Twenty-five thousand. It is the number of fractures caused by osteoporosis in Spain every year. A silent disease that is estimated to affect one in four women over 50. Women who, in many cases, religiously take a calcium or vitamin D supplement with the confidence of doing what is best for their bones. But is this really the best preventive strategy? A study published in the Journal of the American Medical Association (JAMA) questions it.
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This meta-analysis of 33 different trials , in which 50,000 people over 50 years old participated, has not been able to prove that these supplements serve to reduce the risk of suffering these fractures. A not so unexpected result (in 2015 a review of studies published by the 'British Journal' already pointed to the same), but that undoubtedly breaks the molds and removes the waters. So much so that the American Society of Bone Metabolic Pathology has published a document to qualify its results. First, they warn that in the meta-analysis published in JAMA only the use of calcium and vitamin D supplements in healthy people has been taken into account. Among the ranks of the 50,000 participants there were no patients with osteoporosis or people at risk of suffering from it and that makes a big difference.
"It's a good study, it's very well done, but its recommendation speaks to the general population. People who are sick can not say 'do not take calcium supplements because they do not do anything', simply because it's not like that. You have to be careful with the messages, "says Dr. Núria Guañabens Gay , senior consultant at the Rheumatology Service of Hospital Clinic de Barcelona and spokesperson for the Spanish Society of Rheumatology.
The sources of calcium go far beyond dairy products: legumes, cruciferous, nuts, sardines ...
The supplements are good for something, but in very specific cases . For example, they have shown efficacy in the prevention of fractures in the elderly population, who live in residences and suffer from a deficit of calcium intake or low levels of vitamin D. "There are also people who, when they come to the consultation and assess how much calcium they ingest, it is a very small percentage, and since we know that it is very difficult for them to change their eating habits, we resort to a supplement. And another unavoidable case are those people who are under treatment for osteoporosis. Calcium supplements are often given to these patients because the studies that were done to test their medication contemplate it; that is to say, the manufacturer already indicates that the medicine must be associated with the intake of 500 or 1,000 mg of calcium to function ", points out Dr. Núria Guañabens.
And what should the rest of the population do? Well the rest of us should stop looking for the fast track of the pills and start to become aware of what is good and what is not, and thus avoid being candidates for one of those 25,000 annual fractures. And to achieve this we must not expand our sights beyond calcium. "We tend to focus on that, but good bone health is something more than dairy in daily," says dietitian-nutritionist Lucia Martinez and blogger in 'Body Mind'. We forget that it is equally important that the vitamin D status is good, that you have to do physical exercise, that the intake of vitamin K and magnesium has to be adequate ... All these factors are equally important, we should not be alone looking at the specific calcium intake. " We review with both experts what you do and what you should not do to keep your bones healthy.
What your bones do need
Take calcium
Calcium is the main mineral component of our bones and if there is no risk diagnosed, it must be achieved through the diet . And here the manufacturers of dairy products have done a great job, because it is impossible for us to think about this mineral and not associate it with its products in all its forms, textures and flavors. But how much should we eat daily to provide our bones that they need? "The needs are very variable. For an adult, they are recommended from 700 mg / day in the United Kingdom to 1,000-1,200 in the United States. That is, there is up to 30% difference between the two and that does not make sense ", describes Lucía Martínez . This oscillation of figures is due to multiple factors. One of them is, of course, cultural (you do not eat the same in one country as in another). Another thing that we must not lose sight of is that taking calcium and that it is available to our body is not the same. Another one, that when we eat little calcium, the one we eat needs enough vitamin D to reach a good port ... and the vitamin D deficit is chronic in our society. Another is that each stage of life seems to have its own needs for this mineral ... And so it could continue to infinity.
In principle, a healthy adult (and Spanish) should ingest 1,000 mg / day of calcium, which is only able to absorb 300 mg. Do we get to that number? Well, the reality is that the data does not agree on this either. According to the National Survey of Dietary Intake in Spain (ENIDE) , the calcium intake of the Spanish population is 900 mg / day in adults. But the scientific study ANIBES proved that most of us take about 798 mg / day (862 mg / day the most applied). What can we do to increase our intake and reach those figures, for many unreachable? Take a good pantry is the solution. And expand our sights. While dairy products are the favorites of Spaniards when it comes to having strong bones, many must learn that not only does this mineral hide in them. Vegetable milks such as soy, if they are enriched, have the same absorbable calcium fraction as cow's milk and with the same amount of product (100 g). Among the legumes, the white beans provide 17 mg of calcium ready to be used in only 100 g. Cruciferae such as broccoli (25.8 mg) and cauliflower (18.7 mg) can also be a good source of calcium. And the list increases if we include vegetables such as cabbages, nuts such as almonds , seeds such as sesame seeds, and even products such as sardine and anchovy cans . So, in summary, yes, our bones need us to eat calcium and that we do not like milk is not an excuse for not giving it to them.
Include magnesium in your diet
Maybe you do not know, but in your bones there is not only calcium, there is also magnesium. A balanced diet should provide 300 mg of this mineral daily , of which the body barely absorbs 30%. There are several factors that can modify this absorption, such as drinking alcohol, suffering from liver disease, eating foods that contain a lot of water or eating a diet rich in proteins.
Spain is a country with lots of light, but vitamin D deficiency (which is synthesized by exposing the skin to the sun) is a fact
According to the ANIBES study, the Spanish population makes an intake daily below the required: 222 mg / day. Is it imperative to reach those 300 mg to keep our bones intact? At the moment, the studies are not very clear about it. "Just as calcium is a lot of work, the problem is that with other minerals such as magnesium there are many less and contradictory results. It is not at all clear, for example, that taking magnesium supplements reduces the risk of fractures . There is even a study, conducted with women, in which we can see that, indeed, those with lower magnesium intake had less bone, but, paradoxically, that did not mean an increase in the number of fractures, "explains Dr. Guañabens. What the studies do seem to point out is that the nutritional deficits are not good and that, given the scant results obtained with the supplements, we have to take advantage of what we find in the supermarket. According to the University of Harvard (USA) the bulgur is the cereal that more magnesium contains, followed by the barley. The ranking of the magnesium champions is completed with cooked spinach , pumpkin seeds, cornmeal, beans, green beet, halibut, toasted almonds and brown rice.
Check your vitamin D
We may be a country of sun and sand, but our deficit of vitamin D (which is synthesized by exposing the skin to the sun) is a fact. The intake of vitamin D in the ANIBES population is well below the national and European recommendations and that improved the results of the ANIBE study. "We need to sunbathe 10 minutes a day, make analytical to check the levels of vitamin D in case we need a supplement and eat a healthy diet, including foods that provide it," warns Lucia. The group of fish and shellfish was the main source of vitamin D, followed by eggs, milk and dairy products, and cereals and derivatives. With these four food groups already add more than 85% of the reported daily intake of this vitamin.
Discover vitamin K
More studied than magnesium there are two types that are the most interesting for bone health, vitamin K 1 and vitamin K2. Vitamin K, in principle, participates in coagulation and its deficit has been associated with cardiovascular risk. Why is bone also involved? Well, because in our skeleton there is a protein ( osteocalcin ) that needs vitamin K to be coupled as it is due to bone tissue. When a disease (for example, liver) causes a deficit of vitamin K, this protein does not fit well inside the bone and that has been proven to increase the risk of fracture of the femur . Should one then recommend taking a vitamin K supplement? Well, what is recommended is an adequate intake of vegetables, cauliflower, kiwis , avocados ... "There is not enough information to recommend vitamin K supplements to prevent fractures in osteoporosis," concludes Dr. Guañadens.
Exercise daily
The bone, to be healthy, you need to do load exercises (yes, walking serves) and all those strength exercises that are done with machines and serve for the strengthening of extenders. "The exercise is great for the bone and in older people, which you can not ask for according to what things, well more, because simply walking every day retains more muscle mass. Other exercises such as tai chi have shown that not only do they strengthen the muscles of the back, but they help to exercise balance, which means that they fall less, "explains Dr. Guañadens.
What your bones do not need
That you drink alcohol
Consuming three units of alcohol per day is a risk factor for developing fractures. And how much is an alcohol unit? One unit of alcohol equals 200 ml of beer , 100 ml of wine or 25 ml of a liquor. If you regularly consume three beers a day, three glasses of wine or three shots ... in the long run you can have bone problems.
Smoking influences the predisposition to suffer osteoporosis and to suffer fractures because of it
"This is what is said to the general population, apart from those who make excessive use of alcohol, they have seen more fractures for two reasons: the first is because they fall more and the second, because they suffer more osteoporosis because this consumption significantly alters the entire hormonal system and the cells that synthesize the bone tissue have less activity because alcohol affects them directly.The good thing is that if they stop drinking, they improve the bone, "explains Dr. Guañabens .
That you abuse salt
"In general, we consume more salt than recommended, not so much for which we add ourselves, but for the one we consume when consuming ultra-processed products that are usually quite rich in salt. Hence, to have good bone health, a healthy balanced diet is recommended. It is understood that this type of diet consumes less of these products and thus reduces salt consumption while increasing the intake of nutrients, "explains Lucia Martinez. The problem with salt and bone is that if there is too much salt in the body, it 'drags' the calcium into the urine . "Therefore, if a person excretes a lot of calcium in the urine or suffers from kidney colic due to this problem, the first measure that is asked is that they take little salt. If you give a lot of salt, there may be an increase in calciuria and this may contribute to you having a loss of this mineral, "explains Dr. del Clinic.
That you smoke
There are multiple studies that suggest that smoking influences our predisposition to suffer from osteoporosis and to suffer fractures due to this disease. Tobacco and its components attack the bones from many fronts. For example, they interfere with the hormones that the bone needs to remain strong. At the same time, smokers not only have more ballots to suffer a fracture (specifically double), but when it occurs, they heal worse. They recover worse from the fractures they suffer.