Osteoporosis

 

Osteoporosis, or bone thinning, is a chronic skeletal disease affecting 5–8% of the population. It is characterized by a loss of bone mass and structural deterioration, leading to increased fragility and a higher risk of fractures. These fractures can occur even without trauma or with minimal impact, such as falling from a standing height, sitting down abruptly, or making a sudden whipping motion.

 

The most common fractures associated with osteoporosis occur in:

• The hip joint

• The wrist

• The spine (thoracic and lumbar vertebrae)

 

Causes and Risk Factors of Osteoporosis

Osteoporosis often develops slowly and asymptomatically. Its main causes include:

• Deficiency of calcium and vitamin D

• Reduced levels of sex hormones

• Lack of physical activity

• Genetic predisposition (osteoporosis in the family)

• Slim body type (BMI <18)

• Height loss of 6 cm compared to youth or 2 cm with repeated measurements

• History of fractures (especially femoral neck, wrist, vertebrae)

• Smoking

• Excessive alcohol consumption (>3 units per day)

• Chronic inflammatory diseases

• Underweight, intolerance to dairy products or gluten

• Untreated hyperthyroidism, diabetes, chronic kidney failure

• Long-term use of corticosteroids, proton pump inhibitors (omeprazole, pantoprazole), or epilepsy medications​

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Prevention of Osteoporosis

 

Eat Enough Vegetables, Fruits, and Fiber

These foods provide essential vitamins, minerals, and fiber that contribute to overall bone health.

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• Aim to eat at least four servings of vegetables and three servings of fruit daily.

• The World Health Organization (WHO) recommends 400 g of fruits and vegetables per day, ideally in a 2:1 ratio in favor of vegetables (approx. 270 g vegetables and 130 g fruit).

 

Choose Healthy Sources of Protein and Fats

A well-balanced diet helps maintain strong bones and minimizes bone loss.

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• Prefer plant-based proteins such as beans and nuts, which contain beneficial vitamins, minerals, and plant estrogens that support bone health.

• From animal sources, choose fish, skinless poultry, and lean meat.

• Low-fat dairy products are excellent sources of protein and calcium.

 

Stay Physically Active

Exercise helps maintain the balance between bone formation and loss.

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• In youth, it increases bone density.

• In adulthood, it slows bone loss and enhances skeletal strength.

• Physical activity also reduces fall risk by strengthening muscles and improving coordination.

 

Best types of exercise:

• Weight-bearing activities that strengthen bones without excessive strain – walking, Nordic walking, tennis, volleyball, aerobics, dancing.

• Swimming and cycling strengthen muscles and the heart but do not provide the same bone-loading benefits.

• If you’re not used to regular exercise, start slowly and gradually increase intensity. The ideal goal is 40 minutes of exercise 3–4 times per week.

 

Limit Sugar and Salt Intake

Excessive sugar and salt consumption negatively impacts bone health.

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• Foods high in added sugars often lack vitamins and minerals while being calorie-dense.

• Salt can increase blood pressure and accelerate calcium loss from the body.

• Recommended daily salt intake: max. 2.3 g (approx. one teaspoon).

 

Reduce Alcohol and Caffeine Consumption

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• Alcohol accelerates bone mass loss and reduces calcium absorption.

• Daily limit: Men – max. 300 ml of wine or 500 ml of beer, women – half that amount.

• Caffeine slightly increases calcium loss through urine, but up to three cups of coffee per day is considered safe.

 

Ensure Sufficient Calcium and Vitamin D Intake

Calcium and vitamin D are crucial for strong and healthy bones.

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Diagnosis of Osteoporosis

• Evaluation of risk factors and medical history by a doctor.

• Screening questionnaire to determine the need for bone density testing (DXA scan).

• DXA scan is automatically recommended for women over 60 years and men over 70 years.

• Additional lab tests and spinal X-rays may be required.

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Treatment of Diagnosed Osteoporosis

Movement and Fall Prevention

• Avoid sudden movements, jumps, heavy lifting, and twisting motions.

• Recommended activities: 20–30 minutes of walking daily, preferably on soft surfaces, climbing stairs, tai chi, and stretching.

• High-intensity resistance training (HIIT).

• Progressive balance training to prevent falls.

• Using hip protectors to reduce fracture risk.

• Fall prevention – remove loose rugs, improve lighting, wear proper footwear.

• Vision correction – proper eye care to prevent falls.

• Prevent nighttime falls – reduce obstacles in dark areas.

 

Dietary Recommendations

• Ensure sufficient protein intake.

• Avoid smoking.

• Limit alcohol consumption.

 

Calcium Intake

• Daily recommended intake: 1–1.5 g.

• For supplements, doses should not exceed 500 mg at a time and are best taken in the evening.

 

Calcium Content in Foods (mg/100g):

• Poppy seeds – 1375 mg

• Parmesan – 1250 mg

• Edam cheese – 952 mg

• Whole milk – 120 mg

• Yogurt – 178 mg

• Lentils – 600 mg

• Brussels sprouts – 310 mg

• Almonds – 246 mg

 

Vitamin D Intake

Daily recommendations:

• Under 50 years: 400 IU

• Over 50 years: 800 IU (preventive)

Higher doses for osteoporosis treatment

 

Sources of vitamin D:

• Sunlight – 10–15 min exposure to the face and arms daily.

• Diet – Less than 1% of people get enough vitamin D from food alone.

• Supplements – Recommended for individuals over 60 and high-risk groups, especially in winter.

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Other Medications for Osteoporosis

 

Hormone Replacement Therapy (HRT)

• Used for women within 10 years of menopause onset.

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Bisphosphonates

• Bind to the bone surface and create a protective layer.

• Taken on an empty stomach, 30 minutes after waking up.

• Must be taken with water, no food or drink for 30 minutes after.

• Stay upright for 30 minutes after taking the tablet.

• Calcium supplements should be taken at least 1 hour apart from bisphosphonates.

• Possible flu-like symptoms that subside within hours.

• Dental check-up recommended before starting therapy.

 

Other Medications

• Denosumab – administered by injection every 6 months.

• Parathyroid hormone analogs.

 

Additional Resources:

• MedLike – Reliable Health Information

• General Health Insurance Company – Osteoporosis