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Bone Health, Importance - Coggle Diagram

- - - - Primary role
        
        Is bone health/structure
        
        Calcium and phosphorous form hydroxyapatite
        
        Hydroxyapatite cluster around osteoid of bone provides strength and rigidity
      - Nerve transmission/muscle contraction
        
        Action potential passes along nerve cell to muscle, open calcium channel
        
        Calcium flows into muscle cells, contraction occurs
      - Blood clotting
        
        Synthesis of fibrin to form a blood clot
      - Hormone secretion
      - Maintain blood pressure
    - - Absorption increases because of
        
        Active vitamin D
        
        Estrogen enhances synthesis of active vitamin D
        
        Lactose
        
        Younger people absorb calcium better than the elderly
        
        Increased need increases the % calcium absorbed
      - Absorption decreases because of
        
        Food constituents
        
        Phytic acid in whole grains and legumes
        
        Oxalic acid in vegetables
        
        Very high fat intake (steatorrhea)
        
        Vitamin D deficiency
        
        Polyphenols: tannins (tea) and chlorogenic acid (coffee)
        
        High fibre diets
        
        Supplement use
        
        Supplements
        
        Magnesium
        
        Phosphorous
        
        Iron
        
        Zinc
    - - People at risk
        
        Menopausal individuals
        
        Because of decreased estrogen
        
        Decreases synthesis of active vitamin D
        
        Old age (people 50+)
        
        Because of decreased stomach acidity
        
        Decreases efficiency of absorption
      - Leads to osteoporosis
        
        Prevalence
        
        1/8 men over 50 in Canada
        
        1/4 women over 50 in Canada
        
        Risk factors for osteoporosis
        
        Age, gender, hormones
        
        Females: rapid decline in estrogen at menopause (needed to activate vitamin D)
        
        Males: gradual decline in testosterone
        
        Genetics
        
        Heredity plays a role in bone growth
        
        Physical activity
        
        Weight-bearing & resistance exercise benefits bone
        
        Hormones involved in muscle growth are also involved in bone growth
        
        Body weight
        
        Under-weight women at increased risk for developing osteoporosis
        
        Smoking & alcohol
        
        Smokers: lower body weight, earlier menopause
        
        Alcohol: slows bone growth, decrease vitamin D, increase fall risk
        
        Reducing risk for bone fracture
        
        Young women
        
        Adequate nutrient intakes of Calcium, Phosphorus, Magnesium, Fluoride, and vitamins D & K
        
        Limited exposure to sun
        
        Moderately active lifestyle
        
        Especially weight bearing activities
        
        Adults
        
        Adequate intake of nutrients that support bone health
        
        Quit smoking
        
        Moderate if any alcohol intake
        
        Menopausal women
        
        Adequate intake of nutrients that support bone health
        
        Appropriate therapy (if any) determined in consultation with health care professional
    - - Sodium
        
        2 grams of sodium causes a loss of around 40 mg calcium
        
        Reduce salt intake to prevent
      - Caffeine
        
        1 cup of coffee causes loss of around 2-3 mg calcium
        
        Have a latte or add milk to prevent
      - Protein
        
        Every gram of protein above RDA loses 1-2 mg of calcium in urine
        
        Maintain 16:1 to 20:1 ratio of calcium to protein
      - Low fluoride intake
    - - Caused by hyperparathyroidism
        
        Increased parathyroid hormone secretion
        
        Kidneys conserve calcium
        
        Bones release calcium in blood
      - Hypercalcemia
        
        High blood and urinary calcium levels
        
        Calcium deposits into soft tissue
        
        Irreversible damage to organs
      - Those with kidney disease most affected
    - - Animal foods
        
        Milk and dairy products
        
        Canned fish with bones
        
        Fish or meat soup stock
      - Plant foods
        
        Fortified plant-based milks
        
        Fortified products
        
        Tofu (made with a calcium salt)
    - - May be advised depending on situation
        
        Times when there is low calcium and/or iron intake
        
        Taken every day if relying on supplements for adequate calcium intake
        
        Take before bed
        
        Calcium loss from bone to blood and exits body in urine overnight
        
        Advisable when there is deficiency
  - - - Blood & Tissue
        
        Blocks calcium ion channels inhibiting muscle contraction
        
        Proteins, fat & nucleic acid synthesis
        
        Stabilizes phosphate groups in ATP
        
        Function of adenylate cyclase enzyme which regulates neurotransmitters
      - Bone & Teeth
        
        Needed for the action of vitamin D and production of parathyroid hormone
        
        Helps hold calcium in teeth reducing dental caries
        
        Mineral crystal of bone, can replace calcium in hydroxyapatite
      - Acts as vasodilator which protects against hypertension
    - - People at risk
        
        People who have been heavily sweating for a long time
        
        Prolonged vomiting, diarrhea, use of diuretics
        
        People with renal disease, alcoholism
      - Symptoms
        
        Irregular heart beat
        
        Weakness
        
        Disorientation
        
        Irritability
        
        Hypertension
        
        Tetany (involuntary muscle contractions)
        
        Only seen during extreme deficiency
    - - No known toxicity of magnesium
    - - Plant sources
        
        Leafy green vegetables (boiled)
        
        Spinach
        
        Broccoli
        
        Whole grains
        
        Red legumes, beans, tofu
        
        Nuts & seeds
        
        Red bell peppers
        
        Tomatoes
      - Animal sources
        
        Milk
        
        Yogurt
        
        Halibut
      - Hard water sources
        
        Found in the Prairies
  - - - Primary role
        
        Strength and rigidity to bone as in hydroxyapatite crystals
      - Other roles
        
        Blood and Tissue Phosphorus
        
        PO43- is a buffer in the blood
        
        P or PO43- required in phospholipids (cell membranes), lipoproteins, DNA, RNA, ATP
        
        Activating B-vitamin coenzymes
        
        Fluid balance
        
        Major intracellular anionic electrolyte; proper electrical and fluid balance
    - - Absorption increases because of
        
        Plant sources of phosphorus (phytic acid in legumes and some in whole grains)
        
        Vitamin D
      - Absorption decreases because of
        
        Wide availability of phosphorus in the diet makes it less of a dietary concern than calcium
        
        Taking supplements can out compete phosphorous
    - - Is unlikely in North America because it is plentiful in diet
    - - Milk and Milk products
      - Soft drinks (~75 mg/335 mL)
      - Legumes, cereal, bran, nuts
      - Animal protein foods: meat, fish, poultry
    - - Most common mineral crystal that deposits onto the protein matrix to add strength
    - - Stronger crystal structure
- - - - Hormone-action (endogenous or internal source)
        
        Acts as a hormone when skin is exposed to sun (in the summer in Vancouver)
        
        7-dehydrocholesterol in subcutaneous fat layer converted to pre-vitamin D3
        
        Heat from the body produces calciol
        
        Hydroxylated in the liver to Calcidiol
        
        Hydroxylation in the kidneys to calcitriol (active)
        
        Factors affecting endogenous synthesis
        
        SPF greater or equal to 8 (blocks synthesis)
        
        Exposure time: hands and face, 5-10 minutes, 2-3 times/week
        
        Skin colour
        
        Time of day of exposure
        
        Distance from equator
        
        Latitude: ~May to September synthesis in Vancouver, only ~6months/year
        
        Age
        
        Pollution
      - Vitamin action (exogenous/dietary source)
        
        Dietary vitamin D is in pro-vitamin (inactive)
        
        Must be activated in the liver and kidneys to form active calcitriol (active)
        
        Milk
        
        Liver
        
        Egg yolks
        
        Dark green vegetables
        
        Fortified plant-based milks
    - - Primary role
        
        Regulation of blood calcium and bone mineralization
        
        Calcitriol increases blood calcium levels when low
      - Other important role
        
        Maturity of immune cells
    - - Major site of action
        
        Bone: activates osteoclast cells to release calcium from bone into blood
        
        Kidneys: decreases calcium excretion
        
        Intestines: increases calcium absorption
    - - Children: Rickets disease
        
        Clinical signs
        
        Improper mineralization and shaping of bones during formation
        
        Leg bones bend out “bowed legs” when infant starts walking
        
        “Knock-knees”
        
        Malformed ribs (rachitic rosary)
      - Adults: Osteomalacia ("soft bones") disease
        
        Clinical signs
        
        Osteoid: protein matrix secreted by osteoblasts into which minerals are deposited to form bone
        
        Osteoid doesn’t mineralize properly and accumulates, making bone soft and flexible, but not rigid
        
        Progressive weakness with increasing pain in lower back and legs
    - - Most likely cause
        
        Supplement use
        
        From intakes of 250 µg/day over several months
      - Consequences
        
        Hypercalcemia (high blood calcium levels)
        
        Calcium deposits into soft tissues like kidneys, heart, arteries
        
        Can cause irreversible damage to organs
    - - Animal sources
        
        Liver
        
        Fish oils
        
        Fatty fish
        
        Egg yolks
      - Fortified foods
        
        Orange juice
        
        Supplements (fish oil supplements); can contain very high levels of vitamin D and A
        
        Margarine
        
        Yogurt
        
        Fortified milk
    - - Adults over age 50
        
        Advised to take 400 IU (10 µg) of vitamin D daily in addition to diet consumption
      - Calcium (with vitamin D) supplements advisable for people not consuming milk and milk products
    - - Low vitamin D decreases calcium absorption
  - - - Calcium Mineralization of Bone
        
        Osteoblasts require vitamin K to produce osteocalcin which promotes calcium mineralization
      - Blood Clotting
        
        Multiple proteins used to build fibrin clot require vitamin K for synthesis
        
        Thrombin
        
        Prothrombin
    - - Rare
        
        Adults
        
        With fat malabsorption conditions
        
        Crohn’s cystic fibrosis, AIDS
        
        Overuse of antibiotics prohibits bacterial synthesis of vitamin K by the body
      - At risk
        
        Infants
        
        Breast milk has low levels of vitamin K
        
        No vitamin K synthesis at birth (sterile gut)
        
        Not enough endogenous synthesis by bacteria (low levels of gut bacteria)
    - - Rare because Vitamin K is nontoxic
        
        There is a wide range of safe intake levels
      - Symptoms
        
        Red blood cell Hemolysis
        
        Brain damage
        
        Lack of oxygen to the brain by RBC’s
        
        Anemia
        
        Jaundice
        
        Yellow skin due to excess bilirubin in blood stream from breaking down RBC’s
        
        Partial hindrance of anti-coagulant medication
    - - Plant
        
        Leafy green vegetables
        
        Brussel sprouts
        
        Kale
        
        Spinach
        
        Broccoli
        
        Avocado
        
        Cauliflower
        
        Cabbage
      - Animal
        
        Liver
        
        Eggs
        
        Cows milk
      - Non-food
        
        Bacterial synthesis in large intestine
- - - - Animal sources
        
        Seafood
        
        Shellfish
        
        Fish (sardines)
        
        Seaweed
      - Plant sources
        
        Brewed tea
      - Non-food
        
        Mouthwash
        
        Chewing gum
        
        Toothpaste
    - - People at risk
        
        People who live in areas with low fluoride levels in water
        
        May lead to increased risk of dental caries
        
        Causes inability to chew
    - - Symptoms
        
        White specks or brown streaks on teeth
        
        Abnormal hardening of the skeleton
        
        Brittle bones, osteoporosis
        
        Stiffness and pain in joints
      - People at risk
        
        Children ingesting large amounts of toothpaste, or given excessive fluoride drops
    - - Major role: Bone and Teeth Mineralization
        
        Forms fluorapatite
        
        Which is needed for bone and teeth mineralization
        
        Resistant to decay from acid erosion
        
        Fluoride intake is most effective before teeth erupt through gums
        
        20th week of pregnancy: baby teeth forming
        
        8-10 years old: wisdom teeth forming
        
        3-4 years old: permanent teeth forming
        
        Dental problems can contribute to inability to chew properly and to consume a wide variety of foods
- - - - Provides strength and rigidity
    - - Provides flexibility
  - - - Ivory-like, very dense, strong
      - In ~80% of skeleton
        
        Outer surface of all bones
      - Slow turnover
      - Less sensitive to mineral loss and fractures
      - Small bones
    - - Lace like, less dense, dynamic
      - Sensitive to hormone that regulate blood calcium
      - In ~20% of skeleton
        
        End of long bones
        
        Spinal vertebrae
        
        Flat bones
        
        Pelvis bones
  - - - Hydroxyapatite
        
        Deposited onto protein collagen matrix to strengthen
  - - - Non-invasive, painless, relatively quick
      - Very low x-ray energy scan
      - Scans entire body or specific area
      - Generates T-score
        
        Compares with healthy 30-year old of same gender and race
      - Used because of high accuracy and shows bone mineral density
    - - Sound waves used to measure bone density
      - Non-invasive, painless; screening, no diagnostic use
      - Often use the heel
    - - X-rays measure bone density in heel, wrist, and finger
      - Non-invasive, painless; screening, no diagnostic use
  - - - Lowers blood calcium levels
        
        Inhibits activation of vitamin D
        
        Prevents calcium reabsorption in kidneys
        
        Limits calcium absorption in intestines
        
        Inhibits osteoclast cells from breaking down bone
        
        Prevents release of calcium
      - Secreted from thyroid gland
    - - Osteoclast cells: release calcium from bone into blood
      - Intestines: increased calcium absorption
      - Kidneys: decrease calcium excretion
    - - Both
        
        Stimulate calcium reabsorption in kidneys
        
        Stimulate osteoclast cells to break down bone
        
        Release calcium into blood
        
        Raise blood calcium levels
      - Secreted from parathyroid gland
        
        Stimulates activation of vitamin D