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Bone Health - Coggle Diagram

- - - - Responsible for maintenance and development of skeletal system
  - - - Osteoporosis
        
        High risk of fracture
        
        Most commonly found in older woman
        
        T-Score < 2.5
        
        Occurs with too much bone breakdown, with not enough generation
      - Osteopenia
        
        Increased risk of fracture
        
        Low bone mass
        
        Precursor to osteoporosis
        
        T-Score 1-2.5
    - - Provides Strength, rigidity, flexibility and shock absorption
      - Production site for red blood cells, white blood cells and platelets (Bone Marrow)
    - - Reduced bone density could lead to onset of various diseases at an older age
    - - Bones serve as attachment sites for muscles and organs
  - - - Trabecular
        
        Not as Dense as cortical; Lace-like structure (20% of Bone Mass)
        
        Found on the ends of long bone (Humerus, Femur, etc.)
        
        Very sensitive to hormones that regulate Blood calcium
        
        Also found on the inside of flat bones (ie ribs, skull), and in the pelvis.
      - Cortical
        
        Very-dense, Very Strong (80% of Total Bone Mass)
        
        Outer Surface of all Bones
        
        Found on Small Bones (Wrist, Hand, Foot)
    - - Makes up 35% of Bone Matter
      - Majority of organic matter is protein (collagen, fibres)
      - Contributes to Bone Flexibility, which allows for important functions such as shock absorption
    - - Responsible for Bone strength and Rigidity - Keeps body upright, protects organs
      - 2 Major Minerals
        
        Calcium
        
        Vital for hydroxyapatite fomation
        
        The most common mineral crystal
        
        Deposits onto the protein matrix
        
        Adds Strength
        
        Phosphorous
      - Makes up 65% of Bone Matter
  - - - Osteoblast Cells being built
        
        Occurring Constantly
        
        Lose activity during adult years
      - Osteoclast Cells being broken down
        
        Remain active into adult years
        
        Reabsorption requires Vitamin A
  - - - Bone Growth - Size and Length Development
        
        Bone Modelling - Shape
        
        Bone Remodelling - Density --> Involves reabsorption and formation
  - - - The quantity of mineral crystals packed
        into a measured volume of bone
    - - Ultrasound
        
        Oftentimes used on the heel
        
        Non-invasive and painless
        
        Sounds waves are used to measure bone density
        
        Can only be used for screening, not diagnosis
      - pDEXA (Peripheral Dual Energy X-ray Absorptiometry)
        
        X-rays measure bone density in peripheral parts of the body - heel, wrist, finger
        
        Non-invasive and painless
        
        Can only be used for screening, not diagnosis
      - DEXA (Dual Energy X-ray Absorptiometry)
        
        Scans entire body or specific
        areas
        
        T-score can be generated by comparing an individual's results to those of a 30-year old of the same gender and race
        
        Non-invasive, painless, relatively quick - very low x-ray energy scan
        
        Gold-Standard in measurement
  - - - Vitamin D (calcitriol)
        
        Enhances calcium absorption in the intestines
      - Parathyroid hormone
        
        Stimulates activation of Vitamin D
        
        Stimulate Calcium reabsorption in the kidneys
        
        Secreted by parathyroid gland in response to falling blood calcium levels
        
        Stimulate osteoclast cells to breakdown bone, releasing calcium into the blood
    - - Calcitonin
        
        Prevents calcium reabsorption in the kidneys
        
        Limits calcium absorption in the intestines
        
        Inhibits the activation of Vitamin D
        
        Inhibits osteoclast cells from breaking down bone, preventing the release of calcium
        
        Secreted by thyroid gland when blood calcium levels rise
- - - - Roles
        
        Bone and teeth mineralization
        
        replaces hydroxyl group in crystals found in bone to create a stronger mineral, fluorapatite
        
        Most effective before teeth erupt through gums
        
        Topical treatment as adults helps protect against dental caries
      - Deficiency
        
        Low fluoride in water supply can lead to increased risk of dental caries
      - Toxicity
        
        Fluorosis
        
        in skeleton causes abnormal hardening of skeleton making bones more brittle
        
        children consuming large amounts of fluoride at greatest risk
      - Sources
        
        Food Sources: Brewed tea, water, seafood, seaweed, shellfish, fish
        
        Non-food items: chewing gum, mouth wash, toothpaste
  - - - Absorption
        
        Enhanced Absorption
        
        Mostly absorbed in the duodenum, where acidity = increased solubility
        
        Absorption is proportional to needs
        
        Average ~25-30% absorption
        
        Pregnancy ~50% absorption
        
        Children ~50% absorption
        
        Calcium absorption depends on active vitamin D present in intestinal cells
        
        Lactose enhances calcium absorption
        
        Decreased Absorption
        
        Supplement Use
        
        Food constituents
        
        High fibre diets ~50+ g/day
        
        phytic (whole grains and legumes) and oxalic acids (vegetables)
        
        very high fat intake - can lead to steatorrhea
        
        Vitamin D deficiency
        
        Polyphenols (tea, coffee)
      - Roles
        
        Essential for bone formation and maintence
        
        Calcium and phosphate salts form hydroxyapatite crystals deposited into the PRO collagen matrix of bone
        
        substitutions in the hydroxyapatite crystal can form other mineral crystals found in bone
        
        Nerve Transmission and Muscle Contraction
        
        sodium-potassium ATPase pump in nerve cell membrane allows flow of ions across membrane to create an action potential
        
        action potential travels along nerve fibre and stimulates muscle cell
        
        Blood Clotting
        
        Essential in blood clotting process leading to the formation of fibrin and a clot
        
        Hypertension
        
        Inverse relationship between dietary calcium and hypertension
        
        Preventive effect at ~1000mg calcium per day
      - Deficiency
        
        Osteoporosis
        
        characterized by decreased bone density
        
        Factors Affecting Risk for Osteoporosis
        
        Age/gender/hormones
        
        Genetics/Race
        
        Physical Activity
        
        Body weight
        
        Smoking and Alcohol
        
        Nutrition
        
        Bone loss and be prevented by estrogen therapy, vitamin D therapy, Calcitonin therapy, Biphosphonate therapy
      - Toxicity
        
        Hyperparathyroidism
        
        Over production of parathyroid hormone causes kidneys to retain calcium in blood and bone
        
        Can lead to Hypercalcemia - high blood and urinary calcium levels
      - Supplements
        
        Forms: tablets, chewable, liquid, effervescent
        
        common supplements: carbonate, citrate, lactate, phosphate
      - Food Sources
        
        Milk/milk products
        
        Calcium fortified foods and beverages
        
        Bones in canned fish
        
        Skim milk powder
        
        Hard water
    - - Roles
        
        Bone Health
        
        provide strength and rigidity to bone as element in Hydroxyapatite crystals
        
        Fluid Balance
        
        helps maintain fluid and electrical balance through major intracellular anionic electrolyte
        
        Blood and Tissue Phosphorus
        
        makes up 15% of phosphorus in the body
        
        phosphate in found loose in cells
        
        acts as a buffer in blood
        
        many enzyme reactions
        
        many B-vitamins become active when phosphate group is added
        
        DNA & RNA
        
        essential for growth
      - Absorption
        
        enhanced by Vitamin D
        
        depending on the body's needs, absorption can be 60-90%
        
        since phosphorus is widely availble in diet. it makes it less of a dietary concern
      - Foods
        
        Supplements
        
        phosphorus is in abundance in diets, therefore supplements is not needed.
        
        animal protein foods
        
        meat, fish, poultry
        
        milk & milk products
        
        legumes, cereal, bran, nuts
        
        soft drinks
      - Deficiency
        
        very unlikely
        
        neuromuscular, skeletal, hematological and renal malfunctioning
      - Toxicity
        
        no toxic effect of high phosphorus intake
      - Recommendations
        
        RDA for adults is 700mg/day
        
        Canadian men usually consume around 1500 mg/ day
        
        canadian women usually consume around 1200 mg/day
      - hydroxyapatite clusters around the PRO matrix (asteoid)) of bone to give strength.
      - strengthening teeth and preventing tooth decay. Phosphorus and calcium form the hard structure.
    - - Roles
        
        Bones and teeth
        
        needed for mineral crystal structure in bone. replaces calcium in hydrozyapatite
        
        act as a resevoir of magnesium in body
        
        retains calcium in tooth enamel, and prevents dental carries
        
        Blood and Tissue
        
        Stabilizes ATP
        
        cofactors enzyme systems
        
        nerve transmission and muscle contraction activity
        
        Nerve Transmission and Muscle Contraction Acitivity
        
        magnesium is needed for neurotransmitter acitivity as it inhibits muscle contraction
        
        inhibits blood clots
        
        Hypertension
        
        magnesium helps prevent hypertension and heart disease
        
        acts as vasodilator
      - Deficiency
        
        causes
        
        heavy perspiration over a vast period
        
        prolonged vomiting or diarrhea
        
        prolonged use of diuretics
        
        kidney disease
        
        alcohol
        
        symptoms
        
        irregular heartbeat, loss of appetite, weakness, disorientation, hypertension
        
        tetany at entremely low levels in body.
        
        Toxicity
        
        no adverse effects of taking magnesium supplements intakes
        
        occurs at a slow rate, since magnesium is stored in bones
      - Foods
        
        central location in chlorophyll
        
        plant foods are the best source of Magnesium.
        
        ex. whole grains, nuts, seeds, tofu,avacado, leafy vegitable, milk and milk profucts
        
        hard water contains magnesium
        
        Halibut is also a great source of Magnesium
      - Absorption
        
        50% of absorption is excreted through kidneys
      - Recommendations
        
        Adults (19-30 years)
        
        males: 400 mg/day
        
        females: 310 mg/day
        
        Adults over 31 years of age
        
        males: 420 mg/day
        
        females: 320 mg/day
      - makes up the bone minerals. Magnesium is essential in mineral and bone homeostasis and helps the metabolic process of phosphorus and calcium at a cellular level.
  - - - Deficiency
        
        people at risk
        
        Infants
        
        no vitamin K synthesis at birth-sterile gut
        
        low levels in breast milk
        
        low levels of gut bacteria after a few weeks
        
        Adults
        
        rare, usually due to antibiotic use
        
        people with fat malabsorption conditions
        
        excessive intakes of vitamin E impairs the role of vitamin K in blood clotting
      - Roles
        
        Calcium Mineralization of Bone
        
        need for forming osteocalcin to promote calcium mineralization
        
        Blood Clotting
      - Toxicity
        
        risk level: rare
        
        wide safety intake range
        
        non-toxic
        
        coagulation effects can hinder effects of anticoagulant medications
        
        symptoms : RBC hemolysis, jaundice, brain damage
        
        no UL
      - Source
        
        Endogenous
        
        diet
        
        Food source
        
        leafy green vegetables. cauliflower, avocado, cabbage, liver, eggs, cow milk
        
        Exogenous
        
        bacterial synthesis
        
        Non-food source
        
        bacterial synthesis in large intestine
      - vitamin K is resistant to losses during cooking
      - needed for osteoblasts to produce OSTEOCALCIN, a calcium-binding hormone made in osteoblasts that promotes calcium mineralization
    - - Roles
        
        Regulation of blood calcium & bone mineralization, rises blood calcium levels by acting at 3 sites
        
        bone - activates osteoclast cells to release calcium from bone into blood
        
        kidneys - decreases calcium excretion
        
        intestines - increases calcium absorption
        
        Immune function - maturity of immune cells
      - Toxicity
        
        Causes: supplement use, intakes of 250 microgram/day over several months
        
        UL: 100 microgram/day
        
        Hypercalcemia - high blood calcium levels, calcium deposits into soft tissue which is irreversible damage to organs
      - Source
        
        Exogenous
        
        vitamin action
        
        active form transportation
        
        liver (hydroxylated) ——> kidney (active, called calcitriol) ——> cells (use)
        
        Food source
        
        Fatty fish, liver, milk & fortified alts.
        
        Endogenous
        
        hormone synthesis & action
        
        Effects
        
        age
        
        SPF>=8 blocks synthesis
        
        skin color
        
        lattitude
        
        exposure time
        
        pollution
      - Deficiency
        
        Children
        
        Rickets, improper mineralization and shaping of bones during formation, “bowed legs” and “knock-knees”
        
        Cause
        
        as breast milk is low in vitamin D and low dietary intakes combined with little exposure to sun.
        
        Adults
        
        Osteomalacia (soft bones) - protein matrix secreted by osteoblasts into which minerals are deposited to form bone - bone becomes soft and flexible, but not rigid
        
        Cause
        
        kidney, liver, intestinal diseases/low intakes of vitamin D and/or little exposure of skin to sun / closely spaced, repeated pregnancies
      - enhances absorption of Phosphorus
      - vitamin D deficiency will decrease the absorption of the calcium
      - vitamin D with parathyroid hormone raise blood
        calcium levels, enhances
        calcium absorption in
        the intestines.
      - vitamin D helps absorb phosphorus and transport it into the extracellular layer.