Living with Osteoporosis
It is essential to remember that the most important thing is to avoid the risk of fracture and therefore it is a good idea to adopt or change certain habits, such as:
Healthy diet. Calcium intake is not only important when we are growing as children. Calcium formation starts in childhood, increases during adolescence and continues until we are approximately 25 years old. From this age onwards, daily calcium consumption helps maintain bone density.
Food intake is vitally important for maintaining both calcium and vitamin D levels and so osteoporosis patients are advised to plan a personalised diet that includes these nutrients.
The total amount of calcium in each patient's daily diet depends on their age group. Information on food labels can be helpful. From 19 to 50 years: 1000 mg/day; from 51 to 70: men - 1000 mg/day and women - 1200 mg/day; 71 and over: 1200 mg/day.
If you do not reach the recommended amount of calcium, then you should consider taking food supplements.
Calcium absorption is greatest if they are taken with meals and at night.
Quit smoking. Smoking accelerates the loss of bone mass and is known to correlate directly with the risk of suffering a fracture. Furthermore, young smokers may acquire a lower maximum quantity of bone (peak bone mass).
Stop or reduce alcohol consumption. Alcohol affects the body's ability to gain bone mass and moderate or high levels of regular consumption increase the risk of fractures.
Avoid a sedentary lifestyle and remain active. A lack of physical activity is the only extrinsic risk factor with a negative influence on the evolution of osteoporosis. Immobilisation, for whatever reason, is a factor that predisposes the risk of developing osteoporosis and so prolonged periods of rest should be avoided.
During convalescence, whether to recover from a fracture or for any other reason (e.g., due to an accident or sequelae associated with functional impairments or chronic diseases that course with pain or functional incapacity), patients need to take advantage of any small improvements and start to move, but without forcing themselves and while taking into account the intensity of any pain.
Insofar as possible, patients must resume physical activity to prevent the onset of immobilisation osteoporosis.
Sunshine, source of vitamin D
The human body obtains just 10% of its vitamin D requirements from the diet and the remaining 90% is derived from exposure to the sun.
Different vitamin D supplements are available; of vegetable (ergocalciferol/vitamin D2) or animal origin (colecalciferol/vitamin D3).
The calculation for determining how much vitamin D the body requires is more complicated than the one for calcium as it involves diverse factors such as diet, sun exposure time, variation between individuals and the influence of skin protection measures.
Vitamin D deficiency is associated with too little exposure to sunlight in combination with a diet that does not contain enough vitamin D-rich foods. This deficiency is often observed in the elderly (75 years and over).
The majority of the population obtain sufficient levels of vitamin D through exposure to the sun and a calcium-rich diet.
What is the right level of sun exposure?
There is no guaranteed “safe” level of exposure to ultraviolet (UV) radiation that helps produce vitamin D without increasing the risk of skin cancer.
The exposure to small amounts of sunlight on your face and forearms occurring during daily activities can be enough to increase your vitamin D levels.
Accordingly, the length of exposure to sunlight required to produce vitamin D varies in function of environmental (e.g., contamination), physical and personal factors, as well as the time of year.
Although ageing is a non-modifiable risk factor, suffering a fall or a blow of a varying degree of force to a fragile bone constitutes a risk of fracture.
As a bone’s density (strength) decreases, then the risk of it being fractured by a blow increases. Therefore, it is equally important to reduce the risk of falls as it is to prevent the loss of bone mass.
Falls in people over 75 years are a significant health and clinical problem, both because of their frequency and the physical and psychosocial consequences. In this context, we require a better understanding of the causes and greater sensitivity when proposing and unifying effective preventive safety strategies.
Falls are generally the result of a combination of factors; these include muscle weakness, balance problems, visual and hearing problems, and aspects related to home safety or any drug therapies being taken.
Recommendations for preventing falls
Avoid walking on uneven terrain, slippery surfaces or those in a poor condition. Take special care on very humid or rainy days.
Wear close-fitting, comfortable shoes with shock-absorbing air pockets and non-slip soles that grip the ground well – you should also wear them around the house. Avoid wearing sandals.
Remove any “risks” from around the house that could cause a fall. For example, electric cables, the iron’s cable, fringes on rugs, etc. Place a rug or carpet in the kitchen.
In the bathroom, it is a good idea to place non-slip mats both inside and outside the bathtub/shower so that you may get in and out safely. Use seats inside the bathtub/shower and place support rails. Do not support yourself on taps.
Do not walk around the house in the dark. It is safer if you leave a small lamp turned on, or use a torch, if you have to get up during the night. You can also install motion sensors that turn lights on automatically.
Avoid constantly removing and replacing your glasses, and pay special attention on stairways if you were bifocals.
If you do not feel safe when walking, then you should use a walking stick/ walker, particularly when outdoors. Difficulty walking, for whatever reason, can lead to greater instability and bring about a fall. A walking stick/ walker will also help you maintain an upright posture and should be recommended early on to improve the body posture.
If you are taking any medication ask your doctor about possible side effects as some drugs can increase the chance of falls, such as antidepressants, diuretics, beta-blockers or anticonvulsants.
Control dizzy spells and pain. The neuromuscular effects of pain can produce muscle weakness in the legs or slow down your reaction to an imminent fall. Furthermore, when individuals suffer discomfort or constant pain they tend to alter the way they walk in order to reduce it (antalgic gait). This can lead to instability and a loss of balance.
Perform exercises to improve your functional capacity. Strengthening your legs and arms helps maintain balance. Try to remain flexible.
Follow therapeutic training programmes aimed at teaching and training the correct body mechanics for daily activities, such as getting out of bed, lifting objects and decreasing the risk of falls.
Improve your safety with fall detectors and alarms so that you can receive assistance as soon as possible if you suffer a fall either inside or outside the home.
According to an international study involving almost 8000 women in the European Union and United States , the fear of falling and suffering a fracture are the most common feelings among women with post-menopausal osteoporosis. In this context, the loss of independence, changes in daily habits, pain and reliance on help from others can accumulate in a state of emotional decline and stress.
Bodily changes, such as the propensity to slouch (kyphosis), caused by morphological alterations, vertebral fractures or the need to use aids to improve walking or balance, can lead to a tendency for patients to become isolated.
What is more, elderly individuals tend to fall more often than young people because of age-related neurological and motor function deterioration (decreased visual acuity and postural reflexes, reduced muscular mass) – aspects that can also affect their psychosocial sphere.
Therefore it is important to try and reduce the level of incapacity and maintain an active, independent lifestyle for as long as possible, i.e., train yourself to improve your physical and mental capacities. All of these points will help you better tolerate, self-manage and live with osteoporosis.
Clearly it is difficult to change the way we live and adopt new habits, but it is possible if you really put your mind to it. It is therefore very important to maintain a realistic yet positive attitude and show complicity with your healthcare team, tackle problems that arise and adopt the most appropriate solution for each situation.
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