17/11/2014

Qué es la osteoporosis

que es la osteoporosis - Qué es la osteoporosis
¿Qué es la osteoporosis? ¿Cómo podemos tratarla? ¿Puede prevenirse? 

Estas y  otras muchas  preguntas al respecto  se la hacen a diario un gran número de personas, en su mayoría  mujeres de mediana edad y  que ya han pasado  la menopausia.  Para entender qué es la osteoporosis es importante tener en cuenta que el hueso comienza a debilitarse ya a partir de los 30 años, y afecta tanto a hombres como a mujeres,  aunque  efectivamente el problema se hace más grave una vez cumplidos los 50 años y en mujeres, ya que la entrada en la menopausia  agrava aún más la osteoporosis, pudiéndose perder en los 7 años posteriores a ella hasta un 20% de la masa del hueso.

Es necesario ocuparse de tratar adecuadamente este paulatino debilitamiento  óseo, pero sin permitir que llegue a convertirse en una obsesión, y nunca provocar mayores daños al organismo del que queremos evitar. Yo siempre os he aconsejado valorar riesgos y beneficios, y en el tema de la osteoporosis hay que actuar con mucho  sentido común, y nunca provocar daños innecesarios con ingestas masivas de suplementos de calcio sin estar bien asesorados por un buen profesional.  Al igual que las arrugas marcan nuestra cara con el paso de los años, el hueso también pierde densidad, se debilita.   El calcio que tomemos y que no se fije al hueso recorrerá nuestro organismo perjudicándolo, así como muchos tratamientos médicos para la osteoporosis, que tienen terribles efectos secundarios. Algunos de ellos retirados ya del mercado (por ejemplo la calcitonina intranasal usado durante un tiempo para el tratamiento de la osteoporosis y retirados después de evidenciarse un incremento de riesgo de tumores asociado a tratamientos prolongados). Otros como por ejemplo Prolia (Denosumab) puede producir osteonecrosis de mandíbula o fracturas atípicas de fémur sin trauma entre otras muchas complicaciones.
Hoy día la incidencia de fracturas por osteoporosis es tan grande que es motivo de gran alarma social y hemos de tomar las medidas oportunas. Los huesos que con más facilidad se fracturan son las caderas, las vértebras o las muñecas. Esta debilidad de los huesos trae como consecuencia la pérdida de altura o la  aparición de joroba en la espalda (debido ambos a fracturas  vertebrales. De hecho, hay estudios que relacionan la presencia de una “joroba” dorsal con una osteoporosis de cadera). La osteoporosis también puede producir dolor de espalda o dientes menos resistentes.  Aunque en muchos casos solo es una fractura  la que delata el problema de la osteoporosis, no evidenciándose ningún otro síntoma acompañante.

Es recomendable realizarse una densitometría ósea (para comprobar la densidad del hueso) tras haber llegado a la menopausia, aunque no haya signos evidentes de descalcificación.

¿Qué es la osteoporosis?
La osteoporosis es un debilitamiento de los huesos por pérdida de masa, y puede ser tan grave que pueden fracturarse  huesos del cuerpo.  El hueso pierde densidad, se hace más poroso. Cuando la osteoporosis es muy importante, una pequeña caída puede provocar la fractura fácilmente. En algunos casos, el hueso se rompe primero y la persona  cae al suelo después. Este es el caso de algunas personas mayores con fracturas de cadera o fémur.

¿Es lo mismo osteoporosis que osteopenia?
No.  En la osteopenia la densidad ósea es más baja de lo normal, pero no llega a ser osteoporosis, aunque hay una predisposición a padecerla. Puede ser por razones genéticas, ingesta de ciertos fármacos o problemas médicos y pueden padecerlo personas jóvenes.

Factores que influyen en la osteoporosis:

  • Envejecimiento
  • Antecedentes familiares
  • Tener una constitución pequeña y delgada.
  • Ser mujer rubia o pelirroja.
  • No haber tenido ningún embarazo.
  • Tener hábitos de vida no saludables, con una dieta inadecuada.
  • Desnutrición
  • Inmovilización
  • Padecer enfermedades como Diabetes, hipertiroidismo, hiperparatiroidismo, anorexia, asma, enfermedad de Cushing, lupus, enfermedades del hígado o riñón, esclerosis múltiple, artritis reumatoide, enfermedad intestinal inflamatoria, intolerancia a la lactosa o alcoholismo.
  • Menopausia. En la menopausia los niveles de estrógenos disminuyen y provocan una pérdida de masa ósea, a veces rápida y muy importante. Os aconsejo leer el artículo sobre menopausia escrito en este blog.
    Padecer enfermedades como  Diabetes, hipertiroidismo ,  hiperparatiroidismo, anorexia, asma, enfermedad de Cushing, lupus, enfermedades del hígado o riñón, esclerosis múltiple, artritis reumatoide, enfermedad intestinal inflamatoria,  intolerancia a la lactosa o  alcoholismo.
  • La ingesta de ciertos fármacos como los antiácidos (con aluminio), algunos quimioterápicos (medicamentos contra el cáncer), inhibidores de la bomba de protones (usados para problemas de dispepsia, úlcera o reflejo gastroesofágico, y entre los que tenemos el omeprazol, pantoprazol  o lansoprazol), hormona tiroidea o algunos esteroides como la cortisona o la prednisolona.
  • Evitar tomar Hierro y Calcio juntos, ya que se reduce la eficacia de ambos.

TRATAMIENTO:

  • Calcio: nos lo puede aportar una buena dieta o si es necesario podemos tomar algún suplemento o alimentos enriquecidos. Las dosis diarias recomendadas son de 800-1200 mg. Dividir su ingesta en pequeñas tomas ya que se absorbe mejor que si tomamos mucho calcio junto de una vez.
  • Vitamina D (dosis: 500 mg/día divididos en dos tomas): Es imprescindible para que el calcio se fije adecuadamente al hueso. Podemos tomarla en forma de suplementos, o alimentos como aceites de pescados o pescados grasos.  Nuestro organismo puede fabricarla si nos exponemos 10 minutos diarios al sol pequeñas zonas de la piel como las manos o los pies, siempre en las horas del día menos peligrosas, sobre todo en verano. Con la edad la capacidad del organismo para fabricar vitamina D a través de la piel disminuye de manera importante, por lo que es muy  habitual encontrar en las analíticas de sangre, déficit de esta vitamina en una parte importante de la población, aunque vivan en zonas con mucho sol, por lo que es importante confirmar que exista este déficit y tomar los suplementos de esta vitamina, de forma continúa o periódica según el caso.
  • Vitamina C (2000 mg al día divididos en dos tomas) en forma de suplemento o con alimentos ricos en ella, como los cítricos. Esto ayuda a absorber el calcio.
  • Magnesio (500 mg/día divididos en dos tomas).
  • Otros: Manganeso, cinc (en pequeñas dosis, ya que en altas dosis interfiere con el calcio), boro, lisina (aminoácido que ayuda a formar colágeno) o vitamina K (ayuda a formar la osteocalcina). La alfalfa es muy rica en vitamina K y se toma en forma de brotes en ensaladas o tortillas o como suplementos en presentación de comprimidos.
  • Fitoterapia: La cola de caballo por su contenido en minerales es una de las plantas que más se aconseja para el tratamiento de la osteoporosis y puede tomarse en forma de comprimidos durante seis semanas máximo y luego descansar y tomar vitamina B1 (Tiamina) para compensar la pérdida de esta vitamina que la cola de caballo puede producir. No tomar la planta en periodo de lactancia ni durante los embarazos por tener capacidad abortiva.
  • Tomar una ingesta adecuada de proteínas (ni muchas ni pocas).
  • No tomar azúcar, harinas refinadas, cafeína, alcohol o fumar.
  • Los alimentos con ácido fítico como los cereales integrales o el salvado de trigo hay que usarlos con precaución porque no dejan que se absorba el Calcio, y hay que ingerirlos solos y no en ninguna comida importante.
  • Los alimentos ricos en ácido oxálico hay que tomarlos con moderación.
  • Estudios recientes sobre osteoporosis han revelado que la pérdida de masa en el hueso no solo se debe a la falta de calcio, sino también a la falta de una proteína llamada osteocalcina.  La carencia de esta proteína incrementa el riesgo de fracturas (estudio: Dilatational band formation in bone, publicado  en la revista Proceedings of The National Academy of Sciences of the United States of America). En sus conclusiones se plantea que para mejorar los tratamientos contra la osteoporosis ha de considerarse la osteocalcina, cuya metabolización es posible principalmente gracias a la vitamina K, cuyo déficit es más común de lo que podemos pensar. Un déficit de esta vitamina puede crear malformaciones en el desarrollo óseo al inhibir la calcificación.  Hay una investigación publicada en el Journal of Clinical Endocrinoly and Metabolism que asoció un aumento de la concentración de osteocalcina en pacientes que consumen especialmente aceite de oliva.
  • Ejercicio físico: Mejora la masa muscular, beneficiando así secundariamente al hueso, liberándolo de tanta carga mecánica. También y esto es menos conocido, ayuda a segregar HGH, que estimula el metabolismo e incrementa la retención de calcio y la mineralización de los huesos.  Hay importantes beneficios del ejercicio físico sobre el cerebro.  Los mejores ejercicios para unos huesos sanos son los de resistencia y carga, como caminar, subir escaleras o bailar.  Es importante hacer al menos 30 minutos de ejercicio al día.
  • Utiliza la acupuntura porque está dando unos resultados magníficos en el tratamiento de la osteoporosis, y hay estudios que lo avalan, hechos por la Chengdu University of Chinese Medicine. Y si no te gustan las agujas, se pueden sustituir y el efecto es el mismo.

ACUPUNTURA Y OSTEOPOROSIS:

Se observaron científicamente  los efectos positivos de la acupuntura en el metabolismo óseo y el estradiol (hormona femenina que se le relaciona con la osteoporosis), en ratas de laboratorio con osteoporosis, concluyendo que la acupuntura puede suprimir el incremento de peso, disminuir niveles de estradiol, y regular de manera significativa la fosfatasa alcalina, proteína GLA y otras sustancias marcadores bioquímicos de la osteoporosis.
Fuente de la investigación: College of Acu-moxibustion & Massage, Chengdu University of Chinese Medicine

Es fundamental evitar caídas, sobre todo al llegar a una edad avanzada, y más aún si se padece de Osteoporosis, para evitar fracturas de huesos. Esto parece obvio, pero se producen muchos accidentes domésticos evitables sólo revisando nuestro hogar, asegurándonos que existe una iluminación adecuada, revisando que las alfombras no estén arrugadas, colocando antideslizantes en bañeras y duchas, poniendo barras de seguridad  para sujetarnos tanto en pasillos largos como en la ducha, no teniendo muchos objetos o muebles en zonas de paso o teniendo un calzado bien sujeto y con suela antideslizante. Además hay que  tener precaución con la ingesta de sedantes ya que pueden dar inestabilidad en la marcha. Es interesante hacer ejercicios que mejoren nuestro equilibrio, como el taichi o el yoga.

DIETA:

  • Alimentos ricos en Calcio: Los lácteos son uno de los alimentos que más calcio contienen, pero generan mucha polémica.  Cada vez más hay personas que se manifiestan en contra de su ingesta, diciendo que no solo no son adecuados para aportar calcio al organismo, sino que incluso producen el efecto contrario, descalcificándolo. Os adjunto un artículo sobre los efectos nocivos de los lácteos sobre la salud. De cualquier forma, si os inclináis a tomar lácteos, permitidme que os aconseje que sea en forma de yogures o kéfir, ya que son las formas más sanas y asimilables por el organismo.  Otros alimentos ricos en calcio son el brócoli y la col rizada, el tofu (queso de soja) o algunos cereales que vienen ya fortificados con calcio.  Otros alimentos ricos en calcio son las sardinas (comidas con espinas, por eso son ideales las enlatadas), almendras, nueces de Brasil, tahini (hecho con sésamo), sésamo, semillas de lino, quinoa, legumbres o melaza para endulzar.
  • Toma Alfalfa: Es un alimento rico en calcio, vitamina K,  vitamina D y C y calcio entre otras muchas otras sustancias beneficiosas. Puede tomarse en forma de brotes frescos, en ensalada o en tortilla o en suplementos.  También es muy beneficiosa en la menopausia por su contenido en fitoestrógenos, que ayudan en los problemas de sofoco del climaterio.  La vitamina K se encuentra en verduras de hoja verde oscura y abunda en las espinacas, el brócoli o la alfalfa. También la encontramos en la lechuga, el perejil, el aguacate o los kiwis.
  • Toma lentejas, espárragos, calabaza, ciruela, algas o nueces, que son muy ricas en magnesio.
  • Alimentos ricos en lisina: huevos, pescados o habas.
  • Limitar o eliminar los refrescos de la dieta, ya que son altas en fósforo y favorece la excreción de calcio por la orina.  Por el mismo motivo hay que tomar una ingesta adecuada de proteínas (ni demasiadas ni pocas, ya que en ambos casos se impide la adecuada absorción del calcio), así como también modérate con el uso de la sal, embutidos o enlatados (ricos en sodio que producen el mismo problema).
  • Si tomas salvado de trigo, úsalo en poca cantidad y siempre alejado de las comidas, ya que el calcio y otros minerales que tomemos coincidiendo con su ingesta, no se absorberán.

FITOTERAPIA:

La planta más importante para la osteoporosis es la cola de caballo  (Equisetum arvense).  Hay que hacer una decocción de 15 minutos de una cucharadita de la planta seca por vaso de agua y tomar un vaso al día.  Es muy rica en silicio y potasio. Favorece la absorción del calcio y facilita su fijación en el hueso.  Pero es preciso estar aconsejados por un buen profesional, ya que su uso está limitado. Tiene contraindicaciones y precauciones que hemos de tener en cuenta, y no se aconseja tomar más de 6 semanas seguidas ya que puede alterar el ritmo cardiaco, producir dolor de cabeza, debilidad o problemas digestivos.

SUPLEMENTOS DE CALCIO:
Básicamente hay dos tipos y hay que aconsejarse siempre por un buen profesional:

  • Carbonato de calcio: Ha de tomarse con alimentos para que el cuerpo lo pueda absorber y puede producir efectos secundarios como gases, estreñimiento o malestar gastrointestinal).
  • Citrato de calcio: Se absorbe bien con el estómago vacío o lleno y el organismo lo tolera mejor que el anterior, ideal si va acompañado de vitamina D y Magnesio.

Del resto de los tratamientos médicos para la osteoporosis que hay no voy a extenderme, porque son de uso médico y al tener unos efectos secundarios y unas posibles complicaciones tan severas, solo deben de usarse en casos graves de osteoporosis, valorando siempre riesgos-beneficios.

Así que ya sabéis. Poneos en marcha: cuidad vuestros huesos, haciendo una dieta adecuada, ejercicio, aprovechando el sol como un aliado de nuestra salud y si lo necesitáis utilizad de forma responsable suplementos, así como terapias naturales como la acupuntura y siempre aconsejados por profesionales. No dejéis que vuestros huesos os jueguen una mala pasada.

484 comentarios

  1. XIOMARA dice:

    A que especialidad de medico debo ir si tengo osteopenia y osteoporosis ya si la acupuntura es buena

  2. Carmensana dice:

    Hola Xiomara. Imagino que si sabes que tienes osteopenia u osteoporosis te lo habrá diagnosticado un médico. Los que suelen tratarlo son los reumatólogos, aunque si es algo leve puede llevártelo tu mismo médico de cabecera. Como describo en el artículo hay estudios sobre la acupuntura y la osteoporosis con unos magníficos resultados. Es necesario hacer un tratamiento integral con dieta, vitaminas, minerales y acupuntura o stiperpuntura, que van estupendamente, así como ejercicios periódicos que ayuden a fijar el calcio en el hueso. Solo en casos donde el riesgo es muy elevado o no existe mejoría adecuada aconsejo tratamientos médicos más agresivos ya que sus efectos secundarios o posibles complicaciones son tan graves como fracturas espontáneas o necrosis mandíbular. Siempre hay que sopesar riesgo-beneficio .
    Un saludo

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