آرشیو خرداد ماه 1402

Osteoporosis Risk Factors

Osteoporosis is caused by bone loss that results in an increased risk for fractures. There are two types of osteoporosis. Type I associated with postmenopausal women, 50 to 70 years old, in which estrogen deficiency is the assumed cause. Type II osteoporosis is associated with aging and assumed to be from a reduction in calcium absorption. This affects an older people over 70 years old and results more often in hip fractures. Other than calcium deficiency, osteoporosis may also occur due to physical inactivity, elevated cortisol, hyperthyroidism, and steroid medications.

There are additional risk factors for osteoporosis, such as a sedentary lifestyle, depression, chronic stress, and nutrient deficiencies. Depression and chronic stress both entail activation of the sympathetic nervous system. The sympathetic nervous system releases epinephrine, which causes a breakdown in bone matrix. Nutrient deficiencies, aside from decreasing the raw materials necessary for bone creation, can cause depression and stress.

Other than osteoporosis, caused by the thinning of the bones, the common bone and joint diseases include:

• Paget’s disease, affects the formation of bones in the body

• Osteoarthritis, affects the joints instead of the bones

• Rheumatoid Arthritis, caused by inflammation of the joints with the symptoms of painful, swollen, or deformed joints and painful and stiff movements

Bone Mineral Density

Bone strength is determined by its material and structural properties known as bone mineral density (BMD), which is used for diagnosis. However, this parameter provides information regarding the quantity of mineral in bone, which is only one component of bone strength. One of the main causes of low bone mass is family history. Research observations provide support for a significant contribution of heredity to bone density. This study conducted among 160 adult members of 40 families with familial resemblance in bone mineral density at five skeletal sites and evaluating similarities in selected life-style factors thought to influence bone density, such as physical activity, smoking, alcohol use, and diet. Adjustment of bone density for age, height, weight, and significant lifestyle or environmental factors yielded heritability estimates for the five skeletal sites between 0.46 and 0.62. That is, 46–62% of variance in bone density was attributable to heredity. However, certain conditions, medications, and lifestyle factors may account for a potentially large proportion of the non-heritable variance in bone diseases such as osteoporosis.

Elderly Bone Issues

Our bones are continuously changing and play many roles in the body including providing structure, protecting organs, anchoring muscles, and storing calcium. It is important to build strong and healthy bones during childhood and adolescence, as well as taking steps during adulthood to protect bone health.

Osteoporosis, one of the most common bone diseases, is a condition that causes bones to become weak and brittle, depends on how much bone mass we attain when we are younger and how rapidly we lose it over time. Therefore, bone diseases in the elderly can be very serious and can cause pain, fractures or even bone cancer in patients. As we age, our bone density decreases which can cause bone disease or fractures to occur.

There are some suggestions to educate a group of elderly individuals to possibly prevent bone issues:

• Treating or monitoring bone disease in the elderly can greatly decrease their risk for pain and fractures. Decrease in bone density in seniors can cause many seniors to have brittle bones even if they do not have any type of bone disease.

• Seniors should make sure that they are doing all that they can to keep their bones strong, such as getting enough calcium and vitamin D and exercising regularly because that is the best way for them to prevent bone disease.

• When exercising, it is important for seniors to make sure that they are choosing safe activities and will not cause them to fall or get hurt as this can also result in breaks or fractures. Many seniors suffer from broken bones because of falling, so they should make sure that they have an adequate assistance if they have trouble walking.

• Weight-bearing possible exercise is one of the most common suggestions for decreasing osteoporosis risk and slowing its progression. Muscles attach to bones, and when people lift weights, it puts a strain on those attachments which stimulates osteoblasts to create more bone.

Calcium and Bone Protection

Calcium is known to prevent bone diseases and developing strong bone mineral density. For example, the Institute of Medicine advises a calcium intake of 1000 to 1200 mg a day for most adults. But we have also learned that calcium, in the form of supplements, is not risk-free. An intake of 1000 mg from supplements has been associated with an increased risk of heart attack, stroke, kidney stones, and gastrointestinal symptoms (Merz, 2015).

An analysis of reams of research — conducted by a team of New Zealand researchers led by Mark Bolland who first identified the cardiovascular risk associated with calcium supplements — concludes that increasing calcium intake has only a modest effect on bone density in people over 50. For the first analysis, they looked at more than 70 studies on the effects of dietary calcium and calcium supplements in preventing fractures.

They considered both randomized clinical trials and observational studies, and the studies varied widely in terms of numbers of participants, calcium intake, vitamin D intake, and how fractures were reported. The researchers found that neither dietary calcium nor calcium supplements were associated with a reduction in fractures.

These results are not a surprise to Dr. David Slovik, associate professor of medicine at Harvard Medical School and author of our Special Health Report Osteoporosis:

“I don’t believe that we’ve ever thought that calcium reduces fractures; it’s one part of a larger picture,” he says. You really can’t say ‘Take enough calcium and you’ll be fine.’

Cholesterol– Good or Bad? LDL or HDL?

Cholesterol is our best friend...

There have been many misconceptions concerning cholesterol and its effect to our body especially when it comes to the consumption of animal products including meat and their correlation with heart disease. The truth is that cholesterol is our best friend. It is vital for the function of the nervous system and the integrity of the digestive tract. Steroid hormones that help the body deal with stress are made from cholesterol. Sex hormones like estrogen and testosterone are made from cholesterol.

Bile salts that the body uses to digest fats are made from cholesterol. Vitamin D, needed for thousands of biochemical processes, is made from cholesterol. Cholesterol is also a powerful antioxidant that protects us against cancer. It is vital to the cells because it provides waterproofing and structural integrity. And, finally, cholesterol is the body’s repair substance. When our arteries are weak and develop fissures or tears, cholesterol is sequestered and used for repair.

When cholesterol levels in the blood are HIGH, it is because the body needs MORE cholesterol (westonaprice.org). It is important to remember that the risk of high total cholesterol may not necessarily be greater than the risk of very low total cholesterol.

What is Cholesterol?

Cholesterol is a type of lipid, an organic molecule which is an essential structural component of cell membranes. Therefore, it is found in all the cells in our body. We all need some cholesterol to make hormones, vitamin D, and other substances that help us digest food. All the cholesterol we need is made by our body. The question is that since cholesterol is a lipid and hence hydrophobic, how can it be transported in the blood? Well, it travels by specialized proteins called “lipoproteins” made by the liver that surround fat and allow them to move in the bloodstream. There are two types of lipoproteins which carry cholesterol throughout the body:

HDL (high-density lipoprotein)

• HDL (high-density lipoprotein), or “good” cholesterol, absorbs cholesterol and carries it back to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower the risk for heart disease and stroke. Research has shown that lower HDL cholesterol levels were associated with a higher risk of death from cardiovascular causes. However, there was also a higher risk of death from cancer and other causes compared with those having average levels of HDL cholesterol.

LDL (low-density lipoprotein)

• LDL (low-density lipoprotein), or “bad” cholesterol, makes up most of our body’s cholesterol. It builds up in the walls of the arteries, making them hard and narrow. High levels of LDL cholesterol increase the risk for heart disease and stroke. When our body has too much low-density lipoprotein, it can build up on the walls of our blood vessels. This buildup is called “plaque.” As our blood vessels build up plaque over time, the insides of the vessels narrow. This narrowing, blocks blood flow to and from the heart and other organs. When blood flow to the heart is blocked, it can consequently cause angina (chest pain) or a heart attack.

High Cholesterol Facts

Having high total blood cholesterol raises the risk for heart disease, the leading cause of death, and for stroke, the fifth leading cause of death. High total cholesterol (≥ 240 mg/dL) and low high-density lipoprotein (HDL) cholesterol (< 40 mg/dL) levels are major risk factors for cardiovascular disease.

• In 2015–2016, more than 12% of adults age 20 and older had total cholesterol higher than 240 mg/dL, and more than 18% had high-density lipoprotein (HDL, or “good”) cholesterol levels less than 40 mg/dL.
• Slightly more than half of the U.S. adults (55%, or 43 million) who could benefit from cholesterol medicine are currently taking it.
• 93 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL. Nearly 29 million adult Americans have total cholesterol levels higher than 240 mg/dL.
• 7% of U.S. children and adolescents ages 6 to 19 have high total cholesterol.

Symptoms and Testing

High cholesterol has no symptoms, so many people don’t know that their cholesterol is too high. A simple blood test can check cholesterol levels. It is called a “lipid panel” or “lipid profile” which usually reports total cholesterol, low-density lipoprotein, and high-density lipoprotein. A lipid profile also typically measures triglycerides, another type of lipid in the blood, which is completely different than cholesterol and has to be considered separately.

Contributing Factors

There are many factors that can contribute to higher LDL including:

Poor diet:

• Saturated fat, found in some animal products, dairy products, chocolate, baked goods, and deep-fried and processed foods can raise LDL level more than anything else. These foods also include tropical oils such as coconut, palm kernel, and palm oils. Trans fat, found mostly in foods made with hydrogenated oils and fats, such as stick margarine, commercially baked cookies and crackers, microwave popcorn, and french fries, can raise your LDL and lower your HDL level.

Obesity:

• Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.

Lack of exercise:

• Exercise helps boost your body's HDL cholesterol while increasing the size of the particles that make up your LDL cholesterol, making the LDL less harmful.

Smoking:

• Smoking damages the walls of your blood vessels, making them more prone to accumulating fatty deposits. Smoking might also lower your level of high-density lipoprotein, or "good," cholesterol

Age:

• Because your body's chemistry changes as you age, the risk of high cholesterol climbs. For instance, as you age, the liver becomes less able to remove low-density lipoprotein.

Diabetes:

• High blood sugar contributes to higher levels of a dangerous cholesterol called very-low-density lipoprotein (VLDL) and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.

Medicines:

• Certain medicines, including steroids, some blood pressure medicines, and HIV/AIDS medicines, can raise your LDL level.

How can you lower your LDL Level?

Generally speaking, heart-healthy lifestyle changes include healthy eating, weight management, and regular physical activity can lower your LDL level. Healthy eating diet recommendations include:

• Emphasize vegetables, fruits, and whole grains.
• Limit sugar-sweetened beverages and sweets.
• Instead of butter, cook with olive, canola, corn, or safflower oils.
• Beans are great in soups, salads, and over rice.
• Nuts liven up salads, stir-fried meals, and vegetables.
• Eggs make great dinners, as omelets and frittatas.
• Mushrooms add a meaty texture to sauces, casseroles, and stroganoffs.
• Eat more fish, especially fish that are high in omega-3 fatty acids, including herring, sardines, salmon, tuna, trout, and mackerel.