What are the most prevalent diseases that involve bones and joints?

• Osteoporosis, osteoarthritis and rheumatoid arthritis

Why osteoporosis is important and how prevalent is it?

– Osteoporosis is the most common skeletal disease in humans.

– In women, almost one out of every 2 and in men one out of every 4 are exposed to fractures caused by osteoporosis.

– In Iran, about 70% of women and 50% of men over the age of 50 have some degree of bone density reduction.

What are the most prevalent diseases that involve bones and joints?

• Osteoporosis, osteoarthritis and rheumatoid arthritis

Why osteoporosis is important and how prevalent is it?

– Osteoporosis is the most common skeletal disease in humans.

– In women, almost one out of every 2 and in men one out of every 4 are exposed to fractures caused by osteoporosis.

– In Iran, about 70% of women and 50% of men over the age of 50 have some degree of bone density reduction.

What makes the prevention and treatment of osteoporosis difficult?

– Osteoporosis has a gradual and silent course.

– In many cases, osteoporosis is asymptomatic until a fracture occurs. (60% of people are unaware of osteoporosis in their body)

– Osteoporosis is more common in the elderly and in women after menopause. But the start of the bone density reduction is several decades earlier and in old age osteoprosis reaches a degree that makes a person prone to fractures.

What are the most important points in preventing osteoporosis?

• In general, prevention is more important than treatment in relation to osteoporosis. To prevent osteoporosis, it is necessary to pay attention to these points:
  • Having the right level of physical activities and exercise
  • Stop smoking and alcohol
  • Taking a sufficient amount of calcium
  • Providing enough vitamin D for the body
  • Supplying sufficient amounts of magnesium and zinc and vitamin K2.

What kinds of exercise are useful for increasing bone density?

• You should notice that only weight bearing exercise is effective for the prevention of osteoporosis (walking, running, etc).
• On the other hand, swimming although is useful in other ways (for example, for the health of the joints), but because it reduces the weight bearing of the bones, is less effective in preventing osteoporosis.
• Osteoporosis is more common in underweight people than in overweight and obese people. (The effect of bearing weight on increasing bone density)

Can collagen also play a role in increasing bone density?

– It should be noted that while calcium is the most important mineral used in the structure of bones and teeth, collagen is the most important protein used in the structure of bones. Some studies have shown that taking collagen supplements with calcium and vitamin D may be more effective in increasing bone density than taking calcium and vitamin D without collagen.

What sources are able to supply calcium to the body?

– Ideally, we should take calcium through foods such as dairy products, almonds, broccoli, legumes, spinach, turnips, etc.

– If we cannot use enough of these foods for any reason, we can use nutritional supplements containing calcium to prevent this deficiency.

– The human body needs 1000 to 1200 milligrams of calcium daily and even more during pregnancy. Each glass of milk contains about 300 mg of calcium. Some of the other dairy products have the same amount of calcium. For example, a glass of yogurt has as much calcium as a glass of milk.

What are the vitamin D sources for the body?

– Vitamin D may also reach the body in several ways:

o Sun exposure

o Nutrition

o Taking supplements

– The minimum daily requirement for vitamin D is 400 units per day according to older guidelines and 600 to 800 units per day according to newer guidelines.

What are the challenges of providing vitamin D through exposure to sunlight?

Due to spending most of the time in closed spaces, and the use of sunscreen, we may not be able to get the required amount of vitamin D through exposure to sunlight.

• Due to the widespread prevalence of vitamin D deficiency, many of us need to take nutritional supplements containing vitamin D.
• Vitamin D along with calcium may be supplied and consumed in the form of a supplement. Also, according to new findings, having a sufficient amount of vitamin K, especially vitamin K2, plays a role in calcium management and increasing bone density and preventing calcium side effects.

What is the role of magnesium and zinc in bone formation and body health?

• Management of calcium in the body, in addition to vitamin D, requires the presence of sufficient amounts of other minerals such as magnesium and zinc.
• Without the presence of vitamin D, magnesium and zinc, calcium may not be used properly for bone formation and even with deposits in the body’s vessels, it may cause coronary artery problems and increase the incidence of heart attacks.

What other roles do magnesium and zinc play in our health?

– Magnesium is important in the function of nerves and muscles and metabolic activities of the body, and zinc is important in the health of the skin and hair and the immune system.

– In fact, several hundreds of biochemical and physiological reactions in the body require the presence of these elements.

– Zinc is also necessary for the production of collagen (the main protein involved in bone structure).

Can we have calcium, magnesium, zinc and vitamin D together in one product?

• You can use nutritional supplements that contain all four vital substances calcium, vitamin D, magnesium and zinc.
• NutriPad calcium, magnesium, zinc and vitamin D supplements contain all 4 ingredients in one product.

What is osteoarthritis and what are its symptoms? what joints of the body are mostly involved in osteoarthritis?

• Osteoarthritis is the most common joint disease and its prevalence increases with age. (Peak occurrence after age 60). Half to one percent of the world’s population are affected by osteoarthritis
• Osteoarthritis is more common in women than men.
• The most commonly involved Joints are generally knee, hip, wrist, cervical and lumbar spine.
• In this disease, the cartilaginous tissue of the joints is gradually destroyed and degraded, which shows itself by reducing the flexibility and pain. The symptoms of the disease lead to a decrease in the range of motion and finally a significant decrease in the quality of life of the patients.
• Osteoarthritis is a chronic and progressive disease. Patients may eventually need joint replacement surgery.

What are the non-pharmacologic treatments of osteoarthritis?

– Non-pharmacological treatments include weight loss, exercise for strengthening the joint supporting muscles, and physiotherapy.

– Sports activities should be considered in this disease. Many activities may increase joint damage and pain. Hydrotherapy and swimming are useful in osteoarthritis.

– Reducing weight plays a significant role in improving the disease. Sometimes a few kilos of weight loss have a significant effect in reducing the pressure on the joint.

What are the Pharmacologic treatments for osteoarthritis?

• In fact, medication therapy is not able to definitively cure osteoarthritis and often have a palliative role and at best may prevent the progression of the disease. Palliative treatments for pain control, in order and based on the severity of the disease, include:
• Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs with fewer side effects are preferred including ibuprofen in doses less than 1200 mg per day, naproxen in doses equal to or less than 500 mg per day
• Adding weak opiods such as codeine or tramadol to the above drugs (usually used for short periods).
• – If joints close to the surface (such as knees or wrists) are involved, topical medications may be effective and should be used in preference to oral treatments. For example, topical forms of diclofenac, piroxicam or pepper ointment (capsaicin).
• Intra-articular injection of corticosteroid
• Intra-articular injection of hyaluronic acid

Can supplements be helpful in osteoarthritis?

– Osteoarthritis is a chronic disease, and in long-term, medication therapy may affect the patients with adverse effects.  Gastrointestinal side effects and gastrointestinal bleeding are important side effects of NSAID drugs. Especially in patients who have other risk factors such as age above 60, taking aspirin or corticosteroids, etc.

– On the other hand, the use of some supplements has yielded promising results in controlling the symptoms of arthritis. Glucosamine, chondroitin, methylsulfonemethane (MSM), calcium fructoborate, hyaluronic acid, ginger, omega-3, devil’s claw plant, curcumin (substance found in turmeric) are among the supplements that are used to relieve symptoms and especially pain in osteoarthritis. The strength of scientific evidence regarding the effectiveness of these supplements are not equal.

What are the best supplements for osteoarthritis?

• Glucosamine, especially in combination with chondroitin and MSM, have been studied more and there are significant evidence regarding their effectiveness, especially in reducing pain. Among the problems in using the above compounds is the need for a relatively long time (6 to 8 weeks) for their effect to start. Glucosamine must be used in a dose of at least 1500 mg per day to be effective.
• To shorten the onset of action in these supplements, adding calcium fructoborate to glucosamine and chondroitin has been used.

What is the role of calcium fructoborate in reducing the symptoms of osteoarthritis?

 – Calcium fructoborate is a compound with anti-inflammatory effects. Combining this compound with glucosamine has been used to shorten the onset of action of glucosamine.

– The time required to observe the first effects in pain relief by taking combined supplements containing calcium fructoborate has been reduced to one to two weeks.

– Calcium fructoborate also has systemic anti-inflammatory effects and its use is associated with the reduction of inflammatory factors in the body. For this reason, some researchers believe that it has beneficial cardiovascular effects.

• JointPad is a supplement for joint support made by NutriPad, in which the above useful components are placed in one product.

What is the difference between osteoarthritis and rheumatoid arthritis?

• Both diseases involve the joints, but the important difference is in the pathophysiological mechanisms causing the disease. Moreover, the clinical manifestations and the type of joints involved are also somewhat different in the two diseases.
• In short, rheumatoid arthritis (RA) is a chronic inflammatory disease that affects the joints. Autoimmune mechanisms are involved in the occurrence of this disease.
• On the other hand, osteoarthritis (OA) is a degenerative joint disease during which the cartilage tissue in the joint breaks down and degenerates. Joint erosion or so-called wear and tear plays an important role in the pathophysiology of osteoarthritis.

Are supplements useful in the management of rheumatoid arthritis?

– Supplements such as glucosamine have a greater role in the management of osteoarthritis, although they may also be used in rheumatoid arthritis. In fact, sometimes osteoarthritis is added to rheumatoid arthritis at older ages. However, studies related to the effectiveness of glucosamine and cartilage-supporting supplements have been conducted mostly in the population of osteoarthritis patients.

 – Supplements that have known anti-inflammatory effects, such as omega-3, may be effective in reducing the symptoms of rheumatoid arthritis.

Do supplements that containing glucosamine, chondroitin, MSM and calcium fructoborate in combination with each other have any special advantage?

 – Yes. There is stronger scientific evidence regarding the effectiveness of these combined forms. In addition, these supplements that contain only glucosamine and chondroitin need a longer period of time, at least 6-8 weeks, to show the first beneficial clinical effects.

– Calcium fructoborate is a compound with known anti-inflammatory effects, and its combination with glucosamine, chondroitin, and MSM increases the speed of the effect and reduces the onset of action to 1-2 weeks.

– Calcium fructoborate may have beneficial cardiovascular effects due to its systemic anti-inflammatory effects.

– Jointpad is a supplement made by NutriPad, which includes all the above components (glucosamine, chondroitin, MSM, hyaluronic acid and calcium fructoborate) in one product.

What is the required daily dose of glucosamine for effectiveness?

– According to the scientific evidence, glucosamine should be used at least 1500 mg per day for producing a significant effect. So if, for example, each of your glucosamine capsules contains 500 milligrams of glucosamine, you need to use three of these capsules each day. Prescribing with lower doses is not recommended because the scientific evidence for the effectiveness of lower doses is weak.

Can people with diabetes use glucosamine supplements?

– Yes, diabetics can use supplements containing glucosamine. Although increases in blood sugar have been reported with glucosamine, current studies have shown that diabetics can safely use glucosamine supplements. A review study pooling data from other studies concluded that glucosamine had no adverse effect on fasting glucose, glucose metabolism, or insulin sensitivity in both healthy subjects and those with diabetes or prediabetes. At the same time, in general, it is necessary to adjust and optimize the dose of antidiabetic drugs in patients with diabetes, while periodically controlling blood sugar and performing relevant tests under the supervision of a physician.

Is glucosamine safe for people with high blood pressure?

– Yes, glucosamine is safe for those taking anti-hypertensive medications. Patients who use supplements containing glucosamine as an alternative to NSAIDs (drugs of the same family as ibuprofen, naproxen, etc.) for joint problems benefit from it because NSAIDs reduce the effect of blood pressure lowering drugs and increase the risk of problems related to clot formation, but glucosamine does not have these side effects.

The importance of weight loss in patients with joint diseases, especially in patients with osteoarthritis:

– In order to reduce the pressure on the joints, especially in osteoarthritis, the first recommendation of is to lose weight and reach the ideal body weight.

– Due to limitations in activity, reaching the ideal weight in these patients may be a big challenge. These patients usually need to use proper diets to lose weight. In these diets, one should always pay enough attention to getting a sufficient amount of all the vitamins and minerals needed by the body (micronutrients).

What food sources are rich in calcium?

• Ideally, we take calcium through foods such as dairy products, almonds, broccoli, legumes, spinach, turnips, etc.
• If we cannot use enough of these foods, we can use nutritional supplements containing calcium for preventing deficiency.
• The human body needs 1000 to 1200 milligrams of calcium daily and our calcium need is even more during pregnancy. Each glass of milk contains about 300 milligrams of calcium.

What are the sources of vitamin D for the body?

The vitamin D required by the body can be obtained in several ways:

– Sun exposure

– Nutrition

– Taking supplements

The minimum daily requirement for vitamin D is 400 units per day according to older guidelines and 600 to 800 units per day according to newer guidelines.

What is the importance of magnesium and zinc in bone formation and body health?

Proper management of calcium in the body, requires the presence of sufficient amounts of other substances such as magnesium and zinc in addition to vitamin D.

Without the presence of vitamin D, magnesium and zinc, calcium may not be used properly for bone formation. Even with deposits of calcium in the body’s vessels, may cause coronary artery problems and increase the incidence of heart attacks.

What do we know about vitamin K2? Is it useful to combine vitamin K2 with vitamin D in supplements?

– Vitamin K2 is one of the fat-soluble vitamins that, unlike vitamin K1, only researches in recent years have revealed some of its important roles.

– The important role of vitamin K1 is the production of coagulation factors, and deficiency in vitamin K1 causes hemorrhagic coagulation disorders through disruption of the production of coagulation factors. Vitamin K1 is abundantly found in green leafy vegetables such as cabbage and lettuce, and its deficiency is rare in people with normal nutrition.

Unlike vitamin K1, vitamin K2 is not found in green leafy vegetables, but is mainly found in fermented foods like cheese. The microbes in the digestive system can play a role in supplying the body with vitamin K2 by converting vitamin K1 to vitamin K2.

– Vitamin K2 has an important role in the strength of bones and teeth. In fact, the consumption of calcium for building bones requires the uptake of calcium from the blood, and this role is the responsibility of vitamin K2.

– Taking too much calcium (more than 1000 – 1200 mg per day), is dangerous and increases the risk of cardiovascular problems. In fact, excess calcium may be deposited in the arteries and cause the arteries to become hard and rigid, and increase the risk of heart attack.

– Vitamin K2 has been found to prevent this complication with its role in removing calcium from the blood and using it to build bones.

– In recent years, vitamin K and vitamin D have been included in combination in supplements. This combination makes vitamin D more effective in increasing bone density, and on the other hand, reduces possible side effects caused by calcium and vitamin D.

• Vitamin D+Vitamin K1+Vitamin K2 NutriPad oral tablet is a very valuable product that benefits from the combination of Vitamin K1 and K2 with Vitamin D to increase its effectiveness and reduce possible side effects.