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What is Osteoporosis? Osteoporosis literally means “porous bone.” Osteoporosis involves both the mineral (inorganic) and nonmineral (organic matrix, composed primarily of protein) components of bone. Bone is dynamic living tissue that is constantly being broken down and rebuilt, even in adults. Osteoporosis occurs when there is more bone breaking down than being formed. Osteoporosis is usually without symptoms until severe backache or hip fracture occurs. Osteoporosis is best diagnosed by dual energy X-ray absorptiometry (DEXA) a technique that measures bone density. What causes Osteoporosis? Normal bone metabolism is dependent on an intricate interplay of many nutritional, lifestyle, and hormonal factors. Many dietary factors have been suggested as a cause of osteoporosis including: low-calcium-high-phosphorus intake, high-protein diet, high-acid-ash diet, high salt intake, and trace-mineral deficiencies, to name a few. Osteoporosis is most common in postmenopausal Asian and white women. Other risk factors for osteoporosis include: family history of osteoporosis; physical inactivity; short stature, low body mass, and/or small bones; and never having been pregnant. What dietary factors are important in Osteoporosis? A high-protein diet is associated with increased excretion of calcium in the urine and increased risk for osteoporosis, too. Raising daily protein intake from 47 to 142 grams doubles the excretion of calcium in the urine. However, too little protein is also associated with an increased risk for osteoporosis In contrast, a vegetarian diet is associated with a lower risk of osteoporosis. Although bone mass in vegetarians does not differ significantly from that of omnivores in the third, fourth, and fifth decades of life, there are significant differences in the later decades. These findings indicate that the decreased incidence of osteoporosis among vegetarians is not due to increased initial bone mass, but rather to decreased bone loss. A diet high in salt or acid ash also causes calcium removal from bones and increases calcium loss in the urine. Therefore, we recommend avoiding salt and eating an alkaline based diet. Basically, an alkaline diet is one that focuses on vegetables, fruit, nuts, and legumes while avoiding overconsumption of meat and dairy. Soft drinks containing phosphates (phosphoric acid) are definitely linked to osteoporosis because they lead to lower calcium levels and higher phosphate levels in the blood. When phosphate levels are high and calcium levels are low, calcium is pulled out of the bones. The phosphate content of soft drinks, such as Coca-Cola and Pepsi, is very high, and they contain virtually no calcium. If you are concerned about developing or are at risk of developing osteoporosis you will want to eliminate soft drinks from your diet. Refined sugar intake also increases the loss of calcium from the bone. Regular consumption of refined sugar increases loss of calcium from the blood through the urine. Calcium is then pulled from the bones to maintain blood calcium levels as foods containing refined sugar generally do not contain calcium. Calcium is not the only nutrient that is important for bone formation. Many trace minerals such as copper, manganese, zinc and boron are also important. A deficiency in trace minerals can also predispose someone to osteoporosis. Green leafy vegetables from the cabbage family, including broccoli, Brussels’s sprouts, kale, collards, and mustard greens, as well as green tea offer significant protection against osteoporosis. These foods are a rich source of a broad range of vitamins and minerals that are important to maintaining healthy bones, including calcium, vitamin K1, and boron. Vitamin K1 is the form of vitamin K that is found in plants. A function of vitamin K1 is to convert inactive osteocalcin to its active form. Osteocalcin is an important protein in bone. Its role is to anchor calcium molecules and hold them in place within the bone. In addition, soy foods, such as tofu, soy milk, roasted soybeans and soy extract powders, may be beneficial in preventing osteoporosis. In several double-blind studies, taking 40 grams of soy protein powder containing 80-to-90 mg isoflavones increased bone mineral density of the spine and hips in post menopausal women. Alfalfa is another isoflavone and vitamin K rich food that can also be included in the diet. However, while numerous clinical studies have demonstrated that calcium supplementation can help prevent bone loss, the data is inconclusive in regard to any link between a high dietary calcium intake from milk and prevention of osteoporosis and bone fractures. When reviewing the data from the Nurses’ Health Study, a study involving 77,761 women, researchers found no evidence that higher intakes of milk actually reduced fracture incidence. In fact, women who drank 2 or more glasses of milk per day had an increased relative risk of 45% for hip fracture compared to women consuming 1 glass or less per week. In other words, the more milk a woman consumed, the more likely she was to experience a hip fracture. This negative effect may turn out to be due to the vitamin A added to milk (at higher levels, vitamin A, but not beta-carotene may interfere with bone formation). Interestingly, if you look at the rate of osteoporosis worldwide, it is much higher in countries where milk intake is highest. What nutritional supplements should I take for Osteoporosis? Health Bones Plus from Natural Factors is based on the latest research to promote bone health. It provides a comprehensive formula to augment the high nutrient levels in the MultiStart for Women formulas to provide an effective bone health strategy. This combination provides the therapeutic dosages given below for each of the discussed nutrients. OsteoSense provides calcium in the form of tricalcium phosphate. Here is why: - Provides 1,000 mg of highly absorbable forms of calcium and 500 mg of magnesium. - Contains BioSil – the clinically proven bioavailable form of silicon that increases the collagen matrix of bone. - Provides other nutrients critical to both the collagen and mineral matrix of bone. - For more information go to www.healthybonesplus.com. Calcium supplementation alone has shown little benefit in treating or preventing osteoporosis. But, combined with vitamin D, calcium supplementation can slow the rate of bone loss by as much as thirty percent and it offers significant protection against hip fractures. The recommended dosage for calcium is 1,000 mg daily. Vitamin D supplementation is associated with increased bone density and studies that combined vitamin D with calcium produced better results than either nutrient alone. Vitamin D supplementation is especially helpful for elderly people who don’t get sufficient exposure to sunlight (which stimulates the body’s manufacture of vitamin D)-those who live in nursing homes or farther away from the equator, or those who do not regularly get outside. The daily dosage recommendation for vitamin D for prevention is now 2,000 IU. For those with existing osteoporosis I recommend 5,000 IU daily. Magnesium supplementation is thought by some experts to be as important as calcium supplementation in the prevention and treatment of osteoporosis. Women with osteoporosis have lower bone magnesium content and other indicators of magnesium deficiency than people without osteoporosis. The recommended dosage is 250 to 500 mg daily. Vitamin B6, folic acid, and vitamin B12 are important in the conversion of the amino acid methionine to cysteine. If a person is deficient in these vitamins, there will be an increase in homocysteine level. Homocysteine has been implicated in a variety of conditions, including atherosclerosis and osteoporosis. Combinations of these vitamins will produce better results than any one of them. The recommended daily dosages are 25 to 100 mg for vitamin B6, and 400 to 800 mcg for folic acid and vitamin B12. Biosil is a highly bioavailable from of silica that has shown clinical effects in improving bone density and the collagen content of the bone. By increasing the collagen content of the bone by 22% within one year of use, BioSil increases the number of bone mineral binding sites. Supplementing at a dosage of 6 mg per day increased bone mineral density by 2% within one year – safely and without side effect. Vitamin K2 effectively activates osteocalcin, a protein that anchors calcium into the bone matrix. Supplementing with 180 mcg per day has been shown to significantly improve bone health and density. Boron is a trace mineral that has gained attention as a protective factor against osteoporosis. It appears that boron is required to activate certain hormones, including estrogen and vitamin D. In order to guarantee adequate boron levels, supplementing the diet with a daily dose of 3 to 5 mg of boron is recommended. Ipriflavone is a semi-synthetic flavonoid (isoflavone) derived from the soy compound daidzein. Ipriflavone promotes the incorporation of calcium into bone. It also inhibits bone breakdown. Many clinical studies, including numerous double-blind studies, clearly show long-term treatment with ipriflavone (along with 1,000 mg supplemental calcium) is both safe and effective in halting bone loss in post-menopausal women or women who have had their ovaries removed as well as improving bone density in cases of osteoporosis. The typical dosage of ipriflavone is 600 mg daily. Comment: Although nutritional factors are important, I cannot stress enough that the best thing a person can do to strengthen their bones is to get physical activity. Physical exercise, consisting of one hour of moderate activity (e.g., walking, weight lifting, dancing, etc.) three times a week, has been shown to prevent bone loss and actually increase bone mass in postmenopausal women. In contrast to exercise, lack of physical activity doubles the rate of calcium lost from the system. How do I know if the recommendations are working? If you are female, attention to bone health must be a lifetime goal. I recommend getting a baseline bone density assessment such as a DEXA scan. It can provide valuable information on your bone density and can also be used as a long-term monitor.
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Mnogi od nas s vremenom se susreću s pojmom osteoporoze, ne samo u seniorskim, već i u mlađim godinama života, naročito kad se radi o otežanom kretanju, bolovima… Radi se zapravo o gubitku koštane mase i njegovog mineralnog i organskog djela. - Kosti postaju lomljive i upravo su frakture jedna od najopasnijih posljedica osteoporoze - ističe magistra Marijana Piškulić Radionov iz Farmacie u Jurišićevoj 3 u Zagrebu - bolovi u leđima, smanjenje tjelesne visine i prijelomi ukoliko se dogodi pad, simptomi su koji ukoliko se pojave mogu upućivati upravo na ovu bolest - . Farmacia - koja mi je najbliža? Građa i nastanak kosti Poput svih sustava u organizmu koštana masa nije stalna, već je podložna promjenama i bilo kakvo narušavanje ravnoteže može uzrokovati pojavu gubitka koštane mase. Kost se sastoji od čvrstog organskog matriksa kojeg tvore kolagenska vlakna i osnovna tvar sastavljena od izvan-stanične tekućine, kondroitin-sulfata i hijaluronske kiseline. Stvara se na način da stanice osteoblasti seceniraju kolagen i osnovnu tvar. Kolagen se polimerizira u vlakna pa nastaje osteoid. Na njihovoj površini odlažu se kalcijeve soli koje se raspoređuju u pravilnom razmaku na svakom vlaknu tvoreći kristale hidroksiapatita. Kako nastaje osteoporoza? Osteoblasti se nalaze na vanjskim površinama kostiju i u koštanim šupljinama te neprekidno odlažu kost, a u prisutnosti osteoklasta kost se neprekidno apsorbira. Fiziološki postoji ravnoteža između apsorpcije i odlaganja kosti i na taj način ukupna koštana masa ostaje stalnom. Ukoliko aktivnost osteoblasta i osteoklasta nije pravilna, nastat će osteoporoza. Ako je osteoblastična aktivnost smanjena, smanjeno je odlaganje osteoida u kost (nosač kalcijevih soli). Kod nekih bolesti, npr. hiperparatireoze, može biti povećana osteoklastična aktivnost, jer paratiroidni hormon potiče apsorpciju kalcijevih soli iz kosti. Najveća se gustoća kostiju postiže u tridesetim godinama života, s godinama se smanjuje a nakon menopauze smanjuje se 10x brže. Uzroci osteoporoze Čimbenici koji povećavaju rizik njezinog nastanka svakako su smanjena fizička aktivnost jer su kosti pod nedovoljnim fizičkim opterećenjem, a upravo je opterećenje jedan od faktora povećane osteoblastične aktivosti te zdrave izgradnje koštanog sustava. Početak vježbanja u adolescenciji izuzetno je važan za prevenciju kasnijeg nastanka bolesti, a u starijoj dobi ukoliko se bolest pojavila smanjuje njezinu progresiju. Izbjegavanje pušenja i konzumacije alkohola koji smanjuju apsorpciju kalcija u crijevima izuzetno su važne u prevenciji bolesti. Kod mršavih ljudi sa smanjenim BMI kao i kod žena u postmenopauzi rizik je veći jer smanjena razina estrogena smanjuje osteoblastičnu aktivnost. U odnosu na druga stanja, bolesti i lijekove Neke bolesti poput hiperparatireoidizma, Cushingovog sindroma, tireotoksikoza, dijabetesa, poremećaji GI i hepatobilijarne funkcije, kronične bolesti pluća, te različiti tumori uzroci su na koje se ne može utjecati prevencijom ali se ukoliko osteoporoza nastane može uspješno liječiti lijekovima. Kortikosteroidi, antikonvulzivi, antikoagulansi, tamoxifen lijekovi su koji kao nuspojavu mogu imati gubitak koštane mase. Trudnoća i laktacija stanja su koja fiziološki smanjuju razine kalcija u majčinom organizmu i zato je izuzetno važna umjerena tjelesna aktivnost te unošenje suplemenata kalcija. Kako odrediti gustoću i kvalitetu kostiju? Prema individualnom riziku za osteoporozu radi se metoda probira postupkom koji se zove denzitometrija. Denzitometrom se određuje gustoća mineralnog dijela kostiju i to bedrene kosti te lumbalne kralježnice. Denzitometriju trebaju učiniti žene mlađe od 65 godina sa jednim ili više čimbenika rizika. Osim kod liječnika, denzitometrija se provodi i u ljekarnama u vidu javnozdravstvenih akcija, obično u listopadu kada je Svjetski dan borbe protiv osteoporoze, a gustoća kostiju mjeri se pomoću UZV na petnoj kosti. Pacijent odmah dobije nalaz liječnika te preporuku farmaceuta vezano uz suplementaciju kalcijem, vitaminom D, prehranu i fizičku aktivnost. Koji su čimbenici rizika za osteoporozu? Čimbenici rizika su sve žene starije od 65 godina, muškarci s kliničkom slikom osteoporoze, odrasli koji imaju kronične bolesti ili stanja te uzimaju lijekove povezane s gubitkom gustoće kosti i u svrhu kontrole bolesti. Obavezno uzimanje kalcija i D vitamina Kod svih osoba koje imaju povećan rizik razvoja osteoporoze ili već dijagnosticiranu osteopeniju (smanjenje gustoće koštane mase) preporuča se obavezno uzimanje nadomjestaka kalcija i D vitamina. Vitamin D je posebno važan jer pospješuje kalcifikaciju kostiju povećavajući asporpciju kalcija i fosfata u crijevima te ubrzava mineralizaciju kosti. Apsorpcija kalcija je slaba jer su spojevi kalcija uglavnom netopivi. Najbolje iskoristive su soli Ca-citrata i Ca-glukonata, a najslabije Ca-karbonata. Preporučena doza je 1500 mg kalcija i 800 IU vitamina D. Potrebno je napomenuti da dozu od 1000 ili 1500 mg kalcija je potrebno raspodijeliti na više dnevnih doza od 500 mg jer organizam nema sposobnost resorpcije veće doze kalcija odjednom. Doziranje vitamina D u terapiji Doziranje vitamina D se prema najnovijim smjernicama mijenjalo prema višim dozama koje je moguće uzimati jednom tjedno i/ili jednom mjesečno, ovisno o stupnju osteoporoze ili osteopenije koje će propisati liječnik na recept nakon kontrole deficita vitamina D u organizma. Tada se uzima kao pulsna terapija od 25.000 IU tjedno ili 25.000 IU mjesečno. Koje i kakve dodatke prehrani izabrati? Oblici kalcija i vitamina D dostupni na tržištu kao i doze su različiti. Postoji kalcij u šumećim tabletama u kombinaciji sa vitaminom D, tabletirani oblici kalcij-citata ili tekući oblici sa dodatkom magnezija. Vitamin D postoji u obliku kapi i tableta koje se mogu kupiti bez recepta ili visoko doziranih ampula koje se kupuju uz liječnički recept. Magnezij je također izuzetno važan mineral koji pospješuje apsorpciju kalcija. On smanjuje djelovanje paratiroidnog hormona koji povećava razgradnju kostiju i važan je u sintezi vitamina D. Doza magnezija koja se preporuča je 250-400 mg/dan. Prirodni pripravci i fitoterapija Osobe sklone fitoterapiji mogu imati dobre rezultate u prevenciji osteoporoze pripravkom na bazi preslice, koprive i crnog ribiza. Preslica je bogata silicijem i igra važnu ulogu u zacjeljivanju kostiju nakon prijeloma i u prevenciji/liječenju osteoporoze. Navedeni tekući pripravak, uz preslicu sadrži crni ribiz koji djeluje protuupalno i list koprive koja djeluje adjuvatno u simptomatskoj terapiji osteoartritisa i reumatoidnog artritisa. Preparat se uzima 2x dnevno po 5 ml, kroz razdoblje od 3 mjeseca. Osteoporoza u menopauzi U menopauzi, kada se fiziološki smanjuje koncentracija estrogena, posljedično dolazi do smanjenja ugradnje kalcija u kosti. Tekući fitoterapijski pripravci na bazi konopljike i muškatne kadulje regulirat će hormonalnu ravnotežu i indirektno utjecati na zdravlje koštanog sustava. Preparat se uzima 2x dnevno po 5 ml, kroz razdoblje od 3 mjeseca. Prehrana & osteoporoza Prehrana je jako važna u prevenciji i liječenju osteoporoze jer prevelika kiselost našeg organizma (konzumacija većih količina mesa i šećera) ometa apsorpciju kalcija. Mliječni proizvodi, orašasti plodovi, suho voće, sezam, poriluk, alge bogate su kalcijem. Riba i žutanjak obiluju vitaminom D. Mahunarke, žitarice i meso bogati su magnezijem. Od vitamina za apsorpciju kalcija također je važan K vitamin, a od minerala cink. Uznapredovala osteoporoza Kod uznapredovale osteoporoze koristimo lijekove koje će liječnik propisati na recept. Cilj liječenja je stabilizacija i povećanje gustoće koštane mase te unaprjeđenje i očuvanje funkcionalne sposobnosti. Liječnik se može odlučiti za uvođenje hormonske nadomjesne terapije kod žena u menopauzi kako bi se regulirala hormonalna neravnoteža s posljedicom pojave osteoporoze. Međutim za takav način liječenja postoje ograničenja i određeni rizici ukoliko pripadate rizičnim skupinama kao što su npr. povećan rizik od tromboembolije i karcinoma dojke. U ovim slučajevima fitoterapijski pristup koji smo već opisali je dobar izbor. Ovisno o težini osteoporoze, liječnik će propisati i druge lijekove kao što su bisfosfonati koji su ujedno i najupotrebljavaniji lijekovi. Osteoporoza je bolest koja zahtjeva dugogodišnje liječenje, no mjere prevencije su izuzetno važne. Pravilnom prehranom, vježbanjem i izbjegavanjem faktora rizika moguće je itekako smanjiti mogućnosti njezinog nastanka ili progresije!