Osteoporosis: It’s More Than Calcium Jeanne Freeman, PhD, CHES CSU Chico Lori Turner, PhD, RD...
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Transcript of Osteoporosis: It’s More Than Calcium Jeanne Freeman, PhD, CHES CSU Chico Lori Turner, PhD, RD...
Osteoporosis:It’s More Than Calcium
Jeanne Freeman, PhD, CHESCSU Chico
Lori Turner, PhD, RDUniversity of Arkansas
Target Audience
Target: Adult men and women (ages 18-65)
Learning Objectives
Describe the process of bone remodeling.
Describe the two types of bone tissue.
Identify groups at risk for osteoporosis development.
Learning Objectives
Identify positive and negative nutritional practices.
Identify positive and negative lifestyle behaviors.
List medications that increase risk for osteoporosis development.
Barefield, 1996; Boughton, 1999; Lappe, 1994; NIH, 2000; Turner, Taylor, & Hunt, 1998; Ullom-Minnich, 1999
Introduction
Osteoporosis is a public health concern
Epidemic levels Costs of bone fragility
Morbidity, mortality, loss of function
Rehabilitation, institutionalization, cost of living
Notelovitz, 1993; Siddiqui, Shetty, & Duthie, 1999; Boughton, 1999;
Introduction
Multifactorial condition
Called the “silent thief”
Boughton, 1999; Notelovitz, 1993; PDR, 1999; Smith, 1993; Wardlaw, 1993
Bone Remodeling
Two stagesFormationResorption
Two types of boneTrabecularCortical
Donohue, 1999; Glaser & Kaplan, 1997; Kulak, et al., 2000; NIH, 2000; NOF, 2000; Peterson, 2001
Types of Osteoporosis
PrimaryBoth gendersType IType II
SecondaryResult of other disease or
medications
Aufdemorte, 1991; Hart & Dip, 1996; Hsieh, et al., 2001; Mark & Link, 1999; Moon, 2000; Tokar, et al., 2003
Osteoporosis: Who it Targets!
GenderBoth men and women
AgeDevelopment in early 20s and
30s Risk factors
Risk is not age or gender dependent
Cromer & Harel, 2000; Katz et al., 1998; Mark & Link, 1999; Masi & Bilezikian, 1997; NIH, 2000; PDR, 1999
Prevention is the Key
Building strong bones during childhood
Peak bone mass (PBM) Impact of menopauseAge of attainment
Prevention should occur throughout the lifespan!
Gennari, 2001; Gerrior, et al., 1998; IOM, 1997; Krall & Dawson-Hughes, 1999; Weaver & Heaney, 1999;
Diet and Osteoporosis – Positive Effects Calcium
DeficiencyMaximize intakesHealthy People 2010Adequate intakes
Children through older adults
Ervin et al., 1999; Fleming & Heimbach, 1994; Recker et al., 1992; Sutton, 2000; Wardlaw & Weese, 1995
Diet and Osteoporosis – Positive Effects Calcium
SourcesDairy productsFortified foodsCalcium supplements
Groups at risk for deficiency
Combs, 1998; Dowd, 2001; Vieth, 1999; Willhite, 1998
Diet and Osteoporosis – Positive Effects Vitamin D
Fat-soluble vitaminKey to opening “bone” doorRecommendationsSources
Combs, 1998; Dowd, 2001; Pak et al., 1997; Sowers et al., 1986; Swaminathan, 1999; Willhite, 1998
Diet and Osteoporosis – Positive Effects Fluoride
Osteoblast activityTo be used in combination
Vitamin KBone tissue proteinsSources
Combs, 1998; Dowd, 2001; Gennari, 2001; Heaney, 2000; Robbins & New, 1997
Diet and Osteoporosis – Positive Effects Phosphorus
Crystal structure of bonesDeficiency
MagnesiumSourcesRole in bone formation
Devine et al., 1995; Lau & Woo, 1998; Krall & Dawson-Hughes, 1999; NAP, 2000; Powers et al., 1999
Diet and Osteoporosis – Negative Effects Protein
Calcium excretionRecommended protein intake
SodiumCalcium excretionRecommended sodium intake
Barone & Grice, 1994; Conlisk & Galuska, 2000; Kiel et al., 1990; Lloyd et al., 1997; Packard & Recker, 1996
Diet and Osteoporosis – Negative Effects Caffeine
Consumption in U.S.Framingham studyUrinary calcium lossBeverage replacement
Impact on young people
Alekel et al., 2000; Anderson, 1999; Heaney et al., 2000; Messina, 1999; Messina et al., 2002; Ross et al., 1991
Diet and Osteoporosis – Questionable Effects Soy and isoflavones
Chemical structure like estradiol
May reduce bone turnoverAnimal studies have not been
consistent with human modelsQuestions still unanswered
regarding soy impact
ACSM, 1995; NOF, 2000; Taaffe et al., 1997
Lifestyle Factors and Osteoporosis – Physical Activity Two types of exercise
Weight-bearing exerciseResistance exerciseNumber of repetitions
Vague exercise recommendations
Benefits of exercise
Mitchell et al., 1999; Turner et al., 1998
Lifestyle Factors and Osteoporosis – Physical Activity Research among older
populationsFracture riskCardiorespiratory fitnessTypes of activities
ACSM, 1995; Kanders et al., 1988; Sabatini, 2001; Snow-Harter et al., 1992; Turner et al., 2000
Lifestyle Factors and Osteoporosis – Physical Activity Research among younger
populationsAthletes vs. sedentary groups Impact on bone densityCaution for athletes
Amenorrhea
Arden, 1997; Laitinen et al., 1993; Slemenda et al., 1992; Thomas, 1997 Wardlaw & Weese, 1995
Lifestyle Factors and Osteoporosis – Alcohol Intake Suppression of bone formation Increased fracture risk
Low estrogenPoor nutrition
CalciumVitamin D
Balance difficulties
Cornuz et al., 1999; Hollenbach et al., 1993; Mazess & Barden 1991; Thomas, 1997; Wardlaw & Weese, 1995
Lifestyle Factors and Osteoporosis – Cigarette Smoking Decreases serum estrogen
levelsDecreased bone formationReduced calcium absorption
Low body weight Bone density loss
Increased fractures Benefits of smoking cessation
Lindsay & Dempster, 1985; Slemenda et al., 1990; Snow-Harter & Gillis, 1996; Tudor-Locke & McColl, 2000
Heredity and Osteoporosis
Familial connectionGenetics vs. environment
Twin studies Mother-daughter studies Lack of osteoporosis family
history does not equate to lack of risk!
Fujita, 1994; Lau et al., 2001; Luckey et al., 1996; Mackelvie et al., 2001; Tudor-Locker & McColl, 2000
Ethnicity and Osteoporosis
Fracture riskCaucasianAsian
Lifestyle differencesAfrican AmericanHispanic
Ethnicity is more than skin color!
Eastell, 1995; Lucasey, 2001; Reid, 1997; Yosipovitch et al., 2001; Walsh et al., 1996; Wong et al., 2000
Medical History and Osteoporosis Corticosteroids/glucocorticoids
Medical conditions warranting use of steroids
Hamper bone formationCalcium malabsorptionArchitectural integrity of boneNeed for patient education
Cromer et al., 1996; Cundy & Reid, 1997; Kass-Wolfe, 2001; Mark, 1994
Medical History and Osteoporosis Depo-Provera (DMPA)
Contraceptive techniqueSide effects
Significant bone density loss
Use with cautionPatient education
Collins et al., 1988; Cooper et al., 1993; Kleerekoper et al., 1991; Van Winter & Bernard, 1998
Medical History and Osteoporosis Oral contraceptives
Research is controversialStudies citing positive impactStudies citing lack of impact
Group who might benefit from oral contraceptive use
Beals et al., 1999; Clark, 1997; Hartman et al., 2000; Seidenfeld & Rickert, 2001; Treasure & Serpell, 2001
Medical History and Osteoporosis Eating disorders
Anorexia nervosaNutritional intakePhysical activity
Bulimia nervosaAmenorrheaPrevious anorexia nervosa
Summary
Osteoporosis is multifacetedDiet, heredity, and ethnicityLifestyle factors, medication
use, and eating disorders Education and the
dissemination of information is needed!
Online Resources
National Institutes of Healthhttp://health.nih.gov/result.asp/
488
National Osteoporosis Foundationhttp://www.nof.org