Osteoporosis is a disease that makes the bones weak and brittle, and therefore more likely to break or fracture. According to the International Osteoporosis Foundation (IOF), osteoporosis fractures happen about every three seconds worldwide. Osteoporosis in the elderly is a major cause of broken bones which can lead to the loss of independence.
Osteoporosis is often considered a “silent disease” because most people do not feel symptoms of bone weakening. That is until there is an unexpected break or fracture involved. Bones undergo continuous remodeling throughout the lifecycle. This consists of bone tissue being broken down by osteoclast cells to release minerals such as calcium. Followed by osteoblast cells that are in charge of rebuilding the tissue that is lost. Osteoporosis occurs when the creation of new bone does not keep up with the loss of old bone.
There are many risk factors for osteoporosis in the elderly. Some are controllable, while others are not. Uncontrollable risk factors include age, sex, genetics, underlying health conditions, changes during menopause, and low levels of testosterone. Some controllable risk factors include diet, sedentary lifestyle, alcohol, and nicotine.
Research has shown a long-term diet low on protein, calcium, and vitamin D increases the risks of osteoporosis. These nutrients are important for bone health. Let’s look at calcium first.
99% of calcium found in the adult body resides in the bones. If there is not enough calcium coming from the diet, the body will take calcium from the bones.
The dietary reference intake for calcium is different for men and women and based on age. These ranges are different because statistically women are more likely to develop osteoporosis then men and men are at higher risk at an older age. Below are the recommendations:
- Age < 50 = 1,000 mg/day
- Age 51+ = 1,200 mg/day
- Age < 70 = 1,000 mg/day
- Age 71+ = 1,200 mg/day
Good food sources of calcium include:
- Dairy products: milk, yogurt, and cheese. These can be easily absorbed, and they have the additional advantage of being good sources of phosphate and high-quality protein –which also benefit bone health.
- Green vegetables (e.g., broccoli, kale, Bok choy, turnip greens)
- Whole canned fish with soft, edible bones such as sardines
- Nuts (almonds in particular)
- Fortified foods and beverages with calcium added
For people who cannot get enough calcium through their diets, supplements may be beneficial. The two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is absorbed most efficiently when taken with food. Calcium citrate is absorbed equally well when taken with or without food. It is generally recommended that they be taken combined with vitamin D.
Along with calcium, vitamin D plays a beneficial role in bone health. Vitamin D helps the body absorb calcium from the intestines, decrease bone turnover, and ensure correct renewal and mineralization of bone.
The dietary reference intake for vitamin D is based on age. Men and women <50 years old need 600 international units (IU) daily. Individuals 71 years and older need 800 IU daily.
The three ways to obtain vitamin D include sunlight, food, and supplements. According to IOF, sun exposure is the primary source of vitamin D. Vitamin D is made in the skin when it is exposed to ultraviolet B rays. The type of vitamin D made in the skin is referred to as vitamin D3 (cholecalciferol), whereas the dietary form can be vitamin D3, or a closely related molecule of plant origin known as vitamin D2 (ergocalciferol).
Very few foods are naturally rich in vitamin D. Food sources include oily fish such as salmon, sardines and mackerel, eggs, liver, and fortified foods such as margarine, dairy products, and cereals.
Dietary protein provides the body with amino acids to support building of the bones as well. Protein increases blood levels of insulin-like growth factor I (IGF-I) which plays an important role in bone formation. According to many studies, low protein intake is associated with loss of bone mineral density (BMD). Good sources of protein include lean meats, eggs, dairy products, nuts, tofu, and beans and lentils.
Studies have shown that protein supplementation to patients who have suffered a hip fracture reduces post-fracture bone loss, medical complications, and rehabilitation stay.
Exercise is also important for strengthening muscles and bones. Weight-bearing exercises are recommended for bone health and to help avoid fractures from falls. Physical therapists and rehabilitation specialists can help older adults develop a specific routine of exercises.
Staying physically active, limiting alcohol and tobacco consumption, and maintaining a diet rich in calcium and vitamin D are very important to improve or maintain bone and muscle strength. This is important to avoid falls in the elderly population and maintain independence. It is crucial for older adults to talk to their health care team concerning risk factors of osteoporosis and bone loss.
International Osteoporosis Foundation https://www.osteoporosis.foundation/educational-hub
National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center https://www.bones.nih.gov/
Nutrition Care Manual: Osteoporosis Nutrition Therapy https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=58