Osteoporosis: What is it? Stages, Types, Causes, Symptoms, Diagnosis and Treatment

It occurs when bones become more porous, causing them to lose density and mass.

Having bones with a higher degree of mass and density can give more strength and stability to the body.

Bone mass can be lost over time, especially with specific risk factors. As bone mass decreases, there are holes in the bones.

These holes make your bones much weaker, increasing your risk of breaking a bone with minimal pressure.

The same type of fall or injury that only gave you mild pain when you were younger can now require months of recovery, including possible surgery and physical therapy.

Osteoporosis is a sign of age and not a disease; it is part of those we acquire, such as wrinkles and our experience over the years.

Osteoporosis, then, is not a disease, as many want to call it; it is part of the body’s aging process.


Stages and types of osteoporosis

In the early stages of osteoporosis, most people have no symptoms.

Osteoporosis Tipo I

The primary type of osteoporosis occurs in postmenopausal women due to decreased estrogen levels.

Type I osteoporosis is more likely to cause wrist fractures.

Osteoporosis Tipo II

The second type of osteoporosis is also called senile osteoporosis.

Type II osteoporosis occurs after age 70 in men or women, although women are twice as likely to develop the condition as men.

Hip fractures are more common in type II osteoporosis.


Anyone can get osteoporosis, but women of white or Asian ethnic origin are at the highest risk of developing the condition. Smoking also increases your risk.

Other risk factors for osteoporosis include:

  • Going through menopause at an early age (before age 45).
  • Low calcium intake.
  • Eating disorders.
  • The use of medications called corticosteroids.

Certain diseases can also increase your risk of developing osteoporosis, including the following:

Lack of exercise is also a risk factor for both men and women.

Reabsorption and formation

Bone becomes more fragile when the balance between resorption and formation that accompanies us throughout life is out of balance.

Logically, when we get older, all self-repair mechanisms slow down.

A wound will take longer to heal when you are older than a child.

This is a normal thing of age, but there are also many lifestyle factors such as stress, lack of exercise, and lack of sun, which throw this scale out of balance.

Of course, the diet and the abuse of alcohol, tobacco, coffee, and any substance that stimulates the adrenal glands and causes us to produce more corticosteroid hormones, will make this imbalance more pronounced, that is to say, that reabsorption predominates over the formation.

Secondary osteoporosis is produced by some pathologies, especially by hormonal alterations, digestive disorders, kidney disorders, or those made as a consequence of taking medications for a long time, such as corticosteroids, which are the ones that most damage bone health.


In the early stages of osteoporosis, most people have no symptoms. This is why it is sometimes called a silent disease.

The most common first sign of osteoporosis is a fractured or broken bone. Another early indication may be receding gums, which your dentist can report to you during an exam.

Other early signs can include weaker grip strength and brittle or weak nails.

Once symptoms appear, they may include some or all of the following:

  • Gradual loss of height.
  • Back pain, possibly due to a collapsed or fractured vertebra.
  • Change in posture, including slouching.
  • A bone fracture or break, mainly if it occurs much more quickly than expected or after a seemingly minor injury or falls.

Diagnosis of osteoporosis and bone densimetry

Until approximately 1980, a person, after having had a fracture, especially the hip, which is the most serious, or a fracture for no apparent reason, was usually diagnosed with brittle bones.

But from that time on, with technological advances, a series of devices began to be manufactured that are now very common in all health centers. These machines are used to measure the density of bone mass.

There are currently multiple campaigns to prevent osteoporosis, and they are aimed primarily at women between the ages of 50 and 65, recommending diagnostic tests.

Almost all women, who are the ones who commonly go for this type of test, leave the clinics very depressed with a number in their hand called the T score.

The values ​​are expected with great fear since most women over 50 years are diagnosed with osteoporosis.

However, this result is still just a number that expresses the probability of having a fracture in the next ten years.

But it turns out that we can suffer these fractures, especially among older people; only a tiny part of them are due to osteoporosis or brittle bones.

Some scientific studies report that less than 30% of fractures are caused by osteoporosis. However, balance problems can generate up to 40% of these fractures.

Current studies refer that aging leads to bone fragility, but even the most fragile hips do not fracture if falls do not occur. Therefore, rather than putting the accent on the diagnosis of osteoporosis, it should be placed on falls.

Falls increase significantly with age, from approximately 75 years. At that age, you have less stability, and there is a greater probability of falling.

The lack of exercise also influences a lot. If you don’t do physical activity, you have less coordination and less strength.

Another thing that also has a negative influence is toxic habits, such as alcohol, certain stimulants, and drugs or medications.

What is very common is that most older people are heavily medicated.

Many of the drugs widely prescribed by doctors today, with all their goodwill, are hazardous drugs.

Psychotropic drugs and opioids are given for the multiple pains that the elderly suffer. Of course, diseases of neurological origin, some strokes, osteoarthritis, vision problems, and many other problems that afflict them make them fall off more easily.

Thus, more attention should be paid to avoiding falls than having multiple bone densitometry tests.

We are currently focused on a type of healthcare in which there is overdiagnosis and overtreatment of many diseases, especially osteoporosis, which is the topic that concerns us today.

Recent studies show that between 50 and 65 years of age, the risk of fracture in women is only 0.7 percent.

And even knowing these statistics, densitometries are performed in 25 percent of the women, and 22 percent are treated with antiosteoporotic drugs.

The conclusion reached in this study is that bone mass density in women under 65 years of age is considered a test of low diagnostic value.

But the problem is not that they get tested; the problem is that later they leave the doctor’s office very scared and take the corresponding drugs (bisphosphonates) and also consume calcium supplements.

There is a lot of research where it has not been possible to show that the use of these drugs prevents fractures.

However, something else different is that after taking these bisphosphonate-type medications, better results are observed in the densitometry.

That does not mean that the fractures diminish, which in reality is the ultimate goal that is pursued with all this.

Most importantly, this drug treatment overshadows other treatment approaches for osteoporosis, such as modifying lifestyles and physical activity.

Most doctors insist on treating osteoporosis as if it were a disease and with drugs that lack efficacy, especially in the case of primary prevention, without previous fractures, and in young women under 75 years of age.

Everything is justified by densitometry, which is a diagnostic method that lacks predictive value, is scientifically based, and is overused, especially in women under 75 years of age, as has been well demonstrated.


If your doctor has diagnosed osteoporosis, treatments that may also include medications will likely be prescribed.

Prescription drugs for bone-building often have a hormonal effect similar to estrogen, some of which include the following:

  • Bisphosphonates.
  • Calcitonin.
  • Parathyroid hormone.
  • Raloxifene (Evista).
  • Estrogens.

When we refer to osteoporosis, some things are still etched with fire even in much of society, as if they were dogmas of faith and could not be modified.

Treatments need to be targeted to minimize common causes of injury, take steps to prevent it, and establish good habits.

But above all, there are many things in the field of food that are changing day by day, and we must update frequently.

Milk and bone health

It is also necessary to examine how diet influences or does not influence bone health.

Advertising has done a very intense job for many, many years, and they have made us believe that if we do not take dairy and especially milk, our children will not grow properly, and the elderly will break into pieces.

We have been hearing these claims for a long time, but the truth is that there is no scientific endorsement in this regard.

In 1991, a study that many surely know was published a long time ago: the china study, which was later translated into Spanish as the Chinese study headed by Dr. Campbell.

A comprehensive statistical study was carried out between the Chinese and American populations. It was observed that countries that consume high amounts of dairy products have the highest proportions of osteoporosis. However, this study has no more validity than proposing hypotheses that you have to check.

Years later, many more studies have emerged in which these hypotheses have been proven: “dairy does not prevent osteoporosis.”

Thus, for example, a study was carried out for 22 years, following up on young people between 13 and 18 years old, observing how their bones evolved.

This study in 2014 concluded that the greater consumption of dairy products during adolescence did not lead to a reduction in hip fractures in adults.

What you have to see are not the densitometry results, but if there is more bone fragility, there are more fractures, especially in the hip, which are the most important.

Various review and meta-analysis studies have not found any association between milk consumption and hip fractures.

Therefore, what the ads tell us does not make much sense.

Calcium and bone health

Now, we must review what happens if calcium supplements are increased in general.

There are meta-analysis studies where it is observed that for most people concerned about their bone density, increasing the intake of calcium supplements is unlikely to be beneficial.

To understand a little about all this, you must know how bones work.

The main elements that make up a bone are collagen fibers, a protein; osteoclasts, osteoblasts, and minerals.

The mineral part of the bone is mainly composed of calcium and phosphorus in the form of hydroxyapatite, magnesium, and tiny amounts of other minerals.

Bones are living tissue continuously in balance; osteoblasts work to build bone, which is called the formation process, which is logically very active in growing children. The osteoclasts are responsible for degrading bone.

Like all our tissues, they deteriorate and suffer injuries that the body is responsible for repairing in our bones.

There is a mechanism by which the osteoclasts decide to clean and repair the bone when there is some deterioration. Something similar to what the dentist does when he treats a cavity. First, he tends, and once they have it very clean, they place the filling; well, the osteoclasts also have that function.

All those drugs that stop the action of osteoblasts and osteoclasts are causing the bone possibly not to lose mineral density so fast, but this is going to be a poor quality bone.

So we must bear in mind that these cells are at our service and not against us.

In addition, they have another essential function; when there is a lack of calcium in the blood circulation, they do a small demolition of the bone to achieve the expected levels that calcium should have in the blood.

The hormones calcitonin and paranoia mediate all this.

These regulatory hormones act as follows: paranoid hormone stimulates the activity and formation of new osteoclasts, causing the destruction of a certain amount of bone for the release of calcium needed; as soon as normal levels are achieved, comes the calcitonin to slow down the process.

The treatments previously used for osteoporosis were based on calcitonin; what they did was that it slowed down the process of cleaning the bone. The bone had more density but decreased quality and greater bone fragility.

Women who used this treatment had a much higher risk of breast cancer, which is why this treatment fell into disuse. The same may likely occur with bisphosphonates in the future.

Bisphosphonates have many side effects, and we may also see them being withdrawn from the market.

On the other hand, a person exposed to many toxins and who eats poorly, the bone matrix is ​​fundamentally affected and, therefore, our entire body.

Bones are like the black box of airplanes, where everything that happens is recorded there. Forensics and archaeologists take all the information they need from the bones.

There they find what the individual has eaten and if they have been intoxicated; for example, forensics know if an individual has died intoxicated by the toxic remains found in the structure of their bones.

Also, the free radicals of the blood circulation that arrive there affect the bone.

It is observed that when animals eat food containing certain additives, the bones take on a different color.

If toxic products penetrate the most intimate bones, they deteriorate, the cells that work in our favor, such as osteoclasts, have to do more cleaning, and there is a little more demolition of the bone.

Luckily then we have the osteoblasts that are in charge of rebuilding. These elements work best if they get sunlight and vitamin D comes into play.

Food and calcium absorption

In 1991, scientific articles were published in the British Medical Journal, which presented a series of recommendations that have been disseminated by health specialists, such as physical exercise, sun exposure, avoiding stress, avoiding caffeine and alcohol, and eating a healthy diet.

It is necessary to consume foods that have nutrients essential for bone health so that our osteoblasts can do their job well.

Perhaps the most famous ingredient among celebrities related to bones is calcium, and in fact, the advertising of all dairy products is based on the fact that they have a lot of calcium in us.

Currently, nutritionists dedicated to this subject in depth agree that the amounts of calcium recommended by doctors officially are too high. In addition, they have been increasing little by little and are currently in a range between 900 and 1,000 milligrams of calcium per day.

When the reason for these increases in recommended calcium levels is investigated, there are factors in the current diet, such as eating highly processed products.

This causes a lot of calcium to be lost, and therefore calcium needs are being increased, taking into account these losses.

However, instead of carrying out campaigns directed at the population and recommending a change in their eating style and the harmful effects of processed foods, they prefer to continue selling a lot of dairy products, continue to sell a lot glyphosphonates, and continue to sell a lot of calcium supplements.

There are a few investigations that support the possibility of calcium absorption from natural foods added to our daily diet. Calcium is a very abundant mineral in nature, very plentiful in green.

Horses and cows, and all ruminants, have solid bones, which they achieve with the calcium contained in the grass they eat.

We cannot eat grass because we cannot digest it, but we can consume many other foods that contain calcium and can be assimilated by the human body.

But we must know that there is a barrier to digesting calcium well. Because it is so abundant in nature, if it could freely pass the intestinal wall, we would gorge ourselves on calcium, which is not suitable for our health either.

Especially for cardiovascular health, as no one wants their arteries to calcify.

Our body is so wise it sets its limits, and some elements facilitate the absorption of calcium, and we need some features that allow it. First, for the best calcium absorption, we need a sufficiently acidic medium in the stomach.

So all those older people who take antacids widely recommended by doctors will have problems with their absorption.

There are acidic foods that can help us, such as sauerkraut, vinegar, lemon, and some spices such as ginger, pepper, and chili.

Second, there are chemicals like oxalates, phosphates, and phytates. Oxalates, especially those present in spinach and chard, hinder calcium absorption.

But, if we blanch the spinach or chard and throw away the water where we had blanched it, most of the soluble oxalates are lost in the water. Therefore, we could use them without any problem and without the difficulty of absorbing calcium.

As its name indicates, Phytates are in the fiber of whole foods, such as in the seeds of nuts, and whole wheat bread, among others. But today, we know that there are techniques to make your content decrease.

For example, slow-fermenting bread, soaking whole grains and seeds and nuts, and pulling the soaking water activate the phytases, which are responsible for breaking down the phytates and thus leave us more accessible to the entry of calcium.

Phosphates cause another difficulty in absorbing calcium, but mainly those used in the food industry as additives.

Many studies show a much higher calcium absorption in all crucifers than the absorption of milk.

In a study made with humans, looking at the amount of calcium present in the blood after having eaten these foods, milk has a calcium absorption percentage of 32.1 percent, that of kale is 49 percent, broccoli at 61 percent, cauliflower at 68 percent, watercress at 67 percent.

Turnips in 51 percent, and some more like arugula, that is, all the green leaves of the cruciferous family have very absorbable calcium.

There is also data on sesame and almonds, which have lower absorption of 20 percent, but if it is soaked, the water from the soaking is thrown away, and a light roasting is carried out; we also make that calcium is better assimilated.

Today, the higher the salt intake, the more calcium excretion in the urine. However, this does not mean that you should eliminate salt intake or eat tasteless foods.

Eating foods with a bit of salt is OK, as this only happens when salt is consumed in excess.

This excess salt does not come from what is added to food in the kitchen at home; it comes mainly from industrialized foods.

Another great enemy of calcium is sugars, especially those consumed in sugary drinks; these sugars decrease bone density and increase the risk of fractures.

Caffeine increases the risk of fractures by 20 percent, but only when you drink a lot of coffee. However, it does not represent a significant factor; salt and sugar are more critical if the excess is not incurred.

Dairy products and calcium

For those people who, for some reason, have decided not to drink dairy, there are some very practical equivalences. The calcium in a glass of milk is between 200 and 250 milligrams.

This calcium can also be obtained from a heaping tablespoon of sesame seeds or a small heaping tablespoon of tahini or sesame butter. Both the roots and the tahini are whole and toasted.

Also, the vegetable milk enriched with calcium, the ideal would be with calcium from algae, a plate of cauliflower or kale or broccoli, two or three medium canned sardines with thorns, four to five handfuls of almonds, ten figs, together with a healthy diet where we do not consume processed foods, where there is no excess salt or added sugars.

To intake around 500 milligrams of calcium per day, it is necessary to consume two servings a day of these foods.

For those who take dairy, it is recommended that they be a goat or sheep milk that is fermented and whole, not skimmed.

We need smaller amounts of these products to get the calcium equivalent of a glass of milk (between 200 and 250 milligrams).

In this way, only 150 milliliters of yogurt or goat kefir are needed, and if it is semi-cured goat’s milk cheese, only 25 grams will cover the daily needs.

As for sheep’s milk, less quantity is needed since everything that has been made with sheep’s milk has much more calcium than that made with cow’s milk and goat’s milk.

Another essential mineral is magnesium. Magnesium is part of the bone. It stimulates the proliferation of osteoblasts that are the ones that make up bone, called bone-forming cells. It also regulates the balance of phosphorus and calcium.

Magnesium is found in all green leaves, in all nuts, in all seeds, in whole grains, and also in algae. Due to its high iodine content, the latter must be consumed in small amounts.

Other factors that influence calcium absorption

The star ingredient so that calcium is absorbed at the intestinal level and reaches the bones, which is where it has to arrive, is vitamin D, which is synthesized with the help of the sun.

Vitamin D levels in people today are deficient, perhaps due to the current lifestyle, where we spend many hours indoors. When we go out, we apply sunscreen creams, especially in the summer months; sunscreens prevent vitamin D synthesis.

You have to rethink your lifestyle change and enjoy the sun at the recommended hours.

We have the possibility of acquiring vitamin D through some foods, such as fatty fish (oily fish) and in much less quantity from eggs, but one of the foods that have more vitamin D is fish liver, which many times the fishmonger throws it away.

Now, if it is a wild fish of good origin (we know where it comes from), which is very fresh, it is ideal to consume your liver.

Mushrooms also have a high vitamin D content, but if they do not receive the sun, they cannot synthesize ergocalciferol, vitamin D2.

As it is not possible to know when they are bought, if the sun has given it or not, for this vitamin D to be very effective, the body has to go through a whole metabolic process, our body until reaching a final product that is 125 hydroxycholecalciferol, for this, the liver and kidneys must be in good condition.

Foods that provide elements necessary for bone formation

As for vitamin K2, this is the most effective in bone formation.

Vitamin K2 activates an essential protein in the bone, which is osteocalcin.

This is necessary to fix calcium in the bones and teeth, it has synergy with vitamin D, and it is also produced by our microbiota.

Now, those people who take antibiotics are more likely not only to deteriorate their microbiota but also for vitamin K2 levels to drop a lot.

There are foods high in vitamin K2, such as natto, a fermented soybean sold fresh and dry and concentrated in pills.

Sauerkraut, for its part, not only contains K2 but also improves the microbiota.

Vitamin K2, in less quantity, is contained in the egg yolk and all the green leaves.

Another essential food for our bones, which influences the activity of osteoblasts, the bone-forming cells, is omega 3.

The consumption of oily fish is associated with an improvement in bone mineralization. In this food, two elements come together, on the one hand, omega three and, on the other hand, vitamin D.

Carotene also influences the formation and maintenance of bones, we have many carotenes in carrots, and although they are not orange, they are also present in green leaves.

We need the bone matrix to be in good condition and not deteriorate like the rest of our body, especially when celebrating our birthday.

In the same way that the skin wrinkles, the bones also wrinkle, which is why collagen is necessary to protect against the advance of osteoporosis in the bones.

Vitamin C is an antioxidant, and it is necessary for the synthesis of collagen, so here we expand the range; we no longer only want green in our diet; we also wish to purple, we want red; the more colors, the better, because we have more antioxidants.

One of the slightly forgotten minerals that helps the formation of collagen and the assimilation of calcium in the bones is silicon; the truth is that most of the population eats foods that have very little silicon.

Silicon is contained in small amounts in some whole foods such as cereals, especially millet and oats. But where else we have silicon at our fingertips is in horsetail and nettles.

The matrix of bone is made of collagen, which is a protein. Therefore, it is essential to have a good supply of protein in the diet.

In addition, it has been seen that protein increases intestinal absorption of calcium; if the protein is lacking in the diet of older adults, there is a more significant loss of bone mass.

It was believed that excess protein was responsible for the loss of calcium. But there are recent scientific studies that say that this is not the case, that there was a misconception.

In early studies, it was observed that more calcium was eliminated in the urine by eating more protein.

Protein helps in the absorption of calcium, which translates into more calcium in the blood, and when it is in excess, one of the ways to eliminate it is through the urine.

Therefore, it was wrongly believed that excess protein affected calcium absorption.

In a study done with postmenopausal women, one group of women was given a protein diet in balanced rations, and the other group was assigned a diet with twice the protein, and there was no difference in terms of protein—bone health.

Another issue that has also been asserted by many authors is that the acid load of food affects bone health. It has always been believed that it was necessary to make an alkalizing diet. Otherwise, the bones would deteriorate.

But this is a theoretical concept that is a working hypothesis, but apparent scientific studies have not yet been carried out, where it can be affirmed that the acid load of food influences bone health. One source of protein is bone broth.

Formerly, in the houses, there was a practice, now in disuse, which is bone or bone broth, to get not only proteins but also minerals and amino acids.

Broths of bones and thorns provide glycine, an amino acid that the human body cannot synthesize.

This non-essential amino acid is essential for forming body collagen (glycine).

According to traditional Chinese medicine, a series of foods are recommended to strengthen bones, representing energy nutrition.

They recommend foods that have radiant energy and that strengthen our skeleton. Among them, we have, for example, sesame seeds, and the most recommended according to Chinese medicine are black sesame because it has more antioxidants than regular sesame.

Among the legumes are black soybeans and azuki, then they also recommend two fermented soy products: miso and tamari. They also recommend seaweed, blackberries, blueberries, aubergines, and cabbage.

Finally, we can conclude that we need the formation of bone, calcium, magnesium, silicon, and proteins.

But all this is worthless if we cannot properly digest and absorb foods that contain these nutrients.

It is known today that those people who have significant diseases of the digestive system, such as celiac disease, ulcerative colitisand Crohn’s syndrome, have lower bone mass density. But they also have other body parts that are weakened by the difficulty of absorbing these nutrients.

Exercises and calcium absorption

A diet rich in calcium, no matter how much vitamin D and K2 we take, would not be worth anything, and it will not go to the bones if we do not exercise.

Nor is it worth just walking around the block and sitting on each bench. Even with a significant physical limitation, you do what you can.

You have to make a little impact on the exercise to be more effective in bone formation.

The use of small weights, Nordic walking, a little jogging, tai chi, and chi kung, which give us a little impact, are necessary. It is recommended to perform these exercises outdoors and never at night.

It should be ensured that we can receive the sun at a time of day because we can also synthesize vitamin D.

Finally, food, refined salt and sugars, stress, toxic habits, and a sedentary lifestyle must be eliminated.

Make a change in the daily diet, consuming a natural diet, with many vegetables of various colors and a lot of green, seeds and nuts, and not lacking protein. All this must be accompanied by physical activity and the sun.