritis, Crohn’s disease, celiac disease, hyperthyroidism, hypogonadism and diabetes mellitus, can increase the risk of osteoporosis.
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Modified risk factors:
- Insufficient calcium consumption: Calcium is the main building block of bone tissue. Insufficient consumption of calcium with food leads to a decrease in bone density.
- Vitamin D deficiency: Vitamin D is necessary for the absorption of calcium from food. Vitamin D deficiency prevents the normal absorption of calcium and contributes to the development of osteoporosis.
- Low physical activity: Regular physical exercises, especially exercises with weight load (walking, running, dancing, strength training), stimulate the formation of bone tissue and improve its density. A sedentary lifestyle increases the risk of osteoporosis.
- Smoking: Smoking has a negative effect on bone metabolism, reduces bone density and increases the risk of fractures.
- Alcohol abuse: Excessive alcohol consumption worsens the absorption of calcium, reduces the function of bone -forming cells (osteoblasts) and increases the risk of falls, which leads to fractures.
- Excessive caffeine consumption: High consumption of caffeine can increase the removal of calcium in urine, which negatively affects the density of bones.
- Insufficient weight: People with a low body weight (BMI) have a lower bone density and are at greater risk of osteoporosis.
- Long -term use of some drugs: Long -term use of corticosteroids (prednisone), anticonvulsants, thyroid hormones (in high doses) and some other drugs can negatively affect bone health.
- Unstable nutrition: Diets with a high content of salt and phosphates can increase the excretion of calcium in urine and contribute to the development of osteoporosis.
III. Diagnosis of osteoporosis:
Timely diagnosis allows you to start treatment in the early stages of the disease and prevent fractures.
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Densitometry (Dexa scan):
- DEXA (Dual-Energy X-Ray Absorptiometry) is a gold standard for diagnosis of osteoporosis. This is a painless and non -invasive procedure that uses low doses of x -ray radiation to measure bone density in the spine, thigh and, sometimes, in the radial bone.
- The results of Dexa scanning are expressed in the form of T-criteria. T-criteria compares the density of the patient’s bone tissue with the average bone density of the healthy young man of the same gender.
- Interpretation of T-criteria:
- T -criteria> -1.0: normal bone density.
- T -criteria from -1.0 to -2.5: osteopenia (decrease in bone density preceding osteoporosis).
- T -criteria <-2.5: osteoporosis.
- T -criteria <-2.5 with the presence of a fracture: severe osteoporosis.
- Who is recommended by DEXA scan:
- Women over 65 years old.
- Men over 70 years old.
- Women in postmenopause younger than 65 years old with risk factors of osteoporosis.
- Men at the age of 50-69 with risk factors of osteoporosis.
- People who have suffered a fracture with minimal injury.
- People taking medications that can cause bone loss (for example, corticosteroids).
- People with diseases associated with osteoporosis (for example, rheumatoid arthritis).
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Other diagnostic methods:
- Ultrasound densitometry: Uses ultrasonic waves to assess the density of bone tissue, usually in the heel bone. This is a less accurate method than DEXA, and is used for screening, and not to diagnose osteoporosis.
- Quantitative computed tomography (CCP): Uses CT to measure bone density in the spine. This is a more expensive method than DEXA and exposes the patient a greater dose of radiation.
- Blood and urine tests: Blood and urine tests can be used to assess the level of calcium, vitamin D, parathyroid hormones and other indicators associated with bone metabolism. These tests can help identify the causes of bone mass loss.
- Risk assessment of fractures (Frax): Frax (Fracture Risk Assessment Tool) is an online tool developed by the World Health Organization (WHO) for assessing 10-year thigh fractures and basic osteoporotic fractures (vertebra, forearm, shoulder). Frax takes into account age, gender, weight, height, family history, smoking, alcohol use, the use of corticosteroids, rheumatoid arthritis, previous fractures and bone bone bone bone (if available). Frax results help doctors make decisions on the need to treat osteoporosis.
IV. Prevention of osteoporosis: Fundamentals of a healthy lifestyle
Prevention of osteoporosis includes a set of measures aimed at maintaining bone health and reducing the risk of fractures. These measures include a balanced diet, regular physical exercises, the rejection of bad habits and, if necessary, taking drugs.
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Food for bone health:
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Calcium:
- Calcium is the main mineral necessary for the construction and maintenance of bone tissue.
- Recommended daily dose of calcium:
- Women 51-70 years old: 1200 mg
- Men 51-70 years old: 1000 mg
- Women and men over 70: 1200 mg
- Calcium sources:
- Dairy products (milk, yogurt, cheese)
- Green sheet vegetables (cabbage, spinach, broccoli)
- Tofu
- Enriched products (juices, flakes for breakfast)
- Fish with bones (sardins, salmon)
- Almond
- It is important to remember that the body is better absorbed by calcium, consumed in small portions during the day (500-600 mg at a time).
- With insufficient consumption of calcium with food, you can consider taking calcium additives. However, before taking calcium additives, it is necessary to consult a doctor, since excess calcium consumption may be associated with the risk of cardiovascular diseases and kidney stones.
- There are various forms of calcium additives, such as calcium carbonate and calcium citrate. Calcium carbonate is better absorbed when eating, and calcium citrate can be taken regardless of eating.
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Vitamin D:
- Vitamin D is necessary for the absorption of calcium from food. It helps the body to absorb calcium in the intestines and maintain a normal level of calcium in the blood.
- Recommended daily dose of vitamin D:
- People 51-70 years old: 600 IU (international units)
- People over 70 years old: 800 me
- Sources of vitamin D:
- Sunlight: the body produces vitamin D under the influence of sunlight. However, the synthesis of vitamin D depends on the time of year, time of day, geographical position, skin color and the use of sunscreen creams. People with dark skin and those who rarely go outside are at greater risk of vitamin D.
- Fat fish (salmon, tuna, mackerel)
- Egg yolks
- Enriched products (milk, juices, flakes for breakfast)
- Many people need vitamin D additions, especially in the winter months and in regions with a low level of sunlight.
- Before taking the additives of vitamin D, it is necessary to consult a doctor to determine the optimal dose. Excessive consumption of vitamin D can be toxic.
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Protein:
- Protein is necessary for building and restoring bone tissue. He also plays an important role in maintaining muscle mass, which is important to prevent falls.
- Recommended protein consumption: 0.8 grams of protein per kilogram of body weight per day.
- Springs of protein:
- Meat
- Fish
- Bird
- Eggs
- Dairy products
- Legumes (beans, peas, lentils)
- Nuts and seeds
- It is important to choose sources of protein with a low content of saturated fats.
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Vitamin K:
- Vitamin K plays an important role in bone metabolism and helps the body use calcium to build bone tissue.
- Sources of vitamin K:
- Green sheet vegetables (spinach, cabbage, broccoli)
- Vegetable oils
- Some fruits (kiwi, avocado)
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Magnesium:
- Magnesium is necessary for the normal functioning of vitamin D and to maintain bone health.
- Sources of magnesium:
- Nuts and seeds
- Whole grain products
- Green sheet vegetables
- Legumes
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Zinc:
- Zinc plays an important role in bone exchange and helps maintain bone density.
- Sources of zinc:
- Meat
- Seafood
- Nuts and seeds
- Whole grain products
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Limiting the consumption of salt, caffeine and alcohol:
- Excessive salt consumption increases the excretion of calcium in urine.
- High consumption of caffeine can increase the excretion of calcium in urine.
- Alcohol abuse worsens the absorption of calcium, reduces the function of bone -forming cells and increases the risk of falls.
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Physical exercises to strengthen bones:
- Regular physical exercises play an important role in maintaining bone health and reducing the risk of osteoporosis.
- Exercises with weight load:
- These exercises make bones work against gravity, which stimulates the formation of bone tissue and improves its density.
- Examples of exercises with weight load:
- Walking
- Run
- Dance
- Aerobics
- Climb the stairs
- Power training using weights or elastic tapes.
- It is recommended to engage in exercises with a weight load of at least 30 minutes most days a week.
- Power training:
- Power training helps strengthen muscles, which improves balance and reduces the risk of falls. They also stimulate the formation of bone tissue.
- Examples of strength training:
- Heavy lifting
- Elastic ribbons exercises
- Push -ups
- Squats
- Lugs
- It is recommended to engage in strength training at least twice a week, working on all the main muscle groups.
- Exercises for equilibrium:
- Equilibrium exercises help improve coordination and reduce the risk of falls.
- Examples of exercises for balance:
- Standing on one leg
- Walking in a straight line
- Yai-you
- Yoga
- It is recommended to engage in exercises for balance several times a week.
- Before starting any program of physical exercises, you need to consult a doctor, especially if you have any health problems.
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Downs prevention:
- The falls are the main cause of fractures in people with osteoporosis. Prevention of falls plays a key role in the prevention of fractures.
- Dreams prevention measures:
- Provide good lighting in the house: Use bright lighting in all rooms and install nightlines in the bedroom and bathroom.
- Remove the obstacles: Remove carpets, wires and other items that you can stumble about.
- Use the handrails: Install the handrails in the bathroom and toilet.
- Wear comfortable shoes: Wear shoes with a non -slip sole.
- Check your vision regularly: Regularly visit an ophthalmologist to check vision.
- Take medicines with caution: Some drugs can cause dizziness and increase the risk of falls. Discuss with your doctor the possible side effects of your drugs.
- Use auxiliary means: If you have any problems with equilibrium, use a cane or walker.
- Work on equilibrium exercises: Equilibrium exercises help improve coordination and reduce the risk of falls.
- Check your house for the presence of dangers: Go to your home and identify potential dangers that can lead to falls.
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Refusal of bad habits:
- Smoking: Smoking has a negative effect on bone metabolism, reduces 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 worsens the absorption of calcium, reduces the function of bone -forming cells and increases the risk of falls, which leads to fractures. The restriction of alcohol consumption helps to protect bone health.
V. Drug treatment of osteoporosis:
In some cases, a healthy lifestyle is not enough to prevent bone weight and reduce the risk of fractures. In these cases, drug treatment may be required. The decision on the need for drug treatment is made by the doctor on the basis of the results of Dexa scanning, risk assessment of fractures (Frax) and other factors.
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Bisphosphonates:
- Bisphosphonates are the most common drugs for the treatment of osteoporosis. They slow down the destruction of bone tissue and increase its density.
- Bisphosphonates are available in various forms: tablets taken weekly or monthly, and injections administered intravenously once a year.
- Examples of bisphosphonates: Alendronate (Fosamax), Risedronate (Candinel), Ibandronate (Bonviva), Zoledronic acid (Aklast).
- Side effects of bisphosphonates: heartburn, nausea, abdominal pain, esophagus ulcers (when taking tablets), bone pain, muscles or joints, atypical thigh fractures, jaw osteonecrosis (rare, but serious side effect).
- When taking bisphosphonates in tablets, it is important to follow the following recommendations: take the medicine in the morning on an empty stomach, washing down with a full glass of water, and remain in an upright position (standing or sitting) for 30-60 minutes after admission.
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Selective estrogen receptor modulators (SMER):
- The SMER imitate the effect of estrogen on bone tissue, increasing its density and reducing the risk of fractures.
- Example SMER: Raloxifen (Evista).
- Side effects of SMER: ebb, thromboembolic complications (deep vein thrombosis, pulmonary thromboembolism).
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Denosumab (Prolia):
- Denosumab is a monoclonal antibody that slows down the destruction of bone tissue.
- Denosumab is introduced subcutaneously once every 6 months.
- Side effects of denosumab: pain in bones, muscles or joints, infections, jaw osteonecrosis (rare, but serious side effect).
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TerparatiD (Forsteo) and Abaloparati (Timlos):
- Teriparaphyde and abalpararate are synthetic analogues of parathyroid hormone, which stimulate the formation of new bone tissue.
- These drugs are administered subcutaneously daily for 2 years.
- Teriparaphyde and abalparacytide are usually prescribed for people with severe osteoporosis, in whom other drugs are ineffective.
- Side effects of teriparapytide and abalparastic: dizziness, nausea, joint pain, increased blood calcium levels.
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Romososumab (Evenity):
- Romososumab is a monoclonal antibody that increases the formation of bone tissue and slows down its destruction.
- Romososumab is introduced subcutaneously once a month for 1 year.
- Romososumab is usually prescribed for people with severe osteoporosis, who have a high risk of fractures.
- Side effects of romososomab: joint pain, headache, cardiovascular complications (myocardial infarction, stroke).
VI. Alternative and additional treatment methods:
Some people use alternative and additional treatment methods to improve bone health. However, it is important to remember that the effectiveness of these methods is not always proven, and before their use it is necessary to consult a doctor.
- Phytoestrogens: Phytoestrogens are plant compounds that have a weak estrogen -like activity. Some studies show that the use of products rich in phytoestrogens (soy, linen, red