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Bone Health, Essential for!, stimulates the activation, Inhibits the…

- - - - Jaw bones
      - teeth
  - - - protein (collagen) matrix
    - - where RBC, WBC and platelets are made
  - - - for strength and rigidity
        
        Hydroxyapatite Ca10[PO4^3-]6[OH]2
        
        required Calcium and Phosphorus
        
        depends on bone mineral density
    - - protein collagen for flexibility
    - - osteoblasts cells
        
        build
      - osteoclast
        
        crumble
    - - Ca, P, Mg, F; Vit. D and K
    - - Cortical
        
        dense and strong
        
        ~80% of the bones
        
        outer layer of all bones
        
        some small bones
      - Trabecular
        
        not dense, very dynamic and sensitive to hormones
        
        ~20% of the bones
        
        lace like
        
        examples
        
        ends of long bones
        
        spinal vertebrae
        
        inside flat bones
        
        pelvis bones
        
        Healthy Trabecular bones
        
        Protein matrix (osteoid)
        
        provide flexibility
        
        Mineral Crystals
        
        provide strength
    - - bone growth
        
        size and length
        
        osteoblast is more active than osteoclast
        
        net gain in bone
        
        in adult year
        
        osteoblast lose activity; osteoclast remain active
        
        osteoblast only active when under physical stress
        
        osteoclast resorption requires Vit A
        
        ~700 mg Ca enter and leave bone each day
      - bone modelling
        
        shape
      - bone remodelling
        
        density
        
        through resorption and formation
  - - - absorption
      - renal excretion
      - 3 hormones
        
        Parathyroid Hormone(PH)
        
        secreted when falling blood Ca by parathyroid glands
        
        stimulates Ca reabsorption in the kidneys
        
        stimulate osteoclast cells to breakdown bone
        
        release Ca into the blood
        
        Calcitonin
        
        secreted when rising blood Ca by thyroid gland
        
        prevents Ca reabsorption in the kidneys
        
        help lower blood Ca level
        
        inhibits Calcitonin secretion
        
        limits Ca absorption in the intestines
        
        inhibits osteoclast cells from breaking down bone, preventing the release of Ca
        
        Vit D (calcitriol)
        
        enhance Ca absorption in the intestines
        
        help raise blood Ca levels
        
        inhibits PH secretion
    - - blood Ca DOES NOT reflect Ca status
        
        +-3% of 10mg/dL
  - - - Dual Energy X-ray Absorptiometry
        
        gold standard measure
        
        non-invasive, painless, quick
        
        very low x-ray energy scan
        
        scans entire body or specific areas
        
        T-score generated
        
        compared with health 30y/o of same gender and race
        
        normal
        
        +1 to -1
        
        Osteopenia
        
        -1 to -2.5
        
        low bone mass
        
        increase risk of fracture
        
        Osteoporosis
        
        lower than -2.5
        
        high risk of fracture
    - - sound wave
      - often used on heel
      - non-invasive, painless
      - screening, no diagnostic use
    - - Peripheral Dual Energy X-ray Absorptiometry
        
        x-ray for heel, wrist, finger
        
        non-invasive, painless
        
        screening, no diagnostic use
- - - - Teeth
        
        holding Calcium in the enamel
        
        prevent dental caries
      - Bones
        
        replace Calcium in hydroxyapatite
        
        mineral crystal structure in bones
        
        reservoir of Magnesium in body
        
        indirect effect on Calcium balance
        
        Mg is used for the action of Calcium-regulating hormones, vitamin D and PTH
      - Blood and tissue
        
        Stabilise High Energy Phosphate Bonds (ATP)
        
        Enzyme systems
        
        as a cofactor in more than 300 enzymes systems
        
        PRO, FAT and nucleic acid synthesis
        
        Generate E from CHO, PRO, FAT
        
        Nerve transmission and muscle contraction activity
        
        Mg needed for neurotransmitter activity
        
        Mg inhibits muscles contraction (antagonist to Calcium)
        
        Blood clotting
        
        Mg inhibits blood clotting (antagonist to Calcium)
      - Hypertension
        
        magnesium acts as vasodilator
        
        protect against hypertension and heart disease
        
        Lower rates of heart disease
      - support immune systems
    - - cause
        
        heavy perspiration over a long time
        
        prolonged vomiting
        
        prolonged diarrhea
        
        prolonged use of diuretics
        
        kidney disease
      - deficiency
        
        irregular heartbeat
        
        loss of appetite
        
        weakness
        
        disorientation
        
        hypertension
        
        tetany at extremely low levels of Mg in the body, like Ca
    - - in central location of chlorophyll molecules
        
        plant cells
        
        whole grains
        
        nuts
        
        seeds
        
        tofu
        
        legumes
        
        peanuts
        
        spinach
        
        beet greens
        
        avocado
        
        leafy green vegetables
        
        milk
        
        milk products
      - halibut
      - hard water
        
        Contains Magnesium and Calcium
  - - - 99% of calcium is present as hydroxyapatite in bones and teeth
        
        Remaining 1%of calcium is present in bloodstream and soft tissues
      - Mineral of greatest amount in the body approx. 1200g in a 60 kg person
        
        All cells require Calcium
      - Absorption
        
        About 25-30% of dietary calcium is absorbed
        
        Decreased Absorption
        
        Dietary Factors
        
        High fibre diet (50 or more grams daily)
        
        Phytic acid and oxalis acid (whole grains and legumes, vegetables)
        
        Very high fat intake (may cause steatorrhea)
        
        Vitamin D deficiency
        
        Polyphenols (present in tea and coffee)
        
        Supplement use
        
        High magnesium, phosphorus, zinc and/or iron intakes with a low calcium intake
        
        Menopause
        
        Aging
        
        Mostly absorbed in duodenum (transiently acidic = increased solubility)
        
        Enhanced Absorption
        
        Calcium absorption is dependent on active Vitamin D present in intestinal cells
        
        Estrogen enhances the synthesis of Vitamin D (which thereby aids calcium absorption)
        
        Younger people absorb calcium more efficiently
        
        Lactose enhances calcium absorption
      - NON-BONE important roles
        
        Nerve transmission and muscle contraction
        
        Blood Clotting
        
        Calcium is essential in blood clotting and the formation of fibrin and a clot
        
        Hypertension
        
        An inverse relationship exists between dietary calcium and hypertension
        
        Preventative effect at approximately 1000mg/day
      - Deficiency
        
        OSTEOPOROSIS!
        
        Naturally occurring bone degenerative disease
        
        Increased bone fragility, increased risk for fractures typically in hip, spine or wrist.
        
        Risk factors: Osteoporosis
        
        Genetics and race
        
        African American individuals have more dense bones than their Caucasian American counterparts
        
        Heredity plays a role in bone growth, peak bone mass and the rate of bone loss
        
        Physical Activity
        
        Weight bearing exercise = increased muscle and bone strength
        
        Women over the age of 40, particularly after menopause (decreased estrogen, reduced activity of osteoblasts)
        
        Bone-loss rate is accelerated for 5-10 years at menopause
        
        Body weight
        
        Underweight individuals, particularly women, are at a greater risk of osteoporosis
        
        Smoking and alcohol
        
        Smokers tend to have lower body weights, and female smokers tend to reach menopause earlier
        
        Alcohol is toxic to bones and reduces bone formation when used chronically
        
        Inadequate calcium nutrition and associated nutrients
        
        Dietary calcium deficiency
        
        Fluoride taken during youth leads to increased bone crystal strength
        
        Dietary Vitamin D deficiency
        
        How can bone loss be prevented?
        
        Vitamin D therapy
        
        Calcitonin therapy
        
        Estrogen therapy
        
        Bisphosphate therapy
        
        How can we decrease fracture potential?
        
        Young women
        
        Regular menstruation/ovulation
        
        Moderately active lifestyle
        
        Limited sun exposure
        
        Women and menopause
        
        Appropriate therapy
        
        Adequate intake of nutrients promoting bone health
        
        Remain physically activity
        
        Adult men and women
        
        Adequate intake of nutrients promoting bone health
        
        Moderately active lifestyle
      - Toxicity
        
        Caused by hyperparathyroidism
        
        HYPERCALCEMIA!
        
        High blood and urinary calcium levels
        
        Calcium deposits in soft tissue
        
        May cause irreversible organ damage
        
        Disproportionately affects those with kidney disease
      - Bone Health
        
        Essential for bone formation and maintenance
      - UL FOR CALCIUM IS ABOUT 2500mg/day!
  - - - Enhanced absorption by Vitamin D
    - - Plant sources come in the form of phytic acid
    - - Provide strength and rigidity as hydroxyapatite
      - 85% of body phosphorus found as hydroxyapatite
    - - Intracellular anionic electrolyte
      - Phosphate acts as a buffer in the blood
      - Phosphorus used in phospholipids, lipoproteins, DNA, RNA, ATP, and for activated B-Vitamin Co-Enzymes
    - - AVG consumption for women is 1180 mg/day, men is 1500 mg/day
  - - - Non-Dietary sources
        
        Chewing gum
        
        Mouthwash and toothpaste
        
        Water (excluding bottled)
      - Dietary sources
        
        Plant Foods
        
        Brewed teas and seaweed
        
        Animal Foods
        
        Seafood and shellfish
      - Ubiquitous (found everywhere)
        
        Animal Foods
        
        Plant foods
        
        Water supplies
        
        Soils
      - Function
        
        Toxicity
        
        Seen in children ingesting large amounts of toothpaste or fluoride drops
        
        FLUOROSIS!
        
        Fluorosis in Skeleton
        
        Abnormal hardening causing stiffness and joint pain
        
        Bones may become more brittle (leading to osteoporosis)
        
        White specks and/or brown streaks appear on teeth
        
        Deficiency
        
        Low fluoride in water supplies can be associated with an elevated risk of dental caries
        
        Dental problems may impact chewing ability and therefore limit diet variety
        
        Bone and teeth mineralization
        
        Replaces a hydroxyl group in the hydroxyapatite crystal, which creates a stronger crystal
        
        Product: Fluorapatite (Ca10[PO4^3-]6[F][OH]
        
        Fluoride is advised to be taken before teeth erupt from the gums
        
        Adults may use topical fluoride treatments for anti-microbial protection and to help re-mineralized enamel lesions
        
        Baby teeth forming (20th week of pregnancy)
        
        Wisdom teeth forming (8-10 years of age)
        
        Permanent teeth forming (3-4 years of age)
- - - - Along with the parathyroid hormone during low levels of blood calcium...
        
        stimulate reabsorption of calcium into the kidneys, decrease calcium excretion
        
        stimulate osteoclast cells to break down bone, to release calcium into blood
      - Enhances calcium absorption in intestines
      - Activation is inhibited by calcitonin during high levels of blood calcium
    - - Skin
        
        7-dehydrocholesterol, a precursor made from cholesterol in the liver, when exposed to UV light and heat from the body turns into
        
        Vitamin D3 (Calciol)
        
        Activated by hydroxylation in the liver to calcidiol, then calcitriol in kidneys, to become activated Vitamin D3
        
        Activated Vitamin D3 (Calcitriol)
        
        Factors affecting endogenous synthesis include skin colour, age, SPF greater than 8, pollution, weather, latitude, and exposure time.
        
        No toxicity through skin
      - Diet
        
        Vitamin D2 from plants and D3 from animals
        
        50% absorption
        
        Incorporated into chylomicrons, then the remnants delivery dietary D3 to liver for hydroxylation
    - - Rickets in Children
        
        Improper mineralization and shaping of bones during growth
        
        "Knock knees" when infant starts walking
        
        Low Vitamin D in diet/breast milk, and little exposure to sun may lead to rickets
      - Osteomalacia
        
        Osteoid doesn't mineralize properly, making bones soft and flexible, but not rigid
        
        Treatment through increase dietary intake, supplements, controlled exposure to sun
    - - Toxicity usually caused by supplements usually at intakes of 250 micrograms a day for several months
  - - - Phylloquinone
        
        plant
      - menaquinone
        
        animal
      - 40-80% absorbed
      - stored in liver, some in adipose tissue
      - Coenzyme for protein synthesis
      - sources
        
        exogenous
        
        diet
        
        endogenous
        
        bacterial synthesis
        
        antibiotic use can increase dietary need
    - - Calcium Mineralization of Bone
        
        required for osteoblasts to produce osteocalcin
      - Blood Clotting
        
        important for infants with sterile gut (no bacterial synthesis)
        
        takes few weeks to establish Vit K synthesis
        
        infants receive a dose of Vit K
        
        prevent hemorrhaging
        
        Fibrin
        
        made of 13 proteins
        
        4 require Vit K for synthesis
    - - people at risk
        
        infants
        
        no Vit K synthesis at birth
        
        low levels in breast milk
        
        low level of gut bacterial
        
        adults
        
        rare
        
        due to antibiotic use
        
        fat malabsorption conditions
        
        AIDS
        
        cystic fibrosis
        
        excess intake of Vit E
        
        impairs the role of Vit K in blood clotting
    - - rare
        
        wide safety intake range
      - non-toxic
      - effect anticoagulant medication
      - symptoms
        
        RBC hemolysis
        
        jaundice
        
        brain damage
    - - adult 19+ years
        
        males
        
        120 ug/day (DRI-AI)
        
        females
        
        90 ug/day (DRI-AI)
    - - broccoli, spinach, kale, swiss chard, Brussels sprouts, asparagus, collards
      - cauliflower, avocado, cabbage
      - liver, eggs, milk(cow)
      - bacterial synthesis in large intestine
      - resistant to losses during cooking