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Bone Health - Coggle Diagram

- - - - Minerals
    - - Collagen Matrix
  - - - Modelling
        
        Bones take on a shape
      - Remodelling
        
        Bone is broken down and reformed at all times
        
        Osteoclasts maintain activity while osteoblasts lose activity
        
        Osteoclasts break down old bone where new bone is built
        
        Bone is built in locations of physical stress
      - Growth
        
        Osteoblast (bone building) cells are more active
        
        Net gain of bone
        
        Increase in bone size and length
    - - Deposited onto collagen matrix of bone
      - Ca10[PO4 3-]6[OH]2
  - - - Dual energy x-ray absorptiometry
      - Measures bone density for specific areas and/or entire body
      - T scores generated indicate bone density
        
        T score of -1 to 2.5
        
        Osteopenia
        
        Increased risk of fracture
        
        Low bone mass
        
        T score of > -2.5
        
        Osteoporosis
        
        Causes increased risk of fracture and bone fragility
        
        Multiple factors increase risk
        
        Age
        
        Bone density and strength decreases with age
        
        Osteoclasts become more active and osteoblasts become less active
        
        Menopause at 40 years or older
        
        1 more item...
        
        Pressures to be thinner can cause malnutrition at ages where bone density needs to be maximized
        
        Genetics
        
        Bone growth, bone loss, and peak bone mass is hereditary
        
        African genes cause denser bones than Caucasian genes
        
        Habits
        
        Physical activity
        
        2 more items...
        
        Smoking
        
        2 more items...
        
        Alcohol use
        
        3 more items...
        
        Gender
        
        Females are twice as likely to have osteoporosis
        
        Females live longer than men, so more bone loss occurs the longer they live
        
        Hormones
        
        Decrease in testosterone related to fractures
        
        Bone loss sped up during menopause because of drop in estrogen
        
        Nutrients
        
        Every gram of protein over the RDA causes 1-2 mg of Calcium to be excreted
        
        2 grams of Sodium intake causes 40 mg of Calcium to be excreted
        
        1 cup of coffee causes 2-2 mg of Calcium to be excreted
        
        Harm prevented by maximizing bone mass at younger ages
        
        Prevention
        
        Estrogen therapy
        
        Vitamin D therapy
        
        Calcitonin Therapy
        
        Biphosphonate Therapy
        
        Physical activity
        
        Naturally occurring
        
        Characterized by decrease in bone density
        
        T score of +1 to -1
        
        Normal
    - - Uses sound waves to measure bone density
      - Non-diagnostic
      - Usually measures bone density of the heel
    - - Peripheral dual energy x-ray absortiometry
      - Measures bone density of the heel, wrist and finger
      - Non-diagnostic
  - - - Location
        
        Outside surface of every bone
        
        Small bones
      - Slow turnover
      - Dense and strong
      - 80% of skeleton
    - - Location
        
        Spinal vertebrae
        
        At the end of long bones
        
        Inside flat bones
        
        Pelvis bones
      - Dynamic
      - Sensitive to blood Calcium regulating hormones
      - 20% of Skeleton
      - Contains protein matrix / osteoid
        
        Allows for flexibility
  - - - Contains cartilage, connective tissue and nerves in osteoid
      - Produces WBC, RBC and platelets in the bone marrow
    - - Attached to muscles, act as leverage for muscles
      - Protects and positions organs
      - Provides the body support and shape
  - - - Vitamin D
      - Vitamin K
    - - Calcium
      - Phosphorous
      - Magnesium
      - Fluoride
- - - - Essential for hydroxyapatite
    - - Neuromuscular
        
        After nerve transmission, Calcium enters muscle cells and causes contraction
        
        After muscle contraction, Calcium leaves muscle cells and causes relaxation
      - Blood
        
        Necessary for forming blood clots
        
        1000 mg per day prevents hypertension
    - - Decreased by
        
        Magnesium and Phosphorous supplements
        
        Calcium supplements > 500 mg
        
        Diets with >50 grams of fibre per day
        
        Abnormally high fat intake
        
        Phytic acid
        
        Oxalic acid
        
        Polyphenols
        
        Coffee
        
        Tea
        
        Menopause
        
        Old age
      - Increased by
        
        Active Vitamin D
        
        Present in intestinal cells
        
        Estrogen increases it's synthesis
        
        Lactose
        
        Lower intake
        
        Pregnancy
        
        Childhood years
      - Absorbed in the Duodenum
    - - Health effects
    - - Effects
      - Cause
        
        Hyperparathydroidism
        
        Caused by overproduction and secretion of parathyroid hormone
        
        Causes kidneys to retain Calcium in the blood
        
        Causes bones to release Calcium in the blood
      - Who is most affected
        
        People who have kidney disease
    - - Fortified plant milks
      - Skim milk
      - Milk products except cottage cheese
      - Milk
      - Low Calcium with high bioavailability
        
        Cauliflower
        
        Bok choy
        
        Watercress
      - High Calcium with low bioavailability
    - - Active Vitamin D Increases Calcium absorption in the intestine
    - - Calcium, Fluoride and Phosphorous form fluorapatite
        
        Ca10[PO4 3-]6FOH
        
        More resistant to acid erosion
    - - Max absorption ~500-600mg per dose
  - - - Essential for hydroxyapatite
        
        Hydroxyapatite
        
        Adds strength to bones by depositing onto the collagen protein matrix
        
        The most common mineral crystal
        
        Adds rigidity to bones
        
        85% of Phosphorous is found in hydroxyapatite
    - - Increased by
        
        Vitamin D
      - Decreased by
      - ~60-90% is absorbed
    - - Fluid balance
        
        Anionic electrolyte in ICF
      - Buffer in blood in the form of the Phosphate ion
      - Required in important cellular machinery
        
        Phospholipids
        
        Lipoproteins
        
        DNA
        
        RNA
        
        ATP
        
        Phosphate groups in ATP stabilized by Magnesium
      - Activates B-Vitamin coenzymes
    - - Unlikely with a healthy diet that has variety and balance
        
        2nd most abundant mineral in the body
    - - In the form of phytic acid
        
        Legumes
        
        Whole grains
      - Plants
        
        Broccoli
        
        Sunflower seeds
        
        Oatmeal
      - Animals
        
        Coho salmon
        
        Cheddar cheese
    - - Vitamin D enhances absorption of Phosphorous
    - - Magnesium and Phosphorous in supplement form decreases Calcium absorption
    - - Can limit the maximization of bone density with low Calcium intake
        
        Higher risk in teens
        
        Soda pops contain high phosphorous
    - - Combines with calcium to form hydroxyapatite
  - - - Roles in bones
        
        Can replace the Calcium in hydroxyapatite
        
        Supports holding Calcium in teeth, reducing dental caries
        
        Required for Vitamin D action and parathyroid hormone
        
        Affects Calcium balance
      - Roles in blood and tissue
        
        Provides stability phosphate groups in ATP
        
        Neuromuscular
        
        Neurotransmitter activity needs Magnesium
        
        Muscle contraction is inhibited by Magnesium
        
        Inhibits blood clotting
        
        Needed for DNA, protein, and fat synthesis
        
        Prevents high blood pressure
        
        Can lower heart disease rates
    - - Risks
        
        Heavy sweating
        
        Liver disease
        
        Often caused by alcoholism
        
        Extended vomiting, diarrhea, diuretic use
        
        high fibre diet inhibits absorption
      - Symptoms
        
        High blood pressure
        
        Irregular heart beat
        
        Weakness
        
        Irritability
        
        Severity is rare for healthy people
        
        Tetany
    - - No known toxicity
    - - Animals
        
        Milk
        
        Yogurt
        
        Halibut
      - Plants
        
        Whole grains
        
        Legumes
        
        Tofu
        
        Nuts
        
        Seeds
        
        Hard water
        
        Inside chlorophyl
    - - Calcium in supplement form interferes with Magnesium absorption
      - Magnesium Blocks the Calcium Ion Channel
- - - - Bone
        
        Activates osteoclasts to release bone calcium into the blood
      - Kidneys
        
        Reduces excretion of Calcium in urine
      - Intestines
        
        Calcitriol Increases absorption of Calcium
  - - - Too much parathyroid hormone raises blood calcium by forcing kidneys to conserve it and bones to release it.
  - - - Less Calcium leaves the bone and enters blood
- - - - Regulation of blood calcium and bone mineralization
      - Maturity of immune cells
    - - Consequences
        
        Children
        
        Rickets
        
        Improper mineralization and shaping of bones during formation
        
        Adults
        
        Osteomalacia (soft bones)
        
        Osteoid does not mineralize properly and accumulates, making bone soft and flexible
      - Clinical signs
        
        Bone Pain
        
        Mucsle weakness or cramps
        
        Frequent fractures
        
        Delayed wound healing
    - - Cause
        
        Supplement use
        
        Tablets, softgels, liquid
        
        Adults over age 50 should take 400IU (10μg) daily in addition to regular diet
      - Health effects
        
        Hypercalcemia
        
        High blood calcium levels
        
        Calcium deposits into soft tissue
        
        Irreversible damage to organs (ex. kidneys, heart, arteries)
      - Who is most affected
        
        Children
        
        Infants who are supplemented with Vitamin D by their parents
    - - Endogenous (internal) synthesis
        
        In the skin
        
        UV light from the sun
        
        From the diet
        
        Plants
        
        Fortified plant-based milks
        
        Dark green vegetables
        
        Animals
        
        Fatty Fish
        
        Fish oils
        
        Liver
        
        Egg yolks
      - Exogenous
        
        Hydroxylated in the liver and then kidneys to become active (Calcitriol)
  - - - Blood clotting
        
        4 of the proteins required for fibrin clots require Vitamin K for synthesis
      - Calcium mineralization of bone
        
        Needed for osteoblasts to produce osteocalcin
    - - Infants don't have Vitamin K synthesis at birth
      - May be seen in adults due to antibiotic use
      - Excessive intakes of Vitamin E impairs the role of Vitamin K in blood clotting
    - - Rare
      - Coagulation effects can hinder effects of anti-coagulent medications
      - Red blood cell hemolysis
      - Jaundice
      - Brain damage
    - - Bacterial synthesis in large intestine
      - Plants
        
        Leafy greens
      - Animals
        
        Liver
        
        Eggs
    - - Activates osteocalcin (protein in the bone)
        
        Osteocalcin binds calcium to the bone matrix
- - - - In the 20th week of pregnancy
        
        Before baby teeth erupt
      - When child is 8-10 years old
        
        Before wisdom teeth erupt
      - When child is 3-4 years old
        
        Before permanent teeth erupt
      - In times of bone and teeth development
    - - For Children
        
        Strengthens developing teeth
      - For Adults
        
        Remineralizes enamel lesions
        
        Protects tooth enamel from acid
        
        Antimicrobial and protective
    - - Who is at risk
        
        People who only drink bottled water
        
        People with poor teeth brushing habits
        
        People in areas without fluoridated water
        
        Elderly & people with dry mouth
      - Higher risk of dental caries
        
        Worsens ability to chew
    - - Fluorosis
        
        Dental
        
        White spots or brown streaks on teeth
        
        Permanent discolouration
        
        Increased resistance to tooth decay
        
        Skeletal
        
        Unusual hardening of skeleton
        
        Increased brittleness of bones
        
        May cause osteoporosis
        
        Joint stiffness and pain
      - Often caused when children ingest greater quantities of toothpaste
    - - Seafood
        
        Shellfish
        
        Sardines
        
        Fish
      - Plants
        
        Seaweed
        
        Brewed tea
      - Dental products
        
        Toothpaste
        
        Mouthwash
      - Chewing gum
      - Tap water in many areas
    - - Can replace one OH component in hydroxyapatite
        
        Forms fluorapatite
      - Can prevent dental caries