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Bone Health Concept Map 31, Bone Types, Transcellular absorption dependent…

- - - - Absorption
        
        Enhanced Absorption
        
        Mostly absorbed in duodenum
        
        Lactose enhance Calcium absoption
        
        Younger people absorb Calcium better than the elderly
        
        Estrogen enhances synthesis of active vitamin D
        
        Decreased Absoption
        
        Food Constituents
        
        High fibre diets
        
        Phytic acid & Oxalic acid intake
        
        High fat intake
        
        Polyphenols intake
        
        Supplement use
        
        Old age
        
        Menopause
        
        Average Absoption
        
        ~25-30% of Calcium intake
      - Roles
        
        Bone-related roles
        
        Non-Bone related roles
        
        Nerve transmission/ muscle contraction
        
        Action potential open Ca ion channel, letting Ca flowing into muscle cells and causing contraction
        
        Tetany occurs when Ca levels in muscle cells fall below normal
        
        Rigour occurs when Ca levels rise above normal
        
        Blood clotting
        
        Ca and thromboplastin form blood platelets
        
        Hypertension
        
        DASH diet
        
        Inverse relationship appears to exist when intakes of Calcium are >1000mg/day
      - Deficiency
        
        Osteoporosis
        
        Decrease in bone density
        
        Increased bone fragility
        
        Increase risk of fracture
        
        Silent disease and multifactorial etiology
        
        Affecting Factors
        
        Age/Gender/Hormones
        
        Genetics/Race
        
        Physical Acticity
        
        Body weight
        
        Smoking & Alcohol
        
        Calcium Nutrition & Associated Nutrients
      - Body contains: ~1200g
        
        Bone and teeth: 99%
        
        Bloodstream & soft tissues: 1%
      - Prevention
        
        Estrogen therapy
        
        Used at menopause to compensate for decreased level of estrogen
        
        Slows the rate of bone loss
        
        If stop taking, rate of bone loss will increase initially, then taper off
        
        May increase risk of breast or endometrial cancer in some women
        
        Therapy = estrogen + ~1500 mg Calcium/d
        
        Vitamin D therapy
        
        Increased Ca absorption at intestine and increased retention by kidneys (Calcitriol)
        
        Calcitonin therapy
        
        Bisphosphonate therapy
      - Toxicity
        
        Causes
        
        Hyperparathyroidism
        
        Over-abundant production & secretion of parathyroid hormone
        
        Kidneys to retain Ca in blood
        
        Bone release Ca into blood
        
        Effects
        
        Hypercalcemia
        
        high blood and urinary Ca level
        
        Ca deposits into soft tissue
        
        Can cause irreversible damage to organs
        
        People affected (mostly)
        
        People with kidney disease
      - Reduce potential
        
        Young women
        
        Ensure adequate nutrient intakes
        
        regular menstrual cycles and ovulation
        
        moderately active lifestyle
        
        Adult women & Men
        
        Adequate intake of nutrients
        
        Moderately active lifestyle
        
        No smoking
        
        Moderate alcohol intake
        
        Menopausal Women
        
        Adequate intake of nutrients
        
        Appropriate therapy if needed
        
        Remain physically active
        
        Healthy lifestyle
      - Supplements
        
        Types
        
        Forms
        
        Tablets, chewable, liquid, effervescent
        
        Common supplemnets
        
        carbonate, citrate, lactate, phosphate
        
        Different amounts/bioavailability per type of supplement
        
        Avoid
        
        Unrefined oyster shell, dolomite, coral or bone meal supplements
        
        Absoption
        
        ~30% of all supplement
        
        Calcium carbonate should take with food
        
        Calcium citrate can be taken without food
        
        Timing
        
        Take when there is low Ca or Iron intake
        
        Take before bed
        
        Can take everyday for adequate Ca intake
        
        Determine effectiveness
        
        Consider both quantity and bioavailability
      - Food Sources
        
        Animal food
        
        Milk & dairy product
        
        Canned fish with bones (e.g. salmon, sardines)
        
        Soup stock made from fish or meat bones
        
        Plant Food
        
        Fortified plant-based milks (eg. soy, rice)
        
        Other fortified products (e.g. energy bars, OJ)
        
        Tofu (made with Ca salt)
      - High Ca intake will prevent phosphorus uptake from the gut; High phosphorus intake will decrease Ca absorption due to the formation of crystal
      - Mg plays an important role in bone and mineral homeostasis, aiding the metabolic processes of Ca and phosphorus in biochemical reactions.
    - - 1% of total body weight
        
        85% found with Calcium in Hydroxyapatite Crystals in Bone and Teeth
      - Absorption
        
        Efficient at 60-90% depending on body needs
        
        Wide availability, less of a concern
        
        Enhanced absorption with Vitamin D
      - Roles
        
        Non-Bone Related Roles
        
        Fluid Balance
        
        Major intracellular electrolyte
        
        Blood and Tissue Phosphorus
        
        15% of body Phosphorus
        
        Phosphate (salt) acts as buffer
        
        Inside Cells
        
        ATP
        
        Cell membranes and Lipoproteins
        
        Enzymatic reactions
        
        DNA and RNA
      - Deficiency
        
        Unlikely due to high absorption
        
        May see symptoms such as Neuromuscular, skeletal, hematological, and renal malfunctioning
        
        No supplements needed as it is plentiful in diet
      - Toxicity
        
        No real toxic effects
        
        Adverse effects with low Calcium and high Phosphorus intakes
    - - Absorption
        
        50% from foods
        
        High fibre intake can minimize it
        
        High calcium intake interferes with it
      - excretion
        
        kidneys
      - body contains: 25g
        
        muscle: 20%
        
        other tissues:20%
        
        bones: 60%
      - Functions
        
        Bone and Teeth
        
        bone is it's reservoir
        
        indirectly affects calcium balance
        
        needed for action of Vitamin D
        
        produces parathyroid hormone
        
        used in mineral cyrstal structure of bone:
        
        replaces calcium in hydroxyapatite
        
        reduces dental caries
        
        Blood and Tissue
        
        protein, fat and nucleic acid synthesis
        
        stabilizes phosphate groups in ATP
        
        neural transmission and muscle contraction
        
        inhibits blood clotting
        
        Hypertension
        
        vasodilator: protects against high blood pressure
        
        lowers heart disease where people drink hard water
      - Deficiency
        
        occurs slowly
        
        rarely seen in healthy individuals
        
        Canadian adults have sub-optimal intake
        
        loses come from
        
        vomiting
        
        diarrhea
        
        perspiration
        
        use of diuretics
        
        renal disease
        
        alcoholism
        
        Symptoms
        
        irritability
        
        disorientation
        
        weakness
        
        irregular heart beat
        
        hypertension
        
        tetany at low levels
      - Toxicity
        
        Not common/rare
      - Food Sources
        
        Rich Sources
        
        Roasted pumpkin seeds
        
        baked halibut
        
        Boiled Spinach
        
        Plant Foods
        
        Legumes
        
        Whole grains
        
        Beans
        
        Leafy green vegetables
        
        Tofu
        
        Nuts
        
        Seeds
        
        Animal Foods
        
        Yogurt
        
        Milk
        
        Halibut
      - Centre in chlorophyll molecule
      - Found in hard water
      - Mg forms insoluble complexes with fluoride, which will decrease the absorption of fluoride when eating together.
  - - - Found in:
        
        Water supplies
        
        Plant foods
        
        Soils
        
        Animal foods
      - Absorption Rate:
        
        30-80%
      - Intake
        
        Moderate can reduce dental caries
      - Function
        
        Bone and Teeth Mineralization
        
        Creates stronger crystal: Flourapatite
        
        Best taken before teeth come up through the gums
        
        antimicrobial
        
        re-mineralize enamel lesions
        
        topical treatment protective
        
        Food sources
        
        Plant Foods
        
        Brewed Tea
        
        Animal Foods
        
        Shellfish
        
        Fish
        
        Sardines
        
        Seafood
        
        Seaweed
        
        Water is a possible source
        
        Non-Foods
        
        Toothpaste
        
        Chewing Gum
        
        Mouthwash
      - Deficiency
        
        dental problems
        
        Inability to chew properly
        
        Risk of dental caries
        
        Inability to consume many foods
      - Toxicity
        
        Fluorosis
        
        Stiffness and pain in joints
        
        Bones become brittle
        
        Abnormal hardening of skeleton
        
        Osteoporosis
        
        Discolouration, white/brown specks on teeth
        
        Children consuming large amounts of toothpaste
      - Calcium, Phosphorus and Fluoride all help with the strengthening of tooth and preventing tooth decay. Fluoride can repair enamel by replenishing lost Ca and phosphorus.
  - - - Actions
        
        Hormone action (endogenous source)
        
        5~10mins, 2~3 times every week during summer months in Vancouver
        
        Need dietary/ supplemental VD in winter months
        
        Vitamin action (exogenous source)
        
        Dietary vitamin D in pro-active form
        
        Must be hydroxylated in the liver and then the kidneys to become active, then transported to cells for use
        
        Active vitamin D called Calcitriol
      - Absorption
        
        ~ 50 % absoption
        
        Incorporated into chylomicrons to lymph to blood
        
        Chylomicron remnants deliver dietary vitamin D to the liver
      - Roles
        
        Regulation of blood calcium & bone mineralization
        
        Calcitriol raises blood Ca level
        
        Intestines
        
        Increase Ca sbsorption
        
        Bone
        
        Activates osteoclast cells to release Ca from bone to blood
        
        Kidneys
        
        Decrease Ca excretion
        
        Immune fuction
        
        Maturity of immune cells
      - Deficiency
        
        Children
        
        Rickets
        
        Improper mineralization and shaping of bones during formation
        
        Bowed legs; knock-knees
        
        Low dietary intakes combined with little exposure to sun
        
        Increasing prevalence in Canada
        
        Adults
        
        Osteomalacia
        
        Causes
        
        Kidney, liver, intestinal disease
        
        Low intakes of vitamin D
        
        Little exposure of skin to the sun
        
        Closely spaced, repeated pregnancies
        
        Treatments
        
        Increased dietary intake, supplements, or controlled exposure of skin to sun
      - Toxicity
        
        Cause
        
        Supplement use
        
        Most likely reason for increased risk of toxicity
        
        Seen at intakes of 250 µg/day over several month
        
        Effects
        
        Hypercalcemia
        
        People affected (Mostly)
        
        Infants given inappropriate amount of supplements by parents
      - Supplements
        
        Types
        
        Tablets, softgels, liquid
        
        Available as vitamin D2 or vitamin D3
        
        Both D2 & D3 well absorbed
        
        D3 most effective in body
        
        Dose
        
        Adult age >50 take 400IU in addition
        
        Can be in one dose/day
        
        High in fish oil supplements
        
        Absorption
        
        ~50-80% of ingested amount
        
        Fat - soluble vitamin: chylomicron
      - Food source
        
        Animal food
        
        Fatty fish
        
        Fish oils
        
        Egg yolk
        
        Canned fish with bones (e.g. salmon, sardines)
        
        Plant Foods
        
        Fortified plant - based milks
        
        Other fortified products (e.g. energy bars, OJ)
      - Vitamin D stimulates phosphorous absorption, transporting phosphorus into the extracellular layer.
    - - Roles
        
        Calcium Mineralization in Bone Matrix
        
        Blood Clothing
      - Deficiency
        
        Infants
        
        Low levels of Vitamin at birth
        
        Low levels in breast milk
        
        Low levels of gut bacteria to synthesis the Vitamin
        
        Adults
        
        Rare but possible due to antibiotic use
        
        Fat malabsorption disorders, specially when combined with antibiotics
        
        Excessive Vitamin E
      - Toxicity
        
        Rare as food sources are considered non-toxic
        
        Can hinder effects of anti-coagulant drugs
        
        Symptoms
        
        RBC Hemolysis
        
        Jaundice
        
        Brain Damage
      - Family of compounds:
        Quinones
        
        Phylloquinone (plant)
        
        Menaquinone (animal)
        
        Stored Mostly in liver, some in adipose tissue
      - Absorbtion Rate:
        
        40-80%
        
        Resistant to losses in cooking
      - Sources:
        
        Abundant in Diet
        
        Bacterial Synthesis
      - Food Sources
        
        Animal Foods
        
        Liver
        
        Eggs
        
        Milk
        
        Plants Foods
        
        Leafy Green Vegetables
        
        Peas
        
        Broccoli
        
        Green Beans
      - Reccomendations
        
        Al: Adult males: 120 µg/d
        
        Al: Adult females: 90 µg/d
      - Vitamin K can produce osteocalcin which promotes Ca mineralization in bone.
- - - - Organic Matter (~35%)
        
        Nerves
        
        Cartilage
        
        Collagen
        
        Connective Tissue
        
        Provides flexibility
      - Inorganic Mineral Crystals (~65%)
        
        Provides strength and rigidity
      - Bone Marrow
        
        Site of production for:
        
        White Blood Cells
        
        Platelets
        
        Red Blood Cells
  - - - Bone Modeling
        
        Shape
      - Bone Growth
        
        Size & length
      - Bone Remodeling
        
        Density
    - - Period of growth
        
        Osteoblast cells are more active than osteoclast cell
        
        100% of bone is rebuilt during the first year of life
      - Adult years
        
        Osteoclast cells loss activity while osteoclast cells remain active
        
        ~700mg Calcium enter and leave the bone each day
        
        Osteoclast cell resorption requires vitamin A
  - - - Ultrasound
      - pDEXA – Peripheral Dual Energy X-ray Absorptiometry
      - DEXA – Dual Energy X-ray Absorptiometry