Brittleness of the bones in the elderly and the fractures which can result from it do not necessarily have to happen.
It is advisable to work on the proper building of the bone structure from an early age. This preventive attitude must then find its prolongation in nutrition and a healthy lifestyle.
Osteoporosis is a real public health issue, its costs estimated at 1 billion pounds in the UK, regardless of the human costs, the after-effects associated with the disease and the death toll which can result from it.
- Doctors recommend an increase in calcium rations and vitamin D through three to four dairy products per day.
- 80% of women do not have sufficient calcium and are not aware of it ...
Osteoporosis: An insidious process
- The osteoporosis process is well-known: degradation of bone mass and density, as time goes by, which leads to an increase in risks of fractures.
- This process is related to age but also to genetic factors.
- The building of bones results from the relationship between osteoblasts (cells in charge of the synthesis of bone tissue) and osteoclasts (cells in charge of its resorption).
- We consider that during a lifetime, a skeleton is renewed four to five times...
- The increase in bone mass takes place up to the age of 20 to 25.
- It stabilises around 30, before a gradual loss.
- A 40-year old man loses 0,5% of body-mass per year
- A post menopausal woman, in situation of hormonal deficiency, can lose more than 3% of it.
- This process is asymptomatic, and can be measured only by osteodensitometry.
- The loss of height, often stated by the elderly, is an obvious sign of compression of the vertebra and should be taken as a warning about the loss of bone mass before the occurrence of an accident:
In addition to wrists or long bones, there are approximately 50.000 hip fractures per year, causing a morbidity of 20% in the first year.
Preserving your bone structure
The bone mass acquired by the age of 25 is the structure on which the body will table throughout a person's life.
- The formation of the bone mass depends on endogenous factors such as gender, race, age, stoutness, hormonal status, age of puberty ...
- There are also exogenic factors that may intervene and on which it is possible to act in particular smoking, coffee consumption, alcohol, corticosteroid therapy on the long run... There are many embrittling factors.
- Food combined with a healthy lifestyle and sufficient physical activity in the open air, can contribute to ensure a primary prevention of the disease .
Calcium, vitamin D and proteins
Calcium, vitamin D and proteins constitute the trio on which nutritionists base their recommendations for disease prevention:
- There is a direct correlation between calcium intake and bone density.
- Thus, the majority of the studies recommend contributions in dairy products, knowing that a quarter of liter of milk per day ensures a contribution of 300 Mg of calcium.
It facilitates the intestinal absorption of calcium, and is obtained by food as well as by sun exposure.
- It should not be neglected, as its link with the secretion of IGF (insulin-light, growth factor similar to insulin).
- Protein deficiencies are particularly detrimental in young people following a diet, for example, or in the elderly who are satisfied with just a soup in the evening...
- A elderly person should eat as an adolescent !
A deficit, medical solutions?
- As Professor Jean-Philippe Bonjour from the University hospital of Geneva points out, the most effective therapeutic means would reduce the risks of osteoporotic fractures only by 50%, and would not restore the bone structure.
- Estrogens, largely used as first intention treatment in post-menopausal prevention of bone loss, saw their prescriptions decrease following a great study published in 2002 in JAMA review [ 1 ].
- It stated that their effect was beneficial in the prevention of osteoporotic fractures, but also that they increased vascular accidents and breast cancer risks.
- The conclusion of the study was that the risks incurred by their ingestion exceeded the expected benefits. Even if the results of this study are partly debatable, it contributed largely to the decrease of estrogens prescription.
"For these several reasons, Professor Bonjour underlines that prevention by non pharmacological means remains the best strategy in fighting osteoporosis.
Non pharmacological means
- The strategy consists in optimising the acquisition of mineral mass and the resistance of bones during growth and their future loss during adulthood, particularly after menopause, and at a later age for both sexes.
- A moderate physical activity and an adequate nutritional intake constitute the two pillars of this prevention."
Studies in favour of calcium and protein intakes
- A multidisciplinary study on 280.000 patients/year highlighted a correlation between bone mass and risk factor of fracture: a "normal" BMI of 20, compared to a BMI of 25 multiplies the risks of fracture by two.
- To calculate your BMI: Pour calculer votre IMC
- To measure the direct consequences of food on the brittleness of the bones, the studies remain heavy and delicate, because it is difficult to carry out clinical trials of the type "calcium amounts - bone answer" within the various categories of a general population.
- A recent meta-analysis of double blind randomised clinical trials evaluating the effectiveness of calcium supplements revealed a good outcome on the incidence of osteoporotic fractures, insofar as the contribution in vitamin D were adequate [ 2 ].
- The crucial role of proteins, plant or animal, and of calcium in the constitution of the bone structure and its maintenance is generally considered to be obvious by the scientific community [ 3 ].
However, it should be known that the results of certain studies could put in question these preconditions because of acidification which can be caused by a diet rich in proteins and low on fruit and vegetables.
"As a long-term point of view", says Pr Bonjour, "the current research is directed much more towards browsing the potential interactions between calcium supplementation and other factors acting on the bone metabolism, of nutritional nature (proteins, phosphates), mechanics (body weight, physical activity), endocrine (sex hormones, IGF-1) or genetics (nutrigenomic, nutrigenetic)."
Source: Nutrition infos Review
 Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.
 Boonen S, Bischoff-Ferrari HA, Cooper C, Lips P, Ljunggren O, Meunier PJ, Reginster JY. Addressing the evidence. Calcif Tissue Int. 2006 May;78(5):257-70. Epub 2006 pr 21.
 Bonjour JP. Dietary protein: an essential nutrient for bone health. J Am Coll Nutr. 2005 Dec;24(6 Suppl):526S-36S.
Calcium and vitamin D: effect of food supplements on old women living in an institution
An experimental study financed by the Yoplait company was carried out between December 2006 and April 2007, concerning 36 menopausal women (average age 84,8), without obvious pathologies, enjoying a good mental health, having a diet low in calcium, little exposed to the sun and presenting a deficiency in vitamin D.
- The subjects did not present any antecedents of recent fracture nor of kidney failure.
- During four weeks, the participants ate two pots of 100g cottage cheese per day i.e. of 302 calcium Mg, 2,5 ?g of vitamin D and 14,2 g of proteins (25% of the ANC of a woman of more than 55 years).
- Proportions of biochemical markers resulted in noting, after one month, a reduction in the CTX serum (marker of bone resorption) and an increase in the propeptide N-terminal of the collagen of type 1 (marker of bone formation).
- In addition, the increase in the serum levels of IGF-1 and albumin reveal an increase in the nutritional status of the subjects.
Osteoporosis: identifying the risk factors of the patients
Early knowledge of individual risk factors which can lead to osteoporosis can be enough to set up a strategy of prevention, to organize an adapted supervision or to start a treatment when the risk is particularly high.
- This is why the International Osteoporosis Foundation (IOF) developed a rapid test which can be done online on its site (http://www.iofbonehealth.org/patients-public/risk-test.html).
- This test is based on the conclusions of the new report of the foundation, "fighting the break: learn and reduce your osteoporosis risk factors", launched at the time of the osteoporosis worldwide day celebrated on October 20th, 2007 in more than 80 countries.
The IOF wishes to encourage individuals at risk to identify their risk factors via this test and to adopt a way of life beneficial for their bones: a diet sufficiently rich in calcium and vitamin D and maintaining a normal BMI without alcohol consumption, nor tobacco, and with a regular physical activity.
Thanks to its anti-inflammatory and osteoprotective properties, Oleuropein, a major polyphenol present in the products coming from the olive-tree, has a part to play in the benefits of a Mediterranean type diet.
The scientific team lead by Veronique Coxam from INRA in Clermont-Ferrand-Theix highlighted the effectiveness of two phenolic compounds in animals, Hesperidin from citrus fruits and the Oleuropein from the olive-tree, for osteoporosis prevention.
These works showed in ovariectomised female rats that these phytonutrients had a good outcome both on the bone mass and on the fracture strength at the end of a lifetime.
Hesperidin, at 0,5% for three months in a diet, proved to be effective in the protection of the bone structure and acquiring a peak in bone mass.
As for the consumption of Oleuropein, 0,015% in the diet was enoguh to protect the skeleton from the ageing process thanks to its anti-inflammatory properties.
Even if the clinical studies on man are still under process, these two phenolic compounds for the complementary benefits open interesting prospects in the osteoporosis prevention both post-menopausal as well as senile.
These researches are already subject to two patents submitted by INRA.