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BONE HEALTH, Relationship: Calcium, phosphorus and magnesium are all…

- - - - Primary Roles
        
        Bone Health
        
        Provides strength and rigidity to bones. (element in hydroxyapatite crystals)
      - Other Important Roles
        
        Fluid Balance
        
        Phosphorus is a major intracellular anionic electrolyte
        
        Blood and Tissue Phosphorus
        
        Phosphate ion is a buffer in blood
        
        Phosphorus or phosphate ion is reuired in phospholipid cell membranes, lipoproteins, DNA,RNA,ATP and to activative B-vitamin coenzymes
    - - about 60-90%
    - - Vitamin D
    - - Deficiency unlikely when following a varied and balanced diet
    - - Plant Sources (mostly in form of phytic acid)
        
        Broccoli
        
        Roasted Sunflower Seeds
        
        Legumes
        
        Whole Grains
        
        Breakfast Cereal (high fibre)
      - Animal Sources
        
        Milk and Dairy Products
        
        2% Cow Milk
        
        Fatty Fish
        
        Coho Salmon
        
        Canned fish with bones
    - - Cause
        
        more than 4000 mg/day
      - Effect
        
        Compromises maximizing peak bone density with high phosphorus and low calcium intake in teenagers
    - - UL: 4000 mg/day
      - DRI-RDA for all adults: 700 mg/day
      - Average Canadian Adult Intake
        
        Women: ~1180 mg/day
        
        Men: ~1500 mg/day
    - - Relationship: Calcium and phosphate ions bind to form hydroxyapatite crystals, the primary mineral component of bone. Hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂), clusters around the PRO matrix (osteoid) of bone to provide strength.
  - - - Bone and Teeth
        
        Indorectly affects calcium balance because it's needed for action of vitamin D and production of parathyroid hormone
        
        Used in mineral crystal structure of bone
        
        Magnesium can replace calcium in hydroxyapatite
        
        Magnesium helps retain Calcium in teeth which reduces dental caries
      - Blood and Tissue Magnesium
        
        Over 300 enzymes need Magnesium to function
        
        protein, fat, nucleic acid (DNA) synthesis
        
        Stabalizes phosphate groups in ATP
        
        Required for good neural transmission and muscle contraction
        
        regulated by Mg-dependant adenylate cyclase enzyme system
        
        Magnesium inhibits muscle contraction by blocking calcium ion channel
        
        Inhibits Blood Clotting
        
        ion antogonist to calcium
      - Hypertension
        
        Magnesium as as a vasodilator, protecting against high blood pressure
        
        Lowers rates of heart disease in areas where people drink hard water
    - - ~50%
    - - In healthy individuals deficiency is rare; develops slowly
      - Cause
        
        Sub-optimal Magnesium intake
        
        Heavy perspiration over time
        
        Prolonged
        
        Vomitting
        
        Diarrhea
        
        Use of diuretics
      - Symptoms
        
        Irregular heart beat
        
        Weakness
        
        Disoreintation
        
        Irritability
        
        Hypertension
        
        Tetany
    - - no known toxicity
    - - Animal Sources
        
        Dairy
        
        Yogurt
        
        Milk
        
        Halibut
      - Plant Sources (Mg centre in chlorphyll molecule)
        
        Vegetables
        
        Red Bell Pepper
        
        Broccoli
        
        Red Cabbage
        
        Spinach
        
        Whole grains
        
        Breakfast Cereal (high fibre)
        
        Oatmeal
        
        Legumes
        
        Lima Beans
        
        Beans
        
        Tofu
        
        Nuts/Seeds
        
        Pumpkin seeds
        
        Brazil Nuts
    - - High calcium intake usually through supplementation can interfere with magnesium absorption
      - Very high fibre intake
    - - Bones: ~60%
      - Muscle: ~20%
      - Other Tissue: ~25%
      - The body contains about 25 mg of Magnesium
    - - DRI-RDA
        
        19-30 Years
        
        Males: 400 mg/day
        
        Females: 310 mg/day
        
        31+ Years
        
        Males: 420 mg/day
        
        Females: 320 mg/day
      - DRI-UL for all adults: 350 mg/day from supplements only
  - - - Bone formation and maintenance
        
        Form hydroxyapatite crystals which provide strength and rigidity
      - Nerve transmission and muscle contraction
        
        Sodium-potassium ATPase pump in nerve cell membrane allows the generation of action potential
        
        Calcium flowing into muscle cell causes contraction and calcium flowing out of muscle cell causes relaxation
      - Blood clotting
        
        Calcium in body fluid is essential for the formation of fibrin and a clot in the blood clotting process
    - - People at risk
        
        People between the ages of 30 to 40, when bone loss occurs and decreased stomach acidity makes calcium absorption less efficient
        
        Affects 1 in 4 women and 1 in 8 men over the age of 50
      - Osteoporosis
        
        Factors affecting osteoporosis
        
        Age, Gender and Hormones
        
        Osteoblast activity decreases with age and osteoclast activity remains the same therefore there is more breakdown of bone than synthesis
        
        Women are more likely to have osteoporosis due to the rapid decrease of estrogen during menopause
        
        Men will be less affected because the decrease of testosterone levels is more gradual
        
        Genetics and Race
        
        Bone growth, peak bone mass and the rate of bone loss can be affected by heredity
        
        Physical Activity
        
        Exercise for force muscles to pull on bone which will increase the strength of trabecular bone
        
        Weight bearing exercises will increase impact on bone and therefore increase muscle and bone strength
        
        Body Weight
        
        Women with low body weight are at a higher risk of osteoporosis
        
        Smoking and Alcohol
        
        Smokers tend to have lower body weight and women smokers will reach menopause earlier
        
        Alcoholics will have slower bone formation and therefore a lower bone density
        
        Calcium nutrition and associated nutrients
        
        Low levels of calcium and vitamin D intake will reduce overall absorption of calcium
        
        High caffeine, protein and sodium consumption will pull calcium into the urine and increase calcium excretion
        
        Prevention
        
        Decrease sodium, alcohol and caffeine intake
        
        Increase vitamin D and Calcium intake in diet by eating foods such as fruits and vegetables
    - - Hyperparathyroidism, the overabundant production and secretion of parathyroid hormone caused by retention of calcium by kidneys and the release of calcium from bones
      - Hypercalcemia, high blood and urinary calcium levels can cause damage to organs and calcium deposits into soft tissue
      - Constipation
      - Increased risk of developing kidney stones and kidney dysfunction
      - Interferes with the body's ability to absorb other nutrients
    - - Canned fish with bones
      - Leafy greens (eg broccoli, bok choy, chard, kale)
      - Legumes (beans, lentils, tofu fortified with calcium salt)
      - Milk and products (milk yogurt, cheese)
      - Citrus fruits (orange juice)
    - - Only recommended if you are aware of the type, dose, absorption and the mineral-mineral interaction timing
      - Various forms - tablets, chewable, liquid, effervescent
      - Avoid supplements with unrefined oyster shell, dolomite, coral or bone meal due to possible heavy metal levels
      - Dose should be divided through the day, not more than 500mg/dose
      - Should be taken at time of low calcium or iron intake, ie at night
      - Calcium carbonate should be taken with food, calcium citrate can be taken without food due to greater solubility
      - 30% absorption for all supplements
      - Decreases absorption of other minerals (ie iron and magnesium)
- - - - Most effective intake time
        
        20th week of pregnancy ; baby teeth forming
        
        permanent teeth forming -> around 3-4 years old
        
        wisdom teeth formation -> around 8-10 years old
      - replace the hydroxyl portion of the hydroxyapatite
        
        leads to the formation of Fluorapatite
        
        stronger bones
        
        teeth more resistant to decay
    - - increase rise of dental caries
        
        Interfere with the ability to chew properly
        
        consumption of variety of foods decreases
      - groups at greatest risk for early childhood caries
        
        Indigenous children
        
        Newly immigrated children
      - Dental decay
    - - Flurosis
        
        effects on teeth
        
        permanently discoloured -> white specks or brown streaks
        
        more resistant to decay
        
        effects on the skeleton
        
        bones become more brittle
        
        leading to osteoporosis
        
        pain and stiffness in the joints
    - - Plant Foods
        
        Brewed tea
      - Animal Foods
        
        seafood
        
        shellfish
        
        fish
        
        seaweed
        
        sardines
      - Non- Foods
        
        Toothpaste
        
        Mouthwash
        
        chewing gum
    - - ~30-80 % absorbed
    - - DRI - AI
        
        Male Adults: 4 mg/day
        
        Female Adults: 3 mg/day
- - - - Regulating the blood calcium and bone mineralization
      - Immune function
        
        Maturation of immune cells
    - - Intestines
        
        Increase calcium absorption
      - Bone
        
        Activate the osteoclast cells to release calcium into blood
      - Kidneys
        
        Decrease the excretion of calcium
    - - Children
        
        Rickets
        
        Bones unable to calcify
        
        Bowed legs
        
        Beaded ribs
      - Adults
        
        Osteomalacia
        
        Bones become deformed, flexible
    - - Cause
        
        Supplement use
        
        250 µg per day over several months
      - Effect
        
        Hypercalcemia
        
        High blood calcium level
        
        Hardening of blood vessels
        
        Calcium transfers into soft tissue
        
        Causes organ damage
    - - Animal food
        
        Fatty fish
        
        Egg yolks
      - Plant food
        
        Fortified plant-based milk
  - - - 40-80%
    - - Mostly in the Liver
      - Some in Adipose Tissue
    - - Calcium Mineralization of Bone
        
        Needed for osteoblast cells to produce osteocalcin (calcium-binding hormone)
      - Blood Clotting
        
        Especially important for infants
        
        4 out of 13 proteins in fibrin clot require vitamin K for synthesis
    - - At Risk
        
        Infants
        
        Cause
        
        No Vitamin K synthesis at birth, sterile gut
        
        Low levels of Vitamin K in breastmilk
        
        Low levels of gut bacteria after few weeks
        
        Adults (deficiency is rare)
        
        Cause
        
        Antibiotic use
        
        Individuals with fat malabsorption conditions
        
        Excessive intake of vitamin E. Impairs role of vitamin K in blood clotting
    - - Non-Food Source
        
        Bacterial synthesis in the large intestine
      - Food Sources
        
        Animal Sources
        
        Liver
        
        Egg
        
        Cow Milk
        
        Plant Sources
        
        Broccoli
        
        Spinach
        
        Kale
        
        Swiss Chard
        
        Brussel Sprouts
        
        Asparagus
        
        Cauliflower
        
        Avocado
        
        Cabbage
      - Resistant to losses during cooking
    - - rare, non-toxic
      - Coagulation effects may hinder the effects of anti-coagulant medications
      - Symptoms
        
        Red blood cell hemolysis
        
        Jaundice
        
        Brain Damage
    - - DRI-AI µg/day
        
        Male Adults: 120 µg/day
        
        Female Adults: 90 µg/day
- - - - Structural
        
        Muscles are attached to bones via tendons
        
        Organs hang from and are protected by skeleton (e.g., rib cage)
        
        Mandible (jaw) and teeth allow for chewing food
      - Metabolically active tissue
        
        Constantly rebuilding at all ages
    - - Composition
        
        Types of bones
        
        Trabecular
        
        Spongy inside of bones and ends of long bones
        
        Makes up 20% of skeleton
        
        Not as dense but very dynamic and sensitive to hormones that regulate blood calcium levels
        
        Fast bone turnover at 26% per year to maintain flexibility and dynamic characteristic
        
        Cortical
        
        Outer surface of all bones
        
        Makes up 80% of skeleton
        
        Very dense and strong bone
        
        Slow bone turnover at 3% per year to maintain biomechanical strength
        
        Major minerals in bone
        
        Calcium
        
        Major mineral crystal in bone
        
        Hydroxyapatite
        
        Deposits onto the protein matrix to add bone strength
        
        1 more item...
        
        Bone strength depends on bone mineral density (quantity of mineral crystals packed into a measured volume of bone)
        
        Inorganic mineral that plays a role in structural strength and bone regeneration
        
        Make up mineral complex portion of osteoid
        
        1 more item...
        
        Phosphate
        
        65% mineral matter (strength, rigidity)
        
        35% organic matter from collagen (flexibility)
    - - Osteoporosis
        
        More prolonged osteoclast activation than osteoblast and cortical and trabecular bone breaks down
        
        T-score lower than -2.5
      - Rickets
        
        Bone development condition in children that leads to soft, weak bones and deformities
  - - - 3 stages of bone development
        
        1) Bone growth (size and length)
        
        2) Bone modelling (shaping)
        
        3) Bone remodeling (density)
        
        Bone is being broken down and rebuilt for more integrity
        
        During first year of life, 100% of bone is rebuilt
        
        Bone is being built because osteoblasts are more active than osteoclasts
      - Osteoclast cells
        
        Break down bone - more active than osteoblasts in later adult years
        
        Requires vitamin A for resorption
      - Osteoblast cells
        
        Build bone - more active than osteoclasts during periods of growth for net gain in bone
        
        Build bone when under physical stress (i.e., exercise)
    - - Lifestyle factors
        
        Food choices
        
        Improved with diet high in calcium, vitamin D, magnesium, phosphorus, fluoride, and vitamin K
        
        Improved with exercise
        
        Worsened with excessive alcohol intake and certain medications
      - Hormones
        
        Calcitonin
        
        Produced and released by C-cells of thyroid gland
        
        Lowers blood calcium
        
        Inhibits activation of vitamin D
        
        Prevents calcium reabsorption in kidneys and absorption in intestines
        
        Inhibits osteoclast cells from breaking down and releasing calcium into blood
        
        Parathyroid hormone
        
        Produced by parathyroid glands
        
        Increases blood calcium
        
        Stimulates activation of vitamin D
        
        Vitamin D stimulates kidney calcium reabsorption and intestinal absorption
        
        Stimulate osteoclast cells to break done bone and release calcium into blood
        
        Calcitriol
        
        Active form of vitamin D
        
        Regulates calcitonin and parathyroid hormone
      - Genetics
      - Age
      - Sex
    - - Calcium balance
        
        Regulated through absorption/reabsorption from hormones
        
        Renal excretion can regulate blood calcium levels
      - Bone is a calcium storage site that can undergo calcium deposits (osteoblasts) or withdrawals (osteoclasts) to maintain levels
- - - - Provides T-score that represents that the lower the density, the greater risk of fracture, and osteoporosis or osteopenia