Osteoporosis is a condition characterised by a reduction in bone mass; bone is not a static structure, but rather a very dynamic one that is continuously remodelled by two cell lines called osteoblasts and osteoclasts. Osteoblasts are builder cells and have the task of forming "new" bone tissue, while osteoclasts destroy the mineralised matrix of the bone, releasing bone calcium into the system. These two types of cells contribute to bone turnover and the micro-architecture that influences the resistance of the bone, when the skeleton has less resistance it is more predisposed to fractures. Osteoporosis can be primary, that is, post menopausal (caused by the collapse of estrogen) or senile, which appears in old age, but it can also be secondary to other diseases (e.g. hyperparathyroidism, hyperthyroidism, hypogonadism, hypercortisolism, coeliac disease, chronic renal failure, rheumatoid arthritis), or as a result of medication (e.g. corticosteroids) or nutritional imbalances. The standard test for diagnosing osteoporosis is bone densitometry.
However, it is important to take care of bone health throughout life: bone mass mineralises until around the age of 30, so it is essential to try to reach a good peak bone mass and then maintain it and slow down physiological loss as much as possible with the support of nutrition and a healthy lifestyle. When we talk about nutrition in relation to bone health, the first thing that comes to mind is calcium, a mineral that plays a very important structural role in bones and teeth. The recommended daily intake is around 800-1000 mg, but this is not an absolute requirement as it also depends on other factors related to diet, such as vitamin K, vitamin C, phytoestrogens and other minerals such as iron and zinc. Nutrition should therefore be evaluated as a whole, rather than focusing on a single nutrient. Furthermore, it is not enough to include calcium-containing foods in the diet; attention must also be paid to all those situations that create a greater demand for calcium, inhibit its intestinal absorption or facilitate its excretion through urine. These factors include: excess sodium, excess animal protein and caffeine. Also to be considered is the presence in some foods of compounds such as oxalates and phytates that can make calcium insoluble and therefore resistant to absorption, so, for example, a vegetable may contain less calcium but have good bioavailability. Oxalates are found, for example, in spinach, watercress, rhubarb and beetroot leaves; these vegetables should preferably be boiled in plenty of water rather than steamed in order to dissolve the oxalate salts. If you want to eat them raw, it is preferable to soak them first. Phytates are found mainly in cereals (especially whole grains), legumes, vegetables and, in smaller quantities, in nuts and cocoa. Long soaking or an acidic environment (e.g. adding lemon juice) reduces their quantity. Vitamin D and magnesium, on the other hand, are “friends” of calcium. Vitamin D promotes its absorption in the intestine and magnesium promotes its retention.
In practice, some useful guidelines to apply to our diet are:
- reduce the use of table salt and foods rich in sodium (sausages, stock cubes, canned or pickled foods)
- use foods that contain phytoestrogens (legumes, including soy and its derivatives, fennel and Brussels sprouts, buckwheat, carrots, onions, apples, pears, cherries)
- maintain an adequate amount of lipids, seafood and fish rich in good fats to promote vitamin D synthesis
- consume almonds, sesame seeds and pumpkin seeds
- consume oily fish, squid and shellfish
- avoid excess animal protein in your diet
- do not overdo cheese and dairy products, which are usually recommended for their calcium content, as they also contain a lot of salt, saturated fat and proteins with a high acid load
Here are some examples for a complete menu:
- Toasted bread or rusks with butter or ricotta cheese + jam or honey and grapefruit juice
- Unsweetened whole milk yogurt or Greek yoghurt or kefir with oat flakes, a kiwi and mixed dried fruit
- Sour fruits such as lemon and grapefruit and fruits rich in vitamin C (grapefruit, orange, kiwi)
- Pasta with anchovies, capers, cauliflower accompanied by raw spinach with pine nuts
- Pasta with rocket pesto, courgettes and almonds accompanied by beans with sage
- Cream of chickpea soup with ricotta and prawns
- Mashed potatoes with lemon chicken breast, radicchio dressed with oil, salt and chopped almonds.
(Article by Dr. Giulia Daniotti)
