Healthy Living

Osteoporosis or bone decalcification is a disease that affects the bones. The bone mass decreases and the bones become porous.
An increase in the risk of fractures (especially of the hip, femur and wrist) and spinal collapse causing the body length to decrease are the main consequences. For example, a small accident, for example an unfortunate punch against a table edge, may be enough to break the wrist.

Osteoporosis occurs in about 3 percent of men and 20 percent of women over the age of 65. The risk of osteoporotic fractures in Belgium is approximately 1 in 3 in postmenopausal women, and 1 in 5 in men over 50 years of age. Every year, 2 percent of women between the age of 85 and 89 have a broken hip. In men we see the same trend, but with a delay of 6 to 7 years.

Osteoporosis in itself does not cause any complaints. Therefore, this condition often goes unnoticed, until the bone is so weakened and a bone fracture occurs. A collapsed vertebra rarely causes pain. A broken vertebra can hurt. Sometimes you can temporarily do less because of it. Low back pain is rarely caused by bone decalcification.

How does osteoporosis develop?

Osteoporosis occurs when the bone is broken down faster than new bone is created. The bone is a living tissue that is constantly renewing itself. The production and breakdown of bone tissue go hand in hand. The peak bone mass or the maximum amount of bone mass that one builds is generally reached around the age of 35 years. After that, less bone is created than is broken down and the "bone capital" decreases and the bone structure becomes brittle. The older one gets, the more bone is lost. In women, this process is faster from menopause than in men. This explains why osteoporosis mainly affects women.

At some point, bone degradation reaches a so-called fracture threshold. Below that threshold, there is a good chance that something will break in the slightest incident. As of the age of 50, some 10 percent of women are at increased risk of fractures due to osteoporosis, and in the 65 to 74 age group, some 40 percent of women are "at-risk persons"" for osteoporotic fractures.

The risk of fractures can be measured by a special technique, bone density measurement or botdensitometry. It is completely painless and lasts barely about 10 minutes. For people at increased risk of osteoporosis, a bone scan (botdensiometry or DXA scan) is recommended from the age of 65. Bone density can be measured if you are over 50 years of age and:

• you have broken a vertebra;
• you have broken a bone in the last two years.

Causes of osteoporosis

• Due to menopause, the ovaries stop functioning and the production of estrogen, the female hormone, is stopped. This hormone plays an essential role in the build-up of the bone. If the production of estrogens gets going too late or is interrupted, the bone build-up does not work optimally. This happens, for example, during early menopause, late-on-life or temporary absence of monthly periods or removal of ovaries.
• Heredity also plays a role: if osteoporosis occurs in your immediate family, you are at higher risk.
• Osteoporosis may have other causes, such as certain conditions, such as excessive functioning of the thyroid gland, the parathyroid or adrenal gland, Crohn's disease, rheumatoid arthritis, chronic kidney disease, COPD, anorexia, etc.
• Prolonged bedriddenness or disability (a bedridden person loses about 1% to bone mass per week)
• The long-term use of certain medicines (e.g. drugs with cortisone, epilepsy medicines, etc.).
• Contrary to popular belief, pregnancy is not a cause of osteoporosis, on the contrary.
• Small, petite and lean people typically have less bone mass than heavier-built people.
• Smoking, alcohol, coffee and a salty diet are harmful to the bone. A very high-fibre diet (e.g. makrobiotic) also reduces calcium intake and can therefore reduce bone build-up.

Who's at risk?

Volgende personen lopen een verhoogd risico op osteoporose:

• vrouwen ouder dan 65 jaar;
• mannen ouder dan 70 jaar;
• mensen die weinig bewegen;
• mensen met ondergewicht;
• rokers;
• mensen die meer dan drie glazen alcohol per dag drinken;
• mensen met lage concentraties vitamine D en/of calcium in het bloed;
• mensen met bepaalde chronische aandoeningen (zoals diabetes type1, reumatoïde artritis, chronische inflammatoire darmziekten, COPD...).

1. Calcium

Since the breakdown of bone tissue becomes inevitable from the age of 35 onwards, it is important to build up as much as possible from childhood to 'bone capital'. A healthy diet with enough calcium during childhood determines a set of strong bones later in life, according to several studies. In the elderly, high calcium intake is associated with a slower loss of bone and a reduction in fracture risk.

A balanced diet with a sufficient intake of calcium, is a key element in the prevention of osteoporosis.

Dairy products such as cheese, milk and yoghurt contain relatively high calcium. To get 1000 mg of calcium you need to use 40 grams of cheese (2 slices) and 550 grams (2-3 servings) of milk (products) per day. If you can't or don't want to use dairy products, vegetable products are an alternative. Green vegetables, nuts and legumes also provide calcium. However, you do need to eat a lot of these products to meet the calcium requirement. Another alternative to dairy is to opt for the same kind of products but on a soy basis. Soy products are naturally low in calcium but can be enriched with calcium, vitamin B and vitamin D to the same level as 'normal' dairy products. Always check the packaging of the product if it is enriched with calcium.

For adults up to 50 years of age, the advice is to take 1000 mg of calcium daily. People aged 50 and over and younger people with osteoporosis are even advised to have a slightly higher intake of 1200 mg. This in combination with at least 10 μg (=micrograms) of vitamin D. In people already suffering from bone decalcification, a daily amount of 20 μg of vitamin D is recommended. As much movement as possible is essential to keep bones strong.

Coffee, alcohol, and caffeinated beverages (e.g. coca cola) have a negative impact on our bone mass. Tobacco, in turn, prevents the smooth absorption of calcium by the organism and accelerates the breakdown of estrogens: all factors to be avoided in the fight against osteoporosis. A very high-fibre diet (e.g. makrobiotic) also reduces calcium intake and can therefore reduce bone build-up.

2. Vitamin D

A sufficient application of vitamin D - especially from sunlight - is also very important, because it stimulates the absorption of calcium in the blood through the intestinal wall.

• Vitamin D is formed by ultraviolet radiation on our skin. With us, the sun from March to November is strong enough to produce vitamin D in the skin. For this, it is not necessary to sunbathe extensively. Half an hour of outdoors with his head and hands uncovered is sufficient.
• Your body absorbs a small amount of vitamin D from the diet. Vitamin D, for example, is found in oily saltwater fish such as mackerel, salmon, sardines and also. The old-fashioned cod liver oil (fish oil of mainly haddock species) contains a lot of vitamin D. Vitamin D is also in eggs, liver and has been added to margarines.
• For some people, intake of extra vitamin D may be necessary to prevent bone decalcification (see below).

3. Exercise

Physical activity is an effective measure to prevent osteoporosis. Movement ensures the storage of calcium in the bones. Too little exercise leads to a decrease in calcium intake.
Sufficient daily movement in childhood stimulates the build-up of the bone and also determines the maximum bone mass. After all, the body tries to adapt the structure and mass of the bone to the requirements of the skeleton.
Physical activity also improves flexibility and movement coordination and increased muscle strength, reducing the risk of falling.

The recommendation is for adults to do at least 30 minutes of exercise (of moderate intensity) per day, and for children at least 1 hour. All forms of exercise in which the bones are taxed (walking, walking, dancing, gardening...) stimulate the production of bone tissue. Swimming and cycling offer less protection against osteoporosis.
Bed rest (immobilization) leads to accelerated loss of minerals in the bone.

34. Fall Prevention

In old age, it is wise to take some measures to prevent falls.

• Make sure there are no loose mats or power cords on your floor.
• Provide good lighting in the home. Leave a light on at night so you can see enough.
• If you sometimes get dizzy when you get up, first sit on the edge of the bed.
• Take off your reading glasses when you walk around, otherwise you won't see the floor or steps of the stairs properly.
• If you have glasses to see in the distance, put them on before you walk. You will have a better view of thresholds, stairs and curbs.
• Often certain exercises (balance and strength training) and tools (walker) can help you to be firmer. If you're using sleeping tablets, try to stop or reduce them. These tablets make you drowsy (even during the day). This makes it easy to fall, especially if you get out of bed at night.
• Other medications, such as antidepressants, can also increase the risk of falls, as well as low vitamin D.