All About Osteoporosis: Exercises, Diet and More

Osteoporosis occurs when there is an imbalance in bone breaking down and new bone formation. You may be wondering why bones break down, only to form again. Simply put, normal bone is in a constant process of breaking down and re-forming, called bone remodeling. Typically, there is an even balance, but when there is more breaking down than re-forming, osteoporosis may occur. Let’s explore bone health tips and the prevention of osteoporosis.

The word osteoporosis means porous bone. When viewed under a microscope, bones with osteoporosis have a more porous look than normal bones, meaning there is more open space than usual, and bone metabolism is disrupted. Osteoporosis leads to decreased bone strength and increases the risk of bone fractures.

You may have heard the term osteopenia, a precursor of osteoporosis since it’s a milder form.

Osteoporosis is a major public health problem, especially in the aging population with a longer life span. Women and older people are the most vulnerable to this disease. Preventing osteoporosis is a crucial strategy for maintaining strong bones and mitigating the risk of developing this chronic condition.

What is bone metabolism?

Bone metabolism refers to the continuous process of bone growth, remodeling, and resorption throughout life. The bone mass grows and is formed until adulthood. Peak bone mass reached at puberty is determined by genetic factors, health, nutrition, gender, physical activity, and endocrine health. After puberty, the bone mass starts decreasing.

Osteoporosis appears when this natural process becomes unnatural and the lost (resorption) rate is more than the rebuilt (formation) rate. This imbalance is caused by many factors; however, age and menopause are the most significant players.

What are the symptoms of osteoporosis?

The most obvious finding in advanced osteoporosis is a stooped or hunched-over position. Other signs consist of a loss of height and low back pain. However, most cases of osteoporosis don’t present with any specific symptoms. Many people are unaware they have the disease until a fracture, or break, of a bone, occurs more easily than expected from the level of trauma. The fractured bone can be anywhere, but it most commonly occurs at the wrists, hips, or spine.

How is osteoporosis diagnosed?

The best way to diagnose osteoporosis is with a test that measures bone mineral density through a dual-energy X-ray absorptiometry test. Density specifically refers to the thickness of the bone. Osteoporotic bone has a decreased density.

There are two different kinds of machines:

  • A peripheral, or smaller machine, checks the density (thickness) of a peripheral bone, such as a finger, heel, or wrist.
  • Central DEXA machines are much larger and measure the density of the bone at the hip or spine.

The machines give different scores, which compare the person’s score to other standard scores.

The biggest players in bone health: calcium and vitamin D

Osteoporosis and diet are tightly related to each other. Calcium and vitamin D are essential vitamins that help prevent osteoporosis. Calcium and phosphate make up the mineral component of the bone. Vitamin D helps absorb calcium and phosphate in our intestines and stimulates the rebuilding (formation) rate and mineralization of the bones while reducing the lost (resorption) rate of the bones.

Calcium

The body needs 1,000–1,200 mg per day, depending on gender and age. You can get calcium from dairy products like milk, yogurt, and cheese; however, there are also non-dairy products that contain large amounts of calcium.

Good non-dairy sources of calcium include:

  • Beans and lentils
  • Nuts, like almonds
  • Kale
  • Certain fish, like sardines and canned salmon
  • Rhubarb
  • Leafy green vegetables
  • Whey protein
  • Tofu
  • Edamame
  • Foods fortified with calcium, such as some orange juices and cereal

We recommend you check the nutrition labels on the foods for exact information.

Vitamin D

You’ve probably heard about the recent trends to soak up the sun to get vitamin D. Most people need approximately 15 minutes of sunlight per day to obtain the required amount of vitamin D. It is even longer for those with darker skin. However, be cautious of skin cancers. For those spending a lot of time in the sun, see your dermatologist for yearly skin checks.

In case you don't live in sunny locations, you can take supplements to obtain adequate vitamin D in your system. Vitamin D supplements consist of two main types: vitamin D2 and vitamin D3. The dosage of the supplements is in terms of international units (IUs). For people at or under 70 years of age, taking 600 IU of vitamin D each day is recommended. After 70, the recommended dose increases to 800 IU each day. It is important to note that vitamin D is fat-soluble and can be toxic if taken in too large of a dose. For that reason, the upper limit is 4000 IU per day.

Certain foods contain high vitamin D levels, such as egg yolks, saltwater fish, canned tuna, liver, enriched orange juice, and fortified milk.

Exercises for osteoporosis and osteopenia

Exercise is another important prevention tool for osteoporosis. Physical exercises can help prevent fall risk, which means a lower fracture rate for osteoporotic individuals. The contraction and relaxation of muscles around the bones will strengthen the bones as well as muscles by creating better posture, stronger trunk muscles, and improved balance.

There are a few types of exercises that are the most beneficial for bone density:

  • Resistance or weight training because it creates mechanical loading and increases the special hormones, such as testosterone and other humoral factors that lead to bone formation
  • Cardiovascular exercises, such as biking, walking, treadmill, and elliptical that can be combined with weight training
  • Stretching combined with resistance type of exercises (yoga, Pilates, tai chi)
  • Balance exercises to help prevent fall risk and fractures in the bone
  • Swimming for those who have difficulty tolerating those exercises because of their health condition or severe osteoporosis stage

The best type of exercise should be prescribed individually and during consultation with a health care specialist.

Do not forget that daily life activities can be a good supplementary tool in your prevention from osteoporosis routine. Climbing stairs, choosing a bike, or walking instead of the car if you need to reach not-so-long distances will be a great choice.

Risk factors for osteoporosis and lifestyle adjustments

Understanding the risk factors for osteoporosis and implementing lifestyle adjustments can help mitigate the development and progression of the disease. Here are the following recommendations and considerations:

  • Limit alcohol use. Having more than two alcoholic beverages per day increases the risk of osteoporosis, so avoid excessive alcohol use.
  • Avoid cigarette smoking. Researchers aren't entirely sure how cigarette smoking can lead to osteoporosis, but it has been shown to correlate with the development of the disease.
  • Medications to help prevent osteoporosis. Most medications for osteoporosis exist for use after the diagnosis. An exception exists for postmenopausal women when doctors prescribe estrogen replacement hormones since they help decrease the risk of osteoporosis. Breast cancer can be a side effect of these hormones, so proceed with caution.
  • Medications that cause osteoporosis. Certain medications can cause osteoporosis, such as corticosteroids and several anti-seizure medications. Please check with your physician or pharmacist.

Creating an osteoporosis prevention plan

Proper lifestyle adjustments, combined with medical guidance, can contribute significantly to bone health and overall well-being. To create an effective osteoporosis prevention plan, consult a medical provider according to your individual situation. Regularly visiting your doctor and discussing any concerns, especially if there's a family history of osteoporosis, is crucial. Your doctor can advise on when to undergo a bone mineral density test and check your vitamin D levels with a blood sample.

Maintaining a balanced diet rich in calcium and vitamin D through the consumption of healthy foods and vegetables is also essential for optimal bone health. Additionally, engaging in regular exercise and staying active can help strengthen muscles and bones. To further reduce the risk of osteoporosis, it's important to quit smoking and limit or eliminate alcohol consumption.

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