Krauses Chapter

25
Nutrition and
Bone Health

Prepared and
Presented by
Najlaa
Almohmadi

Objective
1.
2.
3.
4.

Understand the bone structure and its physiology.

Identify the relationship between nutrition and Bones
health.
Identify Osteopenia and Osteoporosis, , definition,
causes and risk factor.
Discuss the clinical senerio.

Outline

bone structure and its physiology.

Bone Mass.
Nutrition and Bone.
Osteopenia and osteoporosis.

Bone Structure and bone

physiology
Composition of bone
calcium, phosphate salts
(hydroxyapatite)
Types of bone tissue
Trabecular or spongy(20%)
cortical (80%).
Bone cells: osteoblasts,
osteoclasts, and osteocytes
Cartilage

http://www.mhhe.com/biosci/esp/2001_gbio/folder_structure/an/m5/s2/assets/images/anm5s2_1.jpg

Calcium Homeostasis
Calcium homeostasis
99% of Calcium in bone and 1% in blood
Parathyroid hormone (PTH) and 1,25(OH)2D
When Ca++ is low in the blood PTH
1- Stimulating bone resorption.
2- Stimulating Ca++ reabsorption in kideny.
3- Stimulates Ca++ absorption in the small intestine by
stimulating synthesis of 1,25(OH)2D in the kidney.
When Ca++ is high in the blood the thyroid gland releases
calcitonin which inhibits PTH and activate osteoblast.

Bone Modeling and Remodeling

Bone

modeling is the term in growth phase until

achieve mature height.
Bone remodeling is the term after growth phase and
bone keep courteously change based on osteoblasts
and osteoclasts activation.
Osteocalcin and bone markers.
Osteocalcin is a protein prevent overminerlization

Bone mass
Bone

mineral content (BMC) is in modeling phase and

bone mineral density is better to describe bone in
remodeling.
Peak of bone mass reached by 30 years old.
Loss of bone mass start at age 40.

Measurement of bone mineral content

Dual-energy

X-ray absorptiometry DEXA

Ultrasound measurements of bone
Fracture risk assessment
Developed by WHO

The most important nutrients for bone health are calcium,

phosphate and vitamin D. However protein, calories, and other
Nutrition and bones
micronutrients help to maintain the structure and function of the
bones.

Minerals
Calcium from foods is first recommended
Calcium from supplements
Upper limit is 2500 mg after 1 year.
9-18 years old, pregnant and lactating take 3000 mg/day
Phosphate
Magnesium
Trace minerals
Boron, copper, fluoride, iron, manganese, and zinc.

Vitamins:
Vitamin D, Vitamin K, Vitmin A retinol
Nutrition and bones
Other dietary components
alcohol
Caffeine
Soft Drinks
Dietary fiber
Sodium
Vegetarian diets

Isoflavones
Potassium Bicarbonate
Nutrition and bones

Osteopenia occurs when the standard deviation below

than 1- 2.5
Osteoporosis occurs when the standard deviation below
than 2.5
Osteopenia and Osteoporosis

Osteopenia occurs when the standard deviation below

than 1- 2.5
Osteoporosis occurs when the standard deviation below
than 2.5
Osteopenia and Osteoporosis

http://www.34-menopause-symptoms.com/pics/osteopenia-and-osteoporosis-the-difference.jpg

Type
Primary
Secondary
Risk factors
Alcohol
Smoking
Low Body weight
Ethnicity,
Lactation Limited weight bearing exercise Loss of
Menses Nutrient
Medication

Osteopenia and Osteoporosis

1- Medical Nutrition Therapy

Calsium 1000mg/ day
Vitamin D 800-1000 units day
2- FDA Approved drug treatment
Estrogen replacement therapy, bisphosphonate and
selective estrogen receptor modulation.
3- Prevention of falls.

Prevention of Osteoporosis and Fractures

Clinical Scenario

Annie B., a 70-year- old white woman of Northern European

ancestry, developed lactose intolerance during her early 50s when
she had a serious gastrointestinal infection. She currently is retired,
live alone, and stays indoors most of each day watching television.
3 years her DEXA was low
Her physician recommended taking calcium1000mg/ day and 800
units/ day
She took supplementation regularly. However, her bone mineral
density BMD has small decline.
Her parathyroid hormone and 25-hydroxy vitamin D fell in the upper
half of normal range.
Serum calcium and phosphate were normal.
She is placed on bisphosphonate drug with calcium and vitamin D
After one year of the new therapy her BMD increased.

Clinical Scenario

PES
Inadequate calcium and vitamin D intake (NI-2.1) related to lactose intolerance (NC1.4) as evidenced by DEXA measurement shows low bone mineral density.
Intervention:
Increase calcium intake to 1000 mg. at least 500 mg/ day from food like increase
consumption of spinach, kale, okra, soybeans white beans, and some fish, like
sardines, salmon, perch, and rainbow trout
Also increase intake of Foods that are calcium-fortified, like some orange juice,
oatmeal, and breakfast cereal.
She need to be seen by doctor for prescribe calcium and Vitamin D supplementation.
Monitor and evaluation:
Patient needs to be seen after month, 3, and 6 months
She is encouraged to have food record to assess her calcium intake.
Goal
Increase her intake from calcium to 800 mg/day from food and 400 units vitamin D
from food.

Clinical Scenario

PES
Physical inactivity (NB-2.1) related to isolation as
evidenced by patient stated that she is stay indoors most
of the time.
Intervention:
Increase physical activity 3 time/ week.
Patient need to focused on weight bearing exercise but as
patient tolerated.
Monitor and evaluation:
Patient needs to be seen after month, 3, and 6 months to
assess her physical activity.
Goal
Increase her physical activity 3 time/ week.

Clinical Scenario

1- How would you classify Annies calcium intake at the

initial visit with her physician who did not take a diet
history or estimate her calcium intake ? Her vitamin D
intake? Her exposure to sunlight?
I classify Annies calcium intake, vitamin D, and exposure
to sunlight is less than requirement as evidenced by her
DEXA result.

Clinical Scenario

2- What would you recommend to improve her calcium intake from

foods so that she could reduced her supplemental calcium to 500 mg/
day? Why would you recommend foods to provide calcium rather than
supplement ? Could you make similar recommendations for improving
her intake of vitamin D from food?
I recommend that she increases her consumption of spinach, kale,
okra, soybeans white beans, and some fish, like sardines, salmon,
perch, and rainbow trout
Also increase intake of Foods that are calcium-fortified, like some
orange juice, oatmeal, and breakfast cereal.
Calcium is better from food because
1- body absorbs calcium from food better than supplements.
2- calcium is co ingestion with other essential nutrient.
3- using high-dose calcium supplements probably increase the risk of
heart disease.
I would make similar recommendations for vitamin D.

Clinical Scenario

3- Design a set of 3 days minimum of daily menus that provide 80 mg

calcium and 400 of vitamin D
Day 1 1200-1300 kcla

Clinical Scenario

Clinical Scenario

Clinical Scenario
Day

2 1300-1400 kcal

Clinical Scenario
Day

2 1300-1400 kcal

Clinical Scenario
Day

2 1300-1400 kcal

Clinical Scenario
Day

1400-1500 kcal

Clinical Scenario
Day

1400-1500 kcal

Clinical Scenario
Day

1400-1500 kcal

Thank you