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* Not drinking alcohol, or drinking only in moderation | * Not drinking alcohol, or drinking only in moderation | ||
* Only taking certain medications linked to osteoporosis (anticonvulsants, corticosteroids) at the minimum dose and for the minimum amount of time needed. | * Only taking certain medications linked to osteoporosis (anticonvulsants, corticosteroids) at the minimum dose and for the minimum amount of time needed. | ||
===Nutrition=== | |||
*[[Calcium]] - the patient should include 1200 to 1500 mg of calcium daily either via dietary means (for instance, an 8 oz glass of milk contains approximately 300 mg of calcium) or via supplementation. The body absorbs only about 500 mg of calcium at one time and so intake should be spread throughout the day. However, the benefit of supplementation of calcium alone remains, to a degree, controversial since several nations with high calcium intakes through milk-products (e.g. the USA, Sweden) have some of the highest rates of osteoporosis worldwide, though this may be linked to such countries' excess consumption of protein. A few studies even suggested an adverse effect of calcium excess on bone density and blamed the milk industry for misleading customers. Some nutritionists assert that excess consumption of dairy products causes acidification, which leaches calcium from the system, and argue that vegetables and nuts are a better source of calcium and that in fact milk products should be avoided. This theory has no proof from scientific clinical studies. Similarly, nutritionists believe that excess caffeine consumption can also contribute to leaching calcium from the bones. | |||
A [[meta-analysis]] of [[randomized controlled trials]] concluded "Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, recommended minimum dose calcium is 1200 mg, and of vitamin D is 800 IU (for combined calcium plus vitamin D supplementation)."<ref name="pmid17720017">{{cite journal |author=Tang BMP et al |title=Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis|journal=Lancet |volume=370 |issue= |pages=657-666 |year=2007 |pmid= |doi=10.1016/S0140-6736(07)61342-7}}</ref> A study that examined the relationship between calcium supplementation and clinical fracture risk in an elderly population, there was a significant decrease in fracture risk in patients that received calcium supplements versus those that received placebo. However, this benefit only applied to patients who were compliant with their treatment regimen.<ref>{{cite journal |author=Prince RL, Devine A, Dhaliwal SS, Dick IM |title=Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women |journal=Arch. Intern. Med. |volume=166 |issue=8 |pages=869–75|year=2006 |pmid=16636212 |doi=10.1001/archinte.166.8.869}}</ref> | |||
*'''[[Vitamin]]''' - increasing vitamin D intake has been shown to reduce fractures up to twenty-five percent in older people, according to recent studies.<ref>{{cite journal |author=Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B|title=Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials |journal=JAMA|volume=293 |issue=18 |pages=2257–64 |year=2005 |pmid=15886381 |doi=10.1001/jama.293.18.2257}}</ref><ref name="pmid17720017" />. The very large Women's Health Initiative study, however, did not find any fracture benefit from calcium and vitamin D supplementation, but these women were already taking (on average) 1200 mg/day of calcium . Muscle weakness can contribute to falls so it is beneficial for people living with osteoporosis to improve muscle function. Vitamin D deficiency causes muscle weakness.<ref>{{cite journal |author=Holick MF |title=Resurrection of vitamin D deficiency and rickets |journal=J. Clin. Invest.|volume=116 |issue=8 |pages=2062–72 |year=2006 |pmid=16886050 |doi=10.1172/JCI29449}}</ref>. A meta-analysis of five clinical trials showed 800 IU of vitamin D per day (plus calcium) reduced the risk of falls by 22%.<ref>{{cite journal|author=Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B |title=Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes |journal=Am. J. Clin. Nutr. |volume=84 |issue=1 |pages=18–28|year=2006 |pmid=16825677 |doi=}}</ref>. A different randomized, controlled study showed nursing home residents who took 800 IU of vitamin D per day (plus calcium) having a 72% reduction in the risk of falls.<ref>{{cite journal |author=Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP |title=A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study |journal=Journal of the American Geriatrics Society |volume=55 |issue=2 |pages=234–9|year=2007 |pmid=17302660 |doi=10.1111/j.1532-5415.2007.01048.x}}</ref>. New vitamin D intake recommendations (National Osteoporosis Foundation, July 2007) are adults up to age 50, 400-800 IU daily and those over 50, 800 - 1,000 IU daily. | |||
*'''[[Excess protein]]''' - there are three elements relating to a person's levels of calcium: consumption, absorption, and excretion. High protein intake is known to encourage urinary calcium losses and has been shown to increase risk of fracture in research studies.<ref>{{cite journal|author=Feskanich D, Willett WC, Stampfer MJ, Colditz GA |title=Protein consumption and bone fractures in women |journal=Am. J. Epidemiol. |volume=143 |issue=5 |pages=472–9 |year=1996 |pmid=8610662 |doi=}}</ref><ref>{{cite journal |author=Abelow BJ, Holford TR, Insogna KL |title=Cross-cultural association between dietary animal protein and hip fracture: a hypothesis |journal=Calcif. Tissue Int. |volume=50 |issue=1 |pages=14–8 |year=1992 |pmid=1739864 |doi=}}</ref>. | |||
*'''Others''' - There is some evidence to suggest bone density benefits from taking the following supplements (in addition to calcium and vitamin D): boron, magnesium, zinc, copper, manganese, silicon, strontium, folic acid, and vitamins B6, C, and K.<ref>Gaby, Alan R.,''Preventing and Reversing Osteoporosis,'' 1994. ISBN 0-7615-0022-7</ref><ref>Kessler, George J., ''The Bone Density Diet,''2000. ISBN 0-345-43284-3</ref> This is weak evidence and quite controversial. | |||
===Exercise=== | |||
*Multiple studies have shown that aerobics, weight lifting, and resistance exercises can all maintain or increase BMD in postmenopausal women.<ref>{{cite journal |author=Bonaiuti D, Shea B, Iovine R, ''et al'' |title=Exercise for preventing and treating osteoporosis in postmenopausal women |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3|pages=CD000333 |year=2002 |pmid=12137611 |doi=}}</ref> | |||
*Many researchers have attempted to pinpoint which types of exercise are most effective at improving BMD and other metrics of bone quality, however results have varied. One year of regular jumping exercises appears to increase the BMD and moment of inertia of the proximal tibia<ref>{{cite journal |author=Cheng S, Sipilä S, Taaffe DR, Puolakka J, Suominen H |title=Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women |journal=Bone |volume=31 |issue=1 |pages=126–35 |year=2002 |pmid=12110425|doi=}}</ref> in normal postmenopausal women. | |||
*Treadmill walking, gymnastic training, stepping, jumping, endurance, and strength exercises all resulted in significant increases of L2-L4 BMD in osteopenic postmenopausal women.<ref>{{cite journal |author=Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS |title=Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women|journal=Calcif. Tissue Int. |volume=67 |issue=6 |pages=443–8 |year=2000 |pmid=11289692 |doi=}}</ref><ref>{{cite journal|author=Iwamoto J, Takeda T, Ichimura S |title=Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis |journal=Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association |volume=6 |issue=2 |pages=128–32 |year=2001 |pmid=11484097 |doi=10.1007/s0077610060128}}</ref><ref>{{cite journal|author=Kemmler W, Engelke K, Weineck J, Hensen J, Kalender WA |title=The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results |journal=Archives of physical medicine and rehabilitation |volume=84 |issue=5 |pages=673–82 |year=2003 |pmid=12736880 |doi=}}</ref> | |||
*Strength training elicited improvements specifically in distal radius and hip BMD.<ref>{{cite journal |author=Kerr D, Morton A, Dick I, Prince R|title=Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent |journal=J. Bone Miner. Res.|volume=11 |issue=2 |pages=218–25 |year=1996 |pmid=8822346 |doi=}}</ref> | |||
==References== | ==References== | ||
Revision as of 15:42, 10 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3], Charmaine Patel, M.D. [4]
Overview
Lifestyle modification, as well as calcium supplementation, are the best early and long-term measures for the prevention of osteoporosis. There are also medications available that can be used to prevent worsening of osteoporosis. Pharmacologic treatment can stabilize bone mineral density, prevent further bone loss, and reduce the risk of fractures, however it is unlikely to restore bone quality and strength. The primary prevention of osteoporosis is particularly important because the microarchitechtural changes that occur in osteoporosis are largely irreversible.
Primary Prevention
Lifestyle
There are various lifestyle modifications that can be implemented to help prevent the development of osteoporosis.
- Exercise - exercise promotes the mineralization of bone, and bone accumulation particularly during growth. High impact exercise in particular has been shown to prevent the development of osteoporosis, however high impact exercise can have a negative effect on bone mineralization in cases of poor nutrition, such as in anorexia nervosa and celiac disease
- Nutrition - a diet high in calcium and vitamin D prevents bone loss. Patients at risk for osteoporosis, such as persons with chronic steroid use are generally treated with vitamin D and calcium supplementaton. In renal disease, more active forms of Vitamin D such as paracalcitol or (1,25-dihydroxycholecalciferol or calcitriol are used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D.
- Quitting smoking helps prevent osteoporosis, as well as other diseases
- Not drinking alcohol, or drinking only in moderation
- Only taking certain medications linked to osteoporosis (anticonvulsants, corticosteroids) at the minimum dose and for the minimum amount of time needed.
Nutrition
- Calcium - the patient should include 1200 to 1500 mg of calcium daily either via dietary means (for instance, an 8 oz glass of milk contains approximately 300 mg of calcium) or via supplementation. The body absorbs only about 500 mg of calcium at one time and so intake should be spread throughout the day. However, the benefit of supplementation of calcium alone remains, to a degree, controversial since several nations with high calcium intakes through milk-products (e.g. the USA, Sweden) have some of the highest rates of osteoporosis worldwide, though this may be linked to such countries' excess consumption of protein. A few studies even suggested an adverse effect of calcium excess on bone density and blamed the milk industry for misleading customers. Some nutritionists assert that excess consumption of dairy products causes acidification, which leaches calcium from the system, and argue that vegetables and nuts are a better source of calcium and that in fact milk products should be avoided. This theory has no proof from scientific clinical studies. Similarly, nutritionists believe that excess caffeine consumption can also contribute to leaching calcium from the bones.
A meta-analysis of randomized controlled trials concluded "Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, recommended minimum dose calcium is 1200 mg, and of vitamin D is 800 IU (for combined calcium plus vitamin D supplementation)."[1] A study that examined the relationship between calcium supplementation and clinical fracture risk in an elderly population, there was a significant decrease in fracture risk in patients that received calcium supplements versus those that received placebo. However, this benefit only applied to patients who were compliant with their treatment regimen.[2]
- Vitamin - increasing vitamin D intake has been shown to reduce fractures up to twenty-five percent in older people, according to recent studies.[3][1]. The very large Women's Health Initiative study, however, did not find any fracture benefit from calcium and vitamin D supplementation, but these women were already taking (on average) 1200 mg/day of calcium . Muscle weakness can contribute to falls so it is beneficial for people living with osteoporosis to improve muscle function. Vitamin D deficiency causes muscle weakness.[4]. A meta-analysis of five clinical trials showed 800 IU of vitamin D per day (plus calcium) reduced the risk of falls by 22%.[5]. A different randomized, controlled study showed nursing home residents who took 800 IU of vitamin D per day (plus calcium) having a 72% reduction in the risk of falls.[6]. New vitamin D intake recommendations (National Osteoporosis Foundation, July 2007) are adults up to age 50, 400-800 IU daily and those over 50, 800 - 1,000 IU daily.
- Excess protein - there are three elements relating to a person's levels of calcium: consumption, absorption, and excretion. High protein intake is known to encourage urinary calcium losses and has been shown to increase risk of fracture in research studies.[7][8].
- Others - There is some evidence to suggest bone density benefits from taking the following supplements (in addition to calcium and vitamin D): boron, magnesium, zinc, copper, manganese, silicon, strontium, folic acid, and vitamins B6, C, and K.[9][10] This is weak evidence and quite controversial.
Exercise
- Multiple studies have shown that aerobics, weight lifting, and resistance exercises can all maintain or increase BMD in postmenopausal women.[11]
- Many researchers have attempted to pinpoint which types of exercise are most effective at improving BMD and other metrics of bone quality, however results have varied. One year of regular jumping exercises appears to increase the BMD and moment of inertia of the proximal tibia[12] in normal postmenopausal women.
- Treadmill walking, gymnastic training, stepping, jumping, endurance, and strength exercises all resulted in significant increases of L2-L4 BMD in osteopenic postmenopausal women.[13][14][15]
- Strength training elicited improvements specifically in distal radius and hip BMD.[16]
References
- ↑ 1.0 1.1 Tang BMP; et al. (2007). "Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis". Lancet. 370: 657–666. doi:10.1016/S0140-6736(07)61342-7.
- ↑ Prince RL, Devine A, Dhaliwal SS, Dick IM (2006). "Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women". Arch. Intern. Med. 166 (8): 869–75. doi:10.1001/archinte.166.8.869. PMID 16636212.
- ↑ Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005). "Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials". JAMA. 293 (18): 2257–64. doi:10.1001/jama.293.18.2257. PMID 15886381.
- ↑ Holick MF (2006). "Resurrection of vitamin D deficiency and rickets". J. Clin. Invest. 116 (8): 2062–72. doi:10.1172/JCI29449. PMID 16886050.
- ↑ Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006). "Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes". Am. J. Clin. Nutr. 84 (1): 18–28. PMID 16825677.
- ↑ Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP (2007). "A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study". Journal of the American Geriatrics Society. 55 (2): 234–9. doi:10.1111/j.1532-5415.2007.01048.x. PMID 17302660.
- ↑ Feskanich D, Willett WC, Stampfer MJ, Colditz GA (1996). "Protein consumption and bone fractures in women". Am. J. Epidemiol. 143 (5): 472–9. PMID 8610662.
- ↑ Abelow BJ, Holford TR, Insogna KL (1992). "Cross-cultural association between dietary animal protein and hip fracture: a hypothesis". Calcif. Tissue Int. 50 (1): 14–8. PMID 1739864.
- ↑ Gaby, Alan R.,Preventing and Reversing Osteoporosis, 1994. ISBN 0-7615-0022-7
- ↑ Kessler, George J., The Bone Density Diet,2000. ISBN 0-345-43284-3
- ↑ Bonaiuti D, Shea B, Iovine R; et al. (2002). "Exercise for preventing and treating osteoporosis in postmenopausal women". Cochrane database of systematic reviews (Online) (3): CD000333. PMID 12137611.
- ↑ Cheng S, Sipilä S, Taaffe DR, Puolakka J, Suominen H (2002). "Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women". Bone. 31 (1): 126–35. PMID 12110425.
- ↑ Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS (2000). "Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women". Calcif. Tissue Int. 67 (6): 443–8. PMID 11289692.
- ↑ Iwamoto J, Takeda T, Ichimura S (2001). "Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis". Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 6 (2): 128–32. doi:10.1007/s0077610060128. PMID 11484097.
- ↑ Kemmler W, Engelke K, Weineck J, Hensen J, Kalender WA (2003). "The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results". Archives of physical medicine and rehabilitation. 84 (5): 673–82. PMID 12736880.
- ↑ Kerr D, Morton A, Dick I, Prince R (1996). "Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent". J. Bone Miner. Res. 11 (2): 218–25. PMID 8822346.