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Bone Health, bone loss can be prevented with therapies such as, Calcium…

- - - - Calcitonin: Secreted by thyroid gland; decreases osteoclast activity, reducing calcium release from bones.
      - Parathyroid Hormone: Levels fall, leading to increased urinary calcium excretion.
      - Calcitriol: Levels fall, reducing calcium absorption.
    - - calcitriol, parathyroid hormone, and calcitonin hormones
        
        Calcium Release: Intestine absorption, kidney conservation, bone release (osteoclast action).
        
        Calcitriol (Vitamin D): Activated in kidneys by PTH; increases calcium absorption in intestines; conserves calcium in kidneys; releases calcium from bones via osteoclasts.
        
        Parathyroid Hormone (PTH): Secreted by parathyroid glands; stimulates final activation of Vitamin D (Calcitriol) in kidneys; acts on osteoclasts to release calcium from bones.
- - - - Calcium
        
        other non-bone roles
        
        Nerve transmission/ Muscle contraction
        
        Action potential travels along nerve cell to muscle.
        
        Opens calcium ion channels, allowing Ca²⁺ to flow into muscle cells.
        
        Calcium influx triggers muscle contraction.
        
        High calcium levels can lead to rigour (muscles do not relax).
        
        Low calcium levels in muscle cells can cause tetany (spasmodic relaxation).
        
        blood clotting
        
        Calcium is essential for the synthesis of fibrin to form a blood clot.
        
        Combines with thromboplastin and blood platelets.
        
        Vitamin K is required for several early precursors in the clotting process.
        
        Prothrombin (inactive) is converted to thrombin (active enzyme).
        
        Thrombin converts fibrinogen (soluble) into fibrin (solid clot).
        
        Hypertension
        
        inverse relationship appears to exist when intakes of Calcium are ≥1000mg/day
        
        DASH diet – low fat, high fibre, low fat dairy, moderate sodium, adequate calcium – decreases hypertension
        
        primary role
        
        Bone formation and maintenance
        
        calcium absorption increased through
        
        Duodenum: Acidic environment enhances calcium solubility and absorption.
        
        Vitamin D-Rich Foods: Fatty fish, egg yolks, and fortified foods enhance calcium absorption.
        
        Estrogen-Supportive Foods: Soy products (phytoestrogens) may help increase calcium absorption.
        
        Lactose: Dairy products improve calcium absorption.
        
        Balanced Calcium Intake: Moderate calcium intake (not excessively high) leads to better absorption efficiency.
        
        calcium absorption decreased through
        
        High-Fiber Foods: Excess fiber (>50g/day) from whole grains and legumes can hinder absorption.
        
        Phytic Acid: Found in whole grains and legumes; inhibits calcium absorption.
        
        Oxalic Acid: Present in vegetables like spinach and rhubarb; binds calcium, reducing its absorption.
        
        High-Fat Foods: Can lead to fat malabsorption, hindering calcium uptake.
        
        Polyphenol-Rich Foods: Tea and coffee can reduce calcium absorption.
        
        Excessive Phosphorus-Rich Foods: High phosphorus foods (e.g., red meat, poultry, and processed foods) can interfere with calcium absorption.
        
        deficiency
        
        lead to
        
        Osteoporosis
        
        which is
        
        a naturally occurring degenerative bone disease
        
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        Hypertension
        
        Tetany
        
        individuals at risk are
        
        Postmenopausal women
        
        Estrogen loss accelerates bone resorption
        
        older adults
        
        Insufficient dietary sources lead to low body stores
        
        Individuals with Low Vitamin D Intake
        
        Impaired calcium absorption due to lack of vitamin D
        
        Individuals with Eating Disorders
        
        Poor nutrition affects bone health
        
        Smokers and Heavy Drinkers
        
        has negative impact on bone density and calcium metabolism
        
        People with High-Fiber or High-Phytate Diets
        
        Interfere with calcium absorption
        
        Prevalence in North America is
        
        Fairly common
        
        interactions with other nutrients are
        
        excess Sodium Caffeine, and Protein intake can cause
        urinary loss of Calcium from body
        
        decreases absorption
        
        vitamin D
        
        estrogen
        
        calcitonin (e.g., Miacalcin)
        
        Bisphosphonate (e.g., alendronate–Fosamax, risedronate–Actonel)
        
        increases absorption.
        
        toxicity affects/ leads to
        
        Hypercalcemia
        
        causes
        
        Elevated blood and urinary calcium levels
        
        causes
        
        Calcium deposits in soft tissues including
        
        Heart
        
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        Arteries
        
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        Organ Damage
        
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        Kidneys
        
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        Hyperparathyroidism
        
        causing
        
        over-abundant production and secretion of parathyroid hormone
        
        causes kidneys to conserve calcium in blood
        
        causes bone to release calcium into blood
        
        individuals at risk are
        
        those with kidney disease
        
        rich in food sources such as
        
        Dairy
        
        eg : cheddar cheese, yogurt
        
        fortified plant-based milks
        
        eg : almond milk, rice milk
        
        leafy greens.
        
        eg : broccoli, cabbage
        
        Seafood
        
        eg : sardines, tuna
        
        supplementation of Calcium and Vitamin D
        
        is advisable for
        
        those at risk of deficiency or inadequate dietary intake
    - - Phosphorus
        
        have various roles which are
        
        Primary Role
        
        Formation of hydroxyapatite in bones.
        
        Other Roles
        
        Fluid Balance (ATP)
        
        major intracellular anionic electrolyte; proper electrical and fluid balance
        
        cellular function
        
        required in phospholipids (cell membranes), lipoproteins, DNA, RNA, ATP, and for activating B-vitamin coenzymes
        
        Acts as a buffer in the blood
        
        interactions with other nutrients are
        
        Increase Phosphorus Absorption:
        
        Vitamin D-Rich Foods: Same foods that boost calcium absorption also enhance phosphorus absorption.
        
        Protein-Rich Foods: Meat, dairy, and nuts contain high levels of phosphorus that are easily absorbed.
        
        Moderate Calcium Intake: Helps in balanced absorption of both calcium and phosphorus.
        
        Decrease Phosphorus Absorption:
        
        High-Fiber Diets: Similar to calcium, high fiber can reduce phosphorus absorption.
        
        Excessive Calcium Intake: Can bind phosphorus in the gut, reducing its absorption.
        
        deficiency
        
        prevelance in North America is
        
        Rare
        
        because
        
        phosphorus is abundant in many foods.
        
        may lead to
        
        neuromuscular, skeletal, hematological and renal malfunctioning
        
        rich in food sources such as
        
        Meat
        
        eg: ground beef, chicken breast
        
        Dairy
        
        eg : egg, cheddar cheese
        
        nuts
        
        eg : brazil nuts, almonds
        
        Whole grains
        
        eg : oatmeal, whole wheat bread
        
        Vitamin D increases the absorption of phosphorus in the intestines, essential for bone health and metabolic functions.
        
        toxicity
        
        leads to
        
        Compromise of maximizing peak bone density with high phosphorus (soda pop) and low calcium intake (in teens)
  - - - Vitamin D
        
        unique from other nutrients due to 2 different sources
        due to
        
        Hormone action – endogenous source
        
        vitamin D acts as a hormone when skin is exposed to sun; forms into calcitriol
        
        Vitamin-action (exogenous or dietary source)
        
        when consumed in the diet, vitamin D is in a pro-vitamin (inactive) form and must be activated in the liver and kidneys to form active CALCITRIOL
        
        3 major sites of action for calcitriol are
        
        Intestines (increases calcium absorption)
        
        bones (promotes resorption; OSTEOCLAST cells cause bone to release Calcium into blood)
        
        kidneys (reduces excretion; conserves calcium).
        
        CALCITRIOL is the active form of vitamin D
        
        factors that affect vitamin D synthesis are
        
        Sun exposure
        
        skin color
        
        Age
        
        distance from equator
        
        SPF³8
        
        time of day of exposure
        
        functions are
        
        Primary Role
        
        regulates blood calcium and bone metabolism
        
        Another Role
        
        Immune Function
        
        calcitriol is associated with maturation of immune cells
        
        consequences of deficiency
        
        In Children is
        
        Rickets
        
        causes
        
        Poor bone mineralization and shaping.
        
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        In Adults is
        
        Osteomalacia
        
        causes
        
        Improper mineralization of the osteoid protein matrix, leading to soft and weak bones.
        
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        causes of toxicity
        
        Excessive supplementation
        
        particularly at high doses (e.g., 250 μg/day or 10,000 IU/day).
        
        causes health consequences like
        
        Hypercalcemia
        
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        Calcium Deposits (lead to calcification in soft tissues)
        
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        individuals at risk are
        
        infants given inappropriate amount of supplements by parents
        
        rich in sources such as
        
        sunlight
        
        fortified dairy
        
        eg : yogurt, cheese
        
        Fatty fish
        
        eg: Tuna, Salmon
    - - Vitamin K
        
        Vitamin K is necessary for calcium binding in bones, aiding in proper bone formation and mineralization.
        
        functions are
        
        Calcium Mineralization in Bone Matrix
        
        vitamin K needed by osteoblasts to synthesize OSTEOCALCIN,
        
        a calcium-binding protein that deposits. the minerals into the collagen protein matrix of bone and is therefore needed for normal bone formation
        
        Blood clotting
        
        vitamin K necessary for proteins in the production of fibrin, a blood clotting protein
        
        Vitamin K Toxicity
        
        May lead to Red Blood Cell (RBC) hemolysis.
        
        Can cause jaundice.
        
        Potentially leads to brain damage.
        
        The toxicity of vitamin K is rare, vitamin K from food sources considered non-toxic. However, excessive vitamin K can hinder effects of anticoagulant drugs (e.g., Warfarin). symptoms: RBC hemolysis, jaundice, brain damage
        
        Can hinder the effects of anticoagulant drugs like Warfarin.
        
        rich in food sources such as
        
        eg : leafy green vegetables, liver, egg, milk, peas, broccoli, green beans are rich in vitamin K
        
        non- food source of vitamin K
        
        endogenous (internal) source – through bacterial synthesis in the GI tract
        
        Vitamin K deficiency
        
        individuals at risk are
        
        Infants-low levels at birth; low levels in breast milk
        
        adults- due to antibiotic use, individuals with fat malabsorption disorders, especially if taking antibiotics and excessive vitamin E intake can impair the role of vitamin K in blood clotting
        
        The toxicity of vitamin K is rare, vitamin K from food sources considered non-toxic. However, excessive vitamin K can hinder effects of anticoagulant drugs (e.g., Warfarin). symptoms: RBC hemolysis, jaundice, brain damage
  - - - Fluoride
        
        consequences of deficiency
        
        caused by
        
        low Fluoride in water supply can lead to an increased risk of dental caries
        
        leads to
        
        inability to chew properly and consume a wide variety of foods
        
        consequences of toxicity
        
        fluorosis
        
        individuals at risk are
        
        children consuming large amounts of toothpaste or given excessive fluoride drops
        
        leads to
        
        white specks, mottling, or brown streaks on teeth
        
        fluorosis in skeleton causes abnormal hardening of the skeleton making bones more brittle
        
        may lead to osteoporosis; also, can cause stiffness and pain in joints
        
        primary roles
        
        Fluoride replaces hydroxyl group in hydroxyapatite crystals found in bone and teeth to create FLUORAPATITE
        
        leads to stronger crystals in bones and teeth
        
        Fluoride taken during youth leads to increased bone crystal strength
        
        Provide more resistant for bone and teeth to decay from acid erosion
        
        major role in health
        
        Fluoride is best taken during time of bone and teeth development
        
        moderate Fluoride intake can reduce risk for the formation of dental caries, especially during teeth development before the teeth erupt through the gums
        
        thought to be most effective Before teeth erupt through the gums
        
        topical treatment as adults helps protect against dental caries
        
        Fluoride is antimicrobial and helps fill in surface micro-lesions
        
        rich in food sources such as
        
        Brewed tea
        
        Eg: oolong tea, green tea
        
        Water (not usually bottled water)
        
        eg : spring water, well water
        
        Seafood
        
        Eg : seaweed, Shellfish
- - - - Cortical (dense, outer layer, slow turnover)
        
        80% of entire skeleton
        
        Healthy cortical bone constituents are
        
        Ivory-like and very dense; most of small bones & outer surface of long bones; slow
        turnover; ~80% of entire skeleton
      - trabecular (spongy, inner layer,dynamic)
        
        20% of skeleton
        
        Healthy trabecular bone constituents are
        
        protein matrix (osteoid)
        provides flexibility
        
        mineral crystals deposited onto PRO matrix provide strength
        
        lace-like in texture; ~20% of skeleton; very dynamic; ends of long bones, spinal vertebrae, pelvis, ribs...
        
        sensitive to hormones that regulate deposits and withdrawals of Calcium into and from bone
- - - - during periods of growth, osteoblast cells (bone building cells) are more active than osteoclast cells (bone crumbling
        cells) = net gain in bone
        
        during adult years, osteoblast cells lose activity while
        osteoclast cells remain active
  - - - bone growth – size and length
      - bone modelling – shape (e.g., ribs, femur)
      - bone remodelling – density, involves resorption & formation
- - - - very low x-ray energy scan
      - non-invasive, painless, relatively quick
      - diagnoses Osteopenia
      - predicts fracture risk
      - diagnoses osteoporosis
    - - +1 to –1 – normal
      - –1 to –2.5 – osteopenia, low bone mass, increased risk of fracture
      - more negative than –2.5 – osteoporosis, increased risk of fracture
- - - - Mg needed for the mineral crystal structure in bone
      - can replace Calcium in hydroxyapatite.
    - - Mg needed for neurotransmitter activity
      - Mg inhibits muscle contraction (antagonist to Calcium)
  - - - irregular heartbeat,
      - loss of appetite,
      - weakness disorientation,
      - hypertension.
    - - when heavy perspiration over a long time
      - prolonged vomiting and/or diarrhea
      - prolonged use of diuretics
      - kidney disease
      - alcoholism
  - - - nuts, whole grains, leafy green vegetables
  - - - indirect effect on calcium balance because Mg is needed for the action of the calcium-regulating,
    - - And phosphorus functions inside the cells as part of very high energy phosphate bonds(ATP), magnesium function as Stabilizes High Energy Phosphate Bonds (ATP)
        
        Our body forms bones with calcium after regulating, ( which the absorb part of calcium) and Stabilized phosphorus.