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Why does osteoporosis affect women more than men?

Men's Health, Age related illnesses, Women's Health, Menopause, Bones | October 21, 2020 | Author: Naturopath

age related, men, women's health

Why does osteoporosis affect women more than men?

Osteoporosis is the name given for bone that has degenerated. Osteo – meaning bone; porosis – meaning porous (spongy). Bone is continuously replacing itself throughout life, although this does not always occur in a balanced way. In some instances more bone is lost than is replaced. If this continues, the result is a bone structure which is porous, and can easily be fractured. This imbalance can occur due to a variety of reasons - such as low mineral intake, low vitamin D, small stature, immune disorders, genetics, the microbiome and hormonal changes. Osteoporosis occurs more often in females than males.

The structure of the body

The skeleton is the framework that supports the body and acts as a protective barrier for our internal organs and tissue. The skeleton facilitates movement and mobility. It consists mostly of living substance known as collagen, a protein that provides a soft framework. The mineral calcium and phosphoric acid, combined they are known as hydroxyapatite, is the compound that gives strength, hardness and flexibility to the bone. 99% of the calcium found in the body is contained in bones and teeth, with the remaining 1% located in the blood. Magnesium and other substances such as carbonate, fluoride and citrate are also found in bone.

  • The inner layer of bone is trabecular bone, this is spongy and a honey-comb like structure providing strength
  • The outer layer is cortical bone and is compact and dense

TThe Growth Periodhe Growth Period

During the rapid growth period of early childhood and the subsequent teenage years, new bone is made at a faster rate than old bone is removed. This results in larger, heavier bone production with increased density. This production of faster new bone rates of production vs old bone resoption continues into the late 20's to early 30's years of age, when total bone formation reaches a maximal density. Bone mass peaks at this time.

For some people, the removal of bone without replacement can begin earlier - the their early 20’s – this is attributal to certain lifestyle factors such as:

  • tobacco smoking
  • excess alcohol consumption
  • lack of exercise
  • deficient intake of calcium, vitamin D and other minerals.

People are more likely to develop osteoporosis if they fail to reach full bone mass density potential during the bone-building years.

Why do women develop osteoporosis more often than men?

There are two main reasons women are more at risk of porous bones more than men.

  • The size of bones. Women generally have smaller and thinner bones than men.
     
  • Hormonal changes after menopause. Bone density can decrease rapidly in the first 4 - 8 years after menopause. This is due to reduced levels of oestrogen resulting in a decline in calcium absorption and an increase in excretion. Oestrogen is thought to have a protective effect on bone before menopause.

By the age of 65 both men and woman generally show similar quality bone tissue characteristics.

Preventing osteoporosis

Calcium

There is evidence a high intake of calcium may reduce the rate of bone loss and reduce the risk of fractures.

Preventing osteoporosisDietary calcium intake and supplementing with a good quality calcium (if diet is deficient) will help improve general bone density and potential bone mass optimisation.

Calcium supplements come in various  forms of calcium or in combination with other minerals. They may be in tablet, capsule, powder, liquid and chewable forms. Absorption is important and small, divided doses are recommended over one large dose.

Some forms such as calcium carbonate require reasonable stomach acid levels for absorption. This can be a problem for people with intrinsically low stomach acid or those taking acid-blocking medication. Some forms include:

  • Calcium hydroxyapatite -  bone building material 
  • Calcium citrate –  a calcium salt that can be taken anytime with or without food
  • Calcium carbonate – a calcium salt that must be taken with food
  • Calcium gluconate - used as an injection of calcium

More is not better – bone can only absorb and take up limited amounts of calcium. Always follow product recommendations and take into consideration sources from the diet. A daily intake of 1000mg to 1500mg of calcium is recommended to maintain healthy bone density and protect bone calcium levels.

Food sources high in Calcium include:

  • dairy products – milk and cheese for example
  • soy sources – tofu for example
  • fish with edible bones such as salmon and sardines
  • leafy green vegetables like kale and broccoli
  • almonds
  • legumes
  • fortified foods – check packaging for calcium content 

Some foods, although high in calcium, may not deliver calcium. This can be due to other compounds within the food blocking (binding) calcium from gastric absorption. Examples that restrict calcium delivery include oxalates found in spinach, and phytates found in legumes and nuts.

Decrease salt in diet

Sodium can also increase calcium excretion through the kidneys. Reducing dietary sodium helps lower high blood pressure, and will also assist with calcium absorption.

Vitamin D

Vitamin D is essential for calcium and phosphorus absorption to support the formation and maintenance of bone tissue. During low vitamin D levels the parathyroid hormone increases hormonal release that triggers osteoclast (a bone cell used to break down bone) to release calcium from the bone into the blood (reabsorption). It is important for the body to maintain a level of calcium in the blood. This action over time will result in bone calcium loss and weakening of bone structure.

Vitamin DVitamin D is produced by the action of ultraviolet B (UVB) radiation on 7-dehydrocholestrol in the skin producing D3 (cholecalciferol), which is then transported to the liver and converted to 25-hydroxycholecalciferol. The kidneys become involved with this hydroxylation, and forms 1,25-dihydroxyvitamin D (calcitriol). Calcitriol is the most potent component. Other minerals are required to assist with this reaction. 

It is important to have adequate vitamin D levels. Vitamin D levels can reduce over the winter months. Guidelines recommend vitamin D3 supplementation at 25–50 micrograms (1000–2000 IU) per day for people with mild vitamin D deficiency.

Sources  of Vitamin D – salmon with bones, egg yolk, butter and fortified foods. And sunshine – without sunblock.

Magnesium

Magnesium is the second most important mineral for bone structure consideration. Magnesium is important for bone building, calcium absorption and many metabolic processes. Many people may not obtain enough magnesium from the diet and supplementation is recommended. Magnesium deficiency can impair the parathyroid hormone and 1,25-dihydroxyvitamin D negatively effecting bone mineralization. Magnesium can also help with some distressing symptoms of menopause and other health concerns such as insomnia, chronic constipation, restless leg syndrome, anxiety, irritability and depression. Supplementing with 200mg - 400mg of magnesium is recommended.

Food Sources of magnesium -  can be obtained from eating nuts, whole grains, leafy green vegetables, legumes, fish and meat.

Vitamin K2

Vitamin K2 includes a range of K2 forms referred to as menaquinones most of which are synthesized by the human gut microflora or found in fermented foods and animal products. Vitamin K is an essential cofactor involved in bone metabolism. Deficiency may lead to osteoporosis and bone fractures.

Weight bearing exercise

Regular exercise can increase size, strength and capacity of muscles which impacts bones making them stronger.

This is very important in the menopause years when muscle mass can also start to decline. Weight-bearing exercise is considered best for strengthening bone. Brisk walking, jogging, skipping, dancing and aerobics are examples of good bone density exercises. Applying pressure to bones will provide an osteogenic benefit. A variety of different exercises should be performed at least 3 times a week with the aim to increase degree of difficulty.

Onero™ is an evidence-based exercise programme for people with low bone density delivery by physiotherapists and accredited exercise physiologists. https://onero.academy/osteoporosis-exercises/

Do not smoke or drink excessive amounts of alcohol

Skip the coffee and cola - go for a soy or dairy milkshake instead

Bone density testing. If over 50 and with health risks, knowing the condition of your bones can help you take action to prevent osteoporosis.

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References

https://teambone.com/education-basic/basic-biology-of-bone/

https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxyapatite

https://www.healthdirect.gov.au/medicines/brand/amt,65160011000036101/calcium-gluconate-phebra

https://www.bones.nih.gov/health-info/bone/bone-health/what-is-bone

https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/overview-of-disorders-of-calcium-concentration?query=the%20role%20of%20calcium%20in%20the%20body

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calcium-supplements/art-20047097

https://www.nrv.gov.au/nutrients/calcium

https://www.osteoporosis.org.au/

https://www.jeanhailes.org.au/health-a-z/menopause/about-menopause

https://www.naturalmedicinejournal.com/journal/2010-11/naturopathic-approaches-preventing-and-treating-osteoporosis

https://www.nps.org.au/news/vitamin-d-supplementation

https://lpi.oregonstate.edu/mic/vitamins/vitamin-K#introduction

https://health.clevelandclinic.org/sodas-tea-coffee-can-make-bones-brittle/

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