Preventing osteoporosis - What you can do
One in four women and one in 17 men in Germany is affected by osteoporosis [1]. Because this disease, which is partly linked to nutrition, is so common, it is also referred to as a "widespread disease". The occurrence of osteoporosis in the family is a major concern for many, as genetic predisposition plays a major role in the disease. However, the situation is by no means hopeless, as there are many ways to prevent osteoporosis. Find out here how nutrition, exercise, etc. can have a positive effect on bone density.
Table of contents
- What is osteoporosis?
- Overview of risk factors for osteoporosis
- What role does bone density play in osteoporosis prevention?
- These nutrients and foods support osteoporosis prevention
- Why foods containing phosphates can increase the risk of osteoporosis
- Alcohol and caffeine also promote the development of osteoporosis
- Are dietary supplements suitable for preventing osteoporosis?
- What is the most effective exercise to prevent osteoporosis?
- Hormones and osteoporosis
- Conclusion
What is osteoporosis?
Osteoporosis is a systemic disease of the skeleton . Low bone mass and poor structure of bone tissue at the micro level lead to increasing fragility [2].
Our bones consist of a special tissue that gives them shape and forms the basic structure. Minerals such as calcium and phosphorus are stored in this framework. This is what makes the bones really stable. Up to the age of 25-30, the body builds up more bone mass than it breaks down. After this turning point, however, the breakdown is more severe. Various factors such as a lack of calcium and exercise or hormonal diseases can promote disorders of bone metabolism [2, 3].
Overview of risk factors for osteoporosis
Osteoporosis occurs primarily in women after menopause , but also in older people of both sexes . Women are more likely to suffer from the disease because they lose bone mass more quickly after menopause [2]. This is explained in more detail in the subsection Hormones and Osteoporosis.
Genetics play a major role in the development of osteoporosis. If the mother suffers from osteoporosis, the children's bone density is lower than in children of mothers who do not suffer from the disease [2].
In addition to genes, lifestyle is also important. Cigarettes and alcohol have a negative effect on bone activity. Other risk factors include a diet low in calcium or one that impairs calcium bioavailability. Some medications (e.g. laxatives and diuretics, cortisone) and diseases (e.g. kidney or thyroid diseases) have a negative effect on calcium balance. In addition , exercise and vitamin D deficiency increase the risk of osteoporosis because these factors are important for bone health. [2]
What role does bone density play in osteoporosis prevention?
Bone density is a decisive factor in osteoporosis. Maximum bone density or “peak bone mass” is reached between the ages of 25 and 30 [2]. It is largely genetically determined , but is also influenced by lifestyle [4].
Once maximum bone density is reached, it only decreases. The aim of prevention is to first achieve the highest possible "peak bone mass" and then to keep bone loss to a minimum .
These nutrients and foods support osteoporosis prevention
Calcium plays a key role in the prevention of osteoporosis [5]. The mineral is needed to maintain normal bones. In sufficient quantities, it counteracts bone loss in postmenopausal women [6]. In addition to dairy products, calcium is also found in significant quantities in broccoli, kale, soybeans and Brazil nuts.
Which mineral water is suitable?
Many mineral waters also contain calcium. Those with at least 150 mg/L can be advertised as containing calcium. Calcium-rich mineral waters are particularly helpful in preventing and treating osteoporosis for people who avoid dairy products. In addition to a high calcium content, a low sodium content and a lot of bicarbonate as an acid buffer are recommended [7].
Vitamin D3 is important for calcium absorption and bone health [5]. The so-called sunshine vitamin is necessary for a normal calcium concentration in the blood and the normal absorption of calcium and phosphorus into the body [6]. Unfortunately, vitamin D is only found in a few foods such as fatty fish, eggs and mushrooms. It is mainly produced in the body when UV radiation hits the skin.
The macronutrient Magnesium is incorporated into the bone matrix and contributes to the maintenance of normal bones [6]. Magnesium is found in legumes, many seeds, millet and bananas.
Carotenoids and vitamin C can protect bone mass because they have an antioxidant effect and counteract free radicals in the body [6]. Vitamin K activates important bone proteins in the body [5] and thus also contributes to the maintenance of normal bones [6]. Carotenoids and vitamin C are found in various types of fruit and vegetables along with other vitamins, minerals and secondary plant substances. Vitamin K is found primarily in green leafy vegetables and vegetable oils.
In a Swedish study of university students and athletes, measurements of total bone density in the spine found a positive correlation between the omega-3 fatty acid level (especially DHA) and bone growth during the observation period. However, the subjects' other eating habits were not taken into account, which is why the results should be critically examined [8].
There is no general effect that can be given for proteins . While a low protein intake leads to an increased risk of fractures in older people, excessive intake can have a negative impact on calcium balance [5]. The dose also makes the difference for fiber . The DGE recommends a moderate intake for a balanced diet, but excessive consumption of isolated fiber is detrimental to osteoporosis prevention because of its ability to chelate with calcium [2].
Isolated fiber and chelation with calcium
Isolated dietary fibers such as pectin or inulin can be purchased in the form of powder, drinks or chewable tablets. Chelating agents can form complex compounds with metal ions such as calcium by surrounding them. The chelates are then excreted via the kidneys in the urine.
Why foods containing phosphates can increase the risk of osteoporosis
The consumption of cola should be kept to a minimum, as the soft drink contains phosphoric acid . If there is a lot of phosphorus but little calcium in the body, calcium binds to phosphorus, causing serum calcium, i.e. the calcium level in the blood serum, to fall. With small intakes, it is unlikely that the calcium-phosphorus ratio will be disrupted; however, larger amounts without the intake of calcium or other neutralizing components are not recommended [5].
Alcohol and caffeine also promote the development of osteoporosis
A systematic review from 2019 found a link between alcohol consumption and an increased risk of osteoporosis [9]. Excessive consumption of alcoholic beverages inhibits the cells involved in bone formation. In addition, vitamin D metabolism is negatively affected [10]. In addition to alcohol, caffeine is also unfavorable for osteoporosis prevention, as it increases the excretion of calcium in the urine [2].
Are dietary supplements suitable for preventing osteoporosis?
Calcium intake recommendations for older adults are often not met, which is why doctors often recommend calcium supplements to older patients. Younger people usually get enough calcium from their diet and therefore do not need supplements [5].
Although the majority of the population does not have a vitamin D deficiency, they do not make full use of the preventive potential of vitamin D for bone health [11]. To compensate for this supply deficit, supplementation could be useful, especially in times of little sun, as vitamin D is hardly contained in food. A vitamin D supplement should always be coordinated with vitamin K2 , as vitamin K2 supports the positive effects of vitamin D by activating proteins such as osteocalcin and thus making them usable [12].
Dietary supplements cannot replace a balanced diet [5]. But diet is not the only important factor in preventing osteoporosis. Physical activity also has a major impact on bones.
What is the most effective exercise to prevent osteoporosis?
Regular walks reduce the risk of osteoporosis because they provide exercise and are a natural way to get vitamin D [13]. However, studies have shown that weight-bearing physical activity is also important for bone health. Short, intense activities have a stronger effect than long, less intense ones [4]. The senior physician at an orthopedic clinic, Dr. Rath, also emphasizes the importance of muscle strength and coordination for preventing falls [13]. It is still important to ensure that no damage occurs due to excessive strain [4].
Quote from Dr. Rath: "It is important that muscle strength and coordination are improved in order to avoid possible falls"
The exercise sessions should be adapted to the individual's fitness level . It should be at least 120-150 minutes per week spread over three or more sessions. Gymnastics and aerobics are also suitable for untrained and older people; game sports combine a variety of movements and strains [4].
Hormones and osteoporosis
Estrogens ensure that calcium is stored in the bones [14]. From puberty onwards, these hormones are important for peak bone mass and then for maintaining the bone mass achieved until menopause. Estrogens are produced in the ovaries . Since ovarian function ends with the onset of menopause , women are often affected by osteoporosis during this phase. An early menopause and a late onset of menstruation are therefore associated with a higher risk of osteoporosis [15]. Hormone therapy can prevent excessive bone loss; however, estrogens are suspected of increasing the risk of breast cancer, and menstruation also returns [2].
Hormonal changes are also often the cause of osteoporosis in men . As we get older, testosterone production levels off. This sex hormone is used to produce estradiol, which is involved in bone formation. If less testosterone can be converted to estradiol, bone loss occurs [16].
Conclusion:
Osteoporosis is characterized by low bone mass and poor bone microarchitecture. The goal of osteoporosis prevention is to achieve high bone density at a young age and to slow down bone loss from the age of 35. Bone density is largely genetically determined, but a calcium-rich diet, regular exercise and abstaining from smoking and alcohol consumption can have a beneficial effect within certain limits.
