NTR315 Exam 3 Osteoporosis/ Osteopenia

Warning signs of osteoporosis

- any fracture after age 50 - loss of height - back pain - dowager's back (kyphosis) - bone density test t score below -2.5

Risk of mortality within one year with hip fracture at age 90

> 90= 66/129 51% pg 15

Nutrient intake for bone health

A diet that consists of whole foods like whole grains, fruits and vegetables, legumes, nuts, seeds, lean meats and dairy can supply the nutrients needed to maintain bone health and minimize bone loss.

Lifestyle and bone health o Diet -Minerals, vitamins

An adequate, balance, varied diet also contributes significantly to minimizing bone loss.

Medications that Decrease Risk of Fracture a. Anti-resorptive - action of drugs (ex. Estrogen) b. Anabolic - action of drugs

Anti-resorptive • A variety of different drugs in this category exist, and their primary action is to decrease osteoclast activity, thus reducing bone loss. Estrogen is an example of an anti-resorptive drug. These drugs are used in patients who have a T-score of less than -2.5. Side effects vary with the type of medication that is used, so it is important to discuss which drug is most appropriate with your physician. Anabolic • Drugs in this class act to stimulate the number and activity osteoblasts to build new bone. The long term safety of these drugs is still unclear, so these drugs are used short term, less than 2 years, and on patients who have advanced osteoporosis.

T-score - know what it is and how to read it, T-score for osteopenia and osteoporosis - DEXA/DXA scan

DEXA measures spine, and hip bone density (exposure to radiation is 10% to that of chest X-ray. Bone density measured as T - score* * T-score is the number of standard deviation above or below the bone mass of a 30 year old (same sex and race) t score between -1 and 0 is normal bone density t score between -1 and -2.5 is low bone density (osteopenia) t score of -2.5 and below is osteoporosis For every decrease in 1 standard deviation of T- score there is 1.5 - 3 times risk of fracture increase.

Osteoblasts and osteoclast activity over the life span

During growth, the osteoblasts are predominantly active. This results in net bone deposition and growth. With age, osteoclast activity becomes predominant with more bone being removed than deposited. Over time, bone mass decreases.

Bone density through the life cycle

From birth to the mid-20s, there is active growth and deposition of bone. In the mid-twenties, peak bone mass is achieved and maintained until about 40 years of age. After 40, there is a progressive loss of bone mass, with women experiencing a more rapid and exaggerated bone loss than men during the period of menopausal transition

Risk factors for osteoporosis (non-modifiable, modifiable)

Non- modifiable pg.7: - Number 1 is aging, which is the strongest risk factor - Number 2 is being female. 1 in 2 women over 50 will experience an osteoporotic related fracture in their lifetime, whereas 1 in 4 men - The third risk factor is early menopause. When a woman experiences early menopause, she loses bone earlier and and for a longer period of time - The next risk factor is ethnicity. White and Asian females are more likely to develop osteoporosis than women of other ethnicities. - A person's genetics and family history also comes into play when considering risk of osteoporosis. A small-boned person is at higher risk than a larger boned person. And, a person who's mother has osteoporosis is at higher risk Modifiable pg 8: - lifestyle can impact body weight. Excessive dieting, or having too little body fat, as with athletes, increases risk of osteoporosis. Generally, a larger body has denser, stronger bones, but, in obese individuals there is mounting evidence that excess body fat may negatively affect bone quality - Physical activity is very important in developing bone strength during grown and maintaining bone mass during adulthood. A sedentary or inactive lifestyle can lead to bone loss - A lifelong adequate intake of calcium and other minerals, as well as vitamin D are also very important in bone health. - Cigarette smoking increase osteoporosis risk. Smokers tend to be of lower body weight, and the nicotine in smoke increases bone loss - Alcohol abuse heightens risk by increasing calcium losses from body and adversely interfering with vitamin D production in the body. - Some medications have a negative effect on bone mass, such as cortisone, thyroid hormone, GERD medication, antidepressants and anticoagulants to name a few.

Osteoporosis description and cause

Osteoporosis occurs when the bones become so porous that they are susceptible to fracture. The risk for developing osteoporosis in later years begins in childhood and adolescence

Protein - amount recommended by many researchers (Not the RDA) and type of protein that is optimal for bone health

Protein is the major component of bone matrix. Consuming adequate amounts of protein is associated with fewer fractures.

Weight bearing exercise

Regular exercise, in particular weight bearing exercise, stresses the bones and makes them stronger Weight bearing exercise like walking, jogging, dancing, sports such as tennis, weight lifting, yoga, and Tai Chi can improve balance, strengthen muscles and slow bone loss.

Bone remodeling (watch video on bone remodeling)

The process of bone remodeling is an extremely important one as it repairs fractures, removes old bone, and frees up calcium when the body needs it. The cells that are involved with bone remodeling are called osteoclasts and osteoblasts. Osteoclasts remove bone through the action acids and enzymes, and osteoblasts deposit a protein matrix to which calcium and phosphorus attach, thus creating new bone.

Effect of exercise on bone density

Weight bearing exercise like walking, jogging, dancing, sports such as tennis, weight lifting, yoga, and Tai Chi can improve balance, strengthen muscles and slow bone loss.

Recognize the importance of maximizing bone density during growth

When there is an inadequate intake of calcium, other bone building nutrients, and a lack of weight bearing activity during the growing years, suboptimal peak bone density results, thus increases risk of developing osteoporosis later in life

Possible negative effect on bone health - describe effect a. Sodium

a. One nutrient that may be detrimental to bone health in large amounts is sodium. Research has shown that high intakes of sodium increases excretion of calcium in urine. Whether increases of calcium loss in the urine is detrimental to bone health has not been conclusively determined. Minimizing processed foods in the diet can help lower sodium intake.

Positive effect - describe effect a. Calcium supplements - Types discussed in lecture, % calcium; benefits /risks (know DRI) b. Best calcium supplements to take depending on adequate stomach acid secretions c. Supplement with highest amount of calcium d. Vitamin D supplements / sun exposure - benefits / risks (know DRI) e. Vitamin C, Vitamin K (function, food sources) f. Potassium, magnesium, phosphorus, fluoride (recognize that these minerals are also important in bone health)

a. pg 18 Dietary sources that can help meet recommendations are dairy products, fortified soy products, sardines, some green veggies b. calcium carbonate is the recommended choice, however, in older individuals who have decreased stomach acid or take medication for acid reflux, absorption of this form of calcium may be reduced. c. Calcium carbonate is a good choice because it contains 40% calcium, which is the highest amount you can find in a supplement. d. Vitamin D increases absorption and retention of calcium and aids in bone mineralization. It also helps in maintaining muscle strength and decreases fall risk in the elderly. Vitamin D production from sun exposure decreases with age, so dietary sources and or a supplement is recommended. Dietary sources are dairy products (which is fortified), fatty fish, eggs, and mushrooms that have been exposed to ultraviolet light e. Vitamin C is important in bone matrix formation as it is required for collagen synthesis. Dietary sources are fruits and vegetables. - Vitamin K is involved in the synthesis of a protein, osteocalcin, which binds minerals in the bone. A portion of our vitamin K needs are met by production by bacteria in the colon, but dietary sources dietary sources are also needed to meet the RDA. Foods such as green leafy vegetables, vegetable oil, liver and milk provide vitamin K. f. Other key nutrients involved in bone health are phosphorus, magnesium, potassium, and vitamin A

Signs / symptoms of osteoporosis

know.

Bone loss before, during and after menopause - Estrogen's effect on bone cells

women experiencing an accelerated phase of bone loss as estrogen levels decrease during menopausal transition. Women can up to 20% of their bone mass during this period. After age 65, the rate of loss slows to about 1 percent per year. •As menopause approaches - loss of about 1% per year •after menopause increase bone loss of 2 - 6% per year for one - 5 years (can lose up to 20% of bone mass) •by 10th year bone loss slows to 1%. •After age 65 bone loss slows to less than 1% per year