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Tips for osteoporosis patients

Osteoporosis is a skeletal disease in which there is a decrease in bone mass density. It does not manifest symptoms until the bone loss is so significant that fractures appear. Here are some tips for patients with osteoporosis

Adequate intake of calcium products.

The primary source of calcium in the diet is dairy products. Even though this is well known, people often wonder whether low-fat dairy products have less calcium or whether all cheeses have the same calcium content. It is important to know that skimmed dairy products provide the same amount of calcium and that the cheeses with the highest calcium content are aged cheeses. In general terms, an approximate intake of one gram of calcium per day is necessary for an adult to have good bone health. This can be achieved, for example, with one liter of milk. But there are other sources of calcium that can contribute to the daily requirement such as nuts (almonds, hazelnuts, walnuts), legumes (white beans, chickpeas), fish (canned sardines with bones), vegetables (watercress, broccoli), seeds (sesame) and tofu.

Exposure to sunlight.

A general recommendation is daily exposure to the sun on the face, hands, and arms for 10-15 minutes. However, skin production of vitamin D depends on the season of the year, geographical latitude, time of day, skin color, age, and the use of sun protection creams.

 It is important to be careful not to overexpose oneself to sunlight because of the associated skin problems, such as skin cancer and skin aging.

Intake of foods that provide vitamin D.

The main source of vitamin D is cutaneous synthesis from exposure to sunlight. However, the diet can also contribute to the acquisition of daily requirements, from foods fortified with vitamin D (dairy products, cereals and margarine) and from the intake of fatty fish. Thus, it is advisable to include salmon, sardines, tuna and mackerel in the diet.

Other foods can contribute to the dietary intake of vitamin D, although to a lesser extent and with an almost negligible contribution to the daily vitamin D requirements. These include egg yolk, certain mushrooms, especially those exposed to ultraviolet light such as the brown mushroom or the crimini mushroom, as well as animal liver such as beef or lamb liver.

Adequate nutrition for bone health.

Adequate protein intake is required for bone health but also to keep muscle mass, an important factor in preventing the risk of falls. Additionally, a healthy diet with fruits and vegetables that are sources of vitamin K (green leafy vegetables, vegetables such as broccoli, and fruits such as kiwi) and magnesium (green leafy vegetables, pumpkin and flax seeds, almonds) is recommended. The diet should also provide zinc and especially vitamin B.

Regular physical exercise.

It is advisable to exercise with ground impact in order to maintain good muscle and bone health. Thus, the most recommended type of exercise is walking, running, or low-impact aerobic exercise (if the patient’s health permits). Jumping is not recommended in patients who have suffered vertebral fractures and should be replaced by walking, in order to reduce the excessive impact on the spine. Bicycling or swimming, which do not involve contact with the ground, are highly recommended for general health but have little effect on the maintenance of bone mass. 

Physical exercise programs generally include 20 to 30 minutes practiced regularly, 2-3 days a week, always adapted to the patient’s specific characteristics. The most recommended exercises are isometric, stretching, and spinal extension exercises to strengthen the upper back. High-impact exercises and those involving extreme flexion and torsion of the trunk should be avoided. Thus, care should be taken in activities that may require these postures such as golf, tennis, bowling, and some yoga positions.

Promote proper postures and balance.

It is advisable to improve balance with programs that include 3 hours a week of targeted physical exercise. It has also been suggested that regular practice of Tai Chi can improve balance and body schema perception and thus contribute to a reduction in stumbles, falls, and loss of balance in older individuals.

 Adequacy of the environment and other tips to prevent falls.

It is recommended to eliminate from the environment of the patient with osteoporosis all those objects that can facilitate falls, such as, for example: carpets, electrical and telephone cables. In addition, good lighting in the home is recommended, ensuring access to light in the bedroom and corridor, as well as the use of non-slip mats in the bathtub or shower. Other important aspects are to wear appropriate footwear avoiding high heels, flexible slippers and shoes with slippery soles. Good vision control should not be forgotten.

Avoidance of drugs that may increase the risk of falls.

It is recommended to avoid sedative hypnotic drugs, since advanced age, poor sleep and their use are often associated with and increase the risk of falls and fractures, through mechanisms related to cognitive and psychomotor impairment. All this leads to decreased coordination, with alterations in balance and gait. Caution should also be exercised when taking psychotropic drugs, antipsychotics and antidepressants. 

Treatment with antihypertensive drugs should be appropriately adjusted, as they have been associated with the development of hypotension and syncope. Their role in the risk of falls is controversial, although there may be an increased risk of falls at baseline and with intensification of treatment. 

Avoid tobacco and excess alcohol.

Avoidance of tobacco use is recommended. The exact role tobacco plays in osteoporosis is unclear, but a direct relationship between tobacco uses and decreased bone density has been described.

It is also recommended not to drink alcohol in excess, as its chronic and abusive consumption is associated with a double harmful effect: increased risk of falls and reduced bone mineral density.

See your doctor if you have had a fracture following a minor fall.

It is recommended to consult your doctor if you have suffered a fracture that was not induced by a hit-and-run, sports or automobile accident. It is common to think that “you fractured because you fell”. Your doctor will assess whether it may be an osteoporotic fracture. Your diagnosis and treatment will help prevent the development of new fractures.

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