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They are most effective in the spine, which is the most common site of osteoporotic fracture. The role of adequate calcium intake has always been mentioned as most essential in the growth and development of all normal tissues, including bone. A low-calcium diet restricts the intake of dairy products, has low amounts of fruits and vegetables, and includes a high intake of low-calcium beverages. Other dietary factors can also affect bone health and accrue to the development of low bone density. Among these are a high-sugar diet, refined grains and flours, caffeine, alcohol and excessive intake of calcium, phosphorous and sodium. Soy has been attracting interest for its likelihood in producing positive effect on bone health. Soybeans contain phytoestrogens called isoflavones and diadzein. Soy is the only dietary source of daidzein. Soy appears to increase the length of the menstrual cycle by one to five days and thus assert a positive effect on bone density due to higher estrogen levels. Animal studies supported this assumption and hold promise for human bone health. A study conducted on menopausal women at the University of Illinois found an increase in the mineral levels and density in their lumbar spines after taking 55-90 mg of isoflavones for six months. The study showed that soybean protein diet was effective in preventing bone loss in the fourth lumbar vertebra and the right hip. Other studies indicated that soybean protein may have greater effect on the trabecular bone in the spine than on cortical bone in the hips (Hudson)
Other nutrients involved in bone formation include folic acid, Vitamin B6, C and K (Hudson 2006). Bone loss in postmenopausal has been partly traced to increased levels of homocysteine and experiments showed that folic acid is involved in the breakdown of homocysteine. Vitamin B6, on the other hand, reverses the elevated levels of homocysteine and may influence the production of progesterone. Vitamin C aids in the formation and cross-linking of some bone structural proteins. Furthermore, studies showed that deficiency in this Vitamin can cause osteoporosis. Scurvy, which is caused by Vitamin C deficiency, is linked with bone abnormalities. And Vitamin K is involved in the formation, remodeling and repair of bone. Vitamin K produces osteocalcin, which brings calcium to bone tissue (Hudson).
Women over 65 should be screened for osteoporosis on account of the high incidence of the disorder and the continuously aging population, fracture risk levels because of low bone density, and the promise of therapy in combination with diet improvement (Phillips 2003). An observational study conducted on women more than 50 years old showed that osteoporosis was linked with the fracture rate at four times that of normal bone mineral density. Another study identified the best predictors for hip fracture as female gender, age, low weight and current non-use of estrogen. Women 65 and older had increased risk yet none of the screening scaled exhibited adequate discriminatory performance. Multiple technologies predicting fractures, like the dual-energy x-ray absorptiometry and ultrasonography, have not shown effectiveness in screening women aged 65 (Phillips).
Yet 15% or 5 million American women aged 50 and over and of all races have osteoporosis and 40% or 14% have osteopenia (French et al. 2002). Tests showed that it increases with age from 4% of white women aged 50 to 59 and 48% ot those aged 80 to 89. At least 1 vertebral fracture can occur in 5% of white women aged 50-59 and 25% at age 80. White women aged 50 and above face a lifetime risk of hip fracture at 14% for women and 5% for men. Hip and symptomatic vertebral fractures happen mainly to women over 75, with wrist fractures increasing in frequency in the late 50s. Bone strength deteriorates with age. Prevention should start in childhood and be maintained throughout life in order to maximize bone mass. Efforts should be exerted to reduce falls, improve the diet, exercise regularly and avoid adverse habits. Most fractures occur as a result of falls at 90%, especially among women over 70. At this age, they suffer from poor cognitive function, slow gait and poor movement, poor vision, intake of drugs affecting alertness and balance and a history of falls. Adverse health habits, which should be stopped or avoided, include smoking, alcohol and too much coffee (French et al.).
Current available therapies for osteoporosis include calcium and Vitamin D, estrogen, biophosphonates, estrogen receptors modulators and salmon calcionin (French et al. 2002). Tests showed that increased or improve intake of calcium with or without Vitamin D positively affected fracture incidence. Doctors prescribe 1,200 to 1,500 mg a day and 800 IU of Vitamin D a day taken with meals. Statistics revealed that hormone replacement therapy, which combined an estrogen and a progestin, reduced hip and vertebral fractures. Estrogen exhibited positive effect on bone mass density whether in early or late post-menopause. Bisphosphates, alendronate and risedronate, have been approved by the U.S. For both prevention and treatment of postmenopausal osteoporosis. Results of tests showed that both rapidly reduce the risk of symptomatic fractures in women who have had fracture and osteoporosis. A bisphosphonate is now the drug of choice for severe osteoporosis. Oral bisphosphonates are, however, not well-absorbed and patients are advised to take the medicine with a full glass of water and remain upright sitting or standing for at least 30 minutes after taking it and should not recline until food is consumed. On the other hand, raloxifene is the only selective estrogen receptor modulator approved in the U.S. For the prevention and treatment of osteoporosis. Evidence showed that it significantly decreases new vertebral fractures in women who have a history of fractures and osteoporosis, similar to the effect of bisphosphonates. Raloxifene also reduces the risk of breast cancer with low estradiol levels and myocardial infarction in women at high risk. And salmon calcitonin showed beneficial analgesic effect for osteoporotic fracture. At large doses, it decreases new vertebral fractures among women with previous osteoporotic vertebral fractures. Nasal calcitonin solution may also prevent or resolve irritation and dryness (French et al.).
Ibandronate is the newest oral bisphosphonate approved in the U.S. For the treatment and prevention of osteoporosis in postmenopausal women and the first in its class that can be taken on a daily or monthly basis (Ference 2006). Oral ibandronates may cause esophagitis, esophageal ulcer or gastric ulcer with increasing risk in patients suffering from renal impairment and concurrently taking non-steroidal anti-inflammatory drugs. Its adverse side effects include dyspepsia, gastroenteritis and nausea, back pain, headache, bronchitis and myalgia from both the daily and monthly modes (Ference).
Evidence showed that treatment with ibandronate decreases the absolute risk of new, symptomatic, radiographically confirmed vertebral fracture in a test conducted over a period of three years (Ference 2006). However, the effects on the rates of fracture, death and symptomatic vertebral fracture have not been tested and evaluated. There have not been sufficient data on the fracture prevention capabilities of ibandronate in patients with osteoporosis. Ibandronate costs approximately $78 for either the daily or month mode. Weekly alendronate costs $77 a month and risendronate costs $74 a month. It can be taken only once a day or once a month and only with water. The patient must be upright when taking it for one hour and should not be taken within one hours after eating or taking other medications. Foods or medicines containing calcium, aluminum, magnesium or iron may interfere with the absorption of ibandronate. Examples of such foods and medicines are milk and antacids. This suggests the convenience of the monthly mode over the daily mode. Ibandronate has been demonstrated to decrease vertebral fractures in women with osteoporosis and with a history of previous vertebral fractures. Neither formulation has, however, shown to reduce the risk of hip fractures or other non-vertebral fracture nor reduce them in women without previous fractures. Ibandronate has also not been tested and compared with other bisphosphonates in combination with adequate daily doses of calcium and Vitamin D (Ference).
Other therapies are progesterone and Vitamin K Tests conducted on progesterone showed mixed results in using combined soy milk and progesterone on 88 postmenopausal women with osteoporosis (Gaby 2005). There was apparent negative interaction between soymilk and progesterone, assumed to be partly due to the higher proportion of smokers in the tested subjects. It failed to confirm the assumption that transdermal progesterone increased bone mass density at an expected average of 15% in the subjects (Gaby).
In vitro studies showed that Vitamin K2 is far more active than K1 in both bone formation and reduction of bone loss (Plaza 2005). At a typical dose of 45 mg daily, the use of Vitamin K2 as a strategic intervention for osteoporosis offers evidence. It is effective in treating decreased bone mass density from postmenopausal osteoporosis and other causes. It was also viewed to be an important supplement to those who have the tendency towards lipid malabsorption. Currently, however, the extensive application of Vitamin K has not gone…[continue]
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