Nutrition and Bone Health

Departemen Ilmu Gizi BLOK DERMATOMUSKULOSKELETAL

 Adequate nutrition is essential for the development and maintenance of the skeleton Bone disease complex etiologies development of disease by providing adequate amounts of nutrients

 65 years 25% of the population by 2020 risk osteoporosis and (doubling or tripling) hip fracture

Bone Mass and Bone Density

Bone mass bone mineral content (BMC) assesing amount of bone accumulated before the cessation of growth Bone density describe bone after the developmental period is completed

Calcium Metabolism

Calcium Homeostasis

Peak Bone Mass (PBM)

PBM reach 30 years Long bone stop growing in length age 18 (females) and age 20 (males) Man > woman Hereditary Dietary calcium intakes Weight-bearing physical activity Body weight

Loss of bone mass

Age is important Age 40 BMD diminish gradually (both sexes) Loss after age 50 (women) or the time of the menopause 1-2% per year over the next decade Man lower rate than women (same age) But age 70 same for both

Difference between normal bone and osteoporotic bone

Nutrition and Bone

Calcium, phosphat, and vitamin D Micronutrient Phytoestrogens

Recommended Intakes of BoneRelated Nutrition for Adults

Calcium : 1500 mg/day for postmenopausal women, 1000-1200 for younger women Vitamin D: 600-1000 units Magnesium : 400-600 mg Manganese: 2-5 mg Zinc: 15 mg Boron: 3 mg Copper:2-3 mg Vitamin K: 500 mcg

Calcium Intake
Food sources are recommended first for supplying calcium needs because of the coingestion of other essensial nutrients Sources: Calcium from food Calcium from supplement Calcium from fortification food

Calcium from food

Calcium from food is generally good, but from a few foods such as spinach it may be lower Wheat bread may be a good source of calcium Green leafy vegetables such as broccoli, kale, bok choy, and soy bean (lower with oxalate) Dairy products: highcalcium milk, cheeses, yoghurt (best)

 Calcium in selected foods:

Tofu Yoghurt Sardines Collard greens,cooked Cheese Non-fat milk Pudding, vanilla Whole milk Custard Buttermilk Ice-milk Spinach

Calcium from supplement

Significant increases in spinal and total body BMD Good but it seems more likely that keeping the gains in BMD accrued before age 20 Best: combination of regular physical activity and a reasonable consistent daily calcium intakes

Calcium bioavailability from calcium supplement

Depends on the anion used Calcium citrate malate absorbed efficient than calcium carbonate and other calcium supplements Calcium carbonate constipying effect (minimize by dividing dose and taking more fluids and fibers)

Effect of supplement
High dose calcium supplement may reduce the absorption of nonheme iron and possibly zinc. Magnesium, and other divalent cations

Potential Risks Associated with Excessive Calcium Supplementation

Contamination of bone meal or dolomite supplements with cadmium, mercury, arsenic, or lead Urinary tract or renal stones in susceptible individuals Hypercalcemia or milk alkali syndrome from extremely high intakes (>4000 mg/day) Deficiency of iron and other mineral divalent cations resulting from decreased absorption Constipation

Calcium fortification of food

Another way to increase the consumption of calcium by females Orange juice and many brands of nondairy milks at avout 300 mg/ cup of juice and to breadds and other foods Food preferable

Vitamin D
Vitamin D intake: adequate vit D intake is important excess need is avoided Sun light exposure for skin Calcium and vitamin D supplements are often given

Rickets

Phosphat intake
Calcium and Phosphat = 1:1 needed for mineralization High phosphorus bone loss Consumption 1000 mg to 1200 mg/day (females), 1200-1400 mg/day (male)

Protein intake
Anabolic effect High dietary proteinno effect Low dietary protein Low serum albuminlow IGF-1 and serum calcium vulnerable fracture 1 g/kg per day Animal protein rise urinary losses of calcium (acid) Plant proteinlittle effect (neutral or basic urin)

Magnesium intake
Little effect, but suggest adequate intakes of Mg improves BMD

Vitamin K intake
Osteocalcin needs vitamin K Vitamin K supplementation retard bone loss

Intakes of other dietary component

Dietary fiber: excessive intake depression calcium absorption Potassium bicarbonatesufficient to neutralize endogenous acid Vegetarian diet beneficial effect by provides less calcium than animal protein Isoflavon (phytoestrogen) soybean lower lifetime exposure for estrogens

Intakes of other dietary component

Caffein and carbonated beverages excessive intakes deterious effect on BMD Intakes of colaslower BMD Alcoholadverse effect

Osteopenia and Osteoporosis

Osteopenia: When BMD falls sufficiently below healthy values (1 SD) according WHO standard Osteoporosis: When BMD becomes so low (greater than 2.5 SDs below healthy values)

Nutrition management
Adequate calcium intake Adequatevitamin D intake from food, supplement, and sun exposure Avoidance of excess phophorus A balance diet that procides adequate protein, energy, and micronutrients Exercise

Prevention
Three factors influenced (for women): diet, exercise, and estrogen Diet calcium from food (including fortified food), adequate intake of vitamin D either from sun exposure or foods or supplement Engaging in regular weight-bearing exercise Estrogen (before 50)

The end