Osteoporosis is a disease characterized by a loss of bone mass (BM) and strengthen below the threshold level required for mechanical support of normal activity, as well as an increased occurrence of non-traumatic fractures. It is a disease that gradually causes the bones to become fragile and break easily. It is a metabolic bone disorder characterized by a diffuse decrease in the amount of bone. It affects both men and women, mainly as they grow older. Loss BM occurs as a normal part of the aging process; however, in the individual with osteoporosis, the loss is so extensive that it falls below the threshold of a fracture. By their 30s, the most people begin to slowly lose more bone than can be replaced. As a result, bones become thinner and weaker in structure. In this article, we will delve into the connection between nutrition and osteoporosis and understand how does nutrition affect osteoporosis.
What is Osteoporosis:
Osteoporosis is a disease characterized by a loss of bone mass and it is the most common disease in elderly women causing fractures in hips, spine and joints. Osteoporosis is likely to be caused by complex interactions among local and systemic regulators of bone cell. Several factors like lack of nutritional foods, deficiency of vitamins D, C, K and lack of physical activities contribute to the cause of osteoporosis.
The human skeleton is a collection of bones – held together by ligaments, tendons, muscles and cartilage – in which crystals of calcium phosphate are embedded, providing a framework for the body. It holds and protects the organs. The adult skeleton consists of 206 bones. A newborn baby has more than 300 bones, but many of these fuse together as a child grs into an adult. Bones are of two types. First is cortical bone, also called compact bone. With a hard outer layer making up to 80% of the total BM, it gives white color to the bones. Second is the trabecular bone, also called cancellous or spongy bone. This forms the inside and makes up the remaining 20% of the total BM. It is light and porous, and makes up most of the bone material. This tissue also has space for blood vessels and bone marrow. Both cortical and trabecular bone contribute to the overall strength of a bone. The trabeculae function as a storage site for calcium phosphate crystals. As osteoporosis progresses, the cortex also thins and weakens. These bones can be injured easily, even without a serious accident or fall. Fractures have been known to result from an affectionate hug.
How Does Nutrition Affect Osteoporosis:
Many nutrients and food components can potentially have a positive or negative impact on bone health. They may influence bones by various mechanisms, including: alteration of bone structure, the rate of bone metabolism, the endocrine system and homeostasis of calcium and possibly of other bone-active mineral elements. Among the essential nutrients, vitamins A, B, C and K also play important roles in bone health. Reduced levels of calcium, vitamins, estrogen and physical activity have been implicated in the increased incidences of osteoporosis.
Role of Vital Nutrients in Osteoporosis:
Nutrition Affects Osteoporosis:
Calcium is one of the main bone-forming minerals, and an appropriate supply to bones is essential at al stages of life. Calcium is required for normal growth and development of the skeleton. 99% of the calcium in the body is in the skeleton. Inadequate calcium intake during childhood and adolescence can impair bone development and may prevent the attainment of optimal peak of BMD during early early adulthood. In older adults, inadequate calcium intake accelerates bone loss and likely contributes to the development of osteoporosis. Sufficient calcium intake is critical to achieving optimal peak BMD, which modifies the rate of bone loss associated with aging.
In addition to the amount of calcium in the diet, the absorption of dietary calcium in foods is also a critical factor in determining the availability of calcium for the development and management of bones. There is a need to identify the foods and the food ingredients that may positively influence calcium absorption, and to ensure the calcium’s bioavailability from these foods. This approach is important for individuals who fail to achieve the recommended dietary level of calcium and for those with a low efficiency of intestinal absorption of calcium.
Calcium Rich Foods:
- Dairy products: Milk, yogurt, cheese
- Leafy green vegetables: Kale, broccoli
- Fortified foods: Fortified cereals, tofu.
- Nuts and seeds: Almonds, chia seeds.
Phosphorus is an essential bone-forming element. Its adequate supply is necessary throughout life. Both calcium and phosphorus are required for the appropriate mineralization of the skeleton. A depletion of serum phosphate leads to impaired bone mineralization and compromised osteoblast function. In the case of very low birth-weight infants, the dietary intake of phosphorus influences the risk of osteoporosis.
Phosphorus Rich Foods:
- Lean meats
- Diary products
- Nuts and seeds
- Whole grains
Magnesium is required for the bone and mineral homeostasis, and in bone crystal growth and stabilization. Magnesium intake has been reported, in some of the studies, to be positively associated with both BMD and bone resorption markers in middle-aged women. Magnesium is one of the nutrients in fruits and vegetables that contribute to an alkaline environment which may promote bone health by a variety of mechanisms, making it difficult to examine the effects of magnesium alone.
Magnesium Rich Foods:
- Nuts and seeds
- Whole grains
Fluorosis causes joint stiffness, limb deformities and staining of the teeth. Due to naturally high levels of fluoride in drinking water, fluorosis occurs in several parts of the world, such as South Africa, Tanzania and India. Because of its effects on stimulating osteoblastic activity and inhibiting bone crystal dissolution, there has been considerable interest in the use of pharmacologic doses of sodium fluoride for the treatment of osteoporosis. At levels below those associated with fluorosis, and when combined with a low calcium intake, high fluorine intake has been associated with widened bones, reduced BMD, and osteoporosis of cortical regions of the skeleton – possibly due to excessive urinary calcium excretion.
Vitamin D is synthesized in the skin when exposed to ultraviolet radiation from sunlight, and can be obtained from the diet. Older people tend to have reduced endogenous production of the vitamin for a variety of reasons, and they become more dependent on dietary sources to maintain adequate vitamin D status. Younger people also have a reliance on dietary sources of vitamin D, especially if they have limited exposure to sunlight or if they are dark skinned and are living outside of the tropics. It is a well-established fact that marginal vitamin D deficiency is common and it increases the risk of osteoporosis. The active form of this vitamin increases the intestinal absorption of calcium and prevents urinary calcium loss. In the absence of vitamin D, calcium absorption is not efficient enough to satisfy the body’s needs, even when calcium intake is adequate. Vitamin D deficiency contributes to associated bone loss, increasing fragility, and also neuromuscular impairment leading to the increased the risk of falling. Calcium and vitamin D supplementation is now advocated as the basic minimum for treatment of osteoporosis and secondary fracture prevention in women several years after menopause.
Among the vitamins, thinning of the cortices and loss of trabecular architecture are common features of stark vitamin C deficiency. Vitamin K is a cofactor in the gamma carboxylation of glutamic acid, which is important in the production of osteocalcin – one f the main non-collagenous proteins of bone. It is also reported that high intake of vitamin A as retinol has been associated with hip fracture in Sweden.
Other Factors Beyond Nutrition:
1. Physical Activity:
Physical activities enhance bone strength by optimizing BMD, and improving bone quality reduces the risk of falling. Resistance training increase BM and prevents age -related declines in BMD. Bone atrophy with accentuated calcium losses has been reported after periods of inactivity, either from prolonged bed rest or from immobilization. The emphasis of physical exercise programs in elderly osteoporotic patients should be on improving muscle strength and balance. They should be encouraged to participate safely in any activity in a frequent, regular and sustained manner.
An inactive lifestyle or extended bed rest tends to weaken bones. Cigarette smoking is bad for bones as well as the heart and lungs. Similarly, excessive consumption of alcohol increases the risk of bone loss and fractures.
Estrogen has a protective effect on the bone by suppressing resorption. Estrogen deficiency is a major contributory factor to the development of osteoporosis in women, and hormone replacement therapy (HRT) remains the mainstay for prevention of bone loss in postmenopausal women. Increased levels of estrogen lead to elevated levels of vitamin D in the circulatory system in healthy human subjects. Estrogen stimulates the production of calcitonin, which prevents removal of calcium from bone.
In conclusion, we can see that how does nutrition affect osteoporosis in several ways. Osteoporosis may be avoided by eating balanced diet and removing the deficiency of the vital nutrients that affects osteoporosis. To strengthen bones and lower the chance of osteoporosis, it is also important to incorporate regular activities, abstaining from excessive cigarette smoking, alcohol. It is never too early to start considering your bone health, so choose your diet wisely now to ensure that your bones remain strong enough for the rest of your life.
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