Role of Non Pharmacological Measures in Prevention and Treatment of Primary Osteoporosis

Abstract

Osteoporosis is a global health problem characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. - It is a pediatric disease with geriatric outcome and so prevention have to be started in early childhood through raising the student's awareness about risk factors and preventive measures as calcium, nutrition and physical activity. - In young, healthy subjects, it was shown that the type (e.g. with land impact or not) and intensity (e.g. endurance or not) of exercise have independent and additive effects on bone density suggesting that any physical activity could be of primary importance to reach optimal peak bone mass, bone strength and bone geometry. This is of primary importance from a prevention point of view as an optimal BMD before menopause is of major importance to reduce the risk of fracture - Parents have to encourage their kids to eat fruits and vegetables to reduce bone turnover and increase bone mineral density. There are several potential mechanisms by which fruits and vegetables may improve bone health. Fruits and vegetables may reduce urinary calcium excretion, create an alkaline environment, provide specific nutrients, provide an antioxidant effect, and provide bioactive components (phenols and flavonoids), or they may simply be a marker for a healthy lifestyle. Therefore, foods, rather than supplements, may be the best way to get the benefit of antioxidant compounds and vitamins, because they may also provide skeletal benefit. - It is better to get calcium from nutrition as calcium supplements may be associated with mild gastrointestinal disturbances, interfere with the intestinal absorption of iron and zinc and increase risk of cardiovascular events in women with more than 80 years of age. - Vitamin D is also essential for the development and maintenance of bone, both for its role in assisting calcium absorption from the diet, and for ensuring the proper renewal and mineralization of bone tissue. - Encourage sun exposure as the main source of vitamin D is sun. Approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen lead to sufficient vitamin D synthesis. - Average protein intake improve bone mass by the fact that increasing dietary protein is also known to increase circulating levels of insulin-like growth factor 1 (IGF-1). - Phytoestrogens are plants structurally similar to steroid hormone, they are widely self-prescribed against the treatment of postmenopausal osteoporosis. However the extensive use of phytoestrogens is shown to cause grade 1 endometrioid adenocarcinoma, affects breast growth and lactation. - Oxidative stress influence the generation and survival of osteoclasts, osteoblasts, and osteocyte. Antioxidants that may relate to bone health include vitamin A, vitamin E, vitamin C, carotenoids, and flavonoids such as quercetin. These compounds may also have the potential to create a more alkaline environment, reduce urinary calcium excretion, and provide bioactive components (phenols and flavonoids). - Breast fed infants tended to have lower bone density and mass than formula fed infants due to vitamin D deficiencies in breastfed infants as they tend to be kept out of the sunlight, breast milk and formula are also known to differ in their calcium, phosphorus, vitamin K, and protein content. - Greater maternal consumption of calcium and calcium-rich foods, especially milk and milk products, in mid- to late pregnancy was associated with higher total body and spine BMD in the children. - Smoking is a major risk factor for osteoporosis. As radicals inhaled from cigarette smoke down regulate the expression of three important genes: osteocalcin, type 1 collagen, and alkaline phosphatase Moreover, there are over 150 known toxic compounds that have been found in cigarettes, and heavy metals as cadmium, hydroxyquinones, thiocyanate, and nitrosamines. - Caffeine increases urinary and faecal calcium losses and may provoke a negative calcium balance in presence of a low calcium diet this deleterious effect of caffeine seems to be offset by increasing calcium intake. - Sodium chloride elevates urinary calcium excretion. The calciuria is partly due to salt-induced volume expansion, with an increase in GFR, and partly to competition between sodium and calcium ions reabsorption in the proximal renal tubule, oral potassium completely blocks the calciuria of a large sodium chloride load. - Exposure to heavy metal including Lead and Cadmium either environmental or occupational decrease BMD this is because, bone is the long-term storage site for lead. Lead exposure can potentially interfere with bone and calcium metabolism in several ways. Lead and calcium have similar physical and chemical characteristics and follow similar intracellular metabolic pathways. While Cadmium affect bone health either directly by decrease intestinal Ca absorption or indirectly through renal dysfunction. - Low body mass index (BMI) is a well-recognized risk factor for osteoporosis on the other hand obesity have a negative impact on indices of bone strength and possibly on fracture risk and so one of preventive tools is keeping average body weight. - Exercise done during late adulthood increases the bone mass minimally if at all, its main purpose being to maintain the bone mass. It include exercise strengthens muscles, increases flexibility, and improves coordination and balance. - Each person has to tailor the exercises according to his or her own capabilities, keeping in mind that some exercise is better than no exercise at all.