Osteoporosis: The Role of Nutrition in the Prevention and Treatment

Abstract

The purpose of this study is to examine the role of nutrition in the prevention and treatment of osteoporosis, a specific skeletal disorder associated with bone weakness and loss. In addition, it addresses African American seniors as a population group vulnerable to this disease. The significance of this paper is determined by a common unawareness of Black citizens and older people concerning osteoporosis and related dieting and particular barriers to information dissemination and appropriate nutrition associated with African American community. The paper may be used in the future as a basis for further investigation dedicated to osteoporosis-preventative nutrition for an identified population group as there is a lack of research related to this subject.

Introduction

Osteoporosis is a skeletal disorder that affects millions of people all over the world. It is associated with bone weakness, low density, and low mass, as the body loses more bone tissue than it produces. The seriousness of osteoporosis is determined by the threat of bone fracture due to its brittleness – when osteoporosis occurs, even sneezing or coughing can lead to broken bones. In general, there are multiple factors that contribute to osteoporosis development, and age may be regarded as one of the most significant.

African American senior men and women may be regarded as a highly vulnerable population in relation to osteoporosis. Although the prevention and treatment of this disease is a complex process, nutrition plays a vital role. As a matter of fact, a well-balanced may improve health, slow down the molecular mechanisms of aging, and prevent osteoporosis development. That is why, nutrition therapy or a simple consumption of healthy food rich in calcium, vitamin D, and other nutrients is important for older people.

At the same time, it goes without saying that information concerning nutrition should be disseminated among people with osteoporosis to reduce unawareness that already exists in the Black community. However, it is necessary to consider specific barriers and limitations that require particular attention and additional researches. Major barriers include racial nutritional peculiarities, limited access of African Americans to health, and low household income that frequently leads to inappropriate dieting.

This paper is dedicated to nutrition that may be beneficial for osteoporosis treatment and prevention. In addition, it addresses African American senior citizens, both women and men, due to their vulnerability, a lack of awareness, and the significance of nutrition for them. The work states that nutrition is immeasurably important for people with osteoporosis and related information should be distributed considering specific limitations typical for different population groups.

General Background

Osteoporosis is a specific skeletal disorder traditionally characterized by bone tissue’s microarchitectural deterioration and low bone mass. As a matter of fact, bone is constantly broken down and subsequently replaced living tissue. Thus, osteoporosis occurs when the human body makes too little bone, loses too much bone, or both (“What is osteoporosis and what causes it?,” n.d.). If to view under a microscope, it is possible to notice that healthy bone resembles a honeycomb, however, in the case of osteoporosis, the tissue’s spaces and holes are bigger. Thus, osteoporotic bones contain abnormal structure and have lower mass or density in comparison with healthy bones (“What is osteoporosis and what causes it?,” n.d.).

As a result, bones become so highly weak and brittle that even coughing, sneezing, or bending over may cause a fracture. In the majority of cases, osteoporosis is not diagnosed at its initial stages as this disease frequently develops slowly without pain or additional symptoms. Therefore, it is traditionally discovered when sudden stress or fall causes a bone fracture. The most common injuries of patients with osteoporosis include the broken wrist, hip, arm, pelvis, rib, and vertebrae.

Mechanism of Development

Even if the exact factor of osteoporosis development is still unknown, specialists understand the mechanism of this disease’s development. As a living and growing tissue, bone protects vital organs. supports the body, and stores calcium and other essential minerals.

Thus, when there is a lack of calcium in the body, the process of bone remodeling starts. In other words, bones are broken down and rebuilt in order to supply the organism with necessary minerals staying strong at the same time as well. In general, with age, bone mass gradually decreases as bone buildup occurs slower than bone breakdown, however, for people with osteoporosis, bone mass is lost at an accelerating pace. At the same time, the development of osteoporosis partly depends on bone mass accumulated in a person’s youth (Mayo Clinic Staff, n.d.). The higher his or her peak bone mass is, the more bone is reserved for the future. Peak bone mass traditionally varies by ethnic group and may be inherited.

Symptoms

As previously mentioned, osteoporosis may be regarded as a silent disease as its development is frequently unnoticeable. However, under certain circumstances, the following signs may occur and they should be considered:

• A person loses height over time and gets shorted by up to several inches;
• Shortness of brief is experienced due to smaller lung capacity caused by compressed disks;
• The change in a person’s posture, such as bending forward or stooping, is observed;
• Unexpected bone fracture due to insignificant stress occurs;
• A person experiences lower back pain due to collapsed or fractured vertebrae.

Risk Factors

There are certain risk factors that may increase the possibility of osteoporosis development in the future. At the same time, every medical history in relation to osteoporosis is individual, and some people with this disease do not have any risk factors at all. In addition, while some factors may be excluded, others are unchangeable. First of all, the risk of osteoporosis development and related fractures substantially increased with age that may be regarded as a major factor (“Osteoporosis overview,” 2019). As previously mentioned, broken down bone tissue is replaced slower and becomes more fragile and less dense with age.

Although osteoporosis should be considered both by men and women, postmenopausal women and women after the age of 50 are more vulnerable in comparison with men as their bones are smaller and have lower peak bone mass naturally (“Osteoporosis overview,” 2019). In addition, menopause associated with hormone level changes and slower estrogen production is a condition that may contribute to osteoporosis development. Nevertheless, men are also affected by this disease especially at senior age.

Race and ethnicity are factors that may increase the possibility of developing osteoporosis as well. Thus, Asian and Caucasian women are at the highest risk, followed by Hispanic and African-American women (“Osteoporosis overview,” 2019). Another cause of osteoporosis is body weight and bone structure – thin-boned and slender people are affected by this disease more frequently than people with larger frames and more body weight due to less bone available. Nutrition is also among the most considerable factors as poor protein intake and inappropriate dieting low in vitamin D and calcium lead to bone loss and fractures. In addition, individuals who have parents or grandparents with osteoporosis are at a greater risk of its development.

Moreover, osteoporosis development may be provoked by particular medications and medical conditions, including hormonal and endocrine diseases, rheumatoid arthritis, gastrointestinal diseases, blood diseases, the history of organ transplant or bariatric surgery, overactive adrenal, thyroid, or parathyroid glands, anorexia nervosa, and HIV/AIDS(“Osteoporosis overview,” 2019). Medications that may increase the risk of osteoporosis are glucocorticoids, cancer medications, serotonin inhibitors, antiepileptic medicines, and thiazolidinediones. Finally, low physical activity. Smoking and excessive alcohol consumption cause osteoporosis in a significant number of cases as well.

African American Senior Adults: Osteoporosis and Nutrition

As previously mentioned, age may be defined as the main factor that contributes to the development of osteoporosis. Senior men and women experience faster bone breakage down in comparison with its replacement. In general, aging “may be viewed as a multifactorial process that results from the interaction of genetic and environmental factors, which include lifestyle” (Rescigno et al., 2017, p. 1).

At the same time, nutrition has substantive effects as well since nutrients directly impact physiological changes and molecular processes responsible for aging. In addition, in the development of particular human diseases, including osteoporosis, the interaction between environmental and genomic factors is essential. Thus, the diet is regarded as “a key environmental factor with a prominent role in disease aetiology” (Rescigno et al., 2017, p. 8). In other words, nutrition may improve health through the regulation of particular processes, such as age-responsible epigenetic changes. As dietary signals, nutrients are capable of impacting cell homeostasis and metabolic programming reducing the risk of disease through molecular mechanisms. Thus, from the position of nutrigenomics, particular nutrients prevent osteoporosis development additionally affected by aging on a molecular level.

Nutrition Therapy

It goes without saying that osteoporosis treatment is a comprehensive process that includes medications, lifestyle changes, fall prevention, exercise, and proper nutrition. At the same time, nutrition plays a highly essential role not only in treatment but in the prevention of osteoporosis. For African American older adults, nutrition plays an even greater role as due to increased skin pigmentation, they do not receive enough vitamin D from the sun. Thus, knowing that food affects bones, seniors should include products rich in vitamin D, calcium, and other nutrients in their daily ration to keep the bone tissue healthy.

In general, a well-balanced diet for the prevention and treatment of osteoporosis includes fish, dairy products, fruits and vegetables, and multivitamins or supplements if the recommended amount of nutrients is not taken from food (“Nutrition,” n.d.). In addition, in serious cases, nutrition therapy may be prescribed by health care providers to treat weak bones and prevent fractures. At the same time, while vitamin D and calcium are regarded as the main essential nutrients for osteoporosis prevention, the roles of iron, vitamin K, boron, copper, potassium, manganese, selenium, and copper are currently emerging as well (Higgs et al., 2017). Thus, products that should be included in an osteoporosis-preventative diet are the following:

• Fish (fatty varieties like tuna, salmon, mackerel, and sardines, canned fish with bones);
• Dairy products (non-fat or low-fat milk, cheese, yogurt);
• Fruit and vegetables (Turnip greens, collard greens, Chinese cabbage, kale, okra, dandelion greens, broccoli, mustard greens, spinach, tomatoes, beet greens, artichokes, plantains, potatoes, raisins, sweet potatoes, red and green peppers, Brussels sprouts, kale, papaya, oranges, bananas, plantains, prunes, grapefruits, strawberries, pineapples);
• Foods fortified with vitamin D and calcium (these nutrients are frequently added in breakfast foods, juices, rice and soy milk, breads, and snacks).

At the same time, there are products that should be substantially limited or avoided in a well-balanced diet aimed to prevent osteoporosis. While some of them contribute to bone loss, others contain substances that decrease calcium absorption. These products are the following:

• Beans. Along with beneficial magnesium, fiber, calcium, and other nutrients, beans contain phylates that interfere with calcium absorption.
• Wheat bran. Similar to beans, wheat bran contains phylates, however, it may additionally reduce calcium absorption when eaten with another food at the same time.
• Meat and high-protein food. It goes without saying that protein in adequate amounts is essential for bones, and senior people frequently do not get it (“Nutrition,” n.d.). However, too much protein due to multiple meat servings or high-protein diets may cause the loss of calcium.
• Salty food. Sodium causes the loss of calcium and may lead to bone weakness. Salt is also contained in processed and canned foods.
• Foods with oxalates. Oxalates, or oxalic acid, in foods do not allow the body to absorb calcium and other healthy nutrients from them. Foods with oxalates include spinach, beet greens, rhubarb, and certain beans.
• Drinks with caffeine. Tea, coffee, and soft drinks with caffeine contribute to substantial bone loss by decreasing calcium absorption;
• Alcohol. Excessive alcohol consumption directly leads to bone loss.
• Soft drinks with phosphorous. Although there is no clear evidence concerning the harm of soft drinks for bones, phosphorous may contribute to the loss of bone density.

Potential Challenges

In general, a well-balanced diet is essential for African American seniors in order to prevent osteoporosis or relieve an already existing disease. However, the application of nutritional regulations may be affected by specific challenges, and the first one may be defined as racial. In fact, vitamin D and calcium should be taken in optimal amounts to be beneficial for bones, however, standard regulations are not applicable to African Americans. According to the latest researches, they “may not need as much calcium and vitamin D to maintain good bone health as other ethnic groups” (American Bone Health, 2016, para. 5).

Thus, the optimal intake of calcium and vitamin D should not exceed 1,800 mg/day and 800 IUs/day, respectively (American Bone Health, 2016). At the same time, this information is either unavailable or not considered by every medical facility, and older people are unaware of nutrient intake as well. Nevertheless, more studies are required for the in-depth investigation of this subject.

Another barrier is connected with the limited access of African Americans to health care services. It causes by racial discrimination that still exists in society, low income and related poor medical insurance, and a lack of Black health care specialists that may address the issues of African Americans in the most appropriate way. Thus problem also lead to the situation when Black seniors with osteoporosis cannot be provided with efficient information related to nutrition.

Finally, the most essential challenge that should be considered talking about African American older adults is economic as “poverty may be a barrier to acquiring adequate nutrient levels for the prevention of osteoporosis” (Marshall et al., 2020, p. 1). According to the research conducted by Marshall et al. (2020), there is a connection between household income and osteoporosis development, especially for African American men who live in poverty associated with food insecurities. In other words, the inability to afford healthy food leads to inappropriate intake of calcium, vitamin D, and other nutrients and related bone loss.

Potential Solutions

In general, the African American population may be characterized by a lack of awareness and concern in relation to nutrition aimed to prevent osteoporosis. According to Wright et al. (2019), no more than 25% of African American population are aware of this disease and preventative nutrition. That is why it is essential to disseminate information to promote well-balanced dieting concerning defined barriers as well. First of all, discrimination on the basis of race and ethnicity should be reduced on a legislative level to provide access to health care to all senior citizens. Moreover, for low-income older people, financial or natural support may be provided by non-profit organizations, foundations, and governmental authorities.

In addition, specific programs dedicated to the promotion of nutrition for patients with osteoporosis may be created in medical facilities. In other words, when a patient is diagnosed with osteoporosis, he or she may undergo a specific course that will include the provision of basic information, individual consulting and development of a nutrition plan, and control over its following. Moreover, nutritional recommendations should be spread with the use of mass media and Internet sources.

Conclusion

Osteoporosis is a skeletal disorder characterized by low bone mass, bone weakening, and tissue deterioration that traditionally appears when bone breakage down is faster than bone replacement. The development of osteoporosis is impacted by several factors that include age, gender, ethnicity, health condition, medications, lifestyle, body weight, and nutrition. In general, African American older people are highly vulnerable to osteoporosis due to aging, however, a well-balanced diet rich in calcium, vitamin D, and other nutrients may contribute to health improvement and disease prevention. Thus, it is essential to disseminate information related to osteoporosis-preventative nutrition considering such barriers as racial peculiarities, limited access of African Americans to health care, and household income.

References

American Bone Health. (2016). African Americans need less vitamin D and calcium. American Bone Health. Web.

Higgs, J., Derbyshire, E., & Styles, K. (2017). Nutrition and osteoporosis prevention for the orthopaedic surgeon: A wholefoods approach. EFORT Open Reviews, 2(6), 300-308. Web.

Marshall, K., Teo, L., Shanahan, C., Legette, L., & Mitmesser, S. H. (2020). Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities. PLoS ONE, 15(7), 1-27. Web.

Mayo Clinic Staff. (n.d.). Osteoporosis. Mayo Clinic. Web.

Nutrition. (n.d.). National Osteoporosis Foundation. Web.

Osteoporosis overview. (2019). NIH Osteoporosis and Related Bone Diseases National Resource Center. Web.

Rescigno, T., Micolucci, L., Tecce, M. F., & Capasso, A. (2017). Bioactive nutrients and nutrigenomics in age-related diseases. Molecules, 22(105), 1-26. Web.

What is osteoporosis and what causes it? (n.d.). National Osteoporosis Foundation. Web.

Wright, N. C., Melton, M. E., Sohail, M., Herbey, I., Davies, S., Levitan, E. B., Saag, K. G., & Ivankova, N. V. (2019). Race plays a role in the knowledge, attitudes and beliefs of women with osteoporosis. Journal of Racial and Ethnic Health Disparities, 6(4), 707–718. Web.