Osteoporosis

Osteoporosis – characterised by porous bones & decreased bone mass, resulting in an increased risk of fractures of the vertebrae, hips and other bones

Osteopenia – a term used to denote bone loss that is not severe enough to be labelled osteoporosis

In healthy women, bone mass peaks around age 35, after which it begins to decline.  Bone loss typically accelerates for a period of 8-10 yrs around the time of menopause and then continues to decline at a slower rate

Risk Factors of developing osteoporosis:

  • Sedentary lifestyle
  • Cigarette smoking
  • Excessive alcohol intake
  • Family history
  • Menopause
  • Various medical conditions (rheumatoid arthritis, celiac disease, hyperthyroidism, diabetes, etc.)
  • Use of certain medications (glucocorticoids, anticonvulsants, aluminium-containing antacids, and loop diuretics)

Conventional Treatment – weight-bearing exercise, supplementation with calcium and vitamin D

Common Medications: Bisphosphonates, oestrogens, calcitonin

Therapeutic Recommendations:

  • Diet – avoid refined sugar, excessive intake of caffeine, soft drinks, & sodium chloride.  Test for celiac disease in patients with unexplained osteoporosis.  Consider fool allergies in selected cases
  • Environment – attempt to minimize exposure to aluminium, lead, cadmium and tin
  • Calcium – 600-1200 mg/d
  • Magnesium – 300-600 mg/d
  • Vitamin K  – 100-1000 ug/day Vitamin K1; Vitamin K2 at a dose of 45 mg/day may be required in certain cases
  • Supportive Nutrients (daily doses) – Vitamin B6 10-25 mg; Folic Acid 0.4-5.0 mg; Vitamin B1220-1500 mg; Vitamin C 100-500 mg; Zinc 10-30 mg; Copper 1-3 mg; Manganese 3-20 mg; Boron 1-3 mg; Silicon 1-5 mg
  • Strontium – 170-680 mg/day in selected cases.  Consider a dosage reduction after 1 year

 

Dietary Factors: 

Refined Sugar – may decrease the intake of various vitamins and minerals required for bone health.  Ingestion of large amounts may lead to increased amounts in urinary calcium excretion (mobilises calcium from bones).  May cause increased serum concentrations of cortisol causing bone loss.

Soft Drinks – due to contents of phosphoric acid, which leads to leaching of calcium from bones to buffer acidity in the blood.

Caffeine – evidence is controversial.  Bone loss appears to be associated with higher intakes of caffeine 3-5 cups/day.  Patients who are at high risk should avoid excessive caffeine intake.

Sodium Chloride –increases urinary calcium excretion in post-menopausal women in a dose-dependant manner.  High sodium intake is associated with  more rapid bone loss in post-menopausal women.

Celiac Disease – bone loss results due to mal-absorption, which leads to deficiencies of various nutrients needed for bone health.

Food Allergy – chronic ingestion of allergenic foods might cause intestinal inflammation, decreasing the absorption of required nutrients.

Protein – adequate protein intake is essential for the synthesis & maintenance of protein matrix in bone.

Acidic/Alkaline Foods – evidence is not conclusive, it would be reasonable to balance acid/alkaline foods in the diet by consuming abundant amounts of fruit & vegetables & avoid excessive consumption of animal proteins & grains.

Soy & Soy Isoflavones – isoflavones (genistein & diadzene) have weak estrogenic activity.  Genistein has been shown to stimulate osteoblastic bone formation & inhibit osteoclastic bone re-sorption & prevent bone loss in rats.  Evidence is conflicting.