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Bone Health (Introduction (Importance (provides structural support,…

- - - - provides strength, rigidity
    - - protein matrix (collagen)
      - nerves
      - cartilage
      - connective tissues
      - provides flexibility
    - - genetics
      - hormones
      - nutrient intake
      - environment
  - - - ivory-like, very dense
      - mostly small bones and outer surface of long bones
      - slow turnover
      - ~80% of skeleton
    - - ~20% of skeleton
      - lace-like, extremely dynamic
      - ends of long bones
      - spinal, vertebrae, pelvis, ribs
    - - calcium
      - phosphorus
  - - - gold standard measure
      - non-invasive, painless, quick
      - ability to measure bone density at different sites through x-ray
      - generates "T-Score" as a bone density indicator
    - - sound waves
      - primarily used to measure bone density in heel
      - non-invasive, painless, quick
      - frequently used in health fairs
      - non diagnostic, only a screening tool
    - - measures density in heel, finger, wrist
      - frequently used in health fairs
      - non diagnostic, only a screening tool
  - - - acts on three sites
        
        kidneys
        
        intestines
        
        bones
    - - stimulates final step of activating vitamin D during low blood calcium levels
        
        activation occurs in kidneys
      - acts on osteoclast cells to raise blood calcium
    - - helps during high blood calcium levels
      - minimizes action of osteoclasts
      - reduces amount of calcium leaving the bone and entering the blood
- - - - Bone and Teeth Mineralization
        
        creates
        
        stronger crystals in bone & teeth
        
        F- replaces hydroxyl group in hydroxyapatite crystals found in bone & teeth and creates Fluorapatite
        
        more resistant to decay from acid erosion
        
        most effective before teeth erupt from gums
        
        in adults
        
        help protect against dental caries
        
        fluoride is antimicrobial
        
        helps fill in surface micro-lesion
    - - in water supply leads to
        
        increased risk of dental caries
        
        person's inability to chew properly
        
        person's inability to consume a wide variety of foods
    - - high intake during teeth development leads to
        
        fluorosis
        
        white specks, mottling, or brown streaks on teeth
        
        at risk: children with large consumption amounts of toothpaste or fluoride drops
        
        in skeleton causes
        
        abnormal hardening
        
        bones to be more brittle
        
        higher risk of osteoporosis
        
        stiffness and pain in joints
    - - include
        
        brewed tea, water (not bottled), seafood, seaweed, shellfish, fish
        
        non food items
        
        chewing gum, mouth wash, toothpaste
  - - - pharmacologic doses
        
        may result in diarrhea and abdominal cramps
      - no known extreme effects of supplemental magnesium intakes
    - - heavy perspiration over long time
      - prolonged vomiting or diarrhea
      - prolonged use of diuretics
        
        irregular heart beat, loss of appetite, weakness, disorientation, hypertension, tetany
      - kidney disease
      - alcoholism
    - - bones and teeth
        
        Helps prevent dental caries by holding Calcium in the enamel
        
        Calcium balance
        
        needed for the mineral crystal structure in bone
        
        Can replace Calcium in hydroxyapatite
      - Blood and tissue magnesium
        
        Stabilizes high energy phosphate bonds
        
        required as cofactor for enzyme systems
        
        needed for neurotransmitter activity
        
        inhibits blood clotting
        
        inhibits muscle contraction
      - acts as vasodilator
        
        protects against hypertension and heart disease
    - - Plant foods: whole grains, nuts, seeds, tofu, legumes, peanuts, leafy greens
        
        Holds central location in chlorophyll molecule
      - milk and milk products.
      - Hard water
  - - - bone formation and maintenance
        
        provides strength and rigidity to bones
    - - Osteoporosis
        
        bone fragility, increased risk of fractures
        
        factors affecting risk
        
        peak bone mass: intake of Calcium, magnesium, zinc, and fluoride
        
        age/gender/hormones
        
        African Americans have denser bones than Caucasian Americans
        
        Physical Activity
        
        weight-bearing exercise increases muscle and bone strength
        
        muscle pull on bone increases strength of trabecular bone
        
        Body Weight
        
        underweight women have increased risk
        
        women with anorexia
        
        Smoking/Alcohol
        
        have lower body weights, slower bone formation, and lower bone density
        
        degenerating bone disease
    - - Hyperparathyroidism
        
        over abundant production & secretion of parathyroid hormone
        
        causes kidney to retain calcium in blood & bone to release calcium into blood
      - effects
        
        hypercalcemia
        
        high blood and urinary calcium levels
        
        calcium deposits into soft tissue
        
        irreversible damage to organs
    - - milk products
        
        except for cottage cheese
        
        except for fortified soy or other plant-based beverages
        
        most nutrient dense in skim milk (33mg/cup)
        
        yogurt, cheese, calcium-fortified orange juice, tofu made with calcium sulphate
      - some green leafy vegetables
        
        cauliflower, bok choy, watercress
    - - average 25-30% absorption
      - Enhanced Absorption
        
        when calcium is transiently acidic in duodenum
        
        depends on
        
        active Vitamin D present in intestinal cells
        
        estrogen enhances synthesis of active vitamin D
        
        age
        
        younger ages absorb better than elders
        
        presence of lactose
      - Decreased Absorption
        
        food constituents
        
        high fibre diets ~ 50+g/day
        
        vitamin D deficiency
        
        phytic acid: in whole grains, legumes, oxalic acid in vegetables (e.g. spinach, rhubarb)
        
        high fat intake
        
        leads to steatorrhea
        
        polyphenols (tea, coffee)
        
        Supplement Use
        
        high magnesium, phosphorus, zinc, or iron intakes
        
        calcium supplements > 500 mg/dose decrease absorption
        
        also seen in old age
        
        menopause due to low estrogen
        
        decreased stomach acidity
        
        decreased efficiency of absorption
      - inversely proportional to intake
  - - - bone formation and maintenance
        
        forms hydroxypatite crystals
        
        Provides strength and rigidity to bones
      - anionic electrolyte
        
        helps maintain electrical and fluid balance
      - Phosphate acts as buffer in blood
      - Part of DNA, RNA, enzyme reactions, phospholipids in cell membranes, and ATP
    - - Unlikely, may cause neuromuscular, skeletal, hematological, and renal malfunctioning
    - - No toxic effect
    - - animal proteins
        
        meat, fish, poultry, milk and milk products
      - plant foods
        
        legumes, cereal, bran, nuts
- - - - primary roles
        
        regulates blood calcium and bone metabolism
        
        at low blood calcium levels, calcitriol increases calcium blood levels
        
        acts on three sites
        
        intestines
        
        increase calcium absoprtion
        
        kidneys
        
        conserves calcium
        
        bones
        
        osteoclasts cells cause bone to release calcium into the blood
      - hormone action when skin exposed to sun
      - vitamin action
        
        pro-vitamin (inactive) form, activates in liver and kidneys to form active calcitrol
      - immune function
        
        associated with maturation of immune cells
    - - children
        
        rickets disease
        
        poor shaping of bones, improper mineralization bowed legs, malformed ribs
        
        low dietary intake
        
        low exposure to sun
        
        infant vitamin D stores depend on maternal parent
      - adults
        
        osteomalacia disease ("soft bones")
        
        causes
        
        kidney, liver, intestinal diseases
        
        closely spaced, repeated pregnancies
        
        little intake and exposure to sun
        
        treatments
        
        increase dietary intake
        
        increase exposure to sun
        
        osteoid doesn't mineralize properly
        
        progressive weakness, increasing pain in lower back and legs
    - - causes
        
        solar exposure
        
        supplemental use
        
        high intake
      - effects
        
        hypercalcemia
        
        high blood calcium
        
        children most effected
        
        infants who parents unnecessarily supply excess vitamin D
    - - supplements
        
        tablets
      - animal foods
        
        egg yolk, liver, fish, fish oil
      - fortified foods
        
        orange juice, margarine, yogurt
  - - - Calcium Mineralization
        
        Vitamin K needed by osteoblasts to synthesize osteocalcin
        
        required for normal bone formation
        
        deposits minerals into protein matrix
      - Blood Clotting
        
        necessary for proteins in the production of fibrin
    - - rare
      - food sources considered non-toxic
      - excessive intake hinders effect of anti coagulant drugs
      - symptoms
        
        RBC hemolysis
        
        juanidice
        
        brain damage
    - - infants
        
        low levels of gut bacteria to synthesize vitamin K
        
        low levels at birth
        
        low levels in breast milk
      - adults
        
        due to antibiotic use
        
        individuals with fat malabsorption disorder
        
        excessive vitamin E intake can impair the vitamin K role in blood clotting
    - - Animal Foods
        
        liver
        
        eggs
        
        milk (cow)
      - Plant Foods
        
        leafy green vegetables
        
        cauliflower, avocado, cabbage
      - resistant to losses in food preparation