Osteopenia and osteoporosis

Osteopenia refers to reduced bone mineral density associated (BMD) with ageing. In osteopenia you have BMD that is lower than normal levels, but not low enough to be classified as osteoporosis. Osteopenia likely to progress to osteoporosis.

Osteoporosis basically means porous bones and is characterised by excessive loss of calcified matrix, bone mineral and collagen fibres from the bone. It is a condition where bone breakdown exceeds new bone production. It affects 1 in 3 women and 1 in 12 men in the UK, have osteoporosis and mostly affects those over the age of 50. There are some 200,000 fractures per year attributed to osteoporosis; the main fracture main sites are the hip, wrist and spine, which costs the NHS £900 million to 1.8 billion a year.

Osteoporosis is largely a preventable disease with risk factors for its development being multi-factorial and including:

  • Poor nutrition
  • Ethnicity
  • Heredity
  • Mal-absorption diseases
  • Metabolic diseases
  • Menstrual irregularities
  • Medications
  • Small build
  • Smoking
  • Alcohol
  • Fizzy drinks consumption
  • Under / over exercise
  • Depression.

Conventional treatment for osteoporosis is set out in the NICE guidelines. Recommendations about who should be treated with osteoporosis drugs are based upon:

  • Age
  • Bone density measured by your T score
  • Risk factors for fracture

The first line of treatment includes a class of drugs called bisphosphonates, which are a class of drug that destroy cells that breakdown bone, leaving the cells that make bone to do their job. Bisphosphonates are usually prescribed with Vitamin D and calcium. Other treatments include selective oestrogen receptor modulators and hormonal replacement therapy.

As previously stated osteoporosis is largely a preventable disease so nutrition can play an important role in managing it progression. When we think about using nutrition for the management of a health condition we should ask “What do we need to add to this person’s diet and what do we need to remove?”

There is a lot of contention about protein and osteoporosis. The theory goes that the acidic load of eating protein increases the acidity of the blood. This cannot be handled by the kidneys, which needs to use calcium from the bones to act as a buffer. The scientific research is mixed on this point and it is hard to draw clear conclusions however let me try to explain y point of view.

First we can look from an evolutionary perspective and to what our ancestors ate. In the book Nutritional Anthropology: Contemporary Approaches to Diet and Culture we can see that compared to a Farmer’s diet a Hunter gatherer diet demonstrated

  • Almost no dental cavities, whereas farmers showed almost 7 per person.
  • Significantly less bone malformations consistent with malnutrition.
  • Lower rates of infant mortality.
  • Decreased infectious disease.
  • Little sign of iron, calcium and protein deficiency.

Similarly Weston A Price, who was a dentist and a scientist travelled the world in the 1920’s and 30’s studying indigenous populations, what they ate and what disease they suffered from. He found no vegetarian societies, high protein users did not develop osteoporosis and high protein users had excellent bone structure and teeth.

In a more recent and scientific cross sectional survey published in the American Journal of Clinical Nutrition in 2010 it was found that in pre menopausal women:

  • …a higher protein intake does not have an adverse effect on bone in premenopausal women.
  • For every percentage increase in the percentage of energy from protein, no significant longitudinal changes in BMD were observed at any anatomic site over the follow-up period (3y).

Similar in post-menopausal women a study in the American Journal of Clinical Nutrition in 2003 investigated the association of dietary protein intake with baseline bone mineral density (BMD) and the rate of bone loss over 3 years in elderly women. It found “no association between protein intake and the rate of bone loss in the three-year follow up period. Another study in the American Journal of Clinical Nutrition in 2005 compared protein intake with bone mineral density in the heel in 75 year old women and illustrated at this later age that a higher protein intake above 80 grams a day resulted in better bone mineral density.

Scientists and doctors like something called a systematic review to provide them with gold standard scientific information on which they can make recommendations. A systematic review published in the American Journal of Clinical Nutrition in 2009 found:

  • …the relationship between protein intake and BMD were significant and positive (this means the more protein consumed the better the BMD
  • Protein intake ranged from 0.9-1.7g/kg BW, with most studies using 1.2g/kg BW.

So it seems that protein is healthy for our bones and we should be eating regular serving of animal products. What we need to remember is to alkalise the blood by consuming lots of vegetables with the protein.

We also need lots of micronutrients from our food to help our bone health. This includes calcium, phosphorus, vitamin D, vitamin K and vitamin C. The best sources of these foods include green leafy vegetables, bony fish, nuts and seeds and some fruits and this is another reason to eat lots of vegetables with our protein. London nutritionist Steve Hines can help design a diet for you to ensure healthy bones.

There are certain things that we can stop doing to help our bones as well. These include:

  • Stopping smoking.
  • Reducing alcohol.
  • Moving away from a sedentary lifestyle.

London nutritionist osteopenia and osteoporosis.

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