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Bones, Vitamin K, What are bones - Coggle Diagram

- - - - hormones regulate blood calcium concentrations, regardless of dietary intake
        
        blood calcium concentration will remain relatively constant
        
        can’t use blood calcium to indicate bone mineral status
      - leads to:
        
        decreased absorption
        
        food constiuents
        high fiber diet(50+ g/day)
        
        phytic acid in whole grains and legumes
        
        oxalic acid in vegetables
        
        high fat intake (lead to steatorrhea)
        
        vit D deficiency
        
        polyphenols
        
        Supplemental use
        
        high magnesium, phosphorus, zinc or iron
        
        intakes with low calcium intake
        
        % absorbed inversely proportional to intake
        
        Greatest risk
        decreased bone density, increased bone fragility in old age (osteoporosis)
        
        osteoporosis
        
        bone diseases with increased bone fragility and increase risk of fractures
        
        Risk factors
        
        3 more items...
        
        Reducing the risk
        
        Young women
        
        regular menstruation and ovulation, moderate active lifestyle, limited exposure to sun
        adequate Ca intake during growth + P, Mg, F, vit D, K)
        
        Adult women/men
        
        (adequate intake of nutrients that support bone health, moderate active lifestyle, no smoking, moderate-none alcohol intake)
        
        Women and menopause
        
        (adequate intake of nutrients that support bone health, appropriate therapy(choice), remain physically active, some sun exposure, healthy lifestyle choices
      - groups greatest risk of Ca deficiency
        
        women
        
        lower estrogen
        
        elders
        
        decrease in stomach acidity
        
        decrease efficiency of absorption
        
        osteoblasts become less active and osteoclasts continue to function
        therefore over time our bones naturally lose density and strength
      - how common is Ca Deficiency in NA?
        
        1 in 4 Canadian women
        1 in every 8 men over the age of 50 years old develop osteoporosis
    - - -vit D deficiency→ dec Ca absorption
        - dietary Ca deficiency→ dec overall amount of Ca absorbed
      - fluoride taken during youth→ inc bone crystal strength
      - Ca + vit D supplements if not consuming milk/milk products
      - excess sodium, caffeine or protein intake can pull Ca into the urine and loss from body (concern for low intake of Ca)
    - - Hyperparathyroidism: over abundant production and secretion of parathyroid hormone
        
        cause kidneys to retain calcium in blood and bone to release calcium into blood
      - Hypercalcemia: high blood and urinary Ca levels, calcium deposits into soft tissue (e.g. Heart, kidneys, arteries), can cause irreversible damage to organs
        
        Greatest impact to people with kidney disease
      - strategies to reduce risk for bone fracture
        
        Building peak bone mass early in life (i.e through teen and early adult years) can reduce risk of debilitating effects from osteoporosis later in life
        Dec bone density→ inc bone fragility→ inc risk of bone fractures 9
        
        Estrogen therapy
        
        used at menopause to compensate for dec level of estrogen, slows rate of bone loss
        
        Vit D therapy
        
        active form of vit D(calcitriol)→ inc Ca absorption at intestines and inc retention of kidneys
        
        Calcitriol therapy
        
        hormone released by pituitary gland inhibits loss of minerals from bone by dec the action of osteoclasts
        
        Bisphosphonate therapy
        
        medication targeted at inhibiting osteoclast activity
    - - Nerve Transmission and Muscle Contraction
        
        Sodium-Potassium ATPase pump in nerve cell membrane allows flow of ions across the membrane to generate action potential
        
        ions flowing into nerve cells permit the release of neurotransmitters which allow nerve cells to communicate with each other
        
        action potential travels along nerve fibre and stimulates muscle cell
        
        calcium flows into muscle cell causing contraction
        
        when calcium exits muscle cell, relaxation occurs
        
        when cellular Calcium falls below normal levels in muscle cells, Tatany can occur
        
        when cellular Calcium rises above normal level, "rigour" can occur and the muscles can't relax after contracting
      - Blood Clotting
        
        calcium is essential in blood clotting process leading to the formation of fibrin and a clot
      - Hypertension
        
        inverse relationship exists between dietary Calcium and hypertension
        
        see a preventative effect at ~1000mg Calcium/day
        
        (DASH) Dietary Approach to Stop Hypertension diet: low fat, high fibre, ~ 3g sodium/day
  - - - Provides strength and rigidity to bone as element in hydroxyapatite crystals
    - - fluid balance
        
        it's a major intracellular anion electrolyte to ensure electrical and fluid balance in body
      - Blood & Tissues Phosphorous
        
        PO4 acts as a buffer in the blood
        
        P/PO4 is used in phospholipids, lipoproteins, DNA, RNA, ATP and help activate B-vitamin coenzymes
    - - 85% of all body Phosphorus is found with Calcium in hydroxyapatite crystals
      - Phosphorus in phosphate salt form, PO43- teams with Calcium
      - kidney excretion regulates Phosphorus blood levels
    - - efficient absorption at 60-90% depending on body needs
      - Vit D enhances Phosphorus absorption
    - - may result in neuromuscular, skeletal, hematological and renal malfunctions
      - supplements are needed as there are plentiful in the diet
    - - no true toxic effects of taking too much
        
        more likely to deal with low Ca intakes combined w/ high P intakes
    - - animal based proteins (fish, meat, poultry)
        
        milk & milk products
        
        legumes, cereals, nuts
        soft drinks
      - Recommendations
        
        RDA: Adults: 700 mg/day
        
        men, ~1500 mg/day
        
        women, ~1200 mg/day
        
        UL: 4000 mg/day
  - - - A micronutrient mainly present as part of chlorophyll molecules, some other sources
    - - Used in mineral structure of bone
      - Essential in vitamin D, indirectly related to calcium uptake
      - Acts as vasodilator
      - Essential in blood and tissue for enzyme roles, stabilizing ATP, muscle contraction, and blood clotting
    - - Because of bone storage, deficiency is slow process with severe symptoms rare
      - Symptoms: irregular heartbeat, weakness and disorientation, hypertension, and tetany
      - Increased losses can result from heavy perspirations, prolonged vomiting and diarrhea, renal disease, alcoholism
    - - No known toxicity for high Mg intake
    - - Recommendations
        
        DRI(mg/day)-Young females 310, Older females 320, Young males 400, Older males 420
      - Animal based
        
        Milk, Yogurt, Halibut
      - Plant based
        
        Leafy green vegetables, whole grains, legumes, beans, tofu, nuts, seeds
  - - - Functions
        
        Mainly used for teeth and bone mineralization, as fluoride replaces a hydroxyl group for stronger crystals
        
        Very important before teeth exit gums, important in teeth maintenance
      - Deficiency
        
        Increased risk of dental caries
        
        Dental problems lead to problems chewing food, leading to other dietary issues
      - Toxicity
        
        Fluorosis in teeth-white specs/brown streaks permanently appear on teeth, with increased decay resistance
        
        Fluorosis in bones-abnormal hardening of skeleton, joint stiffness and pain, bones become brittle and can lead to osteoporosis
        
        No link to increased cancer
      - Recommendations
        
        DRI(mg/day)-Females 3, Males 4
      - Food sources
        
        Animal Based
        
        Seafood, Shellfish, fish, sardines, seaweed
        
        Plant Based
        
        Brewed Tea
        
        Other
        
        Fluoride can be added in water, mouthwash, toothpaste, gum
- - - - Roles
        
        Primary
        
        Regulates Blood Calcium and Bone Mineralization
        
        acts on intestine, bone, kidneys to increase absorption/retention of calcium in body
        
        other
        
        Immune Function
        
        needed for the nervous system, muscles, skin, reproduction
      - Importance to bone health
        
        Hormone-action (endogenous or internal source)
        
        acts as a hormone when skin is exposed to sun
        
        factors affecting endogenous synthesis
        
        skin colour, age, SPF ≥ 8, pollution, latitude, exposure time
        
        not adequate to carry through winter months- uses of dietary/supplemental Vitamin D needed
        
        5-10 minutes, hand and face, 2-3x week during summer months
        
        Vitamin-action (exogenous or dietary source)
        
        Dietary Vitamin D in pro-active form
        
        hydrolyzed in liver and then kidneys to become active
        
        transported to cells for use
        
        active form of Vitamin D= CALCITRIOL
        
        Raises blood calcium levels
        
        3 more items...
      - Deficiency
        
        Children
        
        RICKETS disease
        
        inadequate intake of vitamin D
        
        improper mineralization and shaping of bones during formation
        
        "bowed legs"
        
        Adults
        
        OSTEOMALACIA disease
        
        "soft bone" disease
        
        osteoid does not mineralize properly and accumulates
        
        makes bone soft and not rigid
        
        see progressive weakness with increasing pain in lower back and legs
      - Food Sources
        
        animal foods: liver, fatty fish, egg yolks
        
        plant foods: fortifies plant-based milks + other fortified products
      - Toxicity
        
        most toxic nutrient when consumed in least amounts above DRI-RDA
        
        solar exposure of skin
        
        non-toxic, body down regulates endogenous synthesis of Vitamin D
        
        Food intake
        
        safe, not toxic at normal intake levels
        
        causes
        
        supplement use
        
        intakes +250 μg/day over several months
        
        effects
        
        HYPERCALCEMIA
        
        high blood calcium levels, calcium deposits into soft tissue e.g. kidneys, heart, arteries
        
        irreversible damage to organs
        
        Most affected
        
        infants given inappropriate amount of supplements by guardian
- - - - inadequate endogenous synthesis of Vitamin K by bacteria
        
        infants receive oral or IM dose of Vitamin K shortly after birth to prevent hemorrhaging
- - - - no vitamin K synthesis at birth -> sterile gut
      - low levels of Vitamin K in breast milk
      - 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 intake of vitamin E impairs the role of vitamin K in blood clotting
- - - - incorporated into chylomicrons
- - - - Ultrasound
        -sound waves to measure bone density in heel
      - pDEXA- peripheral dual energy x-ray absorptiometry
        -X-ray used to measure bone density in heel, wrist, or finger
    - - DEXA (Dual Energy X-ray absorptiometry
        -Bone density measured at different sites or complete body scan
        -results compared to healthy 30 yrs old individual of same gender and race
        -generate a T-score from comparison
        
        -scans measure tiny reduction in bone density makes it possible to diagnose osteoporosis in early stages
        -uses very low x-ray energy for entire body scan
        -noninvasive, painless and quick