Written by Dr. Sanjana V.B Bhms,dbrm,cdn.

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed medically by SIAHMSR

osteoporosis in women 

   Osteoporosis is a condition that makes bones weak and brittle due to decreased bone mass and strength. It develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This reduced strength and bone loss can increase the risk of bone fractures.

   Healthy bones and joints are important for both men and women for mobility and protecting the vital organs. It is always a serious health concern if bone mass and strength start losing with middle age, as weakening of bones cause fractures. However, bone health of women needs to be prioritized as they are more at the risk of osteoporotic fracture particularly after menopause.

   Bones are continuously changing with new bone formation and old bone resorption or loss and it is a constant process. New bone formation process is faster than bone losing process in younger age and hence bone mass remains good. Most people reach their peak bone mass around age 30. After the middle age, bone mass starts losing. Osteoporosis is a condition that makes bones weak and brittle due to decreased bone mass and strength.

Bone mineral density decreases with ageing and with decline in estrogen, which can weaken bone strength. Women, particularly after menopause are at high risk of osteoporosis due to declining estrogen hormones.

   Postmenopausal decline in oestrogen may lead to decreased bone strength and fracture. The function of oestrogen in the bone remodeling process is now clearly understood by the scientific world after several years’ meticulous research.

Oestrogen plays a key role in both the formation of bone as well as the prevention of the resorption of bone. Women can lose up to 20% of her bone density during the five – seven years following menopause. If the bone mass loss is in quicker pace, there is greater chance of developing osteoporosis.

In addition to postmenopausal declining oestrogen, old age, sedentary life style, physical inactivity, poor diet and nutritional deficiencies also contribute to osteoporosis in women.

   Osteoporotic fracture is common in ageing women. Of the estimated 10 million people affected with osteoporosis, about eight million or 80% are women. Approximately one in two women over age 50 is at risk of osteoporotic bone fracture.

  Women who are physically inactive have a higher risk of osteoporosis than do their more-active counterparts. Vigorous physical activity plays an important role in strengthening bones in women. Sedentary habits may reduce bone strength.  Osteoporosis develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This reduced strength and bone loss can increase the risk of bone fractures.

   The dietary habits of women also play crucial role in the development of osteoporotic fracture.  A diet low in calcium contributes to low bone density, early bone loss and an increased risk of fractures. Vitamin D is important for bone mineralization and bone strength. Lack essential nutrients in the diet accelerates the pace of bone weakening process.

    Regular food intake and absorption of nutrients contained in them have crucial role in determining the hardness or strength of bones. Bones need all essential nutrients for its functions; such as protein, minerals, and vitamins to make and regenerate bone.

Calcium, phosphorus, zinc, and magnesium are most important minerals that should be obtained through diet. Vitamins A.D and K are also required for normal bone metabolism. Lack of these nutrients weakens bones and may lead to bone fractures.

                                               SIAHMSR                                                 

Foods to support bone health & helping to prevent osteoporosis

·   Milk and other dairy foods

Milk and milk products are great source of calcium. Cow’s milk contains calcium [118mg], phosphorus [89.6mg] , sodium[44.5 mg],potassium[150mg] ,proteins, lactose and fat. Proper intake of vitamin D and calcium is essential, especially during the period of rapid growth of childhood and adolescence [Recommended daily intake is 1300g]. 

  Calcium requirement for adults is 700mg / day. Calcium intake is vital to keep your bones healthy and adequate vitamin D intake also needed to help your body absorb calcium. Prevalence of Vitamin D deficiency is very high in patients with hip fragility fractures. Vitamin D deficiency is associated with osteoporosis [15].

Dietary recommendations for including milk, and dairy products are vital for the prevention of osteoporosis. A study shows that children who had avoided milk and had not eaten food fortified with calcium, reported fracture before puberty more frequently than children who had consumed cow’s milk [17].

Another study shows that intake of dairy products, was associated with higher  bone mineral density [BMD] of the femoral bone neck and lumbar spine among subjects with normal 25(OH)D concentration[ vitamin D], but bone mineral density was not high in a group with vitamin D deficiency[18].Therefore it is evident that vitamin D is crucial in the body for bone strenght.

According to another study people on a pure vegan diet [who do not take milk and milk products] consume an insufficient amount of calcium and vitamin D, which may lead to osteoporosis due to a decrease in bone mineral density [19]

·       Green leafy vegetables

      Green leafy vegetables, such as broccoli, cabbage and okra are rich in calcium, zinc and vitamins A,C and K;  However spinach is not a good choice.  Although spinach contains a lot of calcium, it also contains oxalate, which reduces calcium absorption, and hence spinach is not considered as a good source of calcium. 

Vegetables high in calcium include collard greens, turnip greens, kale, mustard greens, beet greens, bok choy, okra, Swiss chard, and broccoli.

·       Calcium fortified soy milk

About 200 mL of calcium enriched soy milk contains 240 mg of calcium. The calcium helps bone mineralization and thus strength or hardness of bone.

  ·      Small fishes with bones 

Small fishes such as sardines and pilchards are rich source of omega -3 fatty acids which aid in bone preservation in elderly females at the risk of osteoporosis. Oily fish , such as salmon, sardines and mackerel contain long-chain omega-3 fatty acids. The most important biologically active omega 3 polyunsaturated fatty acids, eicosapentaenoic acid   and docosahexaenoic acid are mainly derived from certain cold-water fish or their oils. Salmon and tuna are also high in vitamin D, which helps the mineralization of bones and help to improve bone strength.

·      Egg  yolks

     Eggs are great source of vitamin D which boosts bone strength helping bone mineralization with calcium and phosphorus.

·  Soya beans

Estrogen hormone is protective of bone. Menopause causes a fall in estrogen level in females.  postmenopausal estrogen decline is linked with bone loss and enhances the risk for osteoporotic fracture.

Soy products contain isoflavones, plant-based estrogenic compounds or phytoestrogens which show an affinity with the estrogen receptor and protects from loss of bone mass. Most clinical studies on postmenopausal women and soy products point out a positive effect of soy on markers of bone turnover and bone mineral density. However, more extensive studies are needed to use soy widely as an estrogen equivalent in medical practice [21]. 

·  Tofu

Tofu, also called bean curd, is a soft, flavorless food product made from soybeans. Tofu is made from dried soybeans that are soaked in water, crushed, and boiled. The mixture is separated into solid pulp (okara) and soy “milk.” The soy milk is poured into molds to allow the carbohydrate-laden whey to drain off. The soft cake residue is cut into squares and stored under water until sold. This is tofu, which contains nutrients such as protein, calcium, potassium, and iron. Soy products are   generally rich source of high amount of calcium as well as plant estrogen like compound isoflavones. These help bone mineralization, prevent bone loss and thus prevent osteoporotic fracture.

·     Legumes

Beans or legumes contain calcium, magnesium, fiber and other nutrients, However they also contain substances called phytates. Phytates may interfere with the absorption of calcium that is contained in beans. You can reduce the phytate level by soaking beans in water for several hours and then cooking them in fresh water.

·       Nuts

Nuts are good source of omega 3 fatty acids, protein, and minerals like calcium and magnesium. Some nutrient rich nuts include almonds and pistachios. Almonds are good source of calcium. A half-cup of the nuts alone has 190 mg of calcium.

·       Vitamin D fortified foods 

     Mostly milk, milk products and margarine were fortified with vitamin D. Consumption of vitamin D fortified foods, especially milk, increase vitamin D intake and was effective in significantly increasing 25(OH)D levels. Other foods include some cereals, juices, staple food, other dairy products and margarine. Vitamin D fortified food intake in adequate amounts may help to strengthen bones.

References

1.    https://www.nhs.uk/live-well/bone-health/food-for-strong-bones/
2.    https://orthoinfo.aaos.org/en/staying-healthy/bone-health-basics/
3.     https://www.kenhub.com/en/library/anatomy/bones
4.     https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htm#:~:text=In%20particular%2C%20heavy%20alcohol%20use,can%20also%20harm%20bone%20health.
5.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140170/#:~:text=Dietary%20consumptions%20of%20sodium%20chloride,to%20increase%20urinary%20calcium%20excretion.&text=Therefore%2C%20a%20high%20salt%20intake,osteoporosis%20due%20to%20increased%20calciuria.
6.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775240/#:~:text=Magnesium%20deficiency%20contributes%20to%20osteoporosis,by%20promoting%20low%20grade%20inflammation.
7.   https://pubmed.ncbi.nlm.nih.gov/26343111/#:~:text=Background%3A%20Vitamin%20C%2C%20traditionally%20associated,radicals%20detrimental%20to%20bone%20health.
8.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955144/#:~:text=Although%20known%20for%20its%20importance,markers%2C%20and%20regulating%20bone%20reabsorption.
9.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172791/
10.            https://pubmed.ncbi.nlm.nih.gov/32548903/
11.          https://pubmed.ncbi.nlm.nih.gov/28093633/#:~:text=Abstract,older%20men%20and%20postmenopausal%20women.
12.           https://pubmed.ncbi.nlm.nih.gov/20035439/
13.           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693714/
14.           https://www.ncbi.nlm.nih.gov/books/NBK537199/
15.           https://pubmed.ncbi.nlm.nih.gov/31708635/
16.           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072827/
17.           https://pubmed.ncbi.nlm.nih.gov/14760576/
18.           https://pubmed.ncbi.nlm.nih.gov/30601986/
19.           https://pubmed.ncbi.nlm.nih.gov/21092700/
20.           https://www.myfooddata.com/articles/high-calcium-vegetables.php
21.           https://pubmed.ncbi.nlm.nih.gov/18277912/
22.           https://www.britannica.com/topic/tofu
23.           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179178/