Do you want to keep your bones healthy? Stop making these mistakes

What is the difference between osteopenia and osteoporosis?

Bone health degradation can be simplified in 3 steps:

1. By the age of fifty, the mineral density in the bones is normal - the bones are strong;

2. After the age of fifty, the first complications may appear - the bones are weaker and the risk of a fracture increases - we are talking about osteopenia. During this period, it is important to strengthen the bone mass in order to delay osteoporosis as much as possible and to keep the bones in good condition for as long as possible;

3. If the prevention of osteoporosis is neglected, bone health will deteriorate - osteoporosis is characterized by demineralization (thinning) of the bones. ^{4, 5, 6}

Do these complications apply to each of us?

Unfortunately, they relate - the deterioration of bone health due to age is completely natural. In addition, some factors can increase the potential for these complications - gender (more than half of women suffer an osteoporotic fracture at some point in their lives, only about one third in men), exposure to harmful substances (alcohol, smoking), diet and physical activity. ^{7, 8}

Is it possible to prevent the risk of thinning bones by changing our lifestyle?

Yes it is. Let's focus on nutrition - it is known that calcium with vitamin D are absolutely essential for bone health. Therefore, a recommended daily intake of calcium after fifty is about 1200-1500 milligrams and vitamin D about 10-20 micrograms. ⁹

However, these are not the only essential nutrients to focus on - equally important are proteins, other vitamins (C, K, B9, B12, D) and minerals (potassium, magnesium), as well as healthy fats (Omega-3) and antioxidants. ¹⁰

Are proteins good for bone health?

The misconception that dietary proteins cause an increase in urinary calcium and that they can demineralize bones has been definitively refuted. Although increasing protein intake causes an increase in urinary calcium, it also increases intestinal calcium absorption (a 2003 study, American Journal of Clinical Nutrition). ¹¹

Diet and nutritional supplements with a high protein content (2.1 g per kilogram of body weight per day) allow to achieve intestinal calcium absorption - 26.3%, compared to 18.4% with a diet with a low protein content (0.7 g / kg body weight) . This represents a significant increase in calcium absorption of 43%. ^{12, 13}

It's not just about excreting calcium: it is said that proteins over-acidify the body, which promotes bone demineralization - is that true?

Proteins are commonly considered to be acidifying, in contrast to vegetables, which are considered to be alkaline. The question is: Does an "acidic" or "alkaline" diet affect bone health?

Research in 2013 (Hanly & Whiting) addressed this topic - concluding that the evidence supporting the role of proteins in the development of osteoporosis is ambiguous. At the same time, the authors found that a "more alkaline" diet did not seem to be any more beneficial for bone health. It follows that there is no link between bone health and an "acidic" or "alkaline" diet. ¹⁴

How then does the protein affect bone health? After all, bones do not consist of proteins ...

Bones are not just made of inert material - they contain proteins such as collagen. A feature of all proteins is their change - they are constantly broken down and regenerated. As a result, increased dietary protein intake can help convert them properly to maintain bone health. ¹⁵

And that's not all - a 2011 study shows that dietary proteins can act on various mechanisms in the body and therefore have a positive effect on bone health. Let's look at: ¹⁶

• By increasing calcium absorption (as mentioned above).
• By suppressing parathyroid hormone (parathyroid hormone) - the hormone of osteolysis (demineralization - decalcification of bones), if its concentration is too high. On the other hand, parathyroid hormone in low concentration just promotes bone remineralization. Its suppression is therefore positive for bone health.
• By increasing the production of IGF-1, a hormone with a positive effect on bone mineralization. ¹⁷
• By gaining muscle mass that provides bone protection and reduces the risk of falls and fractures. A five-year study completed in 2009 showed a positive link between muscle growth and bone health in the elderly. ¹⁸

What foods are best for healthy bones?

The answer is simple: you need a diet rich in protein, vitamins (especially D) and minerals (calcium, magnesium, potassium). The ideal solution is to choose foods and nutritional supplements with the most complete protein profile, i.e. j. rich in essential amino acids. Essential amino acids are amino acids that the body cannot synthesize and must be supplied externally with food or in the form of nutritional supplements.

That's why milk and dairy products are excellent foods for bone health. Milk proteins are a great source of essential amino acids. In addition, minerals in milk, especially calcium, are very bioavailable (good absorption and utilization in the body). Finally, dairy products contain a number of vitamins (D, K, B9 and B12) that are essential for bones. ^{19, 20, 21}

Therefore, it is important to supply the body with enough essential nutrients for healthy bones, especially in the elderly.

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RESOURCES:

[1] David B. Burr, “Muscle Strength, Bone Mass, and Age-Related Bone Loss,” Journal of Bone and Mineral Research 12, no. 10 (1997): 1547–51, https://doi.org/10.1359/jbmr.1997.12.10.1547.

[2] Douglas Paddon-Jones and Blake B. Rasmussen, “Dietary Protein Recommendations and the Prevention of Sarcopenia,” Current Opinion in Clinical Nutrition and Metabolic Care 12, no. 1 (January 2009): 86–90, https://doi.org/10.1097/MCO.0b013e32831cef8b.

[3] Taylor J. Marcell, “Review Article: Sarcopenia: Causes, Consequences, and Preventions,” The Journals of Gerontology: Series A 58, no. 10 (October 1, 2003): M911–16, https://doi.org/10.1093/gerona/58.10.M911.

[4] David L. Glaser and Frederick S. Kaplan, “Osteoporosis. Definition and Clinical Presentation,” Spine 22, no. 24 Suppl (December 15, 1997): 12S-16S, https://doi.org/10.1097/00007632-199712151-00003.

[5] “Osteoporosis vs Osteopenia: Know the Difference,” OrthoAtlanta, accessed February 27, 2020,https://www.orthoatlanta.com/media/osteoporosis-vs-osteopenia-know-the-difference.

[6] Harvard Health Publishing, “Osteopenia: When You Have Weak Bones, but Not Osteoporosis,” Harvard Health, accessed February 27, 2020, https://www.health.harvard.edu/womens-health/osteopenia-when-you-have-weak-bones-but-not-osteoporosis.

[7] Philip D. Ross, “Osteoporosis: Frequency, Consequences, and Risk Factors,” Archives of Internal Medicine 156, no. 13 (July 8, 1996): 1399–1411, https://doi.org/10.1001/archinte.1996.00440120051005.

[8] Farkhondeh Pouresmaeili et al., “A Comprehensive Overview on Osteoporosis and Its Risk Factors,” Therapeutics and Clinical Risk Management 14 (November 6, 2018): 2029–49, https://doi.org/10.2147/TCRM.S138000.

[9] John A. Sunyecz, “The Use of Calcium and Vitamin D in the Management of Osteoporosis,” Therapeutics and Clinical Risk Management 4, no. 4 (August 2008): 827–36, https://doi.org/10.2147/tcrm.s3552.

[10] Shivani Sahni et al., “Dietary Approaches for Bone Health: Lessons from the Framingham Osteoporosis Study,” Current Osteoporosis Reports 13, no. 4 (August 2015): 245–55, https://doi.org/10.1007/s11914-015-0272-1.

[11] Jane E. Kerstetter and Lindsay H. Allen, “Protein Intake and Calcium Homeostasis,” in Nutrition and Osteoporosis, ed. Harold H. Draper, vol. 9, Advances in Nutritional Research (Boston, MA: Springer US, 1994), 167–81, https://doi.org/10.1007/978-1-4757-9092-4_10.

[12] Jane E. Kerstetter, Kimberly O. O’Brien, and Karl L. Insogna, “Dietary Protein, Calcium Metabolism, and Skeletal Homeostasis Revisited,” The American Journal of Clinical Nutrition 78, no. 3 (September 1, 2003): 584S-592S, https://doi.org/10.1093/ajcn/78.3.584S.

[13] J. E. Kerstetter, K. O. O’Brien, and K. L. Insogna, “Dietary Protein Affects Intestinal Calcium Absorption,” The American Journal of Clinical Nutrition 68, no. 4 (October 1998): 859–65, https://doi.org/10.1093/ajcn/68.4.859.

[14] David A. Hanley and Susan J. Whiting, “Does a High Dietary Acid Content Cause Bone Loss, and Can Bone Loss Be Prevented with an Alkaline Diet?,” Journal of Clinical Densitometry: The Official Journal of the International Society for Clinical Densitometry 16, no. 4 (December 2013): 420–25, https://doi.org/10.1016/j.jocd.2013.08.014.

[15] Bach Quang Le et al., “The Components of Bone and What They Can Teach Us about Regeneration,” Materials 11, no. 1 (December 22, 2017): 14, https://doi.org/10.3390/ma11010014.

[16] Jane E. Kerstetter, Anne M. Kenny, and Karl L. Insogna, “Dietary Protein and Skeletal Health: A Review of Recent Human Research,” Current Opinion in Lipidology 22, no. 1 (February 2011): 16–20, https://doi.org/10.1097/MOL.0b013e3283419441.

[17] J. P. Bonjour et al., “Protein Intake and Bone Growth,” Canadian Journal of Applied Physiology = Revue Canadienne De Physiologie Appliquee 26 Suppl (2001): S153-166, https://doi.org/10.1139/h2001-050.

[18] Xingqiong Meng et al., “A 5-Year Cohort Study of the Effects of High Protein Intake on Lean Mass and BMC in Elderly Postmenopausal Women,” Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research 24, no. 11 (November 2009): 1827–34, https://doi.org/10.1359/jbmr.090513.

[19] Elizabeth F. Buzinaro, Renata N. Alves de Almeida, and Gláucia M. F. S. Mazeto, “[Bioavailability of dietary calcium],” Arquivos Brasileiros De Endocrinologia E Metabologia 50, no. 5 (October 2006): 852–61, https://doi.org/10.1590/s0004-27302006000500005.

[20] Léon Guéguen and Alain Pointillart, “The Bioavailability of Dietary Calcium,” Journal of the American College of Nutrition 19, no. sup2 (April 1, 2000): 119S-136S, https://doi.org/10.1080/07315724.2000.10718083.

[21] Frédéric Gaucheron, “Milk and Dairy Products: A Unique Micronutrient Combination,” Journal of the American College of Nutrition30, no. 5 Suppl 1 (October 2011): 400S-9S, https://doi.org/10.1080/07315724.2011.10719983.