on June 26, 2026
un aumento del riassorbimento osseo;
una riduzione della formazione ossea;
una diminuzione della densità minerale ossea;
un aumento della fragilità ossea;
un aumento del rischio di fratture.
In questo contesto il solo aumento del consumo di calcio non rappresenta sempre la strategia più efficace.
Che cos’è realmente l’osteoporosi
L’osteoporosi è una malattia sistemica dello scheletro caratterizzata da:
- riduzione della resistenza ossea;
- alterazione della microarchitettura;
- aumento della fragilità;
- maggiore rischio di fratture.
La definizione clinica più utilizzata deriva dai criteri dell’Organizzazione Mondiale della Sanità basati sulla densità minerale ossea misurata con metodiche strumentali.
Tuttavia oggi sappiamo che il rischio di frattura dipende anche da altri elementi:
- qualità dell’osso;
- età;
- forza muscolare;
- rischio di caduta;
- stato nutrizionale;
- presenza di malattie croniche.
Per questo una densitometria alterata non coincide automaticamente con elevato rischio clinico.
L’osso è un tessuto vivo: il rimodellamento osseo
Il tessuto osseo viene continuamente rinnovato attraverso l’attività coordinata di due principali popolazioni cellulari.
Osteoblasti
Sono le cellule responsabili della costruzione della matrice ossea.
Producono:
- collagene di tipo I;
- proteine della matrice extracellulare;
- componenti coinvolte nella mineralizzazione.
Osteoclasti
Sono cellule specializzate nel riassorbimento osseo.
Derivano dalla linea monocito-macrofagica del sistema immunitario e rimuovono tessuto osseo danneggiato o non più funzionale.
La salute dell’osso dipende dal mantenimento dell’equilibrio tra queste due attività.
Infiammazione e salute ossea: quale relazione esiste davvero?
Negli ultimi anni è emerso il concetto di osteoimmunologia, disciplina che studia il rapporto tra sistema immunitario e metabolismo osseo.
Le citochine pro-infiammatorie possono influenzare il rimodellamento osseo.
Tra i principali mediatori studiati troviamo:
- TNF-α;
- IL-1;
- IL-6;
- RANKL.
Quando gli stimoli infiammatori persistono nel tempo si può osservare:
- increased osteoclastic activity;
- greater bone resorption;
- reduced formation.
This phenomenon is particularly evident in some chronic conditions:
- rheumatoid arthritis;
- visceral obesity;
- inflammatory bowel diseases;
- diabetes;
- aging.
However, it is important to emphasize that there is no evidence that specific “food rotations” constitute a treatment for osteoporosis.
The nutritional approach must be comprehensive and evidence-based.
Metabolic Control and Blood Sugar Spikes
Bone metabolism is also influenced by energy regulation.
Prolonged chronic exposure to:
- excess calories;
- hyperinsulinemia;
- insulin resistance;
can alter the balance of bone tissue.
Conversely, excessive calorie restriction or malnutrition impair bone formation.
The goal is not to eliminate carbohydrates but to maintain:
- a balanced diet;
- adequate energy intake;
- metabolic stability.
Not Just Calcium: The Role of Protein
A widely held belief is that protein “acidifies” and weakens bone.
Current evidence does not support this theory.
Bone is composed of:
- mineral component;
- collagen-rich organic matrix.
Insufficient protein intake is associated with:
- reduced bone mass;
- muscle loss;
- increased fracture risk.
Major scientific societies recommend adequate protein intake, especially for older adults.
Plant-based sources can contribute effectively alongside high-quality protein sources.
Among the foods of interest:
- legumes;
- seeds;
- nuts;
- whole grains;
- soy and soy products.
Milk and Dairy: Are They Really Necessary?
The relationship between dairy and bone health is more complex than is often thought.
Milk and dairy products are a source of:
- calcium;
- protein;
- phosphorus.
However, they are not healthy for everyone, especially over the long term and as people age.
People with:
- lactose intolerance;
- different dietary preferences;
can achieve an adequate nutritional intake through other sources.
Useful foods include:
- leafy green vegetables;
- legumes;
- sesame seeds;
- almonds;
- alkaline water;
- fortified foods.
There is no evidence that milk consumption is universally necessary to prevent osteoporosis.
Vitamin D: much more than calcium
Vitamin D is one of the main regulators of mineral metabolism.
It contributes:
- to the absorption of calcium and phosphorus;
- to the maintenance of normal bones;
- to muscle function.
A severe deficiency can lead to:
- rickets in children;
- osteomalacia in adults.
Insufficient levels are also associated with:
- muscle weakness;
- increased risk of falls.
Cutaneous synthesis through moderate sun exposure is an important source.
In some individuals, a clinical assessment of supplementation may be indicated.
Physical activity: the real stimulus for building bone
Bone responds to mechanical load.
Regular physical activity is one of the most effective tools to support bone metabolism.
Of particular interest are:
- resistance exercises;
- weight-bearing activities;
- balance exercises;
- strength training.
In individuals with established osteoporosis, personalization is useful to reduce the risk of falls.
Normocaloricity: avoid both excess and chronic restriction
Bone health is affected by both caloric excess and chronic restriction.
Too restrictive diets can promote:
- muscle loss;
- reduced bone formation;
- hormonal alterations.
The goal is to maintain sufficient nutrition to compensate for daily requirements.
Osteoporosis cannot be interpreted as a simple calcium deficiency.
Bone health arises from the balance between nutrition, movement, body composition, metabolism, inflammatory status, and adequate vitamin D availability.
A modern approach to the prevention and maintenance of skeletal well-being considers bone as an integral part of a system involving muscle, the immune system, and lifestyle.
Bibliography
Compston J et al. Osteoporosis. Lancet. 2019.
Kanis JA et al. European guidance for the diagnosis and management of osteoporosis. Osteoporosis International.
Eastell R et al. Management of osteoporosis in postmenopausal women. Endocrine Society Guideline.
Rizzoli R et al. Nutrition and bone health. Osteoporosis International.
Bonjour JP. Protein intake and bone health. Int J Vitam Nutr Res.
Weaver CM et al. Calcium plus vitamin D supplementation and fracture prevention.
Holick MF. Vitamin D deficiency. N Engl J Med.
Black DM, Rosen CJ. Clinical practice: Postmenopausal osteoporosis.
Takayanagi H. Osteoimmunology and bone remodeling. Nat Rev Immunology.
Khosla S et al. Pathophysiology of age-related bone loss and osteoporosis.
IOF – International Osteoporosis Foundation. Nutrition and bone health position papers.
