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| ===Calcium and vitamin D=== | | ===Calcium and vitamin D=== |
| '''Calcium:''' The patient should consume 1200 to 1500 mg of [[calcium]] daily, either via [[dietary]] means (e.g., 8 oz glass of milk contains approximately 300 mg of [[calcium]]) or via supplementation. The body absorbs only about 500 mg of [[calcium]] at one time and so intake should be spread throughout the day. However, the benefit of supplementation of [[calcium]] alone remains controversial, to a degree, since several nations with high [[calcium]] intakes through [[milk]]-products (e.g., the USA and Sweden) have some of the highest rates of [[osteoporosis]] worldwide; though this may be linked to such countries' excess consumption of [[protein]]. A few studies even suggested an adverse effect of [[calcium]] excess on [[bone density]] and blamed the milk industry for misleading customers. Some [[nutritionists]] assert that excess consumption of dairy products causes acidification, which leaches [[calcium]] from the system, and argue that vegetables and nuts are a better source of [[calcium]] and that in fact, [[milk]] products should be avoided. This theory has no proof from scientific clinical studies. Similarly, nutritionists believe that excess [[caffeine]] consumption can also contribute to leaching [[calcium]] from the [[bones]].<ref name="pmid21118827">{{cite journal| author=Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al.| title=The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 1 | pages= 53-8 | pmid=21118827 | doi=10.1210/jc.2010-2704 | pmc=3046611 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21118827 }}</ref>
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| * A [[meta-analysis]] of [[randomized controlled trials]] concluded "evidence supports the use of [[calcium]], or [[calcium]] in combination with [[vitamin D]] supplementation, in the preventive treatment of [[osteoporosis]] in people aged 50 years or older. For best therapeutic effect, recommended minimum dose [[calcium]] is 1200 mg, and of [[vitamin D]] is 800 IU (for combined [[calcium]] plus [[vitamin D]] supplementation)". A study that examined the relationship between [[calcium]] supplementation and clinical [[fracture]] risk in an elderly population, there was a significant decrease in fracture risk in patients that received [[calcium]] supplements versus those that received [[placebo]]. However, this benefit only applied to patients who were compliant with their treatment regimen.<ref name="pmid17720017">{{cite journal |author=Tang BMP et al |title=Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis|journal=Lancet |volume=370 |issue= |pages=657-666 |year=2007 |pmid= |doi=10.1016/S0140-6736(07)61342-7}}</ref><ref>{{cite journal |author=Prince RL, Devine A, Dhaliwal SS, Dick IM |title=Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women |journal=Arch. Intern. Med. |volume=166 |issue=8 |pages=869–75|year=2006 |pmid=16636212 |doi=10.1001/archinte.166.8.869}}</ref>
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| ==== Estimating daily dietary calcium intake ====
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| * First step: Estimate [[calcium]] intake from [[calcium]]-rich foods based on these measures:
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| ** [[Milk]] (8 oz.) equal to one serving has 300 mg calcium
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| ** Yogurt (6 oz.) equal to one serving has 300 mg calcium
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| ** [[Cheese]] (1 oz. or 1 cubic in.) equal to one serving has 200 mg calcium
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| ** Fortified food or juice equal to one serving has 80 to 1000 mg calcium
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| * Second step: Add the summation 250 mg for other non-diary foods<ref name="pmid25182228">{{cite journal| author=Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S et al.| title=Clinician's Guide to Prevention and Treatment of Osteoporosis. | journal=Osteoporos Int | year= 2014 | volume= 25 | issue= 10 | pages= 2359-81 | pmid=25182228 | doi=10.1007/s00198-014-2794-2 | pmc=4176573 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182228 }}</ref>
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| '''Vitamin:''' Increasing [[vitamin D]] intake has been shown to reduce [[fractures]] up to twenty-five percent in older people, according to recent studies.<ref>{{cite journal |author=Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B|title=Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials |journal=JAMA|volume=293 |issue=18 |pages=2257–64 |year=2005 |pmid=15886381 |doi=10.1001/jama.293.18.2257}}</ref><ref name="pmid17720017" /> The very large Women's Health Initiative study, however, did not find any [[fracture]] benefit from [[calcium]] and [[vitamin D]] supplementation, but these women were already taking (on average) 1200 mg/day of [[calcium]]. [[Muscle]] weakness can contribute to falls so it is beneficial for people living with [[osteoporosis]] to improve [[muscle]] function. [[Vitamin D deficiency]] causes [[muscle]] weakness.<ref>{{cite journal |author=Holick MF |title=Resurrection of vitamin D deficiency and rickets |journal=J. Clin. Invest.|volume=116 |issue=8 |pages=2062–72 |year=2006 |pmid=16886050 |doi=10.1172/JCI29449}}</ref> A meta-analysis of five clinical trials showed 800 IU of [[vitamin D]] per day (plus [[calcium]]) reduced the risk of falls by 22%.<ref>{{cite journal|author=Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B |title=Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes |journal=Am. J. Clin. Nutr. |volume=84 |issue=1 |pages=18–28|year=2006 |pmid=16825677 |doi=}}</ref> A different randomized, controlled study showed nursing home residents who took 800 IU of [[vitamin D]] per day (plus [[calcium]]) having a 72% reduction in the risk of falls.<ref>{{cite journal |author=Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP |title=A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study |journal=Journal of the American Geriatrics Society |volume=55 |issue=2 |pages=234–9|year=2007 |pmid=17302660 |doi=10.1111/j.1532-5415.2007.01048.x}}</ref> New [[vitamin D]] intake recommendations ([[National Osteoporosis Foundation]], July 2014) are adults up to age 50, 400-800 IU daily and those over 50, 800 - 1,000 IU daily.
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| *'''[[Excess protein]]''': There are three elements relating to a person's levels of [[calcium]], including consumption, absorption, and excretion. High [[protein]] intake is known to encourage urinary [[calcium]] losses and has been shown to increase risk of [[fracture]] in research studies.<ref>{{cite journal|author=Feskanich D, Willett WC, Stampfer MJ, Colditz GA |title=Protein consumption and bone fractures in women |journal=Am. J. Epidemiol. |volume=143 |issue=5 |pages=472–9 |year=1996 |pmid=8610662 |doi=}}</ref><ref>{{cite journal |author=Abelow BJ, Holford TR, Insogna KL |title=Cross-cultural association between dietary animal protein and hip fracture: a hypothesis |journal=Calcif. Tissue Int. |volume=50 |issue=1 |pages=14–8 |year=1992 |pmid=1739864 |doi=}}</ref>
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| *'''Others''': There is some evidence to suggest [[bone density]] benefits from taking the following [[supplements]] (in addition to [[calcium]] and [[vitamin D]]), including [[magnesium]], [[zinc]], [[copper]], [[manganese]], [[silicon]], [[strontium]], [[folic acid]], and [[Vitamin B6|vitamins B6]], [[Vitamin C|C]], and [[Vitamin K|K]].<ref>Gaby, Alan R.,''Preventing and Reversing Osteoporosis,'' 1994. ISBN 0-7615-0022-7</ref><ref>Kessler, George J., ''The Bone Density Diet,''2000. ISBN 0-345-43284-3</ref> This is weak evidence and quite controversial.
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| === Diet ===
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| Sufficient [[protein]] intakes are necessary to maintain the function of the [[musculoskeletal]] system and they also decrease the complications that occur after an osteoporotic [[fracture]]. Correction of poor [[protein]] [[nutrition]] in patients with a recent [[hip fracture]] has been shown to improve the subsequent clinical course by significantly lowering the rate of complications, such as [[bedsores]], severe [[anaemia]], and intercurrent [[lung]] or [[renal]] infection. The duration of hospital stay of elderly patients with [[hip fracture]] can thus be shortened.<ref name="pmid284250853">{{cite journal| author=Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N et al.| title=UK clinical guideline for the prevention and treatment of osteoporosis. | journal=Arch Osteoporos | year= 2017 | volume= 12 | issue= 1 | pages= 43 | pmid=28425085 | doi=10.1007/s11657-017-0324-5 | pmc=5397452 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28425085 }}</ref>
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| ===Exercise===
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| Multiple studies have shown that [[aerobics]], weight lifting, and resistance exercises can all maintain or increase [[Bone mineral density|BMD]] in [[postmenopausal]] women.<ref>{{cite journal |author=Bonaiuti D, Shea B, Iovine R, ''et al'' |title=Exercise for preventing and treating osteoporosis in postmenopausal women |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3|pages=CD000333 |year=2002 |pmid=12137611 |doi=}}</ref>
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| Many researchers have attempted to pinpoint which types of exercise are most effective at improving [[Bone mineral density|BMD]] and other metrics of [[bone]] quality, however, results have varied. One year of regular jumping exercises appears to increase the [[Bone mineral density|BMD]] and moment of inertia of the proximal [[tibia]] in normal [[postmenopausal]] women.<ref>{{cite journal |author=Cheng S, Sipilä S, Taaffe DR, Puolakka J, Suominen H |title=Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women |journal=Bone |volume=31 |issue=1 |pages=126–35 |year=2002 |pmid=12110425|doi=}}</ref>
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| Treadmill walking, gymnastic training, stepping, jumping, endurance, and strength [[exercises]] all resulted in significant increases of L2-L4 [[Bone mineral density|BMD]] in [[Osteopenia|osteopenic]] [[postmenopausal]] women.<ref>{{cite journal |author=Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS |title=Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women|journal=Calcif. Tissue Int. |volume=67 |issue=6 |pages=443–8 |year=2000 |pmid=11289692 |doi=}}</ref><ref>{{cite journal|author=Iwamoto J, Takeda T, Ichimura S |title=Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis |journal=Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association |volume=6 |issue=2 |pages=128–32 |year=2001 |pmid=11484097 |doi=10.1007/s0077610060128}}</ref><ref>{{cite journal|author=Kemmler W, Engelke K, Weineck J, Hensen J, Kalender WA |title=The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results |journal=Archives of physical medicine and rehabilitation |volume=84 |issue=5 |pages=673–82 |year=2003 |pmid=12736880 |doi=}}</ref>
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| Strength training elicited improvements specifically in distal [[radius]] and [[hip]] [[Bone mineral density|BMD]].<ref>{{cite journal |author=Kerr D, Morton A, Dick I, Prince R|title=Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent |journal=J. Bone Miner. Res.|volume=11 |issue=2 |pages=218–25 |year=1996 |pmid=8822346 |doi=}}</ref>
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| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2], Cafer Zorkun, M.D., Ph.D. [3], Raviteja Guddeti, M.B.B.S.[4], Charmaine Patel, M.D. [5]
Overview
In osteoporosis, some of the lifestyle modification strategies would be beneficial for both primary prevention and also initial treatment; as osteoporosis mainly depends on lifestyle. Lifestyle modification, as well as calcium supplementation, are the best early and long-term measures for the prevention of osteoporosis. There are also medications available that can be used to prevent worsening of osteoporosis. The primary prevention of osteoporosis is particularly important because the micro-architectural changes that occur in osteoporosis are largely irreversible.
Primary prevention
In osteoporosis, some of the life style modification strategies would be beneficial for both primary prevention and also initial treatment; as osteoporosis mainly depends on life style.
Fall prevention
Major risk factors for falling are shown below:
- Environmental risk factors
- Lack of assistive devices in bathrooms
- Obstacles in the walking path
- Loose throw rugs
- Slippery conditions
- Low level lighting
- Medical risk factors
- Neurological and musculoskeletal risk factors
- Strategies for fall reduction:
Behavioral modification (smoking cessation and reduced alcohol consumption):
Advise patients to stop smoking. The use of tobacco products is detrimental to the skeleton as well as to overall health. National osteoporosis foundation (NOF) strongly encourages a smoking cessation program as an osteoporosis intervention. Recognize and treat patients with excessive alcohol intake. Moderate alcohol intake has no known negative effect on bone and may even be associated with slightly higher bone density and lower risk of fracture in postmenopausal women. However, alcohol intake of more than two drinks per day for women or three drinks a day for men may be detrimental to bone health, increases the risk of falling, and requires further evaluation for possible alcoholism.[1]
Calcium and vitamin D
References