CNS MNT review: Bone health and Osteoporosis

_____________stimulate production of acids & enzymes that dissolve minerals & proteins in bone (breakdown/remodeling)

Osteoclasts

is characterized by softening of bones caused by impaired mineralization

Osteomalacia

Uncommon, inherited condition characterized by bone deformity, increased bone turnover, and multiple fractures Interferes with body's normal recycling process, in which new bone tissue gradually replace old bone tissue Most commonly occurs in pelvis, skull, spine, legs Complication include broken bones, hearing loss and pinched nerves in spine

Paget's Disease

● Most prevalent form of arthritis that is not systemic or autoimmune. Multiple etiologies, not consequences of wear & tear but a progressive damage of articular cartridge as well as of bone remodeling ● Involves cartilage destruction with asymmetric inflammation caused by joint overuse resulting in loss of habitually weight-bearing, articular (joint) cartilage (allows bone to glide smoothly over one another). Most affected joints are distal interphalangeal joints, hips, ankles, spine. Elbows, wrists, ankles are less affected

Pathophysiology of osteoarthritis

-Raloxifene & Tamoxiphen (estrogen agonist/antagonist agents), -alendronate sodium, -risedronate sodium ,- zoledronic acids (bisphosphonates acts as inhibitors on osteoclasts to reduce bone resorption, shown to incidence of new fractures), --estrogen replacement therapy (ERT) Calcitonin-● to inhibit osteoclastic bone resorption by blocking the stimulatory effects of PTH on these cells. It is recommended only for women at least 5 years postmenopausal

Pharmacologic Treatment(s): for Osteoporosis

● Bisphosphonates are the mainstay of treatment (reduce pain and help regulate bon-building process to stimulate more bone growth) ● Injectable meds: Pamidronate, Zoledronate, Calcitonin (hormone)

Pharmacological medication for Paget

● interferes with calcium absorption or by actively promoting calcium loss from bone Aluminum-containing antacids, Corticosteroids, Cyclosporine, Heparin, Lasix and Thiazide Diuretics, Lithium, Methotrexate, Phenobarbital, Phenothiazine Derivatives, Phenytoin (Dilantin), PPIs, Thyroid Hormone, Tetracycline

Prolonged use of certain medications are a risk factor for osteoporosis because ________________

● 4-8 years 1000mg ● 9-19 years was raised to 1300 mg/d for both genders (including pregnant and lactating) ● 19-50- 1000mg ● Over 51-70 (1000 men, 1200 female) ● Over 71- 1200mg both genders

RDA for calcium

Associated Disorders of OA

Rheumatoid Arthritis, Gout, Charcot's Joints (refers to progressive degeneration of a weight bearing joint), Sciatica & Psoriatic Arthritis, Depression, Sleep Disturbances

being underweight, PPI use, loss of menses Studyforxyz CLINICAL INTERVENTION AND MONITORING

Risk factors for osteoporosis

● Age, especially older than 60 ● Calcium, Vitamin D3, protein, phosphate, Vit K, Magnesium, and other trace elements & vitamins are related to bone health ● Amenorrhea in woman as a result of excessive exercise, menopause, excessive weight loss in anorexia nervosa Androgen depletion with hypogonadism in men Cigarette Smoking & excessive alcohol intake Estrogen depletion form menopause or early oophorectomy (surgical removal of one or both ovaries ● Ethnicity- Hispanics, Asians & whites higher risk, blacks are at lower risk ● Excessive caffeine intake ● Female gender ● Family history of osteoporosis or parental history of hip fracture ● Lack of exercise Prolonged use of certain medications Sarcopenia ● Underweight, low BMI, low body fat mass

Risk factors for osteoporosis

Herbs/Supplements for OA

SAME-e, niacin, calcium & Vit D, Vit K, Vit C; Vit A & E, zinc, copper, boron (nutrient required for the synthesis of collagen & maintenance of normal cartilage structures), topical rubbing gels (anti-inflammatory) based on capsaicin, antioxidants nutrients, glucosamine, chondroitin, fish oil (EPA + DHA), avocado soybean unsaponifiables, bromelain, hyaluronic acid Curcumin, (Meriva, a special from bound to phosphatidylcholine to improve absorption) , Boswellia, Ginger, Procyanidolic Oligomers (berries, grapeseed, pine bark extract, Devil's claw)

Factors that affect Vit D synthesis

Skin tone, sunscreen used, environmental latitude (northern latitudes are at increased risk) and age (older, less efficient because skin is thinner, less exposure, increased body fat, decreased renal function that decreases the hydroxylation of Vit D to its active form due to decreased levels of insulin-like growth factor 1, calcitonin, and estrogen) affect rate of synthesis.

● The Institute of Medicine (IOM) recommends 1,000 mg/d Calcium (ages 19-50, >50 increase to 1200 mg/d) & 600 IU/D Vit D (up to age 70) and 800 IU after 70

Supplements for Paget

Generally, presents as pain that worsens with weight bearing & activity, and improves with rest. Patients often report morning stiffness or "gelling" of the affected joint after period of inactivity ● Loss of weight-bearing, articular (joint) cartilage can result in stiffness, pain, swelling, loss of motion, changes in joint shape, crunching feeling of bone on bone, abnormal bone growth which can result in osteophytes (bone spurs) ● Breakdown of articular (joint) cartilage, changes in joint shape, osteophytes/bone spurs, cartilage or bone fragments in synovial fluid

Symptoms of OA

● Most have no symptoms, but when they do occur, the most common complaint is bone pain (causes your body to generate new bone faster than normal which produces bone that is softer and weaker) ● Other symptoms include headaches, hearing loss, enlargement or bowing of bones, tingling or numbness

Symptoms of Paget

Supplements for Paget's

The Institute of Medicine (IOM) recommends 1,000 mg/d Calcium (ages 19-50, >50 increase to 1200 mg/d) & 600 IU/D Vit D (up to age 70) and 800 IU after 70

the NOF

The National Osteoporosis Foundation

bone remodeling

The continuous turnover of bone matrix and mineral that involves first, an increase in resorption and osteoclast activity, and later, reactive bone formation by osteoblast activity.

Involves provision of an adequate calcium intake (1200-2000 mg per day in divided doses, obtained from the diet plus supplements) and a vitamin D intake of 600-800 IU per day obtained from dairy products and supplements

The dietary component of osteoporosis treatment in osteoporosis

What does uncoupling of bone remodeling mean?

The uncoupling of bone remodeling explains why after peak bone mass is achieved, throughout the rest of the life cycle, bone mass declines. Normal bone remodeling involves first bone resorption and then bone formation. However, when uncoupling occurs, more resorption than formation occurs. This results in bone loss.

vitamin K

This vitamin is essential for bone health and its role in post-translational modification of several matrix proteins, including osteocalcin (serves as a bone marker for predicting future risk of fracture is being studied ), is well established

−________________e tissue loss is primarily responsible for bone fractures in later age.

Trabecular bone

− Cancellous bone tissue/Spongy bone): 20% of the skeleton, less dense than cortical bone, found in the "knobby ends" of long bones, the iliac crest of the pelvis, wrists, scapulae, vertebrae and the parts of the bone that line the marrow, resemble a sponge in appearance (interconnecting bony spicules), red marrow (where blood cells form), and yellow marrow (fat, for storage)

Trabecular tissue

True or False Higher acid diets may increase calcium excretion and have a detrimental effect on bone.

True

True or False May increase acid load and thereby increase urinary calcium excretion. It may also improve calcium absorption and increase growth factors, which also could improve bone health

True

True or False Vit D status depends mostly on sunlight exposure, secondary to dietary intake

True

True or False absorption of calcium from foods high in oxalic and phytic acid (certain veggies and legumes) is lower than from dairy products.

True

True or false A good diet plus exercise from roughly ages 10-20 years is particularly important for skeletal growth, accrual of bone mass, and increased femoral bone dimensions

True

he n-3 and n-6 polyunsaturated fatty acids may influence bone health through several complex mechanisms, including opposing effects on inflammatory cytokines, modulation of prostaglandin E2 production, and enhancement of calcium transport and retention. (true or false)

True

True

True or False OA is often seen in populations with ● Vit D receptor gene polymorphism

Folate, vitamin B12, and vitamin B6 play important roles bone formation. (true or false)

True. Folate, vitamin B12, and vitamin B6 play important roles in the one-carbon metabolism pathway, which is critical for DNA synthesis, methylation, and repair, and there- fore may affect bone formation

Nutrients for bones

Vit A: Consists of retinol (animal sources) & carotenoids (plant sources). May be beneficial in bone health, although research is not definitive Vit D: From any source, Vit D must be hydroxylated in the kidney before becoming the physiologically active calcitriol (1,25-hydroxy vitamin D3). Plays a pivotal role in calcium uptake and therefore bone homeostasis. Vit K: Essential for bone health and its role in post-translational modification of several matrix proteins, including osteocalcin (serves as a bone marker for predicting future risk of fracture), is well established

Main function is to maintain serum calcium and phosphorous levels with a constant range, and also important in stimulating intestinal calcium transport and stimulated activity of osteoclasts. May also have a role in muscle tone and fall prevention.

Vit D

kidney, calcitriol

Vit D must be hydroxylated in the _____________ before becoming the physiologically active _____________ (1,25-hydroxy vitamin D3).

Genetic for OA

Vit D receptor gene polymorphism

Medical Nutrition Therapy (Dietary & Lifestyle) for Paget's

Vit D-rich: Fatty fish (salmon, mackerel, catfish, tuna, sardines), low-fat/non-fat milk, yogurt, cheese (if tolerated), egg yolk,, cod liver oil, and some mushrooms Calcium-rich: Collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens, broccoli, canned sardines with bones Reduce phytates (interfere with body's ability to absorb calcium) Magnesium-rich: spinach, beet greens, okra, tomato products (if tolerated), artichokes, plantain, potatoes, sweet potatoes, collard greens, raisins Potassium-rich: tomato products (if tolerated), raisins, potatoes, spinach, sweet potatoes, papaya, oranges, fresh-squeezed orange juice, bananas, plantains, prunes Vit C-rich: red & green peppers, oranges, grapefruit, broccoli, strawberries, Brussel sprouts, papaya, pineapple Vit K-rich: dark leafy greens (kale, collard greens, spinach, mustard greens, turnip greens, Brussel sprouts) Calcium & Vit D Fortified foods: from juices, breakfast cereals, soy milk, rice milk, snacks & breads Include foods rich in omega-3 FAs (fish oil, flaxseed oil/contraindicated in pregnancy) Moderate amounts of quality protein (too much, no good for bone health) Avoid high-sodium foods that cause body to loss calcium and leads to bone loss (processed & canned foods). Aim to get no more than 2300 mg/d. Educate client on label reading (if it lists 20% or more of % daily value, then high in sodium) Avoid high oxalates foods (spinach, rhubarb, beet greens & certain beans). Shouldn't be counted as sources of calcium because body doesn't absorb calcium well from oxalates. Limit alcohol & caffeine (decrease calcium absorption and contribute to bone loss) Avoid soft drinks (caffeine & phosphorus in them may contribute to bone loss)

Vit A Vit D Vit K ● Supplementation with omega-3 PUFAs, and consideration of glucosamine & chondroitin

Vitamins/supplements for osteoporosis

FRAX

WHO fracture risk assessment tool includes gender, age, body mass index, parental history of hip fracture, current tobacco smoking, long-term use of oral glucocorticoids, having rheumatoid arthritis or other secondary cause of osteoporosis, and alcohol intake of three or more servings daily The risk assessment does not include any diet or physical activity information, or information about the frequency of falling or likelihood of falling. The FRAX is used by clinicians to help them decide when medications should be started. According to FRAX, a probability of more than a 20% risk of fracture indicates that some discussion should begin with the patient about whether medication should be started. However, the FRAX guidelines also should consider the patient's individual situation.

PPIs, anti coagulants and corticosteroids

What 3 classes of medications all have negative effect on bone health. ?

Magnesium and boron Primer

What other nutrients besides Ca and Vit D are often recommended in osteoporosis?

Magnesium and Phosphorus

Which two minerals have to be repleted before supplementing with Calcium?

Estrogen (estrogen agonists)

_____________ have a positive effect on bone health

Secondary Osteoporosis

______________results when an identifiable drug or disease process causes loss of bone {Chronic diarrhea or intestinal malabsorption (including Celiac Disease), chronic obstructive lung disease, chronic renal disease, Diabetes, Hemiplegia, Hyperparathyroidism, Hyperthyroidism, Subtotal Gastrectomy}

2. Which statement or statements about osteoarthritis (OA) is (are) not true? a. Although excessive weight may contribute to the development of OA, weight loss has NOT been shown to lead to improvement in symptoms or functionality. b. Exercise can result in reduced knee pain, and improve physical function in persons with knee osteoarthritis. c. Strength training has not been shown to be helpful for patients with OA and is likely to exacerbate symptoms. d. Exercise of an acutely inflamed or swollen joint should be deferred until the acute processsubsides.

a and c. Weight loss has been shown to lead to improvement of symptoms. Exercise has been shown to lead to improvement of symptoms and is unlikely to exacerbate symptoms if done correctly.

Paget's disease ● Most commonly occurs in pelvis, skull, spine, legs (Up to 50 percent of individuals with skull involvement may develop hearing loss)

a bone disease of unknown cause characterized by the excessive breakdown of bone tissue, followed by abnormal bone formation

osteophytes ● In later stages proteoglycan and keratan sulfate levels in ECM decrease, soft tissues around joints are affected, weakened muscles, inflammatory infiltrates in synovium are seen

a bony outgrowth associated with the degeneration of cartilage at joints. -are hallmarks of OA, they ultimately cause restricted motion.

osteomalacia

abnormal softening of bones in adults

Bisphosphonates

act as inhibitors on osteoclasts to reduce bone resorption. Ex. alendronate sodium, risedronate sodium, and zoledronic acid Side effects include gastrointestinal problems and rare cases of jaw necrosis stopping the medication after 2 to 3 years is recommended

● Genetic variation at the locus encoding osteoprotegerin ● Typically occurs in older population ● Occurs more commonly in European populations and their descendants. 30% of cases often involves more than one family member ● Some believe it is related to a viral infection in bone cells (controversial)

affected populations for Paget's

_____________ travels to circulation and is used as a clinical marker of bone formation rate

alkaline phosphatase

Secondary osteoporosis results when...

an identifiable drug or disease process causes loss of bone tissue

Estrogen agonists or antagonists

are able to stimulate estrogen receptors (ER) in bone tissue and yet have very little effect on the ERs of the breast or uterus. Raloxifene and tamoxiphen The most common side effect is hot flashes

Which statement about osteoarthritis (OA) is not true? a. Massage has been shown to improve symptoms in patients with OA of the knee. b. Patients with OA of the lower extremities should avoid tai chi as it has been shown to exacerbate lower extremity OA. c. Unlike other therapies used as symptom modifiers, such as NSAIDs, glucosamine sulfate and chondroitin sulfate are potentially structure modifying. d. Patients with viral hepatitis, alcoholism, or alcoholic hepatic disease are at greater risk for acetaminophen-induced hepatotoxicity.

b. Tai chi has been shown to be beneficial in patients with OA, including OA of the lower extremities.

1. The following statements about the pathophysiology of osteoarthritis (OA) are all true except: a. OA involves a breakdown of the normal physiological pathways. b. OA affects only bone and cartilage. c. Development of OA is facilitated by cytokines and other inflammatory meditators. d. In later stages of OA, subchondral osteoblasts increase bone formation.

b. The whole joint is affected in OA.

A woman seeks your advice about preserving her bone density and avoiding osteoporosis. She drinks three glasses of wine per week, smokes half a pack of cigarettes per day, drinks three cups of coffee per day, takes a multivitamin that contains 5000 mcg of vitamin A (retinol), and gets adequate calcium and vitamin D in her diet. Your best advice for her would be to: a. Stop the multivitamin b. Stop smoking c. Cut out all alcohol d. Stop drinking coffee

b. This woman's modest alcohol intake should not adversely affect her bone health. Three cups of coffee per day, in the context of adequate calcium intake, should also not negatively impact her bone health. The concerns regarding preformed vitamin A and bone health have been proven to be unfounded. Smoking, however, does negatively impact bone health and has a number of other adverse health consequences.

DXA diagnosis for osteopenia/ low bone mass

between 1 and 2.5 SD

Alkaline phosphatase measured in the blood is a marker of

bone formation.

osteophytes Often seen in OA

bone spurs

Chondrocytes In OA, early changes include ● chondrocyte proliferation, cluster formation leading to failure of elastic restraint of collagen, higher chondrocyte stress and exposure to degradative enzymes

cartilage cells

Osteoclasts are

cells that break down bone matrix stimulate production of acids & enzymes that dissolve minerals & proteins in bone (breakdown/remodeling),

Although osteoporosis is one area in which BMI has been shown to be protec- tive, we now understand that abdominal adiposity can have negative effects on bone through the release of ______

certain cytokines.

Cortical bone

consists of osteons or Haversian systems, is found in the shaft regions of the long bones.

results when an identifiable drug or disease process causes loss of bone (Chronic diarrhea or intestinal malabsorption (including Celiac Disease), chronic obstructive lung disease, chronic renal disease, Diabetes, Hemiplegia, Hyperparathyroidism, Hyperthyroidism, Subtotal Gastrectomy

econdary Osteoporosis

The inulin-type fructans are a group of fiber compounds found in wheat, onion, bananas, garlic, and leeks that may decrease, enhance calcium and magnesium absorption, whereas high-fiber foods that contain phytates or oxalates may increase, lower calcium absorption.

enhance, lower

Type I osteoporosis in women results after menopause when ______ production ceases

estrogen

Although vitamin A deficiency is relatively common worldwide, it is retinol deficiency/ excess that is of most concern to bone.

excess. The evidence suggests a possible increased risk of fracture with excess vitamin A.

Excessive caffeine intake has no effect on BMD (true or false)

false, it may have a deleterious effect. Rapid metabolizers of caffeine may be a high risk group for bone loss

DEXA measurements are considered screening tools, whereas Ultrasound measurements are considered diagnostic. True Fals

false, ultrasound measurements are considered screening tools, whereas DEXA measurements are considered diagnostic.

Population & experimental studies have demonstrated that ______________ consumption may offer significant protection against osteoporosis (polyphenols/catechins)

green tea

Unfractionated ______________ is associated with reduced bone density and fractures when doses of 15,000 units/day or used for 3 mos or longer

heparin This is primarily due to the direct effects of heparin on bone by increasing resorption and reduce bone formation and also reduced active vitamin D.

A high/low sodium intake may contribute to osteoporosis because of increased calcium excretion. Although the calciuric effect of sodium has been speculated, there seems to be no adverse effects when there is adequate calcium and vitamin D intake

high

trabecular bone

interior, spongy bone with a porous, honeycomb structure

Osteopenia

is characterized by low bone mass

Osteoporosis treatment

is characterized by porous bone & diminished bone strength, and is usually without symptoms until severe backache or hip fracture occurs

Trabecular bone

is the spongy bone that is found in the knobby ends of the long bones

It is now clear that many aspects of diet and nutrition are important for bone health, including not only adequate intake of calcium and vitamin D but also

magnesium, potassium, other trace minerals, vitamin K, B vitamins, carotenoids, vitamins C and E, protein, and essential fatty acids.

Osteocalcin

matrix protein for bone

Bone tissue consists of the mineral phase and the organic _____ phase

matrix, The organic matrix or osteoid phase of bone consists mostly of collagen, which provides both the strength and flexibility of the bone.

Prolonged use of certain medications contribute to osteoporosis

(Aluminum-containing antacids, Corticosteroids, Cyclosporine, Heparin, Lasix and Thiazide Diuretics, Lithium, Methotrexate, Phenobarbital, Phenothiazine Derivatives, Phenytoin (Dilantin), PPIs, Thyroid Hormone, Tetracycline) by interfering with calcium absorption or by actively promoting calcium loss from bone

Affected Popuation of Paget's

-Genetic variation at the locus encoding osteoprotegerin -Typically occurs in older population -Occurs more commonly in European populations and their descendants. 30% of cases often involves more than one family member

In human osteoblast cells, increasing caffeine incrementally decreased 1,25(OH)2D3-induced VDR expression and alkaline phos- phatase activity, affecting osteoblastic function. In humans, caffeine is known to increase short-term urinary calcium excretion. However, a 2002 review concluded that caffeine had no effect on total 24-hour urinary calcium excretion, and the negative effect of caffeine on calcium absorption may be offset by "as little as ___ to ___ tablespoons of milk"

1 to 2

d K 540

1. Bone remodeling begins early in fetal development and continues until when? a. The age of 10 b. The age of 20 c. The age of 30 d. Throughout life

c A 541

10. Now that he is a college student, Myungsoo's diet doesn't contain much calcium. How does his body maintain healthy blood calcium levels? a. His osteoblasts are breaking down his bones. b. His kidneys are secreting more calcium into the blood. c. His osteoclasts are breaking down his bones. d. His intestines are resorbing more calcium.

In patients with malabsorption, gluten enteropathy, liver disease, gastric or intestinal bypass, or patients taking long-term antiseizure medica- tions, ____ to____ IU of vD is often required to maintain blood concentrations higher than 20 ng/mL.

1000-2000 IU, Some practitioners prescribe 50,000 units of vitamin D2 once weekly to improve compliance and main- tain serum 25(OH)D concentrations at or higher than 20 ng/mL (50 nmol/L).

b K 541

11. When the actions of the osteoblasts exceed those of the osteoclasts, what is occurring? a. Kyphosis b. Growth c. Osteopenia d. Osteochondritis

a K 541

12. What is the cyclical breakdown and rebuilding of bone called? a. Remodeling b. Adaptation c. Refashioning d. Transformation

c K 541

13. Bone mass increases until it reaches its peak at roughly what age? a. 13 b. 20 c. 30 d. 45

RDA for Calcium 9-19 years was raised to ______________mg/d for both genders

1300

b K 541

14. What is the amount of mineral in a given volume of bone called? a. Bone mass b. Bone mineral density c. Peak bone mass d. Bone mineral concentration

c K 541

15. The greatest amount of bone mineral that a person has during his or her life is called: a. bone turnover. b. bone mass. c. peak bone mass. d. bone remodeling.

c K 542

16. Once we have reached adulthood, what happens to our ability to absorb calcium as we age? a. It increases b. It remains the same c. It decreases d. It undulates

a K 542

17. What hormone is known to be important for maintaining bone strength? a. Estrogen b. Testosterone c. Progesterone d. Glucagon

a K 542

18. What percentage of bone loss in women has been reported to occur each year after menopause? a. 1-3% b. 2-4% c. 3-5% d. 4-6%

d K 543

19. What is the curvature in the upper spine that results from osteoporosis called? a. Ostitis b. Osteoarthropathy c. Ostealgia d. Kyphosis

Age-Related Primary Osteoporosis Estrogen-Androgen Deficient Osteoporosis

2 Types of Primary Forms of Osteoporosis

a K 540

2. What is the soft and rubbery tissue that composes fetal "bones" called? a. Cartilage b. Pre-bone c. Trabecular bone d. Ligaments

The WHO's definition of osteoporosis is a BMD greater than _____ standard deviations below the mean for healthy 20- to 29-year-old adults.

2.5

c K 544

20. How many people do researchers estimate suffer from osteoporosis? a. ~2 million b. ~6 million c. ~10 million d. ~12 million

c A 544

21. Of the individuals listed below, who is most likely at the greatest risk for developing osteoporosis? a. A Hispanic woman, BMI of 22, who is 60 b. An African woman, BMI of 25, who is 50 c. An Asian woman, BMI of 18, who is 60 d. An African male, BMI of 24, who is 50

b K 544

22. What level of risk of osteoporosis is typically associated with using tobacco? a. None b. Increased c. Decreased d. Variable

d K 544

23. Biological factors associated with osteoporosis do not include: a. gender. b. age. c. body size. d. diet.

e K 544-545

24. _____ is/are not associated with increased risk of osteoporosis. a. Smoking b. Certain medications c. A history of eating disorders d. Low circulating estrogen e. Strenuous activity

The BMD of women with postmenopausal osteoporosis may fall as low as ____to_____ of that of age-matched women without osteoporosis.

25% to 40%

d K 545

25. Lori was anorexic from the age of 14 until she was 20. As a result, her risk of osteoporosis is greater because her nutrition was poor and because her levels of what were low? a. Testosterone b. Progesterone c. ADH d. Estrogen

b K 545

26. Chronic alcoholism is associated with _____ risk of osteoporosis. a. decreased b. increased c. neutral d. None of the above

b K 545-546

27. Which of the following exercises is likely to be the best for strengthening bones? a. Rowing b. Walking c. Swimming d. Biking

b K 546

28. What vitamin is required for calcium absorption in the small intestine? a. A b. D c. E d. K

d K 546

29. Which vitamin enables bone-building proteins to bind to calcium? a. A b. D c. E d. K

b K 540

3. What is the process of converting the soft rubbery fetal bones into hard, mineralized bone called? a. Calcification b. Ossification c. Mineralization d. Marbleization

c K 546

30. What are the primary vitamins required for bone building and remodeling? a. D, A, and folic acid b. A, E, and thiamin c. C, D, and K d. D, A, and E

b K 545-546

31. What does weight-bearing exercise do? a. Decreases the overall rate of bone remodeling b. Increases the overall rate of bone remodeling c. Increases the rate of conversion of cartilage into bone d. Decreases the rate of conversion of cartilage into bone

a K 546

32. Though it is not an essential nutrient, consumption of what can increase bone strength? a. Fluoride b. Cobalt c. Chromium d. Molybdenum

c K 546

33. What do medications and lifestyle changes do for a patient with osteoporosis? a. Reverse the disease's progression b. Prevent the disease's development c. Slow the disease's progression d. Stop the disease's progression

a K 546

34. To screen for osteoporosis, what do clinicians measure? a. Bone mineral density and mass b. Serum vitamin D c. Serum calcium d. Urinary calcium

d K 546

35. DEXA measures: a. bone mass. b. bone density. c. blood calcium levels. d. a and b e. all of the above

d K 547

36. Some studies suggest that consuming phytoestrogens may help maintain bone health after menopause. What is the primary food source of phytoestrogens? a. Tomatoes b. Whole grains c. Broccoli d. Soy products

a K 547

37. Bisphosphonates are used in the treatment of osteoporosis. What is their effect? a. Inhibit bone breakdown b. Increase calcium absorption c. Increase vitamin D absorption d. Promote bone formation

b K 547

38. Some of the substances found in food, such as fiber, can decrease absorption of calcium. Which of the substances listed below also decrease the absorption of calcium? a. Saturated fats, trans-fats b. Oxalates, phytates c. Trace minerals, preservatives d. Most herbs, food coloring agents

d K 547

39. Consuming 2 to 3 cups of coffee each day appears to pose what level of risk to bone health? a. Significant b. Moderate c. Some d. None

a K 540

4. What is the thin membrane on the outer surface of bones called? a. Periosteum b. Sheath c. Scabbard d. Casing

e K 547

40. Nutrients that have DRI levels that are intended to promote both bone health and bone growth include: a. calcium. b. vitamin D. c. protein. d. a and b e. All of the above

c K 548

41. The content of which of the following must be included on the Nutrition Facts panels on food labels? a. Calcium and chloride b. Protein and potassium c. Calcium and protein d. Phosphorous and magnesium

d K 540

5. If you removed the layers of bone working toward the center from the outside, in what order would the layers be? a. Cortical bone, trabecular bone, periosteum b. Periosteum, trabecular bone, cortical bone c. Cortical bone, periosteum, trabecular bone d. Periosteum, cortical bone, trabecular bone

Heredity is a major factor contributing to BMD and may con- tribute as much as ___to____% of BMD.

50% to 80%

Vegans who may consume as much as ___ g of fiber a day are most likely to have a significant depres- sion in intestinal calcium absorption,

50g, but this is often offset by adequate calcium intake

a K 540-541

6. Which part of the bone produces red blood cells? a. Bone marrow b. Cortical bone c. Trabecular bone d. Periosteum

a K 540

7. What is the major function of the cortical bone? a. Provide strength b. Produce red blood cells c. Produce while blood cells d. Produce platelets

d K 541

8. Bones _____ have large blood vessels, lymphatic vessels, and nerves. a. do not b. rarely c. sometimes d. always

the NOF recommends a higher intake of vitamin D than does the IM for those 50 years and older ___ to____ IU/day. If these intake goals are not reached by food, supplements should be considered

800 to 1000, In addition, achieving and maintaining a healthy weight and consuming a lower sodium diet is recommended for optimal bone health for women

b K 541

9. What are the bone-forming cells that are responsible for depositing the minerals and proteins needed for bone maintenance, growth, and repair called? a. Osteoclasts b. Osteoblasts c. Hydroxyapatite d. Calcitonin

What limits joint movement in osteoarthritis? a. The osteophytes and irregular cartilage surface b. The wider joint space c. Decreased amount of synovial fluid in the cavity d. Fibrosis involving the joint capsule and ligaments

A

A chronic elevation of which circulating hormone typically leads to an increase in bone resorption and bone loss? a. Thyroid hormone b. Parathyroid hormone c. Corticosteroid hormone d. Glucagon

ANS: B Vitamin D deficiency is associated with secondary hyperparathyroidism. This results in excessive parathyroid hormone secretion, which then stimulates bone resorption to maintain serum calcium concentrations. Excessive use of thyroid hormone or corticosteroids as medications can also contribute to bone loss. Glucagon has not been associated with risk of osteopenia.

Which of the following changes related to nutrition and bone metabolism does NOT occur in elderly subjects? a. Decreased intake of protein b. Reduction of skin biosynthesis of vitamin D c. Increased renal excretion of calcium d. Decline in osteoblast function

ANS: C Although an excessive sodium intake may contribute to an increased renal excretion of calcium, aging itself does not result in this physiologic change. Aging is associated with decreased intestinal absorption of calcium through alterations in the gastrointestinal mucosa and in vitamin D biosynthesis and metabolism. In contrast to osteoblast activity, osteoclast activity increases because of the uncoupling of bone remodeling.

Which of the following dietary variables is NOT related to low bone mass? a. Inadequate calcium b. Excessive phosphorus c. Inadequate vitamin D d. Excessive potassium

ANS: D Bone mass is maintained by adequate vitamin D and calcium intake and adequate phosphorus to maintain the serum calcium-to-phosphate ratio. Too much phosphorus in relation to calcium stimulates parathyroid hormone, resulting in loss of bone. Oral doses of potassium bicarbonate by postmenopausal women neutralize endogenous acids that may contribute to bone resorption.

500

Absorption of calcium is optimal when taken as individual doses of ___________mg or less

Risk Factors & Causes: of Osteoporosis

Age, especially older than 60 WHO (World Health Organization) recognizes that Calcium, Vitamin D3, protein, phosphate, Vit K, Magnesium, and other trace elements & vitamins are related to bone health Amenorrhea in woman as a result of excessive exercise, menopause, excessive weight loss in anorexia nervosa Young women with the "female athlete triad" or disordered eating, amenorrhea, and low BMD (bone mineral density) are at risk for having fractures. Androgen depletion with hypogonadism in men Cigarette Smoking & excessive alcohol intake (toxic effects on osteoblasts) Moderate alcohol has not detrimental effect on bone, and some studies shoe a modest positive effect in postmenopausal women Estrogen depletion form menopause or early oophorectomy (surgical removal of one or both ovaries) Ethnicity- Hispanics, Asians & whites higher risk, blacks are at lower risk Excessive caffeine intake Female gender Family history of osteoporosis or parental history of hip fracture Lack of exercise Sarcopenia Underweight, low BMI, low body fat mass Genetic Diseases: Maran Syndrome, Porphyria, Homocystinuria, Gaucher Disease, Cystic Fibrosis, Glycogen Storage Disease, Ehlers-Danlos, Hemochromatosis Medications

Risk Factors for Developing Osteoporosis

Age, especially older than age 60 Amenorrhea in women as a result of excessive exercise Androgen depletion with hypogonadism in men Cigarette smoking Estrogen depletion from menopause or early oophorectomy Ethnicity: white or Asian Excessive intake of alcohol, caffeine Female gender Family history of osteoporosis or parental history of hip fracture Inadequate calcium or vitamin D intake Lack of exercise Prolonged use of certain medications Sarcopenia Underweight, low body mass index, low body fatness Genetic diseases: Marfan syndrome, porphyria, homocystinuria, Gaucher disease, cystic fibrosis, glycogen storage disease, Ehlers-Danlos, hemochromatosis

Types of Primary Forms of Osteoporosis

Age-Related Primary Osteoporosis occurs at approx. age 70 and beyond. Many women lose several inches in height between 50-80 years of age. Affects both sexes, with women affected more severely because they have a smaller skeletal mass compared to men. Estrogen-Androgen Deficient Osteoporosis occurs in women within a few years of menopause from loss of trabecular bone tissue and cessation of ovarian production of estrogens. Characterized by fractures of distal radius (Colles fractures) and "crush" fractures of the lumbar vertebrae that are often painful & deforming.

Why might protein intake be irrelevant to calcium homeostasis?

Although dietary protein may increase acid load and thereby increase urinary calcium excretion, protein also may improve calcium absorption and increase growth factors, which also could improve bone health

Medications that Increase the Risk of Osteoporosis

Aluminum-containing antacids Corticosteroids Cyclosporine Heparin Lasix and thiazide diuretics Lithium Methotrexate Phenobarbital Phenothiazine derivatives Phenytoin (Dilantin) Proton pump inhibitors (PPIs) Thyroid hormone Tetracycline

You have a client with a T-score of -2.7; therefore, the diagnosis would be: A. Anemia B. Hypocalcemia C. Osteoporosis D. Hypercalcemia BCNS Practice Quizlet

Answer: C - Osteoporosis. A T-score of -1.0 or above is normal bone density.

Heparin

Anticoagulant

● X-ray and non-invasive bone scan ● Blood tests include serum alkaline phosphatase (SAP) which is reflective of rapid new bone turnovers ● Urine tests will indicate the speed at which rebuilding is taking place ● If cancer is suspected, it will be necessary to biopsy the bone

Assessment for Paget

● IBD (15% prevalence for osteoporosis) ● Celiac Disease (47-80% prevalence for osteoporosis) Hyperparathyroidism

Associated Disorders of Osteoporosis

● Rheumatoid Arthritis, Gout, Charcot's Joints (refers to progressive degeneration of a weight bearing joint), Sciatica & Psoriatic Arthritis, Depression, Sleep Disturbances

Associated disorders of OA

Bone is at maximum density in women: A. In her teens B. 30 C. 40 D. After menopause BCNS Practice Quizlet

B. 30

Osteoblasts

BUILD BONE! Production and formation of bone tissue, synthesis of matrix proteins (collagen type 1 (90%), osteocalcin and others (10%)), mineralization, communicate via the secretion of cytokines that act on osteoblasts, absorb minerals from blood and deposit into matrix, is stimulated by calcitonin

False

Being overweight is a risk factor for osteoporosis True or False

FDA-Approved Medicationsfor Prevention or Treatment of Osteoporosis

Bisphosphonates Calcitonin—treatment only Estrogen—prevention only when menopausal symptoms are primarily being treated Estrogen agonist/antagonist—treatment only Tissue specific estrogen complex—treatment only Parathyroid hormone (PTH)—treatment only Receptor activator of nuclear factor k ligand (RANKL) inhibitor—treatment only

Osteoblast function

Bone Formation Synthesis of matrix proteins: Collagen type 1 (90%) Osteocalcin and others (10%) Mineralization Communication: Secretion of cytokines that act on osteoblasts

Osteoclast function

Bone Resorption Degradation of bone tissue via enzymes and acid (H1) secretion Communication: Secretion of enzymes that act on osteoclasts

Osteoblasts

Bone building cells create a protein matrix, primarily of collagen, that provides the structural framework upon which mineralization can occur

Normal: -1 and above Osteopenia- -1 to -2.5 Osteoporosis- -2.5 and below

Bone density T score

Which of the following statements does NOT apply to osteoporosis? a. Bone resorption is greater than bone formation. b. It causes compression fractures of the vertebrae. c. Osteoporosis is always a primary disorder. d. It often leads to kyphosis and loss of height.

C

calcitriol (1,25-dihyroxy vitamin D3); PTH 1-84, which is an intact human recombinant form of PTH; sodium fluoride; and strontium ranelate are all examples of: α. new treatments for osteoporosis in trials b. FDA approved treatments c. FDA unapproved treatments d. WHO recommendations

C. FDA unapproved treatments

Osteoclasts

CRUSH BONE! − Breakdown and resorption of bone via enzymes and acid (H+) secretion, communication via the secretion of cytokines that act on osteoclasts (modeling and remodeling)

Osteoporosis MNT:

Calcium (1000 mg/day) and vitamin D (800 to 1000 units/day) typically are recommended as supplements for patients being treated with one of the bone drugs, either antiresorptive or anabolic. The dietitian nutritionist should evaluate the client's diet for all bone-related nutrients and tailor recommen- dations based on personal preferences, cultural differences, nutrient recommendations, and the need for supplements

Supplements for bone health

Calcium (no more than 1,000 mg/d, Pizzorno), phosphate, Vit D3 & Vit K are essential for normal bone structure and function Calcium carbonate is the most common form. Should be taken with food because an acidic environment enhances absorption Calcium citrate may be more appropriate for those with achlorhydria (seniors) because it does not require an acidic environment for absorption and does not further reduce the acidity of stomach. Absorption of calcium is optimal when taken as individual doses of 500 mg or less. Many formulas include Vit D3, because the likelihood of needing Vit D is high if calcium supplementation is needed.

Medical Conditions that Increase the Risk of Osteoporosis

Chronic diarrhea or intestinal malabsorption (including celiac disease) Chronic obstructive lung disease Chronic renal disease Diabetes Hemiplegia Hyperparathyroid disease Hyperthyroidism Subtotal gastrectomy

What are the two types of bone tissue?

Compact and cancellous

● Fractures & deformities, osteoarthritis, neurologic problems, heart failure (may force heart to work harder), bone cancer (occur in about 1% of cases)

Complications of Paget

Joints affected by osteoarthritis can sometimes affect healthy joints by: a. causing enzymes to be released that travel to other joints. b. bacteria traveling from the affected join to a healthy one through the bloodstream. c. inflammation and edema affecting the entire limb. d. the affected individual's exerting stress on the normal joint to protect the damaged one.

D

What is a typical characteristic of the pain caused by osteoarthritis? a. Decreases over time b. Quite severe in the early stages c. Aggravated by general muscle aching d. Increased with weight-bearing and activity

D

Which of the following can significantly lower calcium requirements? a. High protein diet b. Low fat diet c. Gluten free diet d. Low sodium diet

D. A sodium intake of 1.15 g/day has been shown to significantly lower calcium requirement. High protein diets, particularly diets high in animal protein, are associated with increased calcium excretion. Gluten free diets and low fat diets are not known to significantly influence calcium requirements.

Diagnosis & Monitoring:

DXA (Dual X-ray absorptiometry), previously called DEXA BMD T-Score is 2.5 standard deviations below the mean, osteoporosis diagnosis is made BMD T-Score between 1-2.5 standard deviations below the mean, osteopenia diagnosis is made Within 1 SD of the adult mean is considered normal Enzymes or degradation product in serum or urine have been used for research and are beginning to be used more often to monitor drug treatment efficacy Serum Precollagen Type I N-Terminal Propeptide (PINP)- bone formation marker Serum Collagen Type I Crosslinked C-telopeptide (sCTX)- bone resorption marker Ultrasound Measure of Bone measure the velocity of sound waves transmitted through bone and broadband ultrasound attenuation (BUA) Considered a screening tool, not diagnostic

Why are decreased bone loss observed in vegetarians?

Decreased in bone loss has been observed in vegetarians (lowered intake of protein (acidic and increases urinary excretion of calcium, calcium is taken from bones and used to buffer extra acid)) coupled with an alkaline diet

DXA (Dual X-ray absorptiometry) Enzymes or degradation product in serum or urine o Serum Precollagen Type I N-Terminal Propeptide (PINP)- bone formation marker o Serum Collagen Type I Crosslinked C-telopeptide (sCTX)- bone resorption marker Ultrasound Measure of Bone

Diagnosis & Monitoring: of Osteoporosis

People of _______and_____ ethnicity experience more osteoporotic fractures than Blacks or Hispanics, who usually have a greater bone density.

European and Asian

Exercise prescription for osteoporosis:

Exercises that exert strong force against potentially weak bone are not recommended, such as sit- ups or twisting. Exercises should focus on posture, balance, gait, coordination, and hip and trunk stabilization For those in need of rehabilitation, the client should be evaluated for capabilities and deficiencies, with attention to weight-bearing aerobic activities, posture, resistance training, stretching, and bal- ance training

Men often develop androgen- deficient osteoporosis if they have a significant decline in androgen production. This osteoporosis is characterized by fractures of the distal radius (Colles fractures) and "crush" fractures of the lumbar vertebrae that are often painful and deforming. True False

False, this is rare

Hydroxyapatite

Hardy crystals consisting of calcium and phosphate that form the bone matrix.

Calcium (no more than 1,000 mg/d, Pizzorno), Calcium carbonate Calcium citrate

Herbs supplements for osteoporosis

● Glucosamine sulfate (5000 mgx3 or 1,500 mg), chondroitin sulfate 400 mg x 2-3/day, 8000-1,200 mg daily), MSM (methylsulfonylmethane, 1,000-3,000 mg) ● SAME-e (4000-1,600 mg/day), niacin, calcium & Vit D, Vit K, Vit C; Vit A & E, zinc, copper, boron (nutrient required for the synthesis of collagen & maintenance of normal cartilage structures), topical rubbing gels (anti-inflammatory) based on capsaicin, antioxidants nutrients, fish oil (EPA + DHA), avocado soybean unsaponifiables, bromelain, hyaluronic acid ● Curcumin, (Meriva, a special from bound to phosphatidylcholine to improve absorption), Boswellia, Ginger, Procyanidolic Oligomers (berries, grapeseed, pine bark extract, Devil's claw)

Herbs/ supplements for OA

Associated Disorders: of Osteoporosis

IBD (15% prevalence for osteoporosis) Celiac Disease (47-80% prevalence for osteoporosis) Hyperparathyroidism

Bisphosphonates treat osteoporosis by

Inhibiting osteoclasts. Alendronate sodium, risedronate sodium, and zoledrosonic acid, which are bisphosphonates, are approved for the prevention of osteoporosis, especially for postmenopausal women. The bisphosphonates act as inhibitors on osteoclasts to reduce bone resorption.

Medical Nutrition Therapy (Dietary & Lifestyle) for OA

Key dietary focus in the prevention & treatment is achieving normal body weight and improvement in insulin sensitivity. Mediterranean Diet may show positive effects Consider an Elimination Diet that includes removing Solanaceae (nightshade family-tomatoes, potatoes, eggplant, peppers, etc.) High intake of antioxidant nutrients, especially Vit C Regular consumption of flavonoid-rich berries and naturally occurring Vit C sources (broccoli, kale, mustard greens, spinach) & citrus fruits Educate client on stress management & relaxation techniques (mediation, yoga, reading, journaling, listening to relaxing music, deep breathing, guided imagery are known to help with pain) Physical exercise (non-loading aerobic/swimming/isometrics/walking, range of motion, and weight-bearing has been shown to reduce symptoms, increase mobility and lessen continuing damage). Exercise should focus on posture, balance, gait, coordination, and hip & trunk stabilization. Best exercises are isometrics, walking. American Academy of Sports Medicine recommendations include exercise 2-3 x/week with moderate bone-loading force for a combination of 30-60 minutes) Exercises that exert strong force against potentially weak bone are not recommended, such as sit-ups or twisting.

Symptoms/Clinical Findings of OA

Loss of weight-bearing, articular (joint) cartilage can result in stiffness, pain, swelling, loss of motion, changes in joint shape, crunching feeling of bone on bone, abnormal bone growth which can result in osteophytes (bone spurs) Breakdown of articular (joint) cartilage, changes in joint shape, osteophytes/bone spurs, cartilage or bone fragments in synovial fluid

-anti inflammatory diet -● Consider an Elimination Diet that includes removing Solanaceae (nightshade family-tomatoes, potatoes, eggplant, peppers, etc.) -antioxidants -flavonoids rich foods -berries and naturally occurring Vit C sources (broccoli, kale, mustard greens, spinach) & citrus fruits -exercise -stress management

MNT for OA

-low animal protein -omega 3 -avoid smoking avoid excessive caffeine and soft drinks dietary fiber (not excessive) no excessive phytates and oxalate avoid high Na diets ● Increased intake of Isoflavones (in soybeans, functions as estrogen agonists and antioxidants in bone cells). Educate clients on Acid vs. Alkaline Diets. Higher acid diets may increase calcium excretion and have a detrimental effect on bone - To improve calcium absorption and decrease losses optimum intake of D & K, increased fruits and vegetables, balance of EFAs, cutting back on animal protein, keep dietary sodium under 2,400 mg/day, avoid excess caffeine, eating fewer highly refined carbs are recommended.

MNT for osteoporosis

-Protein

May increase acid load and thereby increase urinary calcium excretion. It may also improve calcium absorption and increase growth factors, which also could improve bone healt

Sodium RDA and AI

Men & Women:1,500 mg/day

Vitamin D RDA or AI and UL

Men & Women:15 μg (600 IU)/day (19-70y)20 μg (800 IU)/day (>70y) UL Men & Women:100 μg (4,000 IU)/day

Vit B12 RDA or AI

Men & Women:2.4 μg/day

Folate RDA or AI and UL

Men & Women:400 μg DFE/day UL Men & Women:1,000 μg/day

Phosphorus RDA or AI and UL

Men & Women:700 mg/day (≥19y) UL Men & Women:4,000 mg/day (19-70y) 3,000 mg/day (>70y)

Magnesium RDA or AI or UL

Men: 400 mg/day (19-30y)420 mg/day (>31y) Women: 310 mg/day (19-30y) 320 mg/day (>31y)

Potassium RDA or AU

Men: 3,400 mg/day Women: 2,600 mg/day

Flouride RDA or AIor UL

Men: 4 mg/day* Women: 3 mg/day* UL Men & Women:10 mg/day

Calcium RDA or AI and UL

Men:1,000 mg/day (19-70y) 1,200 mg/day (>70y) Women:1,000 mg/day (19-50y) 1,200 mg/day (>50y) UL Men & Women: 2,500 mg/day (19-50y) 2,000 mg/day (>50y)

Vitamin B6 RDA or AI and UL

Men:1.3 mg/day (19-50y) 1.7 mg/day (>50y) Women:1.3 mg/day (19-50y) 1.5 mg/day (>50y) UL Men & Women:100 mg/day

Vitamin K RDA or AI and UL

Men:120 μg/day *Women:90 μg/day* UL Men & Women:3,000 μg RAE (10,000 IU)/dayd

Vitamin C RDA or AI and UL

Men:90 mg/dayWomen:75 mg/day UL Men & Women:2,000 mg/day

Vitamin A RDA or AI and UL

Men:900 μg RAE (3,000 IU)/day Women:700 μg RAE (2,333 IU)/day UL Men & Women:3,000 μg RAE (10,000 IU)/dayd

Symptoms/Clinical Findings of Paget's

Most have no symptoms, but when they do occur, the most common complaint is bone pain (causes your body to generate new bone faster than normal which produces bone that is softer and weaker) Other symptoms include headaches, hearing loss, enlargement or bowing of bones, tingling or numbness Complications Fractures & deformities, osteoarthritis, neurologic problems, heart failure (may force heart to work harder), bone cancer (occur in about 1% of cases) Calcium & Vit D3

● Calcium & Vit D3

Nutrient impacts of Paget

Risk Factors/Causes for OA

Obesity, aging, female gender, white ethnicity, greater bone density, and repetitive-use injury associated with athlete Genetic predisposition Inflammation Inflammatory joint disease

Most prevalent form of arthritis that is not systematic or autoimmune Involves cartilage destruction with asymmetric inflammation caused by joint overuse resulting in loss of habitually weight-bearing, articular (joint) cartilage (allows bone to glide smoothly over one another).

Osteoarthritis (OA) Most affected joints are distal interphalangeal joints, hips, ankles, spine. Elbows, wrists, ankles are less affected. Generally, presents as pain that worsens with weight bearing & activity, and improves with rest. Patients often report morning stiffness or "gelling" of the affected joint after period of inactivity.

________________ create a protein matrix, primarily of collagen, that provides the structural framework upon which mineralization can occur. An imbalance between bone removal and bone replacement results in bone loss and the development of Osteoporosis.

Osteoblasts

MNT for Paget

o Vit D-rich: Fatty fish (salmon, mackerel, catfish, tuna, sardines), low-fat/non-fat milk, yogurt, cheese (if tolerated), egg yolk,, cod liver oil, and some mushrooms o Calcium-rich: Collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens, broccoli, canned sardines with bones ▪ Reduce phytates (interfere with body's ability to absorb calcium) o Magnesium-rich: spinach, beet greens, okra, tomato products (if tolerated), artichokes, plantain, potatoes, sweet potatoes, collard greens, raisins o Potassium-rich: tomato products (if tolerated), raisins, potatoes, spinach, sweet potatoes, papaya, oranges, fresh-squeezed orange juice, bananas, plantains, prunes o Vit C-rich: red & green peppers, oranges, grapefruit, broccoli, strawberries, Brussel sprouts, papaya, pineapple o Vit K-rich: dark leafy greens (kale, collard greens, spinach, mustard greens, turnip greens, Brussel sprouts) o Calcium & Vit D Fortified foods: from juices, breakfast cereals, soy milk, rice milk, snacks & breads o Include foods rich in omega-3 FAs (fish oil, flaxseed oil/contraindicated in pregnancy) o Moderate amounts of quality protein (too much, no good for bone health) o Avoid high-sodium foods that cause body to loss calcium and leads to bone loss (processed & canned foods). Aim to get no more than 2300 mg/d. Educate client on label reading (if it lists 20% or more of % daily value, then high in sodium) o Avoid high oxalates foods (spinach, rhubarb, beet greens & certain beans). Shouldn't be counted as sources of calcium because body doesn't absorb calcium well from oxalates. o Limit alcohol & caffeine (decrease calcium absorption and contribute to bone loss) o Avoid soft drinks (caffeine & phosphorus in them may contribute to bone loss)

Age-related primary osteoporosis

occurs at approximately age 70 and beyond. Many women lose several inches in height between 50 and 80 years of age

The chronic, physiologic rise in PTH that can occur with aging or in hyperparathyroidism resulting from other causes increases osteoclastic activity and decreases bone density. Intermittent PTH therapy has the same/ opposite effect.

opposite, The drug PTH works by increasing osteoblast number and function. PTH increases spine, hip, and total body BMD. PTH is often prescribed first, followed by bisphospho- nates, so that an increase in bone mass is followed by antire- sorptive therapy

Calcitonin, the hormone, is used to inhibit __________ by blocking the stimulatory effects of PTH on these cells. Calcitonin can be administered by nasal spray.

osteoclastic bone resorption

Body's reserve of ___________ is found in bone as hydroxyapatite

phosphorus In healthy individuals, urinary excretion approximately equals intake Those at high risk and have osteoporosis should avoid soft drinks (rapid rate phosphorus absorption)

To prevent osteoporosis it is important to avoid excess intakes of:

phosphorus, vitamin A, and sodium, and to maintain moderate alcohol intake

type 1 osteoporosis

porous trabecular bone characterized by rapid bone demineralization following menopause. Type I osteoporosis is associated with "crush" fractures of the wrists and lumbar vertebrae.

carotenoids may have a positive/negative effect on bone through their antioxidant activity.

positive, Cryptoxanthin has been shown to have an anabolic effect on bone calcification by increasing alkaline phosphatase activity and calcium content in rat femoral tissue and directly stimulating bone formation and inhibiting bone resorption.

Osteoarthritis (OA)

progressive, degenerative joint disease with loss of articular cartilage and hypertrophy of bone (formation of osteophytes, or bone spurs) at articular surfaces

Osteoprotegerin

protects you from RANK-RANKL decreasees RANK-RANKL binding, so decreases OSTEOCLASTS LOF mutation = kids pagets

Higher acid diets include those high in _____. Although, several meta-analyses, experimental studies, and reviews have not supported either the negative effect of higher acid diets on bone or the positive effects of an alkaline diet on bone.

protein, dairy, and grains

Vitamin K is necessary for osteocalcin, which serves as a marker for

serum bone marker for predicting the risk of a fracture.

The two types of primary osteoporosis, distinguished in general by

sex, the age at which fractures occur, and the kinds of bone involved

bone mineral density

the quantity of mineral deposited in a given area of bone

osteopenia

thinner than average bone density

To preserve bone health through adulthood, the American Academy of Sports Medicine recommends weight-bearing activity ____to____ times per week and resistance exercise ___ to ____ times per week with moderate to high bone-loading force for a combination of ___ to ___ minutes per week.

three to five, two to three, 30 to 60

Adequate protein intake, with adequate calcium intake, is needed for optimal bone health. (true or false)

true

Although age- associated osteoporosis affects both sexes, women are affected more severely because they have a smaller skeletal mass than men. true false

true

Being overweight is protective against osteoporosis and underweight is a risk factor for fractures true false

true

Increased calcium intake has been associated with lowered blood pressure (true or false)

true

mineral water and medications such as antacids can serve as sources of calcium (true or false)

true, they provide minimal amounts. The amount of calcium in tap water across the U.S. and Canada is generally low, although ranges from 4 mg/L to 220 mg/L, with an average of about 50 mg/L, or the amount of calcium that could be found in a medium orange

Which vitamin is necessary for the maturation of osteocalcin?

vK. Vitamin K is involved in the posttranslational carboxylation process or maturation of osteocalcin. Vitamin D's role in bone formation is in regard to the adequate absorption of calcium from the gastrointestinal tract as well as the stimulation of osteoblast activity. Adequate vitamin A intake is necessary for the promotion of bone growth and maintenance.

corticosteroids affect _____ metabolism and can lead to bone loss. Excessive amounts of exogenous _______ hormone can promote loss of bone mass over time

vitamin D, thyroid

Does Vitamin E play a role in bone health?

yes, Vitamin E is a powerful antioxidant and, like vitamin C, may protect against the negative effects of oxidative stress on bone resorption. Evidence exists that vitamin E can reduce macrophage prostaglandin E2 production and cyclooxygenase activity, which may in turn protect bone

K, K2 number of studies report the link with higher Vitamin K status and reduction of fracture risk

· Vitamin _________: works synergistically with D. ________ is required for gamma carboxylation of osteocalcin, stimulating osteoblastic markers and inhibiting formation and activity of osteoclasts. A

cortical tissue

− 80% of the skeleton, shafts of the long bones contain mostly this tissue, consists of osteons (like pylons, load bearing, aka Haversian systems) through the center the Haversian canals are found, these canals carry nerves and blood cells to nourish the bone

Osteocytes

− Mature bone cells (a result of trapped osteoblasts in the matrix)

hydroxyapatite

▪ Body's reserve of phosphorous is found in bone as _____________________

True

▪ Menaquinones are formed in the gut by bacteria, however, influence on status is weak

Osteoporosis.

● An imbalance between bone removal and bone replacement results in bone loss and the development of __________________

True

● Men are not immune to osteoporosis, though their risk is only about 25% that of women

osteopenia

● Premature, breastfed (without calcium & phosphorous supplementation), long-term PN without enteral feeding infants are particularly susceptible to _________________and may develop bone fracture or florid rickets with a prolonged dietary deficiency (calcium & Vit D3)