Prevention and care of osteoporosis in the elderly: Nutritional perspectives and isotopic tools

Osteoporosis, a multifactorial disease is characterised by reduced bone-strength (bone-mineral density and quality) and proneness to fractures in post-menopausal women and the elderly above 65 years. Over 50% of osteoporotic fractures will occur in Asia by 2050. From prevention to treatment of osteoporosis, intervention should commence as early as childhood to optimise bone strength and to preserve adult skeletal integrity, thereby reducing fragility fractures. Healthy lifestyles throughout lifespan including prudent diets, physically active and healthy body weight are important bone-strength modulators. Calcium, vitamin D, phosphorus and protein, etc. and non-nutrients namely, phyto estrogens, caffeine and phytate, etc. have been shown to modulate bone integrity and bone loss. Supplementation studies with calcium and vitamin D on bone integrity have found positive effects on bone acquisition in growing individuals and retardation of bone loss in the elderly especially in populations accustomed to non-milk-based diets. Bioavailability of calcium from non-milk-based diets is largely unknown. If particular indigenous foods or calcium-fortified foods are proven with highly bioavailable calcium, dietary regimes based on the tested foods may be used in national campaigns to promote bone health and in diet-therapy to retard bone loss. Isotopic and nuclear techniques are indispensable tools to study nutrition and bone health: stable isotopic technique to evaluate calcium bioavailability in foods, calcium kinetics, absorption and retention studies in human. To monitor outcomes of bone-strength and mineral deposition rate by using dual-energy X ray-absorptiometry and QCT, and to determine vitamin D metabolism and bone turnover rate by using radioimmunoassays in screening and nutritional intervention programmes. To conclude, optimization of bone-strength early in life and timely intervention on vulnerable groups in preserving bone integrity are importance to reduce osteoporotic fracture risks. Isotopic and nuclear techniques are indispensable to accurately and precisely evaluate nutritional status and outcomes of bone-strength in screening and intervention programmes for bone health. (author)