Osteoporosis and diet

1. June/July 2014 Health&Medicine BCWJ ~ Page 17
Osteoporosis is a skeletal
disorder of compromised
strength as a result of
poor quality of bone and
increased risk for fracture.
Osteoporosis is linked to high
risk of fractures causing pain
and permanent disability.
Avoiding osteoporosis
requires proactive preventive
strategies, an active lifestyle,
and anti-inflammatory
nutrition.
More than 10 million people
in United States have
osteoporosis, and more
than 2 million osteoporotic
fractures occur each year.
Women have a higher risk
of fractures than men, and
75% of fractures affect
women; however, men are
at a greater risk of dying of
a hip fractures. Diagnosis
of osteoporosis involves the
use of DEXA scans, which
assess bone mineral density,
but they do not assess bone
quality. It is estimated that
about 47% of women over 50
have low bone density.
Risk factors
A Women’s Health Initiative
study found that the
following risk factors play a
major role in osteoporosis:
age above 50, weight,
height, race, ethnicity,
physical activity, history
of fracture, parents with
hip fracture, smoking,
chronic inflammation, and
corticosteroid use as well
as history of rheumatoid
arthritis, hypothyroidism,
celiac disease, and diabetes.
Pharmacological treatment
There are many treatment
options available for
patients with osteoporosis,
including estrogen
hormone replacement,
bisphosphonates,
selective estrogen receptor
modulators, calcitonin,
and strontium, to mention
a few. Fosamax, Actonel,
Boniva, and Reclast belong
to class of drugs called
bisphosphonates. In recent
years, new medications like
Prolia and Forteo have been
approved. All medications
have scientifically proven
benefits, but they also can
have side effects. Therefore,
a thorough discussion with
your healthcare provider is
important to inquire about
your need for osteoporosis
early detection, preventive
steps to take, and choice
of medications.
Lifestyle
Attaining a high peak bone
mass between the ages of 30
and 50 is an important factor
in preventing osteoporosis,
and studies show that
women with a diet adequate
in calcium, vitamin D, and
proteins along with an active
lifestyle during adolescence
and young adulthood have
less risk of developing
osteoporosis.
The substances that are
harmful to bone health
include excessive amounts of
vitamin A, caffeine, sodium,
and an imbalance of calcium
and phosphorus. Smoking
and excess alcohol are also
linked to increased risk of
osteoporosis-related fractures
and complications.
Nutritional supplements
The following supplements
have been studied extensively
for their proven role in
building and maintaining
healthy bones:
Calcium-Calcium is
important, and, to get about
300 mg of calcium, you will
need 8 oz. of milk or yogurt
or 1 oz. of Cheddar, Swiss
or Monterey Jack cheeses.
Nondairy calcium sources
include 1 oz. of white beans,
1/2 cup of spinach or turnips
greens, 1/2 cup of cooked or
fresh broccoli or bok choy,
1/2 cup of soybeans, or 1
oz. of dry-roasted almonds.
Salmon and dried figs are
also good sources.
Which calcium type is the
best-Calcium carbonate
should be taken with meals
and is less expensive. It
provides 40% elemental
calcium. Calcium citrate
is expensive but has some
advantages; it is well
absorbed and can be taken
with or without meals. If
you are on medication to
reduce stomach acids, this
is the best form. Calcium
citrate provides 21%
elemental calcium. Calcium
from sources like dolomite,
oyster shell, or coral are not
recommended.
How to take it-Large tablets
may be difficult to swallow
and may not absorb or
disintegrate in the stomach,
so calcium in powders,
capsules, and liquids
is better.
How much to take-
Remember that calcium
supplements should not
exceed 500 mg at any one
time. You should avoid taking
calcium supplements along
with psyllium or with foods
high in oxalic acid (e.g.,
spinach) or phytic acid (e.g.,
wheat bran).
Vitamin D—the sunshine
vitamin
Over the last decade,
there has been enormous
advancement in research
about vitamin D. Active
forms of vitamin D improve
transport of calcium across
the intestinal system.
Vitamin D also stimulates
the absorption of other
minerals such as phosphate
and magnesium. Vitamin
D and K stimulate bone
mineralization.
It is not a secret that Vitamin
D deficiency is widespread
throughout North America.
Studies have found that
women, older adults,
obese and dark-skinned
individuals, and breast-fed
infants are at higher risk. An
international study found
that 64% of postmenopausal
women with osteoporosis
have low vitamin D (less than
30 ng/mL level). It makes
sense to supplement with
vitamin D at doses of 400-
800 units/day. Vitamin D
supplementation has been
shown to reduce fracture risk
and the chance of falls and
to improve leg function in
older adults.
Vitamin D supplementation
doses
Normal dosing of vitamin D
depends on your blood levels.
After you have discussed
this with your healthcare
provider, a treatment dose
ranging from 2,000 to
10,000 units per day will
be recommended. If you are
already taking vitamin D, add
calcium, magnesium, and
vitamin K.
How much is too much-
It is very difficult to get too
much vitamin D, but regular
monitoring is required.
People with sarcoidosis,
lymphoma, or kidney disease
have to monitor their vitamin
D levels to ensure they don’t
rise too high.
About the author:
Dr. Farhan Tahir, MD is
board certified through the
American Board of Internal
Medicine, Rheumatology
and Integrative & Holistic
Medicine. He is a member
of the American College of
Rheumatology and founder
of Pennsylvania’s first and
only integrative rheumatology
practice. He lives in Bucks
County with his wife and
three young boys. To
contact Rheumatology Care
Consultants, PLLC,
call 267-685-6070 or email:
info@rheumpa.com. Its
website is www.RheumPA.
By: Farhan Tahir MD,
FACR, ABIHM
Window of Opportunity for the Big “O”
Farhan Tahir MD, FACR, ABIHM
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