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

Peak bone mass (PMB)

PMB 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 Bone-Related

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 good

bioavailability
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

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 breads 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