Osteoporosis, known as the silent epidemic, is considered one of the most common diseases in our country, as it affects women in a special way. It has emerged in recent years as a global public health problem that affects more than 200 million people in the world1. In Spain, it is estimated that osteoporosis affects 3.5 million people, which is why it is a public health problem of great magnitude due to its prevalence, the morbidity and mortality it causes and the consumption of health resources2.
The increase in life expectancy has led to the appearance of a series of bone disorders that have an important clinical impact, such as the development of osteoporosis. Factors such as aging, decreased sex hormones and inadequate lifestyle are the main risk factors that determine a low bone mass and, therefore, are in the genesis of a large part of osteoporotic fractures3. Physical inactivity, dietary changes and the hormonal changes that occur as you age lead, ultimately, to a marked reduction in bone mass2.
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In this sense, in order to prevent the appearance of this pathology and to minimize the associated complications, it is necessary to acquire a healthy lifestyle and carry out dietary measures, taking into account that the foods that are consumed usually contain a wide variety of foods. vitamins, minerals and other important nutrients for health.
In particular, and together with the treatment prescribed by the specialist, there are two essential nutrients in the management strategies of osteoporosis: calcium and vitamin D, since "an inadequate level of these two substances has serious consequences, such as bone loss, musculoskeletal pain, muscle weakness, falls and fractures, "says Dr. Manuel Díaz Curiel, of the Internal Medicine Service of the Jiménez Díaz Foundation in Madrid.
For that reason and with the objectives of facilitating the update on the global management of osteoporosis -which includes an adequate pharmacological treatment that helps the absorption of calcium that is acquired through the diet- and to present the role of the vitamin D and calcium for bone and general health, and insist on the importance of proper nutrition, Drs. Jose Manuel Quesada, Manuel Díaz Curiel and Gregorio Varela with the sponsorship of MSD, Danone and Grupo Ferrer have organized, in Madrid, the 'Symposium vitamin D and healthy life', aimed at health professionals, as primary care doctors, specialists in rheumatology , traumatology, rehabilitation, internal medicine, endocrinology and nutritionists.
"It has been shown that vitamin D and calcium supplements reduce the appearance of osteoporosis by up to 40%, which is why we must encourage healthy diets supplemented with calcium," says Dr. Díaz Curiel.
To this, adds Dr. José Manuel Quesada, of the Endocrinology and Nutrition Service of the Reina Sofía University Hospital of Córdoba, belonging to the Thematic Network of Salud , Farmacia , Psicología , Belleza, Medicamentos Cooperative Research on Aging and Fragility (RETICEF) and scientific coordinator of the Symposium, "that in order to have a good absorption of calcium, a good gastric function is also essential, since only in this way is it possible to dissociate calcium from its salts and that this calcium is absorbed correctly. Also, for a good absorption to take place, it is necessary that there be at least 20 nanograms per milliliter of vitamin D, which is very complicated to achieve ".
The sun, source of obtaining vitamin D
It is known that vitamin D, Achilles' heel in the approach to osteoporosis, is key in the prevention of fractures due to this disease, even more so if one takes into account that there is a deficit of this hormone in the elderly population and that associated to calcium decreases the risk of fracture4. Vitamin D is essential for the maintenance of muscle function, facilitating the absorption of calcium and phosphorus.
The main problem is that vitamin D present in food is scarce, so it must be obtained through other sources, such as solar energy. Once the sun comes into contact with the skin, the formation of vitamin D begins.
"90% of vitamin D should be synthesized by the skin through the sun. However, there is an inadequate level of vitamin D throughout the world, including in Spain. It is estimated that practically 70% of the population has an inadequate level of vitamin D and it has been shown that the levels in our country are even lower than those of the inhabitants of Nordic countries, such as Sweden, Finland and Norway "5, states Dr. Quesada.
Foods beneficial for obtaining calcium
Specialists stress the importance of supplementing the diet with a diet rich in calcium. "There are foods that help to present higher levels of this substance. These foods are mainly dairy products - milk cheese and yogurt - and others such as margarine, "says Dr. Díaz Curiel. In turn, Dr. Quesada states that "it is necessary to supplement vitamin D through drugs, while calcium can be acquired relatively easily through diet."
Additional benefits of vitamin D
"Currently, vitamin D is conceived as a true hormone, since it improves bone and mineral metabolism, and is also the calcium manager, keeps the bone compact and strong and reduces up to 49% the risk of falling and improves neuromuscular performance, "says Dr. Diaz Curiel.
But, beyond providing benefits in the management of osteoporosis and avoiding the risk of falls and fractures, it has been shown that "in light of the available evidence, it is critical to maintain optimal levels of vitamin D, since low vitamin levels D, are associated with a higher risk of developing cancer, of suffering from infections, autoimmune, cardiovascular diseases, such as acute myocardial infarction, metabolic syndrome and arterial hypertension, among others. The treatment with vitamin D, by its specific actions, diminishes those risks and that of death as a whole. These data, of great scientific importance, make that maintaining adequate levels of vitamin D is a public health objective "6, says Dr. Quesada.
For its part, Carmen Sánchez, president of the Spanish Association against Osteoporosis (AECOS), insists that "it is essential that women ask their doctor about the health of their bones, since among all it is possible to fight against osteoporosis" .
Update of Recommended Vitamin D Intakes
As indicated by Prof. Gregorio Varela, member of the Department of Nutrition, Bromatology and Food Technology of the Faculty of Pharmacy, University CEU San Pablo, "the intake of vitamin D is lower than recommended in a very high percentage of individuals, ranging between 50 and 100% of the cases studied. Of the entire population, the elderly are the group most at risk of having vitamin D deficiencies. "
Vitamin D plays a key role in the maintenance of bone mass and mineral metabolism, since it regulates the intestinal absorption of calcium. "Taking into account that one of the main consequences of presenting inadequate levels of vitamin D is the appearance of rickets and osteomalacia, it is necessary to redefine the reference values of vitamin D," says Prof. Varela.
Therefore, "it is essential to call for the public health authorities to update the Recommended Intakes, which lead to improve nutritional status," concludes Prof. Varela.
Proper treatment
As explained by Dr. Diaz Curiel, it is essential to detect early those patients with risk factors for osteoporosis. "Preventive work is the best therapy, especially in those people who have
n risk factors. "
"Only half of patients suffering from osteoporosis have been diagnosed, and of this percentage, only 19% have been correctly treated. For this reason, and to ensure an adequate diagnosis, it is also important to know the risk factors of each person ", explains Dr. Díaz Curiel," there are factors that can and should be corrected, such as diet, lack of exercise , the abuse of tobacco and the consumption of alcohol, which can modify the peak of bone mass ".
For this reason, it is essential that "a treatment against osteoporosis be instituted, and that this be enhanced through an adequate and continuous supply of vitamin D, which avoids breaches in indicated supply8, enhancing the calcium intake through the diet ", concludes Dr. Quesada.