Osteoporosis: Causes, Prevention and Therapy

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Osteoporosis: What is it

Osteoporosis is a disease characterized by a reduction in deal mass and a deterioration of the micro architecture of bone tissue that induces increased bone fragility, resulting in an increased risk of fractures.
This pathology mainly affects women (to a lesser extent also men) and, in particular, the risk increases with the onset of menopause: at this stage there is a change in the hormonal picture with a drastic drop in estrogen which have an important role in the regulation of calcium levels and absorption and maintain bone remodeling, inhibiting the action of osteoclasts.

We talk about osteoporosis:

- Primitive: postmenopausal or senile
- Secondary: caused by another problem (for example hyperparathyroidism, hypercorticoadrenalism) or by long intakes of corticosteroids, by an incorrect lifestyle (alcohol, smoking), chronic malnutrition, sedentary lifestyle.

Causes and Risk Factors Osteoporosis

Some risk factors and cause of osteoporosis are genetic and cannot be changed.
Other factors, however, concern lifestyle and can be modified both for preventive purposes and in case of full-blown osteoporosis:

- cigarette smoking, alcohol
- abuse of drains and diuretics
- abuse of laxatives
- stress (cortisol plays a significant role in bone depletion)
- sedentary lifestyle
- somal long amenorrhea
- hydrochlorhydry and subclinical B12 deficiency
- prolonged use of drugs (especially corticosteroids, heparin, anticoagulants)
- inadequate nutrition: drastic diets, eating disorder / DCA, deficiency of micronutrients and, in particular, calcium and vitamin D, excessive consumption of coffee, salt and simple sugars, altered ratio between calcium, magnesium and potassium.

Osteoporosis Diagnosis

Osteoporosis is a subtle pathology, in the sense that it does not manifest symptoms that can distinguish it (especially in the early stages).
So how do you diagnose it in time?

At full-blown menopause or in the presence of one or more risk factors, the best thing to do is to contact your doctor to assess whether it is appropriate to do in-depth examinations or not.
The reference test for the diagnosis of osteoporosis is bone densitometry, or computerized bone mineralometry, commonly referred to as MOC, which allows to measure exactly the bone mineral density, that is, the amount of minerals present in the skeleton in toto or in some skeletal districts particularly subject to bone loss. Sometimes the MOC is also called DXA or DEXA (from Dual Energy X ray Absorbtiometry); in reality these two acronyms indicate the technique with which the examination is performed.

It is a simple, fast and non-invasive examination.

Prevention of Osteoporosis

The prevention for osteoporosis begins at an early age and is essential especially up to 23-25 years (up to the peak of bone mass).
In the growing individual (child / adolescent) mineralization (formation of bone tissue) prevails over demineralization (degradation of bone tissue), around the age of 25 the small of bone mass is reached and from that moment on we are in a neutral situation but bone remodeling can be conditioned with physical activity and mechanical load.
In evanced people and, in particular, in menopausal women it happens that demineralization prevails over mineralization (the opposite of what happens to children). The balance then becomes negative and you begin to lose bone mineral mass. In the first phase of menopause the drop can also be very fast.
The prevention lies in increasing the aforementioned small of bone mass, that is, that moment of life when maximum bone density is reached. Nutrition, exercise and a 360-degree lifestyle are fundamental in all age groups.
Women must be encouraged to dour physical activity to promote mineralization processes at the expense of those of demineralization (or "demolition" of bone tissue). A greater study on physical exercise will be described at the end of the article.

As for nutrition, a dietary intake of calcium varying between 400-1500 mg / day was sufficient for the prevention of bone fractures in women who are in peri-menopause, but also depends on the rest of the lifestyle, the health of the microbiota, the levels of vitamin D.

Osteoporosis Therapy

Calcium supplementation, considering the adverse effects it would protect it to have under certain conditions, should not be medical routine nor should it be taken without the advice of a professional. Levels of absorption and excretion of the patient should be evaluated, as well as protein intake and activation of vitamin D.
It's not just a matter of football!
However, in order to limit the cardiovascular risks due to calcium deposits in the tissues and in the circulation, the support of vitamin K2 may be useful (be careful in case of anticoagulants!). The state of health of the individual must always be assessed.
In addition to the amount of calcium to be taken with the diet, it is good to take into account the synergy of the different nutrients. The absorption of calcium, in fact, is favored by the vitamin D and the presence of the right amount of proteins (an excess can be counterproductive).
There is also another mode of absorption of calcium and it is that by simple paracellular diffusion, a type of absorption that does not depend on vitamin D or age: high intra-luminal concentration of calcium, presence of lysine and arginine or lactose is necessary (it is also important to keep the microbiota healthy in order to promote the absorption of the mineral).
It can also be useful to keep the caffein under control: drinking more than 6-7 coffees a day can affect the reduction of calcium absorption (in addition to the HPA axis and problems associated with hypertension).
It is preferable to reduce the amount of coffee during the day to 2-3: one in the morning when waking up, the second in the middle of the active phase (for example after lunch), a possible third in the afternoon.

Vegan Diet and Calcium

I have seen that a well-balanced vegan or vegetarian diet is not related to an increased risk of fractures, as we often tend to believe.
There are alternative sources of calcium to dairy products. It must also be said that, nowadays, most vegan foods are "enriched" and have good amounts of both B vitamins and vitamin D and calcium (vegetable milk or yogurt, tofu, tempeh are just a few examples).

Osteoporosis and Exercise

In the previous paragraph we talked about the importance of prevention of osteoporosis and that it starts from an early age.
The risk of osteoporosis increases considerably in menopause precisely because of the change in the hormonal structure and decrease in estrogens that have a protective function (they maintain bone remodeling, inhibiting the action of osteoclasts).
Encouraging women to carry out adequate physical activity is essential both for prevention, but also in case of osteoporosis already in place: bone tissue is a living tissue, an adequate motor stimulus can favor the processes of mineralization (or "construction" of bone tissue) at the expense of those of demineralization (or "demolition" of bone tissue).
The best physical exercise, especially for prevention, is the one with load and impact (resistance training is fine, running is fine, jumping or well-structured body free-body workouts are fine). Swimming is less important, because it is not high impact and it is precisely the impact that is healthy for the bone.


- According to studies and analyses carried out on athletes, a gymnast has higher density than a runner who, in turn, has higher density than a swimmer.
- Astronauts perform 1-2 hours a day of cardiovascular and counter-endurance exercise, thus reducing the consequences of weightlessness, which results in a reduction in bone mineral density 10 times higher than when on Earth, in the presence of gravity.


From the literature analyzed, in relation to the effects of physical activity on odemetabolism, it is therefore clear that physical exercise against resistance and cardiovascular act on the molecular pathways of bone remodeling involving all cell types of bone tissue. However, physical activity always has beneficial effects on patients suffering from osteoporosis, and not only on bone homeostasis but on the entire musculoskeletal system.

The last thing to do is to stand still.

NB: Osteoporosis is a disease that cannot be cured but something can be done to prevent it. In case of already established osteoporosis something can be done to train it or stop its progression


- I R Reid , S M Bristow , M J Bolland - Calcium supplements: benefits and risks - J Intern Med 2015 Oct;278(4):354-68.
- Kyoung Min Kim et al. - Calcium and Vitamin D Supplementations: 2015 Position Statement of the Korean Society for Bone and Mineral Research - J Bone Metab. 2015 Nov;22(4):143-9.
- Hunt IF, Murphy NJ, Henderson C et al. - Bone mineral content in postmenopausal women: comparison of omnivores and vegetarians. Am J Clin Nutr 1989; 50: 517-523., Adachi J.D., Ioannidis G., Pickard L., Berger C., Prior J.C., Joseph L., Hanley D.A., Olszy nski W.P., Murray T.M. , Anastassiades T.
- Hopman W., Brown J.P., Kirkland S., Joyce C., Papaioannou A., Poliquin S., Tenenhouse A. and Papadimitropoulos E.A. (2003). The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos. Int.14, 895-904

Curated by
Dott.ssa Patalano Myriam Biologist Nutritionist

Ischia Nutrizione Patalano