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Zoe Poissot
FSN 315
Fall 2013
G. Lordus

Osteoporosis

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Abstract
Objective
10 million Americans are currently suffering from Osteoporosis. This bone disease that
seriously decreases bone strength is known to cause bone fractures in many of the patients
suffering from it. Fractures decrease quality of life and increase risk of early death. Many risk
factors, such as race, age, and sex cannot be changed. However, risk factors such as being
inactive and having a poor diet can be changed, and used to decrease risk of osteoporosis.
Methods
Exploring the common causes and diagnosis of osteoporosis, the researcher can make
conclusions about prevention of the disease. Researching treatment and prevention will help the
reader to learn how to avoid osteoporosis in older age. Research from the China Study will shed
light on the role of nutrition in avoiding osteoporosis.
Conclusion
There are many ways to avoid osteoporosis. If one lives a healthy active lifestyle and
maintains a nutritions high alkaline diet at a young age, their risk of osteoporosis will be greatly
decreased.

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Introduction
Osteoporosis: one in five caucasian women age 50 and older are diagnosed with it and 2
million men in America have it currently (1). Hip fractures, extremely common in the elderly and
associated with osteoporosis, are known to be fatal for 20% within a year of the fracture (5).
Osteoporosis is extremely common and can be fatal for many elderly. Although there are known
unmodifiable risk factors, osteoporosis can be prevented and avoided almost completely, if
action is taken at a young age. This paper will take the reader through diagnosis, risk factors,
treatment and prevention, the China Study, and fractures of osteoporosis.
Osteoporosis Overview
Diagnosis, Risk Factors, and Causes
Osteoporosis is the degeneration of bone mass, most commonly occurring in older adults.
This bone disease is associated with a lack of calcium stored in the bone causing small holes to
form in the bone (1). This causes the person affected to have a lone bone mineral density (BMD),
which is a measure of the grams of mineral per area volume (2). Which leads to the diagnosis
and detection of osteoporosis. The World Health Organization developed a tool to measure BMD
which results in either a T score or a Z score. The Z score is used in premenopausal women while
the T score is used on postmenopausal women (2). The BMD is measured in the hip, femoral
neck, and lumbar spine (2). Table 1 shows an example of BMD scores by different variables in
the patients (4). There are four diagnostic categories used that are based on the measurement of
the BMD, called normal, osteopenia, osteoporosis, and severe osteoporosis. When diagnosed
with osteoporosis, the patient has an increased risk of bone fracture, so the WHO came up with

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the Fracture Risk Assessment Tool (FRAX), in order to calculate the ten year probability of a
fracture (3).

Table 1. Patients BMD scores including variables of patients. Taken from reference 4.
About 10 million people in America are diagnosed with osteoporosis and 80% of those
people are women (2). The most at risk group for osteoporosis are age 50 and over White and
Asian Women(1). The North American Menopause Society (NAMS) has come up with a list of
certain risk factors that include, low BMD score, low BMI, older age, inactive lifestyle, high
consumption of alcohol or smoking, and parental history with the disease (2). Evidence has
shown that tobacco smoking seriously increases bone loss, which in turn increases risk of
fracture in older women (2). Although there are many factors that cannot be modified, such as
race, sex, or age; certain risk factors like living a sedentary life or consuming a diet inadequate in
vitamin D or calcium, can be avoided and help to prevent osteoporosis.
Treatment and Prevention

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Currently there are not many known effective treatments for osteoporosis. Of all the
patients in long term care, its estimated that a maximum of only 36% are receiving bone related
treatment (5). The three main treatments are vitamin D, calcium, and hip protectors to prevent
hip fractures (5). In table 2, the Surgeon General website has posted recommendations for
calcium, vitamin D, and exercise in relation to bone mineral density.

Table 2. Recommendations from the Surgeon General. Taken from source 6.

Vitamin D, specifically D3, supplementation is known to decrease falls and is associated
with a 7% lower death rate (1). The best form of Vitamin D for bone health support is D3 and its
found in the skin after being exposed to direct sunlight (1). Although sun exposure is the best
way to obtain Vitamin D3, it can also be obtained from fortified milk, egg yolks, saltwater fish,
and supplements. Because it is almost completely ineffective to take calcium without Vitamin D,

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these two in conjunction are very important in treatment of osteoporosis. The universal
recommendation for vitamin D3 intake is 1200 IU per day (1).
As for calcium, the recommendation is 1200 mg per day for men and women age 50 and
older (2). However, it is estimated that the average postmenopausal women intakes only about
700 mg of calcium in their daily diet (2). It is best to get calcium from dietary sources, but
supplementation can be used for adequate calcium absorption as well. Some foods high in
calcium are shown in table 3 (7).
Table 3: Selected Food Sources of Calcium

Food

Milligrams (mg) Percent DV*

per serving

Yogurt, plain, low fat,

415
42
8 ounces
Mozzarella, part skim,
333
33
1.5 ounces
Sardines, canned in
325
33
oil, with bones, 3
ounces
Yogurt, fruit, low fat,
313384
3138
8 ounces
Cheddar cheese, 1.5
307
31
ounces
Milk, nonfat, 8
299
30
ounces**
Soymilk, calcium299
30
fortified, 8 ounces
Milk, reduced-fat (2%
293
29
milk fat), 8 ounces
Table 3. Foods high in calcium content. Taken from source 7.
While natural remedies are arguably the best treatment for osteoporosis, there are also
medications offered for treatment of osteoporosis. The FDA has approved several pharmaceutical

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therapies. However, one is used most commonly, biophosphonates (7). Results from a study done
on the use of risedronate, showed that there was a correlation between daily dosing and
decreased incidence of fractures (8). As illustrated in Table 4, risedronate increased the BMD of
the lumbar spine in the clients at month 12 and month 24, proving that risedronate is an effective
means to treating osteoporosis and preventing major bone fractures (8).

Table 4. BMD of lumbar spine in correlation to dose of risedronate. Taken from source 8.
The China Study
A comprehensive nutritional study done in China found major evidence on the impact of
animal versus plant based diets in relation to osteoporosis (9). According to researchers,

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Americas high consumption of animal protein contributes to the reason that there are many more
fractures in America compared to China, where the people consume a plant based diet. Animal
protein increases acidity in the blood and the body, in order to neutralize the acidity, uses calcium
(9). This expenditure of calcium weakens the bones and increases the risk of fracture. The China
Study recommends a low acidity, plant-based diet that includes high alkaline foods, in order to
prevent osteoporosis. This diet mirrors the diet of the majority of Chinese people, who have only
one fifth of the fracture rate of the United States (9). Table 5 shows a chart of foods ranging from
alkaline to highly acidic (10).

Table 5. Foods ranked from strongly acidic to strongly alkaline. Taken from reference 10.
Fractures Caused by Osteoporosis

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There are two main types of fractures that happen in patients with osteoporosis; vertebral,
the most common, and hip fractures (2). Vertebral fractures commonly go unnoticed, because of
the lack of any obvious physical deformity (2). Most women who suffer vertebral fractures
attribute their pain to aging or over exercise. Although there are commonly no visual physical
signs of vertebral fractures, patients who suffer this type of fracture are at an increased risk of
death and a decreased quality of life. To avoid any additional negative impacts from vertebral
fracture, it is important to detect these fractures early on (2). A common way to detect vertebral
fractures is height measurement. It is common that a person who shows a height reduction of 6
cm or more, has suffered a vertebral fracture (2). Treatment of these fractures includes rest for a
short period of time and opioids for pain relief (2). With acute vertebral fractures, however, it is
important to have mobilization early on, to minimize disability.
The second most common fracture in patients with osteoporosis is hip fracture. Hip
fractures, more than any other type of fracture, are the most likely to cause early death (2). It is
estimated that about 18% of women in America will suffer a hip fracture sometime in their later
life (2). Hip fractures are often caused by falls. Although hip protectors are sometimes used to
prevent hip fractures in older adult, they are not fully supported for use by older adult living in
normal community settings (2). Treatment for hip fractures, unlike vertebral fractures, involves
surgery within 24 hours of the incident (2). The best way to prevent any type of fracture in
osteoporosis patients is fall prevention. This includes monitoring medications, particularly sleep
and cardiac medications.
Conclusion

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Ultimately, the best recommendation to avoid fractures, falls, and osteoporosis in general
is to live a healthy active lifestyle and consume the recommended amounts of calcium and
vitamin D in the diet. Though, there are many unmodifiable factors that put one at risk for
osteoporosis, the modifiable ones are the ones that can really decrease risk of osteoporosis.
Avoidance of the very common bone disease osteoporosis, can increase quality and length of life.

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Reference List
1. Bernstein M. and Luggen AS. Nutrition for the Older Adult. Massachusetts; Jones and Bartlett
Publishers; 2010.
2. Roush, K. Prevention and Treatment of Osteoporosis in Postmenopausal Women. AJN 2011;
111:26-35.
3. FRAX. WHO Fracture Risk Assessment Tool: 2013. Available at http://www.shef.ac.uk/
FRAX/index.aspx. Accessed December 1, 2013.
4. Davisson L, Warden M, Layne R, et al. Osteoporosis Screening: Factors Associated with Bone
Mineral Density Testing of Older Women. Journal Of Women's Health (15409996) [serial
online]. July 2009;18(7):989-994. Available from: Academic Search Premier, Ipswich, MA.
Accessed December 8, 2013.
5. FRAX or fiction citation needed
6. Surgeon General. Bone Health and Osteoporosis: 2004. Available at http://
www.surgeongeneral.gov/library/reports/bonehealth/chapter_10.html#Calcium. Accessed
December 1, 2013.
7. National Institute of Health. Calcium Fact Sheet: 2013. Available at http://ods.od.nih.gov/
factsheets/Calcium-HealthProfessional/. Accessed December 1, 2013.
8. McClung MR, Benhamou CL, Delmas PD, et al. A Novel Monthly Dosing Regimen of
Risedronate for the Treatment of Postmenopausal Osteoporosis: 2-Year Data. Calcif Tissue Int.
2013; 92(1): 59-67.
9. Campbell TC and Campbell TM. The China Study. United States: BenBella Books; 2005.

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10. True Health Family Chiropractic. Alkaline vs. Acidic. Available at http://
www.truehealthct.com/what-is-true-health/how-to-eat-well/alkaline-vs-acidic-foods/.
Accessed December 1, 2013.