The peak bone mass (density, strength, structure, micro-architecture) of a person’s bones is attained during the third decade or at about the age of 30. The density naturally declines or is maintained by diet, healthy lifestyle, and continuous physical activity. If bone density is maintained or its decline is slowed down, fractures – which can impact on one’s health and activities – can be avoided.
How do we prevent thinning out of bones or osteoporosis?
The general measures can be grouped into three: adequate calcium and Vit. D levels, good general nutrition, and lifestyle modifications.
Role of calcium and Vit. D in prevention of osteoporosis:
1. Lifelong intake of adequate calcium is associated with higher peak bone mass attained during the third decade of life (about 30 years old).
- Recommended calcium intake is 1,000 milligrams/day for men 50 to 70 years old and 1,200 grams/day for men 71 yrs old and above and for women 51 years old and above. The main sources are dairy products and vegetables like broccoli and cabbage.
- Vitamin D enhances calcium absorption in the intestine. It helps in bone mineralization. The recommended dose of Vit. D is 800 to 1,000 IU/day for men and women 50 years old and above. Higher doses are required by persons who have problems with absorption, obese, older, and by post-transplant patients. The main sources are sun exposure more than 15 minutes a day, fortified milk, cereals, egg yolk, salt water fish, and liver.
The blood level of hydroxyvitamin D (25 OH D) may be measured and more than 20 ng/ml is a good index for adequate bone health and Vit. D stores.
- In men and women already diagnosed for osteoporosis, calcium and Vit. D are used as adjunct to other drugs. They help increase bone mineral density and may reduce the risk of fracture.
- For persons who will use oral corticoste-roids (taken by mouth), calcium and Vit. D supplements are recommended. Intake of Prednisolone, 5 mg or more per day or its equivalent for three months or more, is associated with osteoporosis. Bone loss occurs in the first six to 12 months of steroid use and the risk for fracture increases within three to six months. The risk is similar when higher doses are given for shorter duration.
Inhaled steroids used to control inflammation in the lungs (like in bronchial asthma, chronic obstructive lung disease) are also associated with bone loss, especially if used for a long period.
Good general nutrition has to be maintained to prevent osteoporosis.
The recommended body mass index (BMI) is 19-kg/m2. Low body weight and excessive dieting to lose weight increase one’s risk for fracture. Adequate energy and protein intake (Recommended: U.S. RDA 0.8-g/kg body weight) and a balanced diet are necessary.
Exercise at least 30 minutes per day, three to four times a week. The type depends on the age and physical ability of the person. Jogging, brisk walking, tai chi, weight-bearing, and muscle-strengthening exercises are examples of activities that may be done. Regular/continuous exercise may increase bone density.
Avoid excessive alcohol consumption (less than two units a day).
Avoid excessive smoking.
Limit caffeine intake. Caffeinated drinks should be limited to less than one to two servings per day or less than 240 to 360 ml per day.
Measures to prevent falls should be done. Install sturdy arm rails, grab bars, use of nonslip flooring, adequate lighting to allow a person to see where he/she can safely walk; removal of obstacles like loose wirings or extension/ charger cords, or furniture that may cause a person to trip or fall.
Supervise and monitor persons who use medications with sedating effects, have poor vision, or weak/frail since they prone to falls. Aside from sedatives, tranquilizers, hypnotics, and other prescription drugs (like diazepam, clonazepam, alprazolam), nonprescription drugs that are in common use may alter judgment or cause sleepiness. Examples are tramadol, a pain reliever; meclizine for prevention of motion sickness; and diphenhydramine, an antihistamine or anti-allergy drug.
In next week’s column: Pharmacological treatment of osteoporosis