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Bone Health (Bones (Maintenance (3 Process of Bone Development (Bone…

- - - - Muscle Attachment
      - Jaw Bone and Teeth
      - Organ Organization
    - - Contains Osteoid
        
        Inorganic Materials (65%)
        
        Mineral Crystals
        
        Provides Strength and Rigidity
        
        Manufacture of RBC, WBC
        
        Organic Materials (35%)
        
        Protein matrix (Collagen), nerves, cartilage, and connective tissue
        
        Provides Flexibility
      - Bone Marrow produces
        
        red blood cells, white blood cells, and platelets
  - - - Cortical Bone
        
        ivory-like and dense
        
        small bones and outer surface of long bones
        
        slow turnover, ~80% of entire skeleton
      - Trabecular Bone
        
        lace-like texture
        
        ~20% of skeleton
        
        dynamic, ends of long bones, spinal vertebrae
        
        sensitive to hormones associated with Calcium
    - - osteoblast cells
        
        build bones
      - osteoclast cells
        
        break down bones
    - - Bone Growth
        
        osteoblasts more active than osteoclasts
        
        Size and Length of bones increase
      - Bone Modelling
        
        bones take on specific shape
      - Bone Remodlling
        
        Bone turn over, density is affected
        
        100% bone rebuilt during early years
        
        ~15-30% bones rebuilt each year
        
        Osteoclast resorption requires vitamin A
        
        Chylomicron remnant deliver Vitamin D to liver #
  - - - Strength, Rigidity
      - Hydroxyapatite crystals Ca10[PO43-]6[OH]2 : formed by dietary calcium and phosphate salt #
    - - Flexibility
  - - - blood Calcium doesn't reflect Calcium Status
        
        Blood Calcium homeostasis kept at ±3% of 10mg Ca/dL
        
        Regulated by 3 hormones
        
        Calcitriol (active Vitamin D) #
        
        if level falls, it will decrease the absorption of Calcium
        
        Parathyroid Hormone
        
        if level falls, results in an increase in urinary Calcium
        
        Calcitonin
        
        Low Blood Calcium Levels
        
        Parathyroid gland secretes #
        
        Kidney acts on osteoclast cells to raise blood Calcium, activates #
        
        lead to calcium tetany in muscles
        
        High Blood Calcium Levels
        
        lead to calcium rigour in muscles
        
        Thyroid gland secretes hormone #
        
        causing decrease action of osteoclasts, reducing the amount of calcium leaving bone and entering into the blood
  - - - gold standard measure
      - non-invasive, painless, quick (20 minutes)
      - very low x-ray energy for entire body scan
      - results compared with same age-racial group
      - T-score generated
        
        +1 to -1 is normal
        
        -1 to -2.5 (osteopenia, low bone mass, increased risk of fracture)
        
        -2.5 (osteoporosis, increased risk of fracture)
    - - sound waves, measure bone density in heel
      - non-invasive, painless, quick
      - screening tool, not diagnostic
    - - x-rays used to measure bone density in heel, wrist or finger
      - non-invasive, painless, quick
      - screening tool, not diagnostic
- - - - Enhanced Absorption
        
        In duodenum
        
        Depends on active vitamin D #
        
        estrogen enhances synthesis
        
        Stimulated by parathyroid hormone
        
        Lactose enhanced
        
        Absorption proportional to needs
        
        50% absorbed during pregnancy for growth
        
        50% absorbed in children for growth
      - Decreased Absorption
        
        High fibre diets
        
        Phytic acid
        
        High fat intake
        
        vitamin D deficiency #
        
        Polyphenols
        
        Hormone calcitonin
        
        reduces amount that leaves bone
        
        high supplement use of Magnesium, Phosphorus, Zinc or Iron # #
    - - Bone formation and maintenance
        
        formation hydroxyapatite crystals #
        
        provides strength and rigidity to bones
        
        form other mineral crystals
      - Nerve Transmission and Muscle Contraction
        
        Flows into muscle cell
        
        Causing contraction
        
        Flows out of muscle cell
        
        Causing relaxation occurs
      - Blood Clotting
        
        Formation of fibrin
      - Protection Against colon cancer
        
        Consumption >1250mg/day
      - Weightloss
        
        Stimulate hormone action
        
        Helps break down stored body fat
    - - Degenerative Bone Disease Osteoporosis
        
        Risk Factors
        
        Genetics/Race
        
        African Americans have more dense bones than Caucasian Americans
        
        Age/Gender/Hormones
        
        menopause for women 40 years and older
        
        girls that are unreasonably thin
        
        eating disorders
        
        extreme dieting and exercise during adolescents
        
        30 years of age men begin slow bone loss
        
        Physical Activity
        
        Lack of physical acivity
        
        confined to bed
        
        extreme dieting and exercise during adolescents
        
        Body Weight
        
        underweight women
        
        Smoking and Alcohol
        
        smokers tend to have lower body
        
        alcoholics tend to have slower bone formation
        
        alcohol is toxic to bone
        
        Prevention
        
        Estrogen Therapy
        
        used at menopause
        
        slows the rate of bone loss
        
        Vitamin D Therapy
        
        actives form of vitamin D
        
        increases Calcium absorption
        
        Calcitonin Therapy
        
        inhibits loss of minerals from bone
        
        Bisphosphonate Therapy
        
        inhibites osteoclast activity
        
        Reduction
        
        Young Women
        
        regular menstruation and ovulation
        
        moderately active lifestyle
        
        limited exposure to sun
        
        adequate calcium, Phosphorus, Magnesiu, Fluoride, and Vitamins D & K intake during growth # #
        
        Adult Women and Men
        
        moderately active lifestyle
        
        reduce smoking
        
        reduced amount of alcohol
        
        adequate intake of nutrients that support bone health
        
        Women and Menopause
        
        appropriate therapy and adequate amount of intakes
        
        remain physically active
        
        Most effected
        
        Postmenopausal women
        
        People with lactose intolerance
        
        elderly
        
        Very common in North America
    - - Hyperparathyroidism
        
        excessive production and secretion of parathyroid hormone
        
        causes kidneys to retain calcium in
        blood
        
        causes bone to release calcium into blood
        
        Hypercalcemia
        
        calcium deposits into soft tissue
        
        high blood and urinary Calcium levels
        
        damage to organs
        
        most effected
        
        those with kidney diease
    - - Supplements
        
        Types
        
        Various forms: tablets, chewable, liquid
        
        Common Supplements: carbonate, citrate, lactate, phosphate
        
        Avoid: refined oyster shell, dolomite, coral or bone meal supplement
        
        Doses
        
        UL: 2500 mg/day
        
        Greater than UL may lead to increased blood and urinary Calcium
        
        maximum 500 mg Calcium/doses a day
        
        Absorption
        
        ~30% for all supplements (citrate ~35%)
        
        Take Calcium Carbonate with food
        
        Calcium citrate can be taken without food
        
        Mineral-Mineral Interactions & Timing
        
        take at time of low Calcium or Iron intake
        
        decrease absorption of other minerals (iron, Magnesium)
        
        take before bed
        
        Recommended, but must be taken with consideration
      - Food Sources
        
        milk products
        
        milk
        
        skim
        
        2%
        
        cheese
        
        yogurt
        
        calcium fortified products
        
        soy beverage
        
        fortified orange juice
        
        tofu
        
        Leafy Vegtables
        
        Canned Fish
        
        Hard water
  - - - bone formation and maintenance
        
        component of Hydroxyapatite crystals #
        
        85% is used with calcium to form Hydroxyapatite crystals #
      - Fluid Balance
        
        Major intracellular anionic electrolytes
        
        helps to maintain proper electrical and fluid balance
      - Blood and Tissue Phosphorus
        
        15% of body is Phosphorus
        
        Phosphate (phosphorus salt) acts as a buffer
        
        Intercellular functions
        
        High energy phosphate bond (ATP)
        
        Phospholipids in cell membrane and lipoproteins - transports fat-soluble nutrients in body
        
        Enzyme Reactions (coenzymes needed for energy metabolism)
        
        B-Vitamins activate when phosphate group is added
        
        DNA & RNA
        
        Essential for Growth
    - - In duodenum
      - proportional to needs
        
        50% absorbed during pregnancy
        
        children absorb 50%
      - Enhanced by lactose and Vitamin D #
      - 80-90% of dietary Phosphorus is absorbed
    - - unlikely to happen with varied and well-balanced diet
        
        symptoms
        
        Neuromuscular malfunctioning
        
        Skeletal malfunctioning
        
        Hematological malfunctioning
        
        Renal malfunctioning
      - RDA for Adults - 700 mg/day
    - - There's no true toxic effect caused by high Phosphorus intake
        
        Adverse effects with combination of high Phosphorus intake and low Calcium intake #
      - UL - 4000 mg/day
    - - animal protein foods + milk and milk products
      - Phosphorus supplementation not needed - plenty in diet
      - Legumes, cereal, bran, nuts
  - - - Bone & Teeth
        
        Mg indirectly affects calcium balance as it is needed for the action of vitamin D and the production of parathyroid hormone #
        
        Mg used in mineral crystal structure of bone - can replace Ca in hydroxyapatite #
        
        Bone acts as a reservoir of Mg
        
        Mg helps hold Ca in teeth this reducing dental caries
      - Blood & Tissue Magnesium
        
        More than 300 enzymes systems need Magnesium
        
        Protein, fat, and nucleic acid (DNA) synthesis
        
        Nerve transmission an muscle contraction
        
        needed for neurotransmitter activity regulated via Mg-dependent adenylate cyclase enzyme system
        
        Inhibits muscle contraction - blocks calcium ion channels
        
        Blood clotting
        
        Mg inhibits blood clotting (ion antagonist to calcium) #
        
        Stabilizes Phosphate groups in ATP
      - Hypertension
        
        Protects against high blood pressure - acts as vasodilator
        
        Lower rates of heart disease in regions where people drink hard water
      - Support normal immune function
    - - Develops slowly - Mg is stored in bone
      - severe deficiency symptoms rarely seen in healthy individuals
      - Symptoms
        
        Irregular heart beat
        
        loss of appetite
        
        Weakness
        
        desorientation
        
        hypertension
      - risk for deficiency increases with:
        
        Heavy perspiration over a long period of time
        
        Prolonged vomiting and/or diarrhea
        
        Prolonged use of diuretics
        
        Kidney disease
        
        Alcoholism
      - DRI (supplemental) Adults - 350 mg/day
    - - Unknown adverse effects with supplemental intake
      - Pharmacological dosage may cause symptoms similar to Mg deficiency #
    - - Milk & Milk Products
      - Leafy greens, avocado, beets
      - Whole grains, nuts, seeds, tofu, legumes
  - - - Role in Bone and Teeth Mineralization #
        
        Fluoride best taken during bone & teeth development
        
        Fluoride + Hydroxyapatite = Fluorapatite - Stronger crystal in bones and teeth # #
        
        More resistant to acid erosion decay
      - Deficiency
        
        Increase in dertal caries
        
        A! - Males 4 mg/day; Femaile 3mg/day
      - Toxicity
        
        Flurosis
        
        White specks, molting, or brown streaks on teeth
        
        High Fluoride intake during teeth development
        
        Causes abnormal hardening of skeleton making bones more brittle
        
        Causes stiffness and joint pain
        
        Children are at greatest risk if they consume too much fluoride
        
        UL Adults - 10 mg/day
      - Food Sources
        
        Brewed tea, tap water
        
        Seafood, seaweed, shellfish, fish
      - Non-food Sources
        
        Toothpaste
        
        Chewing gum
        
        Mouth wash
- - - - Exogenous
        
        Vitamin-Action
        
        Vitamin D is pro-vitamin (inactive) must be activated in liver and kidney to form
      - Endogenous
        
        Hormone-Action
        
        Converted to pre-Vitamin D3
        
        Activated when exposed to sun
        
        Inactive form of Vitamin D3
    - - ~ 50%
      - incorporated into chylomicrons for transport-> lymph -> blood
    - - Regulates Bone Calcium and Bone Metabolism in 3 Sites #
        
        Intestine
        
        increase absorption of Calcium
        
        Kidneys
        
        Conserve Calcium
        
        Bones
        
        Osteoclast cause bone to release Calcium into blood
        
        at low blood calcium level, calcitriol increase calcium blood levels
      - Immune Function
        
        calcitriol associated with maturation of immune cells
        
        nervous system, muscle, skin, reproduction
      - Role in multiple sclerosis
    - - Children
        
        Rickets
        
        poor mineralization and shaping of bones, bowed legs, malformed ribs
        
        breast milk low in vitamin D
        
        little exposure to sun
      - Adults
        
        Osteomalacia
        
        osteoid is matrix which minerals are deposited to form bone
        
        osteoid doesn't mineralize properly
        
        Caused by
        
        kidney, liver, intestinal diseases
        
        low intake of Vitamin D and little exposure to sun
        
        repeated pregnancies
        
        Treatment
        
        increase Vitamin D intake and sun exposure
    - - Causes #
        
        excess solar exposure: non-toxic
        
        Food intake: safe, non-toxic at normal intake
      - Effects
        
        Hypercalcemia
        
        calcium deposits into soft tissues
        
        irreversible damage to organs
        
        Children at higher risk
    - - tablet, softgels, liquid
        
        available as D2 (ergocalciferol) or D3 (cholecalciferol)
      - Doses
        
        adults over 50
        
        400 IU (10 μg) of vitamin D daily
      - Absorption
        
        ~50-80% of ingested amount
        
        fish oil are high in vitamin D and A
      - greatest cause of Vitamin D toxicity
      - not advisable to take Vitamin D supplements
    - - Animal Products
        
        egg yolks, liver, fish, and fish oils
      - Fortified Food
        
        milk, margarine, orange juice, yogurt
      - stable to heat, storage, and processing
    - - RDA
        
        Adults (0-70 yr): 15 μg/day* (600 IU)
        
        71+yr: 20μg/day(800IU)
        
        RDA assumes no solar synthesis
      - UL
        
        all adults: 100 μg/d (4000 IU)
  - - - Family of compounds
        
        quinones - plant (phyllo) and animal (mena) sources
      - essential for blood clotting, coenzyme for synthesis of protein
      - 40-80% absorbed, with dietary lipids; incorporated into chylomicrons
      - endogenous sources
        
        bacterial synthesis in the GI tract
      - exogenous sources
        
        antibiotic use can increase dietary need
    - - Calcium Mineralization in Bone Matrix
        
        required by osteoblasts to synthesize osteocalcin
      - Blood Clotting
        
        necessary for proteins in the production of fibrin, blood clotting protein
        
        important for infants with sterile GI tract
        
        receive a dose of vitamin K at birth to prevent hemorrhaging
    - - Infants
        
        low level at birth; low level in breast milk
        
        low levels of gut bacteria to make vitamin K
      - Adults
        
        rare, due to antibiotic use
        
        excessive intake of vitamin E impairs the role of vitamin K in blood clotting
    - - rare, food sources are considered non-toxic
      - Symptoms
        
        RBC hemolysis, jaundice, brain damage
    - - AI
        
        adult males: 120 μg/d; Females: 90 μg/d
      - UL: none
    - - Green leafy vegetables
        
        kale, peas, broccoli, green beans
      - Animal products
        
        liver, eggs, milk
      - abundant in diet, bacterial synthesis in large intestine
      - very stable and resistance to cooking losses