Bone-Healthy Lifestyle

What are the components of a bone-healthy lifestyle?

proper nutrition, moderation of alcohol intake, smoking cessation, exercise, fall prevention

What is the goal of a bone-healthy lifestyle?

to help optimize peak bone mass if employed early in life and if continued throughout life, will help minimize bone loss over time

What are the universal recommendations for all patients?

balanced diet, limit caffeine to 1-2 servings per day, cessation of tobacco, avoidance of excessive alcohol intake, regular weight-bearing and muscle-strengthening exercise, fall prevention

Why is regular weight bearing and muscle strengthening exercising recommended for all patients?

to improve agility, strength, posture, and balance, reduce risk of falls, modestly increases bone density, and benefits are lost when a person stops exercising

What is adequate calcium intake for adults aged 50+?

1200 mg/day

What is the benefit of calcium supplementation?

small increases in BMD; 15% reduction in risk of total fracture; 30% reduction in risk of hip fracture

What are the risks of calcium supplementation?

CV risk: increased risk of MI and stroke

kidney stones

GI: bloating, constipation, acute distress

True or False: more calcium is better

false

What is the best way to get calcium?

from your diet

True or False: serum calcium is reflective of dietary calcium intake

false

Which calcium formulation is acid depndent?

calcium carbonate

Which calcium formulation is acid independent?

calcium citrate

What does acid dependent mean for absorption of supplements?

needs to be taken with food and shouldn’t be taken with PPIs or famotidine

How much calcium is well absorbed in one amount?

500-600 mg

Which calcium formulation is less concentrated and requires more tablets to reach the same dose?

calcium citrate

What are the common side effects of calcium supplementations?

gas, bloating, and constipation

What important drug interacts exist with calcium supplements?

bisphosphonates, certain antibiotics (FQ, tetracyclines, and levothyroxine

What is the role of Vitamin D?

stimulates calcium absorption, cone health, muscle strength and balance, fall risk, enhances response to osteoporosis therapy

Where is vitamin D synthesized?

in the skin on exposure to sun

What foods have vitamin D?

egg yolks, fish, liver, fortified milk, cereals, fortified orange juice

What are the risk factors for vitamin D deficiency?

malabsorption disorders, chronic renal insufficiency, medications that increase vitamin D metabolism (anti-seizure meds?), housebound patients, obesity

What is the vitamin D supplementation recommendation?

1000 IU/day

What is the optimal level of vitamin D?

at least 30 ng/mL

What vitamin D level is considered insuffieicient?

20-29 ng/mL

What vitamin D level is considered deficient?

< 20 ng/mL

What are the treatment options for vitamin D deficiency?

5,000 IU of D3 daily x 81-12 weeks, followed by 1,000-2,000 IU daily OR

50,000 IU of D3 weekly for 8-12 weeks, followed by 1,000-2,000 IU daily

What is a safe upper limit for vitamin D for the general adult population?

4,000 IU/day