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Bone Health Concept Map Group 4 - Coggle Diagram
Bone Health Concept Map Group 4
Major Minerals Involved
Calcium
Basics
Mineral of the greatest quantity in the body
99% is in bone and teeth
1% found in bloodstream and soft tissues
All cells require calcium
Absorption
Factors Increasing Absorption
Times of increased need increases the percentage absorbed
Ex. young kid growing
Ex. pregnancy
Lactose
Forms absorbable complex
Younger people
Absorb better than elderly
Estrogen
Enhances synthesis of active Vitamin D
Factors Decreasing Absorption
Food Constitues
High fibre diets
Phytic acid
Whole grains
Legumes
Oxalic acid
Vegetables
Very high fat intake
Vitamin D deficiency
Polyphenols
Supplement Use
Magnesium & Phosphorus
Magnesium
Phorphorus
Iron & Zinc
Menopause
Decreased levels of estrogen
Old Age
Decreased stomach acidity
Decreased efficiency of absorption
25-30% of Ca intake is absorbed
Mostly absorbed in duodenum
Deficiency
Osteoporosis
Degenerative bone disease
Increased bone fragility
Increased risk of fracture
Build peak bone mass early in life to reduce risk
Factors effecting risk
Age/gender/hormones
Bones strongest/ most dense in early adulthood
Genetics/race
Role in peak bone mass
Bone growth
Rate of bone loss
Physical activity
Weight bearing & resistances exercises benefit
Body weight
Underweight women at increased risk
Smoking and alcohol
Both toxic to bone
Calcium nutrition and associated nutrients
Low Ca intake at young age
Low Fluoride intake
Decreased active Vitamin D = decreased Ca absorption
Prevention
Young Women
Adequate vitamin/mineral intake
Calcium
Vitamin D
Vitamin K
Phosphorus
Fluoride
Magnesium
Regular menstrual cycles
Moderately active lifestyle
Therapies
Calcitonin
Estrogen
Vitamin D
Bisphosphate
Adult Women & Men
Adequate intake of nutrients
Moderately active lifestyle
Quit smoking
Moderate alcohol consumption, if any
Menopausal Women
Adequate intake of nutrients
Paired with a therapy
Remain physically active
~2 million Canadians over 50 live with osteoporosis
1 in 4 women
1 in 8 men (over 50)
Future estimates of bone fragility
1 in 3 women
1 in 5 men
Consequences
Dental changes
Osteoporosis
Easily fractured bones
Toxicity
Causes
Hyperparathyroidism
Causes kidney to conserve Ca in blood
Bone releases Ca into blood
Effects
Hypercalcemia
High blood Ca levels
Ca deposits into soft tissue
damage to tissues
People most affected
Those with kidney disease
Food Sources
Milk & Dairy Products
Canned fish with bones
Tofu (if made with a calcium salt)
Supplements
Choose Ca supplements with less than or equal to 500mg/dose
Common Choices
Carbonate
Citrate
Lactate
Phosphate
Different amounts of Ca per supplement, different bioavailability
Absorption
Absorption plateaus around 500mg
Take divided doses throughout the day
30% for all supplements
Except citrate -> 35%
Take Calcium carbonate with food
Calcium citrate can be taken without food
Mineral-Mineral Interactions & Timing
Take at times when low Calcium and/or Iron intake
Decrease absorption of other minerals
Iron
Magnesium (supplemental intake of Ca)
Take before bed
Overnight Ca loss
Ca from bone to blood, excreted in urine
Roles
Bone Health
Blood Calcium Balance
Regulated by
Parathyroid hormone
Falling blood Calcium stimulates parathyroid secretion
Vitamin D (Calcitriol)
Raises blood Calcium in bone, intestine, and kidneys
Calcitonin
Rising blood Calcium stimulates Calcitonin secretion
Range of +/-3% of 10mg/dL
Bone Formation and Maintenence
Calcium and Phosphorus
Hydroxyapatite cluster around osteoid of bone to provide strength
Non-Bone Important Roles
Nerve Transmission/ Muscle Contraction
Ca levels fall below normal = muscle relaxation
Ca level above normal = muscle contraction
Blood Clotting
Ca essential in synthesis of fibrin
forms blood clot
Hypertension
Inverse relationship when intake is greater than 1000mg/d
Phosphorus
Food sources
Plant sources
Phytic acid
Legumes
Some whole grains
Rich sources
Coho salmon
Sunflower seeds
Edamame
Toxicity
UL: 4000 mg/day
Compromise peak bone density
High phosphorus
Low calcium
Basics
2nd most abundant mineral in the body
Kidneys regulate Phosphorus levels
~85% of body Phosphorus is found in hydroxyapatite
Works with Calcium
Deficiency
Uncommon with varied and well-balanced diet
No need for supplements
Roles
Primary role
Bones health
Hydroxyapatite crystals
Provides strength
Provides rigidity
Clusters around osteoid of bones
Other roles
Major intracellular anionic electrolyte
Helps maintain fluid balance
Helps maintain electrical balance
Buffer in blood
Phospholipids
Cell membranes
Lipoproteins
DNA
Helps activate B-vitamin coenzymes
ATP
Absorption
Vitamin D enhances absorption
~60-90% absorbed
Compared to ~25-30% for Calcium
Recommendations
DRI-RDA: 700 mg/day
DRI-UL: 4000 mg/day
Average adult Canadian intake
Men
~1500 mg/day
Women
~1180 mg/day
Magnesium
Roles
Bone and teeth
Mg needed for the mineral crystal structure in bones, can replace Ca in hyperoxyapatite
Bone act as a reservoir of Mg in the body
Mg prevents dental caries by holding Ca in the enamel
Blood and Tissue Magnesium
Stabilizes ATP
Essential for enzymes system
More than 300 enzyme system require Mg as a cofactor
Nerve Transmission and muscle contraction activity
Mg needed for neurotransmitter activity
Mg inhibits muscle contraction (antagonist to Calcium)
Blood clotting
Mg prohibits blood clotting (antagonist to Calcium)
Hypertension
Mg act as vasodilator--protects against hypertension and heart disease
Lower rates of heart disease are observed where people live in areas with hard water
Mg supports normal immune function
Deficiency
Reasons for increased loss of Mg
Prolonged use of diuretics
Prolonged vomiting and diarrhea
Heavy perspiration over long time
Kidney diseases
Alcoholism
Symptoms
Irregular heartbeat
Loss of appetite
Weakness/disorientation
Hypertension
Tetany
Toxicity
No known adverse effects of supplemental magnesium intakes
Food Sources
Hard water
Halibut
Plant foods
Spinach, beet greens, avocado, leafy green vegetables
whole grains, nuts, seeds, tofu, legumes, peanuts
Milk and milk products
Rich sources
Boiled spinach
Roasted pumpkin seeds
Baked halibut
Basics
Bone contains 60% of body magnesium, muscles ~20%, only 1% in blood
~50% absorption rate, excretion through kidneys
Magnesium Absorption
Our body contains ~25g of magnesium
Mg is part of the chlorophyll molecules
About Bone
What Are Bones
Structural support
Muscles attach to bones
Via tendons
Protection
Ex. rib cage
Allow food consumption
Chewing
Ex. jaw and teeth
Functional characteristics
Manufacturing site
White blood cells
Red blood cells
Platelets
Found within bones
Nerves
Cartilage
Osteoids
Connective tissue
Collagen matix
Components
~65% mineral matter
Hydroxyapatite
Most common mineral crystal
Adds strength and rigidity
Essential components
Calcium
Phorsphorus
~35% organic matter
Protein collagen
Flexibility
Types
Cortical
Characterists
Ivory-like
Dense
Strong
Slow turnover
Makes up ~80% of skeleton
Locations
Outer surface of all bones
Small bones
Foot
Wrist
Hand
Trabecular
Characteristics
Lace-like
Less dense than cortical bone
Dynamic
Sensitive to hormones that regulate blood Calcium
Make up ~20% of skeleton
Locations
Ends of long bones
Arms
Legs
Spinal vertebrae
Inside flat bones
Ribs
Skull
Pelvis bones
Constituents
Protein matrix (osteoid)
Flexibility
Mineral crystals
provides strength
Hydroxyapatite is most common
Formation & Maintenance
Metabolically dynamic
Calcium bank
Calcium withdrawal
Osteoclasts
Resorption
Requires Vitamin A
Breakdown
Calcium deposits
Osteoblasts
Build
Lose activity during adulthood
Osteoclasts remain active
Built under physical stress
Ex. exercise
More active during periods of growth
100% of bone is rebuilt during first year of life
~700mg of Calcium enter and leaves bone each day
Development
3 processes
Growth
Size
Length
Remodelling
Density
Resorption and formation
Modelling
Shape
Ribs
Femur
Calcium balance
Regulated through absorption, and renal secretions
Dietary Calcium intake affects bone health
Dietary Calcium intake indirectly affects blood Calcium
Bone Health
Measuring Bone Density
Ultrasound
Sound waves
Features
Non-invasive
Painless
Screening
No diagnostic use
pDEXA--Peripheral Dual Energy X-ray Absorptiometry
Measures bone density
Heel
Wrist
Finger
Features
Non-invasive
Painless
Screening use only
No diagnosis use
DEXA-Dual Energy X-ray Absorptiometry
Features
Non-invasive
Painless
Quick
~20min
Low x-ray energy
Scans
Entire body
Specific areas
Ex. spine or hip
Gold standard measurement
Generate "T score"
By comparing with healthy 30 year old of same gender and age
Normal: +1 to -1
Osteopenia: -1 to -2.5
Low bone mass
Increased risk of fractures
High risk of fractures
Strategies to reduce risk
Exercise
Follow Calcium intake recommendations
Follow Vitamin D intake recommendations
Factors that affect bone health
Nutrients
Calcium
Phosphorus
Magnesium
Vitamin D
Vitamin K
Hormones
Genetics
Lifestyle
Fat Soluble Vitamins Involved
Vitamin D
Food Sources
Few foods contain naturally occurring Vitamin D
Present in
Animal foods
Egg yolks
Liver
Fish & fish oils
Fortified foods
Fortified milk
Margarine
Orange juice
Relatively stable to heat
Deficiency
Children -
Rickets Disease
Inadequate intake of vitamin D
Poor mineralization and shaping of bones leading to bowed legs, malformed ribs, etc.
Infants are both with 9 month store
Breastmilk low in vitamin D
Due to
Low vitamin D intake
Little sun exposure
Prevalence increasing in Canada
Adults -
Osteomalacia
Osteoid = protein matrix secreted by osteoblasts into which minerals are deposited to form bone
Osteoids accumulate, making bone soft and not rigid
Due to
Kidney, liver, intestinal diseases - Decreased absorption of vitamin D
Low vitamin D intake
Little sun exposure
Closely spaced, repeated pregnancies
Low active Vitamin D can decrease Calcium absorption
Toxicity
Relatively narrower safety range than other fat-soluble vitamins
The most toxic of all vitamins when consumed in least amounts above DRI
Due to
Solar exposure
Food intake
Supplement use (most likely reason)
Hypercalcemia - high blood calcium levels
Calcium deposits into soft tissue
Can cause irreversible damage to organs
Children are most affected
Most likely victims are children whose parents unnecessarily supplement them with vitamin D
Absorption
Hormone-action (endogenous or internal source)
Acts as a hormone when skin is exposed to sun
Factors affecting endogenous synthesis
Skin colour
Age
Distance from equator
Pollution
SPF
Time of day of exposure
Summer synthesis not sufficient to carry through to winter months - need dietary intake
Non-toxic level synthesized through exposure of skin to sun
Vitamin action (exogenous or dietary source)
When consumed in diet, viitamin D must be activated in the liver and kidneys for form active calcitriol
Supplements
Various forms - tablets, softgels, liquid
Available as Vitamin D2 (plant-based) or Vitamin D3 (animal-based)
Doses
Adults over age 50 are advised to take 400 IU of vitamin D daily
Can be in one dose
Absorption
50%-80% of ingested amount
Transported in chylomicrons (fat-soluble)
Roles
Regulates blood calcium and bone metabolism
Calcium Balance
Calcitriol (active form) acts at 3 sites - intestines, bones, kidneys
At low blood calcium levels, calcitriol causes increased calcium blood levels
Enhances Phosphorus absorption
Recommendations
RDA
Adults (0-70 yr): 15ug/day (600 IU)
Vitamin K
Roles
Mineralization of bone
Needed to produce osteocalcin
Calcium-binding hormone that promotes calcium mineralization
Blood clotting
Important in infants with sterile-gut bacterial synthesis
Takes weeks to establish bacterial synthesis
Infants receive dose after birth to prevent hemorrhaging
Fibrin clots
Vitamin K required for prothrombin
Calcium and thromboplastin required for thrombin
Basics
Quinones
Plant
Phylloquinone
Animal
Menaquinone
~40-80% absorbed
Storage locations
Liver
Adipose tissue
Coenzyme for protein synthesis
Resistance to loss during cooking
Sources
Exogenous
Diet
Animal sources
Plant sources
Leafy green vegetables
Broccoli
Spinach
Asparagus
Kale
Brussel sprouts
Cauliflower
Avocado
Cabbage
Endogenous
Bacterial synthesis
Large intestine
Deficiency
At risk populations
Infants
Low levels in breast milk
Low levels of gut bacteria after a few weeks
No Vitamin K synthesis at birth
Sterile gut
Adults
Rare
Usually due to antibiotic use
People with fat malabsorption conditions
Crohn's disease
Cystic fibrosis
AIDS
Excessive intake of Vitamin E impairs Vitamin K in clotting
Toxicity
Rare
Large intake range
Generally non-toxic
Effects on coagulation (clotting)
Hinders effects of anti-coagulation medications
Ex. Warfarin
Symptoms
Red blood cell hemolysis
Jaundice
Brain damage
Recommendations
DRI-AI
Adult males
120 um/day
Adult females
90 um/day
No upper limit
Trace Minerals Involved
Fluoride
Basics
Ubiquitous
Soils
Water supplies
Plant foods
Animal foods
Absorption
~30-80%
Moderate intake can reduce dental cavities
Importance
Bone and teeth mineralization
Fluoride replaces hydroxyl group in hydroxyapatite crystal
Fluoroapatite (Ca10[POc 3-][F])
Components
Phosphorus
Fluoride
Calcium
Makes stronger crystals
Intake is important before teeth erupt from gums
20th week of pregnancy
Baby teeth
3-4 years of age
Permanent teeth
8-10 years of age
Wisdom teeth
During adulthood
Protection topical ointment
Antimicrobial
Helps re-mineralize enamel lessions
Deficiency
Dental problems
Increased risk of cavities
Inability to chew
Toxicity
Fluorosis
Teeth
Permanent discolouration
White specks
Brown streaks
Skeleton
Abnormal hardening
Joints
Stiffness
Pain
Brittle bones
Osteoporosis
No link to cancer
Common causes
Ingestion of toothpaste
Excess fluoride drops
Intake sources
Food sources
Plant sources
Brewed tea
Grapes
Potatoes
Animal sources
Shellfish
Sardines
Fish
Seaweed
Seafood
Water
Non-food sources
Mouthwash
Toothppaste
Chewing gum
Recommendations
RDI-AI
Adult males
4 mg/day
Adult females
3 mg/day
No upper limit