The prevention of osteoporosis
The calcium (contained in the skeleton and teeth) is the
absolute mineral present in greater amounts in our bodies and is the first 0.5
to 2% of the total weight of an adult. But football is also dissolved in the
blood (1%) and provides vital functions as muscle contraction (including heart),
blood clotting, the conduction of nerve impulses, etc.. The prevention of
osteoporosis begins from the moment of conception. The pregnant woman, for
example, should increase the amount of calcium daily from 1000 to 1200-1500
milligrams. During adolescence, then, the intake of calcium should not be less
than 1200 mg a day. This level is increasing over the years. It 'important to
continue taking calcium into adulthood to help compensate for the loss of bone
mass. The products that are naturally contain more milk and dairy products. A
liter of milk, just as an example, provides 1120 mg of calcium. However, we
must consider that the calcium in these foods is absorbed in adults than in
quantity because the metabolism of bone is reduced compared to age youth. In
addition, milk and dairy products also contain a considerable amount of fat. It
is therefore necessary to move towards low-fat cheese and yogurt and prefer
foods such as cabbage, broccoli, radishes, artichokes, walnuts, almonds, octopus,
squid, etc.. One more duty. The calcium is not in solution in fats but only in
the water, so that the skimmed milk or skimmed contains more calcium than whole.
It is always good in taking no longer than the 2500 mg of calcium a day.
Maintaining a good level of vitamin D
The function of vitamin D is to ensure the absorption of
calcium and proper bone mineralization. Its lack, therefore, favors the
development of osteoporosis - and, in more severe forms of osteomalacia - by
reducing intestinal absorption of calcium resulting in secondary
hyperparathyroidism. In the Italian elderly population there is still a
noticeable lack of vitamin D. As is known, that vitamin can be synthesized in
the skin by exposure to the sun or to be introduced with the feed, although it
is not widely available in food. One finds, for example, in fatty fish such as
mackerel, sardines, and the "famous" cod liver oil.
Regular physical activity
Adequate exercise in young people can develop a good bone
quality. Especially if the work is challenging, as the weight training. In the
elderly, physical activity, such as brisk walking (less effective in this
regard are the "non-load" such as swimming or cycling) can slow bone
loss and have beneficial effects on general health and functional capacity. In
addition, regular exercise, improving muscle strength, agility and balance, can
prevent falls.
Quitting smoking
As for adults, smoking has many adverse effects on bone: it
increases the degradation of sex hormones, menopause accelerates, and
represents a risk factor, as we have seen, for osteoporotic fractures. The
pregnant woman should not smoke because nicotine damages the cells that produce
new bone.
Prevention of falls
It 'very important, especially after age 50, prevent falls
and to do this, we need interventions that increase physical strength and
improve balance and gait. Check the weight. Correct vision, for example, where
you have problems of reduced vision, and ensure adequate illumination in the
house and during the night. Avoid drugs with sedative effects.
Reducing the impact of falls
The majority of fractures of the femur depends on a lateral
fall. To avoid the impact of this type of fall should be used if the situation
requires it, or provide support for walking hip padding (hip protectors) for
the elderly, who, unfortunately, often refuse - for psychological reasons - to
use such media.
Pharmacological measures
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Drug therapy of osteoporosis must be able to protect the quality of the bone, trying to preserve the structural properties and materials, by adjusting properly the bone turnover. Of course, the drugs that we describe below should be changed only by prescription.
Taking calcium and vitamin D
The administration of salts of calcium and vitamin D (for
example, calcifediolo or calcitriol) significantly reduces the risk of non-vertebral
fractures of the femur and in the elderly. The therapy has also confirmed safe,
even if the cost / benefit analysis is undoubtedly favorable.
Hormone replacement therapy (HRT)
Because, as we have seen, the reduction of bone mass is
mainly due to falling estrogen in women after menopause, the most common
treatments are based on hormones. Therapy of this type prevents the loss of
bone mass, so that epidemiological data confirm that the therapy reduces by 50%
the incidence of vertebral fractures, and about 30% of hip fractures. Recently,
the market is a parathyroid hormone (PTH) which, in combination therapy with
bisphosphonates, it would seem to guarantee a certain
increase in bone density, although not yet proven. An alternative to this
therapy are tamoxifen or tibolone, which exert an action similar to that of
hormones, but only on certain tissues such as bone and cardiovascular system. SERMs
(Selective Estrogen Receptor Modulators). The only compound of this class that
is commercially available is raloxifene, indicated for the prevention of
postmenopausal bone loss.
Bisphosphonates
Among the bisphosphonates, which include alendronate is
effective in the prevention and treatment of osteoporosis, preventing bone loss
and increasing bone mineral density by 5-10%. In full-blown osteoporosis, alendronate
reduced by 40-50% the incidence of vertebral and nonvertebral fractures (femur,
radio). There is also Risedronate increases bone density at the hip and spine
of 3-6% and 40-50% reduces the incidence of fractures. Risedronate specifically
acts on the deterioration of trabecular microarchitecture that occurs under
conditions of high bone turnover, maintaining mineral properties and structure
of collagen.
Calcitonin, fluoride, etc..
These
drugs have modest effects in the laboratory and still lack convincing
documentation on their usefulnessBibliography - National Institutes of Health. Consensus Development Conference Statement: Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement 2000, 17 (1) :1-36 - Consensus Development Conference. Osteoporosis: prevention, diagnosis, and therapy. JAMA 2001; 285:785-95
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