In the prevention of osteoporosis, the most important issues are:
- Taking Vitamin D
- Adequate calcium intake
- Elimination of osteoporosis risk factors
- Fall prevention
- Exercise and active lifestyle
1. Taking Vitamin D
Vitamin D is absolutely essential for the absorption of dietary calcium from the intestines. Vitamin D is said to be "the key to the calcium pantry." Without it, even the consumption of significant amounts of calcium is ineffective. The human body produces vitamin D in the skin under the influence of solar radiation. It is estimated that approximately 15 minutes of full sun exposure to the face and forearms are needed daily for sufficient vitamin D levels. Unfortunately, the climate of Poland is not the best in this respect either. In the winter-autumn period, days without sun predominate. It is not surprising that the conducted research showed a very low level of vitamin D in 80% of the inhabitants of Poland during this period.
The recommended dose of Vit. D is 800-2000 IU. Prophylactic dose of a person over 60 years of age should take them throughout the year, and all others in the autumn and winter.
2. Adequate calcium intake
Getting the body the right amount of calcium through food is a key issue in preventing osteoporosis. We consume calcium with food, including as much as 75% with milk. Only about 30% of the calcium consumed in food is absorbed in the intestines. In the elderly, as well as in many diseases, the absorption of calcium from the intestines is impaired. If there is a lack of calcium in the diet, the body maintains the proper level of this element in the blood by bone resorption (parathyroid hormone). Increased bone resorption leads to osteoporosis.
The daily requirement for calcium in menopause and elderly people is about 1500 mg. The most calcium is found in milk and its products, especially in cheese. The table below tells you how much calcium we can consume with different foods.
Table - calcium content in food products.
|glass - 250 ml
|cup - 150g
|slice - 30g
|slice - 30g
|slice - 30g
|portion - 100g
|sardines (with bones)
|can - 150g
|slice - 50g
|cutlet - 100g
|portion - 300g
For patients who cannot tolerate milk (lactose intolerance), yogurt is recommended. The way to avoid quite a significant amount of fat and cholesterol contained in yellow cheese is to drink skimmed milk. If our diet does not cover the demand for calcium - it is necessary to supplement it with appropriate preparations. Today, there is a huge variety of calcium preparations, and virtually all of them are available without a prescription.
3. Elimination of risk factors osteoporosis
Disease prevention is primarily about removing the causes that cause them. Risk factors that are unfortunately beyond our control are:
- age - pow. 60 years
- gender - female
Modifiable factors are:
- proper diet
- smoking tobacco
- excessive alcohol consumption
- diseases (hormonal disorders)
Unfortunately, many of them, such as genetic features after our mother, we are not able to eliminate, but we can always reduce their effects by appropriate conduct.
4. Fall prevention
Falling is the cause of 90-100% of radius and hip fractures. Everyone is at risk of falling, and with age they become more frequent and more dangerous. After the age of 60, about 40% of healthy people fall once a year, and after the age of 80, 50%. Every 20th fall ends in a fracture. Falls are one of the leading causes of disability and the fifth leading cause of death in people over 75 years of age.
Falls are due to health and environmental reasons. Check if you are at risk of falling at home; the most common causes are: poor lighting, obstacles on the floor, slippery floors, no rug, no handle in the bathroom. Watch out for slippery surfaces, uneven sidewalks, snow and ice outside your home.
Health causes of a fall: visual impairment, muscle weakness, dizziness, gait disturbances, degenerative changes in the joints, taking many medications, including: tranquilizers, sleeping pills, antidepressants.
To maintain physical fitness, you need a minimum of 30 minutes of walking a day, preferably Nordic Walking, during which 80% of the muscles are involved. Always keep your hands free for a soft landing in the event of a fall. Take a shoulder bag or backpack when shopping. Wear appropriate footwear, especially in winter. If you feel "insecure" take a cane.
5. Exercise and an active lifestyle
The main goal of exercise in osteoporosis is to prevent falls and to inhibit fall/stimulate growth BMD. The optimal solution is exercises conducted by an experienced physiotherapist in a fall prevention center, unfortunately, they are unavailable in our country. Fall prevention exercises are designed to improve balance and gait stability. Currently, the best scientifically documented effectiveness in preventing falls has the Tai Chi system. It has been shown in many reports that it reduces the risk of falling in the elderly by up to 55%. The OTAGO home exercise program is gaining more and more popularity. This program puts the greatest emphasis on improving balance reactions, but also includes elements of resistance exercises and flexibility. Studies have shown a 35% decrease in the frequency of falls (patients over 65 years of age) with regular performance of these exercises. Patients who have already suffered a fall and seniors over 80 benefit the most. Exercise instructions and illustrations are available online (incl. https://fizjoterapia.pl/imgs2/PLIKI_DO_POBRANIA/ otago_pl_kurs.pdf).
In our country, it is possible to offer instruction of exercises by a physiotherapist, which the patient can perform at home. Exercises should be carefully selected to the patient's functional capabilities, difficult or medium difficulty, always observing the safety rules. It is assumed that it is best to do them for 15-20 minutes. every day - a total of about 2 hours a week.
An exemplary set of 5 simple balance exercises (depending on the patient's condition, each exercise can be performed with or without belaying)
- Standing in the leg-by-leg position, arms raised to the side to the height of the shoulder - 10 to 30 seconds (with time you can do it with your eyes closed),
- Standing with one leg, left and right legs, arms raised to the side to the height of the shoulder - 10 to 30 seconds each (with time you can do it with your eyes closed),
- Walk forward and backward - 10 steps forward, back - 5x,
- Walking in a figure eight - 5x,
- Walking with "tiptops" (toes of one foot touch the heel of the other foot) - 10 steps forward, return - 5x,
It is worth mentioning that dancing can also improve stability, which also has many social benefits (there is scientific evidence for this).
It is known that resistance exercise affects bone mass. Bone growth is easy to achieve in younger people, but it has been shown to be possible in older people as well. The condition for the effectiveness of exercises is their systematic and long-term performance.
In the absence of rehabilitation facilities, we recommend Nordic Walking for each patient for 1 hour twice a week. Although there is no evidence that it increases bone mass and reduces the risk of falling, it is known to increase overall fitness because it engages 2% of our muscles.