Osteoporosis was responsible for fractures in approximately 1.5 million Americans in 2004, and this number grows each year due to longer life spans and the aging of the Baby Boom generation. The costs for treating advanced osteoporosis are currently a staggering $18 billion every year, which breaks down to $38 million each day (Surgeon General, 2004). Osteoporosis, defined as “a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture” (Surgeon General, 2004), is also insidious in that most people do not know they have it until the disorder is advanced. For these reasons, both prevention and treatment of this disorder are becoming ever more critical.
Obviously, prevention is preferable. The good news is that prevention is possible through nutrition and exercise. The loss in bone density which characterizes osteoporosis is due to low calcium levels in the bone. Certainly, then, calcium supplements or increased calcium through foods do help in the prevention of osteoporosis, but calcium supplements alone are inadequate. Studies also show that magnesium plays an important role in the absorption of calcium into bones so that without adequate magnesium levels, increased calcium supplements will be ineffective (Abraham, 1991, 170). Without proper levels of magnesium, ingested calcium is likely to be deposited in arteries rather than bone (Abraham, 1991, 172).
Some foods inhibit the absorption of calcium and should be moderated or mitigated by the consumption of other calcium rich foods. For instance, a connection has been established between low amounts of protein in the diet and a weakening of the bones. Conversely, high intakes of protein also translate into a higher risk of osteoporosis (Murray, 2004, 753). Caffeine, alcohol, and salt are also detrimental to bone density. The foundation of this connection is in the pH levels of the body: the higher acidity in the body, the higher the risk for osteoporosis over time (Abraham, 1991, 165). A low pH indicates acidity whereas a high pH is considered alkaline. The body attempts to maintain neutrality in the body, at around a pH of 7. In order to maintain this pH when many acidic foods and beverages are consumed, the body releases minerals from the bones, which results in lower bone density (Abraham, 1991, 165).
More specifically, protein over 46 grams per day for women and over 56 grams per day for men is associated with an increased risk of osteoporosis. Interestingly, a nutritious vegetarian diet lowers the risk of osteoporosis in the later decades of life, though little difference is seen in the middle decades of life (Murray, 2005, 753).
For the most important of other minerals, the following list can prove useful:
Folic acid 20-60 mg
Boron 6-12 mg
Calcium 800-1,600 mg
Vitamin D 400-800 IU
Magnesium 400-800 mg
Vitamin K 150-300 mcg
Silicon 100-300 mg
Lysine 500-1,000 mg
B Complex 50-100 mg (Atkins, 1998, 353)
These nutrients can be taken as supplements or, better yet, they can be found in green leafy vegetables, soy foods, and healthy proteins while reducing refined sugars, soft drinks, and caffeinated and alcoholic beverages. An interesting note about Vitamin K is that in the body its function is to convert inactive osteocalcin to its active form (Murray, 2005, 754). Yogurt can be a good source of Vitamin K as well as green leafy vegetables (Deglin & Vallerand, 2007, 1358).
Another important direction of current research is in a nationwide study of 77,761 women, researchers found a relationship between drinking milk and increased fracture incidence. While calcium intake does increase bone density, drinking milk did not reduce the likelihood of fractures, by as much as 45 percent (Murray, 2005, 754). More research in this area is important to understand and confirm this dynamic.
It is also clear that exercise is critical to preventing osteoporosis. The body is ever adaptive, and when a person exercises, not only are the muscles stimulated, but the bones are also encouraged to become more dense in order to handle the increased work load (Surgeon General, 2004). Exercise also has the benefit of decreasing the risk of falls, because it increases a person’s sense of balance. Exercising three times a week for one hour is the ideal program. The type of exercise is less important than the regularity (Murray, 2005, 755).
Another element in prevention is to address the decrease in estrogen of a woman’s body when she becomes post-menopausal. Estrogen is one of the hormones that regulates calcium levels in the bones. This is why many women become vulnerable to osteoporosis after their change in life (Siris, 2004, 1110). Likewise, in men, testosterone has this effect, and there is a clear connection between lower testosterone and increased risks of developing the disorder.
Since people are not usually aware of the presence of osteoporosis in their bodies until symptoms are pronounced, superior treatment of the disorder is also vital. Treatment is most often a combination of medication, nutrition, and exercise. The exercise and nutrient values listed above are necessary during treatment as well, so in the following pages, pharmaceutical solutions will be addressed, including any contraindications they present to the patient.
The pharmaceuticals used to treat osteoporosis are classified as biphosphonates. These drugs have been developed with the idea that to build bone density, the agents which build up bone, osteoblasts, should be increased while those that remove bone, osteoclasts, should be reduced.
One of the most common biphosphonates is Fosamax. Fosamax is an inhibitor of osteoclast function, distributed first to soft tissue and then to bone (Deglin & Vasserand, 2007, 102). Dosage is usually 10 mg per day or 70 mg once per week. For prevention, Fosamax can be taken at half this dosage.
Fosamax is contraindicated in renal insufficiency and pregnancy, so this must be considered individually. Furthermore, food and drug interactions do exist. Calcium supplements and antacids reduce the absorption of Fosamax into tissue and bone. Food itself significantly reduces Fosamax’s effectiveness, so it should not be taken around the time of a meal. Also, caffeine, mineral water, orange juice, and other highly acidic substances reduce its effectiveness (Deglin & Vasserand, 2007, 102).
Actonel is another pharmaceutical available for treatment. Actonel is also a biphosphorate, though it acts a little differently than Fosamax in that it binds with enzymes in the bone to prevent osteoclast activity (Deglin & Vasserand, 2007, 1040). It is fairly inefficient, because at its best absorption only 40% makes its way to the bone. Nevertheless, it can be effective in reversing the effects of osteoporosis by helping increase bone density and reduce the chance of fracture.
The third most prescribed drug for osteoporosis is Boniva. The Boniva which is absorbed rapidly binds to bone, reducing the action of osteoclasts immediately. 50 to 60 percent is not absorbed, however, and is excreted. Calcium, milk, and other foods reduce its absorption, as is the case for the other biphosphorates (Deglin & Vasserand, 2007, 621).
The development of a regime to prevent osteoporosis is important in all older individuals and must also be considered by people of all ages. Although osteoporosis is most common in postmenopausal women and senior citizen age men, it is a disorder that can happen at any age. It is especially probable in people with eating disorders or those with poor diet and exercise habits.
The seriousness of preventing and/or treating this disorder cannot be understated. Recent studies show that 20 percent of seniors who suffer a fracture die within a year of the break (Surgeon General, 2004). For those that live, the reduction in their quality of life is often permanent. As it has been shown here, good nutrition and exercise regimes can make a tremendous difference to vulnerable individuals.
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