Bone is living tissue that undergoes constant remodeling – old bone is replaced with new bone. Osteoporosis is the disease most common human bone and is characterized by low bone mass and bone mineral density (BMD) and bone loss. Osteoporosis develops when bone is lost is not replaced by new bone. This leads to a decrease in bone mass and increased risk of fractures. The most common causes of osteoporosis vary from a lack of physical stress (exercise) on the legs,, Malnutrition, low levels of hormone (ie, estrogen, androgen, IGF-1), and age. Secondary causes may be due to treatment with glucocorticoids, where cortisol-like substances that are usually used to control inflammation, increases bone loss.
Osteoporosis was considered a disease that mainly affected older women because of decreased levels of estrogen in menopause. Estrogen replacement causes an increase in osteoblasts (bone formation) activity after menopause,Minimum estrogen is secreted by the ovaries. But since the approval of the Female Athlete Triad, osteoporosis, osteopenia and stress fractures are a problem for many young women. It is also clear that people increasingly seem to be developing osteoporosis occurs. According to the National Institutes of Health (NIH), 10 million people suffer from osteoporosis and another 18 million have low bone mass, the odds favor that these people will develop osteoporosis(1). It 'very unpleasant, because osteoporosis is largely preventable.
NIH defines osteoporosis as "a skeletal disease characterized by compromised bone strength predisposing to an increased risk of fractures. A common mistake is to think of osteoporosis only as a result of loss of bone mass. For individuals who never achieve optimal bone mass may develop osteoporosis without significant loss of bone mass. For a discussion osteoporosis, the NIH Consensus Statement on (INSERT URLHER) is a good starting point. This article covers the latest developments, solve some of the current problems, and offers some practical interpretation.
Exercise: What should we do?
To improve the quality of their bones, people need specific training and instructions on how to do the exercises. In the case of young female athletes, which may be over-year, a recommendation may be appropriate to their program to decrease the volume. This article assumes thatindividuals are older and lack of exercise is the problem. It 'clear that not all protocols of exercise are effective, the attention will be focused on what is documented in the research, and that applies today. There is a strong correlation between muscle strength and bone density (2, 3). A simple interpretation is that most people in general have stronger bones. In a controlled study in which subjects were trained strength, bone density is increased, and thus supporting the diameter –studies (4, 5). Recent research using rats show that while endurance exercise might be more useful than aerobic exercise to stimulate bone formation (6). While there is no guarantee the same results in humans are found, making animal research to a greater control over research into practice and examine how it can be difficult to study in humans. Unlike pharmacological and nutritional approaches useful for strength training to influence multiple risk factorsosteoporosis and other diseases caused by an increase in strength, balance and muscles while.
The strength or endurance exercise, are not just going to the gym and "pumping iron". A well-designed program can balance, flexibility, cardiovascular and address agility. It is often overlooked components of fitness, which can easily be in a program to be. The programs are calculated on the basis of what you might have at their disposal (equipment, location, etc.) andThey can really (physical limitations, personal goals, counter, etc.) to do. In previous research, older patients raised food (ie soup cans, sacks of potatoes, milk containers, etc.) and their strength, muscle mass, bone density, body composition and mental attitude.
Research in the past had older patients lift weights slowly and controlled due to concerns that the rapid movements and explosives can not affect it. Approach Today things are very different.One consequence of aging is that there is a decline in the function of motor units quickly dart, and then the muscle fibers. Observations to date show that the effect of such training in the elderly can be very useful in several areas, including improved speed, a decrease of the drug for blood pressure, blood glucose control and decrease depression. E 'easily depressed when you can not move.
In a well-designed exercise program starts with the approval of medicaland a physical examination is to determine the functional capacity of the person, the integrity and muscle strength. For example, if a person has weak legs and without common problems, leg Squats possibility of a bed or a chair works well. Originally limited range of motion and improving strength and balance, the range of proposals has increased. The chair or the bed is a security measure so that the subject is not squat too deep too quickly. Push-ups and straight leg sit-ups (on acot or mat with less recoil up in bed / blanket), is also very effective movement. Try to choose the movements that make it difficult to balance (or a fraction), the resistance to use the full range of movements used in body weight, in particular, unless contraindicated, and stresses the elimination phase on one or two days ( safe, said a 'or' One – two "and attempting to traffic at the same time) with the reduction stage is usually about twice as long. The main point is thatWe do resistance exercises work to increase or prevent loss of bone mass (with many other positive effects), we see now how you can make it fun, do not lend to people who want to work.
Diet: What can we recommend?
Recommendation of a higher consumption of dairy products along with some sunshine will work with some people, but usually not more mature customers. Other dietary factors have been spared. Consumption of fruits and vegetables had a positive relationship with bone density (7, 8).While there may be other explanations for these relationships can be positive, there is overwhelming evidence that supports their prudent advice. Recommendations applicable standards – five to nine servings per day for adults, with plenty of variety. Results from the Framingham Osteoporosis Study showed that, even after the administration of various factors, low protein intake increases bone loss (9).
Studies on rats show that a diet rich in protein is not to adversely affect bone turnover andto support the Framingham study shows that low protein intake lowers IGF-1 and IGF-1 induces resistance in osteoblasts (10, 11). Since the majority of older people too little protein, the protein intake of low-power seems to be more a concern that a high intake of protein, when it comes to preventing osteoporosis. Although the concepts of high and low are used based on the relative contribution of calories to the diet of protein, can be very misleading. A better strategydetermine the adequacy of intake of protein than the body mass and activity patterns of individuals. RDA for protein, 8 g / kg body weight. But strength training improves the recommendation above high as 1.8 g / kg body weight.
Soybean and linseed (oil or flour) are good sources of phytoestrogens. Phytoestrogens are plant substances that may modulate the function of estrogen. Phytoestrogens Many have involved either indirectly or indirectly, toinfluence on bone turnover. Although there was enough evidence to say exactly how these things can influence bone tissue, there is enough evidence to justify their recommended use. In view of the general problem is that the elderly have to eat enough calories, the real trick is how this group to really eat that can help them find. For other groups, but only that many people can not see the value of taking time to plan and make all the healthy foods that know they must eat. Apractical example that has worked very well for some people to smoothies, or mixed blends. One scoop of why the protein is mixed with some frozen berries and flax seed flour provides many nutrients that may benefit bones. And 'fast, convenient, can be stored for later consumption, and transport to another location. For a variety, ranging from oil and flax seed flour, fruit number, and alternate between the use of soy and whey proteins.
Grant: We really needDepending on the market?
It 'clear that an additional drug (s) may be effective compared to placebo. What is not obvious or not is a supplement to prevent bone loss do not work better than a diet with similar nutritional values in the appendix. Collectively, most studies support the idea that if people get enough calcium, vitamin D, vitamin K and boron in their diet and lead an active lifestyle, will achieve and maintain healthy bonesdensity. The dilemma is that large segments of the population, the necessary amount of these nutrients can not. While the advice is often required, this group is composed mainly of older adults may have a way of life firmly established. Dietary supplements may be an appropriate choice, as far as he can remember the pills correctly, with the correct dosage at the right time.
Football is the most specific nutrients for the development of peak bone mass andprevention of bone loss. Recommended intakes of calcium to prevent or treat osteoporosis, 1000-1500 mg per day for older adults. Calcium may move or be moved to be absorbed by other minerals. Calcium supplements should be common for the times of individual mineral supplements or other foods that contain minerals that will be taken if we are to maximize the absorption of calcium. May, with the fruit juice and vitamins are taken. Vitamin D is important for optimal calcium absorption and had a recommendedIus intake of 400-600 per day. Vitamin D alone has limited therapeutic value for people with normal levels of vitamin D (12), but it can increase bone density in people with low serum levels (13).
Research has focused a lot on calcium and vitamin D, the other components of the diet is often overlooked. Drilling initially received attention for use as an intervention to treat and prevent gout. In some parts of the world where boron intake is less than one milligram per day, arthritisincidence is 20-70%. In other places to live, taking from three to ten milligrams a day, arthritis occurs in 10% or less of the population. A significant positive response was reported at 6 mg per day. The combination of 45 mg / day and vitamin K2, 75 micrograms of vitamin D3 increased bone density in postmenopausal women with osteoporosis (14). Vitamin C is also correlated with increased beendigtheid postmenopausal women receiving calcium intake and estrogen(15). Supplement intake ranged from 100-5,000 mg / day with an average dose of 745 mg / d.
A supplement that a lot of attention received marketing ipriflavone. Ipriflavone is a synthetic isoflavone sold over the counter. In some European countries is regarded as one of the earliest and most effective therapies to combat osteoporosis. Studies of ipriflavone, however, give mixed results, with some indicating that the bone mineral density and other increaseswhich shows that it can not happen. In a recent study published in JAMA reported that there was no effect on bone mineral density and the concentration of lymphocytes decreased significantly (16).
Several companies have produced food supplements marketed as anti-osteoporosis agents. In light of the above doses, a complete prescription for osteoporosis will be composed from 1000 to 1500 mg / day calcium, 400-600 Ius of vitamin D / d, 745 mg vitamin C / D, 45 mg / day Vitamin C and 6 mg / d of boron. There is no researchat this stage that the investigation has the effect of providing simultaneously all the above agents on bone density. Ask if the common use of this supplement is more effective than a smaller number of combination is a matter of opinion. The most appropriate place for this protocol supplemention groped in clinical practice a patient's competent professional monitors. A major concern is that citizens can choose between these agents, and prescribe without supervision or guidance of a competentprofessionally.
Puts into practice today
A problem with research on the prevention of bone loss or increase bone mineral density is that there are many variables to control for l '. Activity patterns can vary significantly, and the results of a nutritional intervention may reflect the synergistic effect of diet and exercise, although only the nutritional component is carefully monitored. Another problem is that when bone mineral density in a critical momentpoint, could have significant interference from a statistical point of view, it means a bit 'from the practical point of view. That is when the subject is increasing beendigtheid, can still break bones with the same pace as before the study. This makes the interpretation of the results a bit 'problematic.
A simple strategy is to provide prudent to perform resistance exercise, which challenged the balance (ie that are working against gravity). The program includes the progression as they getstronger, allocations will be more challenging. The diet should contain at least 8 g / kg bw / day, and not more than 1.8 g / kg per day as resistance training. And 'generally acknowledged that most of the nutrients from the diet can be obtained, however, a significant percentage of the population is evidence of a low level of one or more nutrients in relation to bone health. While the recommendations for lifestyle changes is absolutely justified, non-compliance seems to be very high on the lackterm. Grant of one or more of the following can be justified: from 1000 to 1500 mg / day calcium, 400-600 Ius of vitamin D / d, 745 mg vitamin C / D, 45 mg / day of vitamin C and 6 mg / d of boron. Ideally, these strategies should be under the guidance of a competent professional.
References
1. Anonymous, Osteoporosis prevention, diagnosis and treatment. JAMA, 2001. 285 (6): p. 785-95.
2. HUUSKONEN, J. et al. Determinants of bone mineral density in middle-aged men: apopulation-based study. Osteoporos Int, 2000. 11 (8): p. 702-8.
3. Proctor, DN, et al. Relative importance of physical activity, muscle strength and bone density. Osteoporos Int, 2000. 11 (11): p. 944-52.
4. Kerr, D., et al. Resistance training over 2 years increases bone mass in postmenopausal women soccer exhibitions. J Bone Miner Res, 2001. 16 (1): p. 175-81.
5. Ringberg, KA, et al. The effect of long-term, moderate physical activity on functional performance, bonemineral density and fractures in older women. Gerontology, 2001. 47 (1): p. 15-20.
6. Anatomy, T. et al., comparison of resistance and aerobic training for mass, strength, and turnover of bone in growing rats. Eur J Appl Physiol, 2000. 83 (6): p. 469-74.
7. Tucker, KL, et al., Potassium, magnesium, and fruit and vegetables is associated with increased bone density in men and older women. Am J Clin Nutr, 1999. 69 (4): p. 727-36.
8. New SA, et al.Dietary influences on bone mass and bone metabolism: further evidence of a positive correlation between consumption of fruit and vegetable intake and bone health? Am J Clin Nutr, 2000. 71 (1): p. 142-51.
9. Hannan, MT, et al. Effect of dietary protein on bone loss in elderly men and women: The Framingham Osteoporosis Study. J Bone Miner Res, 2000. 15 (12): p. 2504-12.
10. Bourrin, S., et al. Dietary protein restriction decreases plasma insulin-like growth factor I (IGF-I), cortical boneformation and cause osteoblastic resistance to IGF-I in adult female rats. Endocrinology, 2000. 141 (9): p. 3149-55.
11. Creedon, A. and KD Cashman, the effect of high salt and high protein on calcium metabolism, bone composition and bone resorption in mice. Br J Nutr, 2000. 84 (1): p. 49-56.
12. Hunter, D., et al., A randomized controlled trial of vitamin D supplementation to prevent bone loss after menopause and modifying bone metabolism using identical twin pairs.J Bone Miner Res, 2000. 15 (11): p. 2276-83.
13. Kantorovich, V., et al. Increases bone mineral density at the expense of vitamin D in patients with vitamin D insufficiency and the coexistence of primary hyperparathyroidism. J Clin Endocrinol Metab, 2000. 85 (10): p. 3541-3.
14. Iwamoto, J., T. Takeda, and S. Ichimura, the effectiveness of combined administration of vitamin D3 and vitamin K2 on bone mineral density of the lumbar spine in postmenopausal women with osteoporosis. J Orthop Sci, 2000. 5 (6): p.546-51.
15. Morton, DJ, EL Barrett-Connor and DL Schneider, the use of vitamin C supplement and bone mineral density in postmenopausal women. J Bone Miner Res, 2001. 16 (1): p. 135-40.
16. Alexandersen, P., et al. Ipriflavone for the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA, 2001. 285 (11): p. 1482-8.


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