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Bone health (Calcium (Food sources (Milk and dairy products, Canned fish…

- - - - Active vitamin D
      - Age (higher when younger)
      - Lactose
      - Higher estrogen levels
      - Increased demand for absorption (i.e. periods of growth, pregnancy)
    - - High fibre diets
      - Foods rich in phytic acid and oxalic acid
      - High fat intake
      - Vitamin D deficiency
      - Lower estrogen levels
      - Age (lower when older)
      - Supplement use
        
        Unrefined supplements such as oyster, shell, dolomite, coral, or bone meal (may be high in heavy metals)
        
        High doses (higher the dose, the less is absorbed: no more than 500mg/dose for maximal absorption)
        
        Consuming calcium carbonate (low solubility) w/ food
        
        Quantity and bioavailability to determine effectiveness
        
        Calcium and/or Iron intake is low, before bed
        
        Calcium decreases absorption of other minerals (e.g., Iron, Magnesium)
        
        Insufficient calcium intake in diet
        
        Calcium citrate (greater solubility) can be taken w/out food
  - - - Associated risk factors
        
        Age
        
        Strongest and most dense bones in early adulthood, over time our bones naturally lose density and strength
        
        Gender
        
        Men have greater bone density at maturity than women, therefore a lower incidence of osteoporosis
        
        Hormones
        
        Decreased estrogen levels (required to activate vitamin D) triggers an accelerated rate of bone loss
        
        Decline in testosterone
        results in increased rate of bone loss
        
        Genetics/Race
        
        Heredity (e.g African Americans have slower rate of bone loss than Caucasians)
        
        Physical activity
        
        Resistance training
        
        Stimulates hormones secretion which help bone density
        
        Body weight
        
        Underweight women
        
        Smoking and alcohol
        
        Nutrition and associated nutrients
        
        Low intake of calcium during childhood
        
        Low fluoride intake
        
        decrease bone crystal strength
        
        Excess Sodium, Caffeine, and Protein intake can cause urinary loss of Calcium from body
        
        vitamin D
        
        less circulation cause drop in Calcium absorption
      - Quite common for individuals over 50 years of age
        
        1 in 4 women and 1 in 8 men diagnosed
      - Decreased bone density and increased bone fragility
        
        Increased risk of fractures
        
        Prevention Measures
        
        Physical Activity
        
        Therapy
        
        Adequate nutrient intakes that support bone health (i.e Calcium, Phosphorus, Magnesium, Fluoride, and vitamins D & K)
        
        Young women
        
        Regular menstrual cycles and ovulation
        
        quite smoking and moderate alcohol consumption
  - - - high blood and urinary Calcium levels
      - too much calcium gets deposited into soft tissue (e.g., kidneys, heart, arteries) and can cause irreversible damage to organs
      - People with kidney disease
      - Irreversible damage to organ
- - - - indirectly affects
        
        calcium balance
        
        need its
        
        production of parathyroid hormone
        
        for the action of vitamin D
    - - protein, fat and nucleic acid (DNA) synthesis
      - Phosphate groups in ATP
      - blood clotting
      - neurotransmitter activity
        
        Mg-dependent adenylate cyclase
        enzyme system
      - Hypertension
        
        as it protects against high blood pressure
        
        vasodilator
        
        lower rates of heart disease
      - muscle contraction
  - - - irregular heart beat
      - hypertension
    - - heavy preparation over time
      - prolonged vomiting, diarrhea, used of diuretics
      - renal disease
      - alcoholism
- - - - stored mostly in liver, some in adipose tissue
  - - - large intestiine
    - - food sources
        
        green leafy vegetables: broccoli, spinach, kale, Swiss
        chard, Brussels sprouts, asparagus, collards
        
        cauliflower, avocado, cabbage
        
        liver, eggs, milk (cow, not soy)
      - resistant to losses during cooking
  - - - needed for osteoblasts to produce
        OSTEOCALCIN, a calcium-binding hormone
        made in osteoblasts that promotes calcium
        mineralization
    - - especially important for infants who are
        born with a sterile gut-no bacterial synthesis
      - it takes a few weeks to establish bacterial
        synthesis of vitamin K
      - infants receive a dose (oral or IM) of vitamin
        K shortly after birth to prevent hemorrhaging
      - fibrin clot consists of 13 proteins, 4 of which
        require vitamin K for synthesis
  - - - no vitamin K synthesis at birth-sterile gut
      - Low levels in breast milk
      - at risk
      - low levels of gut bacteria after a few weeks
    - - rare
      - usually due to antibiotic use
      - people with fat malabsorption conditions (e.g., Crohn’s, cystic fibrosis, AIDS)
      - excessive intakes of vitamin E can impair blood clotting ability
  - - - non-toxic
- - - - 3-4 years of age
        
        permanent teeth forming
      - 8-10 years of age
        
        wisdom teeth forming
      - 20th week of pregnancy
        
        baby teeth forming
  - - - risk
        of dental caries
    - - inabilities
        
        to consume varietries of foods
        
        to chew properly
  - - - teeth
        
        teeth more resistant to decay,
        
        permanently discoloured
        
        white specks, mottling and brown stretch
        
        high fluoride intake during teeth development
      - skeleton
        
        abnormal hardening of the skeleton
        
        osteoporosis
      - stiffness and pain in joints, making bones more brittle
  - - - a hydroxyl group
        
        hydroxyapatite crystal
        
        a stronger crystal
- - - - ivory-like, very dense, strong,
        slow turnover
      - 80%
      - outer surface of all bones
        small bones
    - - lace-like, not as dense
        as cortical, very dynamic and sensitive
        to hormones that regulate blood
        Calcium levels
      - 20%
        
        skeleton
      - ends of long bones (arms, legs)
        spinal vertebrae
        inside flat bones (ribs, skull…)
        pelvis bones
  - - - bone marrow
    - - getnetics
      - environment
      - hormones
      - nutrient intake
  - - - bone
    - - skeleton
  - - - osteoblast cells (build)
      - osteoclast cells (crumble)
    - - growth
        
        size and length
        
        osteoblast cells (bone building
        cells) are more active than osteoclast cells (bone crumbling
        cells) = net gain in bone
        
        adults
        
        osteoblast cells lose activity while
        osteoclast cells remain active
        
        bone is built when under physical stress (exercise)
        
        osteoclast cell resorption requires vitamin A
        
        ~700mg Calcium enter and leave bone each day
        
        osteoclast cells
        
        net gain in bone
        
        during first year of life: 100% of bone is rebuilt
      - modelling
        
        shape such as ribs and femur
      - remodelling
        
        bone density, involves resorption
        & formation
        
        bone density measures
        
        DEXA – Dual Energy X-ray Absorptiometry
        
        the gold standard measure.
        
        “T-score”
        
        4 more items...
        
        non-invasive, painless, relatively quick
        
        1 more item...
        
        very low x-ray energy scan
        
        2 more items...
        
        Ultrasound
        
        a non-invasive, painless procedure that uses sound waves which is for screening only with no diagnostic use. It often uses the heel
        
        pDEXA – Peripheral Dual Energy X-ray Absorptiometry
        
        x-rays measure bone density in heel, wrist, finger. It is a non-invasive, painless process with screening only and no diagnostic use
        
        both used at health fairs and if low density observed use full-body DEXA scan
        
        the surface of the trabecular bone becomes a new bone by osteoblast
        
        osteoclast cells
        
        new bone
        
        osteoblast cells
  - - - thyroid gland
        
        Calcitonin
        
        osteoclast cell
        
        Ca
        
        bone
        
        blood
      - parathyroid hormone level
        
        increase
        
        urinary Ca
      - calcitriol level
        
        Ca absorption decrease
    - - parathyroid gland
        
        parathyroid hormone
        
        formation of calcitriol
        
        kidney
        
        osteoclast cells
        
        Ca
        
        1 more item...
- - - - born with 9 months vitamin D storage
        
        If they are breastfeed, they are at risk of low dietary intake since breast milk is low in vitamin D
        
        rickets
        
        improper mineralization and shaping of bones
        
        bowed legs, malformed ribs, knoc-knees
        
        low exposure to sunlight
    - - osteomalacia (soft bones)
        
        other causes
        
        kidney, liver, intestinal diseases
        
        closely spaced, repeated pregnancies
        
        treatments
        
        increased dietary intake and more controlled exposure to sun
        
        asteroid doesn't mineralized and accumulates, making bone soft and flexible
        
        progressive weakness with increasing pain in lower back and legs
  - - - vitamin action
        
        dietary vitamin D
        
        proactive form
        
        hydroxylation
        
        liver and then kidney
        
        active
        
        3 more items...
        
        chylomicrons remanenets
      - supplement
        
        250 μg/day over several months
        
        types
        
        tablets, softgels, liquid
        
        available as vitamin D2 (ergocalciferol: plant-based) or vitamin
        D3 (cholecalciferol: animal-based)
        
        doses
        
        over age 50-->400IU (10μg) of vitamin
        D daily
        
        fish oil supplements are high in vitamins D and A – use caution
        
        absorption
        
        D3 is most effective in body
        
        ~50-80% of ingested amount
      - 2 type of the food sources
        
        plant source
        
        fortified plant-based milks
        (e.g., soy, rice)
        
        other fortified products (e.g., energy bars, OJ
        
        animal source
        
        liver
        
        fatty fish, fish oils
        
        egg yolks
        
        canned fish with bones such as salmon and sardines
  - - - lymph
        
        blood
- - - - solar synthesis through skin
        
        Hormone synthesis and action
        
        factors
        
        latitude
        
        May to September synthesis in Vancouver
        
        time of the day
        
        10 am-3pm
        
        6 months/year
        
        5-10 min 2-3X/week
        
        age
        
        skin color
        
        pollution
        
        SPF ≥ 8 blocks synthesis
        
        estrogen level
        
        down-regulates synthesis when circulating levels are adequate
        
        prolonged exposure degrades 7-dehydrocholestrol
  - - - calcium deposits in soft tissues such as kidneys, heart, arteries which cause irreversible damage