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Bone Health - Coggle Diagram

- - - - Used for calcium mineralization in bone matrix: needed by osteoblasts to synthesize Osteocalcin, necessary binding protein for normal bone formation.
        Needed for coagulation:
        
        needing for production of fibrin clotting protein
        
        especially in infants as they produce inadequate bacterial Vitamin K
    - - Infants are the most at risk however in rare cases Adults are also subject to Vitamin K deficiency
        
        for infants this is due to low vitamin K at birth
        
        or low presence of Vitamin K in milk
        
        and low presence of vitamin K producing bacteria
        
        Adults is most often due to antibiotic consumption
        
        A preexisting fat malabsorption disorder
        
        Or and excess intake of Vitamin E
      - -toxicity is rare as most food sources are considered non toxic
        
        An excess of vitamin K will counteract anti-coagulant drugs
        
        Brain damage, Jaundice, and RBC hemolysis are symptoms of Vitamin K toxicity.
    - - Non Food
        
        Bacterial synthesis in the GI tract
      - Food
        
        Green leafy vegetables, peas, broccoli, green beans
        
        liver, egg, milk
    - - Vitamin k in exogenous sources is resistant to loss when cooking.
  - - - Primary
        • regulates blood calcium and bone metabolism
      - Non Bone Important Roles
        • Regulation of Blood and Calcium Mineralization
        --> calcitriol acts as 3 sites: intestine, bone, kidneys to increase absorption/ retention of calcium
        Immune Function:
        • calcitriol is associated with maturation of immune cells
    - - • Skin colour • Age • SPF • Pollution • Latitude • Exposure time to sun
    - - Children - Rickets Disease
        • inadequate of vitamin D: poor mineralization + shaping of bones, bowed legs, malformed ribs
        • children at risk: when Vitamin D is low and there is little exposure to sun
        --> prevalence increasing in Canada
      - Adults - Osteomalacia disease
        • osteoid: protein matrix secrete by osteoblast into which minerals are deposited to form bone
        • osteoid does not mineralize properly and accumulates, making bones soft
      - Cause
        i) kidney, liver, intestinal diseases: decreases absorption of Vitamin D
        --> inefficient conversion to active form in liver & kidney
        ii) low intake of Vitamin D due to little exposure of sun
        iii) closely spaced, repeated pregnancies
      - Treatment
        • increase dietary intake and synthesis through careful exposure of skin to the sun
    - - Primarily animal foods: egg, yolk, liver, fish and fish oil
        
        Fortified foods: fortified milk, margarine, organs juice, yoghurt and supplements (eg: fish oil)
        
        Vitamin D supplements needed in Vancouver as not enough sun exposure from October to April.
    - - Cause
        • a more narrow safety range than other fat- soluble vitamins BUT the most toxic vitamin when consumed in most amounts above DRI
      - Non toxic:
        • solar exposure; body down regulates production of Vitamins D when circulating levels are adequte
        • food intake; safe at normal intake levels
        Toxic:
        • supplement use; most likely reason (eg, 250 ug/ day, 1000 IU/ day)
      - Effects:
        • Hypercalcemia - high blood calcium levels
        • can cause irreversible damage to organs
        Most Affected:
        • children / infants whose parents necessarily supplement then with Vitamin D
    - - • 50%.
        • in chylomicrons for transport into lymph & subsequently entry into blood
    - - Hormone action
        •7-dehydrocholestrol in subcutaneous fat layer is converted to pre vitamin D3, then to a inactive form of Vitamin D3
      - Vitamin action
        • exogenous/ dietary source
        • is in pro- vitamin (inactive) form and must be activated in liver and kidney to form calcitrol
    - - Active form of Vitamin D
        • 2 step hydroxylation process of inactive vitamin D3 in the liver and kidney is required for full activation to form calcitriol
      - • acts as 3 sites: intestine, bone, kidneys to increase absorption/ retention of calcium
      - • at low calcium levels, calcitriol causes calcuium levels to increase
      - • associated with maturation of immune cells
  - - - Primary: bone formation & maintenance - Ca & P in hydroxyapatite
        Other: nerve transmission/muscle contraction, blood clotting, hypertension
    - - Enhances absorption:
        
        Lactose
        
        Being younger
        
        Estrogen (enhances synthesis of vitamin D)
        
        Increased need will increase % absorbed
        
        Decreases absorption:
        
        Food constituents (ie. high fibre diets)
        
        High fat intake
        
        Vitamin D deficiency
        
        Polyphenols
        
        Menopause
        
        Old age
    - - Osteoporosis - a "silent" degenerative bone disease characterized by decreased bone density, increased bone fragility & risk of fracture
        
        Who is at greatest risk?
        
        Under-weight women
        
        1 in 4 women & 1 in 8 men in Canada over 50 will develop osteoporosis
        
        Reduce risk for bone fracture
        
        Adequate intake of nutrients that support bone health
        
        Maintain a moderately active & healthy lifestyle
        
        Don't smoke & limit alcohol intake
        
        Can it be prevented?
        
        Bone loss is natural when aging
        
        Therapies exist to help reduce the rate of loss: estrogen, vitamin D, calcitonin, bisphosphonate
        
        Can be expensive & have side effects
        
        Risk Factors
        
        Age: more likely in people over the age of 50
        
        Gender/Hormones: women experience rapid decline in estrogen at menopause; men experience a gradual decline of testosterone
        
        Genetics/Race
        
        Physical Activity: weight exercises increase bone strength
        
        Body Weight: under-weight women are at higher risk
        
        Smoking & Alcohol: both toxic to bone
        
        Ca Nutrition & Associated Nutrients: low levels of Ca, F, vitamin D, and excess Na, caffeine, protein decrease bone strength
    - - Supplements, dairy products & alternatives, bones in canned fish, fortified products, tofu
    - - Cause: hyperparathyroidism - too much parathyroid hormone causes kidneys to conserve Ca in blood & bone to release Ca into blood
        Effects:
        
        High blood Ca levels
        
        Ca deposits into soft tissue
        
        Can cause irreversible damage to organs
  - - - Bone health - provides strength & rigidity to bone as part of hydroxyapatite
        
        Fluid balance - major intracellular anionic electrolyte
        
        Blood & tissue phosphorus - phosphate is a buffer in blood, phosphorus & phosphate are required in phospholipids, lipoproteins, DNA, RNA, ATP, & for activating B-vitamin coenzymes
    - - Enhances absorption:
        
        vitamin D
        
        plant sources found as phytic acid
    - - Unlikely with varied and well-balanced diet
    - - Dairy products & alternatives, fatty fish, bones in canned fish, tofu
  - - - Bone & teeth - affects Ca balance indirectly, important in vitamin D action & parathyroid hormon synthesis, can replace Ca in hydroxyapatite
        
        Blood & tissue - many enzyme systems need Mg (Mg stabilizes phosphate groups in ATP), inhibits blood clotting
        
        Hypertension - protects against high blood pressure
    - - Deficiency:
        
        Develops slowly, rarely seen in healthy individuals
        
        Not enough intake leads to heavy perspiration over time, prolonged vomiting & diarrhea, renal disease, alcoholism
        
        Symptoms: irregular heartbeat, weakness, disorientation, irritability, hypertension, tetany @ very low levels of Mg
        
        Toxicity: no known toxicity
    - - Enhances absorption:
        
        Lactose
        
        Being younger
        
        Milk, halibut, green leafy vegetables, whole grains
  - - - Together with Mg and Ca, forms fluorapatite crystals in bones and teeth
        
        Treatment for dental caries as fluoride is antimicrobial and fills in surface micro-lesions
    - - Deficiency
        
        Low levels of fluoride can result in dental caries, leading to chewing problems
      - Toxicity
        
        Fluorosis; white specks, mottling, and brown streaks on teeth
        
        Causes abnormal hardening of bones, making them more brittle
        
        Can lead to osteoporosis, stiffness, and joint pain
    - - Found in all soils, water supplies, plant foods, animal foods