I think like the collegues, it´s the combination of sports, food which contains calcium like milk or cheese and vit D, which helps the take up Ca in the intestinum.

Vitamin D - egg yellow, and Calcium - sesam, milk, diary

ejercicio de impacto estimula los osteoblastos, llevando esto a la nueva producciòn de masa ósea. lógico impacto dependiendo la persona, para un adulto mayor completamente sedentario, impacto sería caminar. 

Dear Prof. Jaafar

Please find the link below:

http://nutrition.about.com/od/foodfun/tp/Diet-And-Osteoporisis.htm?utm_term=best%20foods%20for%20osteoporosis&utm_content=p1-main-1-title&utm_medium=sem&utm_source=google&utm_campaign=adid-5cd5b0d4-4a1a-4870-885f-1cc1edb8c28b-0-ab_gsb_ocode-12479&ad=semD&an=google_s&am=broad&q=best%20foods%20for%20osteoporosis&dqi=&o=12479&l=sem&qsrc=999&askid=5cd5b0d4-4a1a-4870-885f-1cc1edb8c28b-0-ab_gsb

http://sportsmedicine.about.com/od/women/a/osteoporosis.htm?utm_term=best%20foods%20for%20osteoporosis&utm_content=p1-main-2-title&utm_medium=sem&utm_source=google&utm_campaign=adid-5cd5b0d4-4a1a-4870-885f-1cc1edb8c28b-0-ab_gsb_ocode-12479&ad=semD&an=google_s&am=broad&q=best%20foods%20for%20osteoporosis&dqi=&o=12479&l=sem&qsrc=999&askid=5cd5b0d4-4a1a-4870-885f-1cc1edb8c28b-0-ab_gsb

Thanking you

with best wishes

Rezs

I think like the collegues, it´s the combination of sports, food which contains calcium like milk or cheese and vit D, which helps the take up Ca in the intestinum.

I have read a tip to improve the uptake of Ca for patients who consume proton pump inhibitors, the should not use Ca-carbonate but prefer Ca-gluconate as Ca donating drug. .

Food that contains calcium (dairy products and if your patients are vegetarians then spinach, beans, nuts (mainly almonds) and so on. They have to be reminded that animal calcium can be absorbed easier than the one derived from vegetables, Protein diet to facilitate calcium to be absorbed and fish mainly which is rich in Vit D. On top of the diet though patient will need an exercising regime according to the age and ability to activities. 

please consult a dietician...

1 hour of body exposition to sun at midday. 2 hours of physical exercise per day, 1 kg of not starchy vegetables per day.

Dear Mario,

who has two hours time for sports per day? Less will also do it.

Since the query is about osteoporosis; see following clinical pathway;

http://www.irishosteoporosis.ie/?/about_osteoporosis/treatments/

My answer concerned elderly, rtired peple. Young peple reqire haf an hour per day of ntense physical exercise

Treatment of osteoporosis is multifaceted. Diet should aim for at least 1200mg/dy of calcium from milk and dairy products like yogurt, fortified foods like bread, cereals. Many people need to have supplements to make up any daily deficiencies.

Exercise should be weight bearing like walking or running- according to ACSM guidelines >/= 3 times vigorous exercise like running or most days per week of moderate like walking. Muscle strengthening exercises like weights or resistance bands are needed at least 2 times per week working the major muscle segments like: neck & shoulders/trunk/ hips and thigh/legs and knees/ ankle & feet.

If person is >60 years add balancing exercises to reduce falls.

Depending on risk of osteoporotic fractures, drugs like aldendronate or strontium could be added. Most important reversible  predisposing factors to osteoporosis like cigarette smoking, steroid use, inactivity should be identified and reversed. Fall prevention measures  should be implemented in an attempt to prevent fractures.

Several interventions to reduce fracture risk can be recommended to the general population. These include an adequate intake of calcium and vitamin D, lifelong participation in regular weight-bearing and muscle-strengthening exercise, cessation of tobacco use, identification and treatment of alcoholism, and treatment of other risk factors for fracture such as impaired vision.

Providing adequate daily calcium and vitamin D is a safe and inexpensive way to help reduce fracture risk. Controlled clinical trials have demonstrated that the combination of supplemental calcium and vitamin D can reduce the risk of fracture. A balanced diet rich in low-fat dairy products, fruits and vegetables provide calcium as well as numerous nutrients needed for good health. If adequate dietary calcium cannot be obtained, dietary supplementation is indicated up to the recommended daily intake.

The NOF (National Osteoporosis Foundation) supports the Institute of Medicine (IOM) recommendations that men age 50-70 consume 1,000 mg per day of calcium and that women age 51 and older and men age 71 and older consume 1,200 mg per day of calcium. Intakes in excess of 1,200 to 1,500 mg per day have limited potential for benefit and may increase the risk of developing kidney stones, cardiovascular disease and stroke. The scientific literature is highly controversial in this area. There is no evidence that calcium intake in excess of these amounts confers additional bone strength.

Vitamin D plays a major role in calcium absorption, bone health, muscle performance, balance and risk of falling. NOF recommends an intake of 800 to 1,000 international units (IU) of vitamin D per day for adults age 50 and older. Institute of Medicine Dietary Reference Intakes for vitamin D are 600 IU per day until age 70 and 800 IU per day for adults age 71 years and older.

Reference: National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2013.

Prevention of osteoporosis, practical recommendations

*consume daily at least 3 portions of milk and dairy produce with reduced fat content.

*choose vegetables with high calcium content (broccoli, cabbage)

*drink mineral water with high calcium content

*moderate your alcohol intake

*eat fish at least once a week

*limit consumption of foods and drinks high in phosphates

*use spices in place of salt to enhance flavor (chives, parsley)

*eat vegetables and fruit five times daily

*limit consumption of foods high in oxalates

*ensure sufficient intake of vitamin D (fish, livers, milk), vitamin K (leafy vegetables, livers, fish) and vitamin C

*engage in regular physical aktivity

*do not smoke

*limit salt intake

Reference: M. STRÁNSKÝ , L. RYŠAVÁ. Nutrition as Prevention and Treatment of Osteoporosis. Physiol. Res. 58 (Suppl. 1): S7-S11, 2009.

One of the mechanisms by which dietary protein may improve bone mass can be explained by the fact that increasing dietary protein is also known to increase

circulating levels of insulin-like growth factor 1 (IGF-1), and conversely, a low-protein diet decreases IGF-1. IGF-1 is a key mediator of bone growth but also has a role in the skeletal response to anabolic Parathyroid Hormone (PTH) therapy. Increasing dietary protein from 0.85 to 1.55 g/kg per day resulted in lower markers of bone resorption and higher circulating levels of IGF-1 in healthy older men and women.

Reference: Bárbara Santarosa Emo Peters, Lígia Araújo Martini. Nutritional aspects of the prevention and treatment of osteoporosis. Arq Bras Endocrinol Metab. 2010;54/2.

http://nof.org/files/nof/public/content/file/917/upload/481.pdf

http://www.iofbonehealth.org/sites/default/files/PDFs/good_nutrition_for_healthy_bones.pdf

http://www.biomed.cas.cz/physiolres/pdf/58%20Suppl%201/58_S7.pdf

http://scielo.br/pdf/abem/v54n2/14.pdf

Important nutrIents for bone health are magnesium, vitamin K2, vitamin D3, vitamin E and adequate but not excessive calcium. Vitamin A should be adequate but not excessive. So avoid eating liver and supplementing vitamin A. Have weight bearing exercise in the sunshine, if it is available. Omega three fatty acids from fish may be helpful. Hard cheese and other fermented foods provide some vitamin K2. I suggest avoiding bisphosphonates, since healthy bone needs osteoclast activity in balance with osteoblasts, and the deaths of match makers in the past appear to be from bisphosphonate. I would supplement vitamin K2 as MK7, magnesium as glycinate, and vitamin D3. Aim at 125-150 nmol/L (50-60mcg/L) of 25-hydroxy vitamin D. I would only supplement calcium in those with a low dietary intake, as excessive calcium intake may calcify the arteries. Vitamin K2 protects the arteries by removing calcium from them.

About Physical Activity increase the strenght training for reduce bone resorption and formation bone tissue about 2-3 times per week, and aerobic training 2-3 times between 30-60´ per day. For other hand increase the intake of calcium, Vitamin D and K is essential in the process. But the most important is the menopause/andropause status and assessment and monitoring the levels of testosterone in men and estradiol in women.

Everything depends on the T-score marker in femoral neck and lumbar spine. A person with T-score below -2.5 SD the intervention in physical activity program is very special. For example, a strength training with great intensity in a person who has -3.0 SD in Femoral Neck, the training can cause a fracture in Femur.