Inverting our aproach to Osteoporosis

Osteoporosis is responsible for 1.5 million life altering fractures a year in the United States . Hip fractures are among the most debilitating fracture related to Osteoporosis and considerable resources are utilized in treating these patients. Typically, high risk patients who are post-menopausal women are screened for Osteoporosis and treatment is geared towards prevention of bone loss. Often patients are diagnosed too late and would have benefited from early intervention.

Peak bone formation in males and females occurs around 25 years of age , while women undergo accelerated bone loss at menopause. In fact, bone mass increases progressively during childhood and 40% of total bone mass is accumulated during late adolescence . Children are capable of extracting calcium out of their diets more efficiently than the elderly. This may cause us to rethink where the emphasis should be placed in treating Osteoporosis.

In considering treatment for Osteoporosis, primary prevention is as much if not more important than secondary or tertiary prevention. In other words, it is vital as family physicians to educate and promote good lifestyle choices to our youth while their bones are still forming and before bone loss begins.

In the United States, children have been replacing caffeinated drinks for dairy in their diets, playing video games instead of baseball and some children have begun smoking. All of these factors are contributing to decreased peak bone mass and studies have shown that bone mass in adolescents is related to risk of Osteoporosis later in life. We should emphasize bone formation early on than preserving bone later in life.

RISK FACTORS (modifiable)

If we are going to be successful in preventing osteoporosis, we must understand the risk factors, especially ones that we can alter. The modifiable risk factors for Osteoporosis can be divided into metabolic risk factors and mechanical risk factors.

Metabolic risk factors

Smoking, caffeine, and alcohol can all cause excretion of calcium from the urine. In addition, excessive intakes of protein and phosphate can cause a negative calcium balance1. Inadequate diet and low calcium intake early in life may result in a decreased peak bone mass . All of these factors are negligible if appropriate calcium intake or supplementation are implemented.

Increased consumption of soft drinks is replacing dairy drinks and this affects bone structure in many ways. These drinks will cause diuresis and loss of calcium from the urine, while providing high amounts of phosphates which also promote calcium loss in the urine. Finally, the absence of calcium rich dairy products only adds to the calcium deficiency.

Decreased exposure to the sun can decrease Vitamin D levels in the body which in turn can cause a decreased absorption of calcium in the blood. Parathyroid hormone then is secreted and bone loss occurs to maintain calcium levels . Over time this can have deleterious effects on bone structure and can cause thinning of cortical bone.

Mechanical risk factors

Although, bone metabolism relies on the total body calcium loads, bone formation depends on weight bearing exercise. Bone becomes stronger as demand and work increases. Low loads allow for bone maintenance, high loads cause bones to become stronger and very high loads are not good for bone. It is imperative that children exercise and run around and the trend towards video entertainment makes this more difficult to find balance.

PREVENTION

Diet

As explained above, children are much better handlers of calcium than adults. Due to this fact, we will obtain better results for bone health if we encourage calcium consumption at an early rather than older age.

Current recommendations for calcium intake can be found in Table 2. Good sources of calcium can be found in yogurt, milk, cheese, sardines and salmon . If supplementation is needed, Calcium Citrate and Gluconate are more soluble than Calcium Carbonate. A more comprehensive list of foods rich in calcium can be found in Table 3.

Patient population Mg

Children

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