PREVENTION AND THERAPY OF OSTEOPOROSIS

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Objective of the preventive measures is to achieve the maximum amount of bone mass in childhood and adolescence, in adulthood to prevent from bone mass loss due to inappropriate lifestyle and to prevent from development of secondary osteoporosis. Essential part of prevention and therapy of osteoporosis is represented by non-pharmacological measures: sufficient intake of calcium in diet (food), vitamin D saturation of an organism, maintaining body weight adequate to body height, appropriate physical activity, prevention of falls, exclusion of smoking and of excessive intake of alcohol and caffeine.

Calcium and vitamin D are taken in prevention of osteoporosis, but they are also necessary part of osteoporosis therapy. There is an evidence that intake of calcium in the dose of 500–1000 mg/day and vitamin D in the dose of 400–800 IU/day reduces bone mass loss. Calcium is an essential component of human skeleton. Its sufficient amount is necessary especially during formation of the maximum amount of bone mass, i.e. till about 30th year of age, but also later calcium is important for maintaining the bone mass amount. Sufficient intake of calcium can significantly reduce risk of fractures in postmenopausal women. Calcium is absorbed in small intestine; some foods facilitate, others deteriorate this process. Calcium absorption is facilitated by vitamin D, also by acid environment, so the diet should be rich in fruit juices, vegetable salads, cucumbers, cabbage, and sour vegetables. Diet must be complemented with sufficient amount of liquids (2–3 litres). The main sources of calcium for the organism are dairy products. Calcium from dairy products is well absorbed, and it also ensures balanced supply of other minerals (phosphor, magnesium). Calcium absorption is, on the contrary, deteriorated by oxalates, so the diet should include limited amount of for example spinach, chocolate, cocoa, tomatoes, gooseberries, and currants.

Diet should also have limited amount of caffeine and excessive supply of salt (daily dose of salt should not exceed 8 g; excretion of excessive sodium from an organism includes also excessive excretion of calcium in urine), phosphates (in frequent drinking of sweet coca-cola-type drinks and excessive intake of some types of meat). Phosphates bind calcium in bowel, so they deteriorate its absorption. Every unbalanced diet is unsuitable, vegetarian diet is especially lacking calcium; insufficient amount of calcium is taken also in various reduction diets. Diet which energetically outweighs organism’s needs is also unsuitable, e.g. diet with excessive amount of sugar, fat, and proteins; excessive intake of fibres is also unsuitable. Low body weight is a risk factor for formation of osteoporosis; overweight leads to higher production of estrogens in fat tissue and, at the same time, in higher static load on skeleton it affects relatively against formation of osteoporosis. For patients who are not able or wiling to take calcium in diet, there are various preparations containing calcium, though the best accessibility of calcium is still from food, specifically when divided in smaller amounts taken throughout the day, if possible.

Examples of content of calcium in some foods

Food100g Calcium (mg)
Milk 118
Whipped cream 70
Cream 12% 114
Cream for coffee 6% 118
Acid milk 120
White yoghurt 237
Emmental cheese 45% of fat in dry mass 843
Blue cheese 50% of fat in dry mass 615
Gouda cheese 30% of fat in dry mass 690
Eidam cheese 30% of fat in dry mass 669
Brie cheese 157
Sheep cheese 644
Livarot 596
Processed cream cheese 254
Soft curd 40% of fat in dry mass 366
Soft curd not fat 101
Hard curd 152
Whole egg 60
Beef meat 8
Chicken meat 12
Rabbit 17
Sardines in oil 437
Salmon 85
Chives 325
White cabbage 56
Carrot 44
Salad 45
Apples 7
Apricots 16
Mandarins 32
Poppy seed 1400
Almonds 254
Hazelnuts 290
Rye bread 66
Wheat bread 27
Beans 137
Peas 57
Pasta 26
Rice 24

Vitamin D improves absorption of calcium and positively affects bone metabolism. Vitamin D is formed in the skin exposed to solar radiation; another source is food, especially fish and dairy products. So it is very important to stay in the fresh air long enough every day. Probably as much as half of the population suffers from lack of vitamin D in winter, situation of people who stay in old people homes or other social institutions for a long time is even worse.

Examples of content of vitamin D in some foods

Food 100 g Vitamin D (IU)
Bull-trout 440
Catfish 20
Pike 40
Eel 1600
Salmon 480
Spanish mackerel 120
Fluke 120
Sardine 400
Herring 920
Sprats 520
Codfish 40
Tuna 240
Prawn 20
Oyster 80
Kipper 200
Sardines in oil 200
Sardines in tomato sauce 320
Tuna in oil 120
Canned herring 640
Whole milk 0.8
White yoghurt 3.5% 2.4
Butter 40
Whipped cream 40
Emmental 45% 120
Brie 12
Gouda 40
Parmesan 24
Fat curd 8
Wheat 2760

Within prevention and therapy of osteoporosis it is important to reduce drinking of alcohol, reduce intake of caffeine, and it is absolutely essential not to smoke! Regular and adequate physical activity is an integral part of osteoporosis prevention and therapy. Exercise definitely has a favourable effect on bone metabolism. Regular motion activity helps to achieve the maximum amount of bone mass in young age, and in older age it protects against bone mass loss. Motion activity must be individually induced, regular, and properly performed. Each patient should be examined by a physiotherapist, and based on this examination, each one should create his or her own motion regime to be regularly adhered to on a daily basis. Regular walking and swimming should become a typical part of life of osteoporotic patients. Each motion activity is accompanied with certain fall risk rate, therefore also a fracture risk rate; however, risk of fracture is even higher for a bone which is not burdened. Within fracture prevention each patient should care about safety of his environment. It is important to consider appropriate and strong shoes, which guarantee stability, antiskid surfaces in bathroom are suitable, as well as handrails facilitating movements in a bath, railing on staircase,…