Bone Health Exam 5 Life Stages

Woosley LLU Nutrition

Osteoporosis: a ____ bone disease characterized by a ___ leading to bone ___ and consequently an increased risk of ____

metabolic, low bone mass, fragility, fracture

Osteopenia: individuals with a bone density ______ but not as low as a diagnosis of osteoporosis

below normal

Osteomalacia: impaired ____ (___) caused by ___ and ___ deficiency

mineralization (softer bones), calcium, vit D

Trabecular bone: found in the ___ ends of the long bones, the ____ of the pelvis, the ____, ____, ____, and regions of the bone that line the ____

knobby, iliac crest, wrists, scapulas, vertebrae, marrow

Trabecular bone comprises ____ of the skeleton

20%

Cortical bone is found in the ___ of the long bones and comprises ____ of the skeleton

shafts, 80%

Osteoblasts: bone cells that form or produce ____

bone tissue

Osteoclasts: bone cells that govern _____

bone resorption

Bone mineral density (BMD): measurement of the ____. Normal, T-score of ___, is the average bone density of the US population of premenopausal females

density of bone, 0

How to find bone mineral density

Dexa scan

Osteoporosis density:

Low bone density:

Normal:

-2.5 to -4

-1 to -2.5

4 to -1

Each bone contains bone tissue of two major types:

trabecular and cortical

Trabecular and cortical tissues undergo bone modeling during ____ (___) and bone remodeling after ____

growth (height gain), growth ceases

Trabecular bone is ____ than cortical bone as a result of an ____ of interconnecting bony ____ that resemble a sponge in appearance

less dense, open structure, spicules,

Trabecular bone adds ___ to the cortical bone shell of the ____ and provides a _____ that is exposed to ____ from the ____, and is lined by a larger number of cells than ____

support, long bones, large surface area, circulating fluids, marrow, cortical bone tissue

The loss of trabecular bone tissue late in life is largely responsible for the occurrence of ___, especially those of the ____

fractures, spine

Calcium homeostasis refers to the process of maintaining a ______

constant serum calcium concentration

When calcium intake is inadequate, homeostasis is maintained by drawing on ___ from the ___ to keep the serum calcium at its set level

mineral, bone

Serum calcium concentration is regulated by 2 calcium regulating hormones:

parathyroid hormone (PTH) and 1,25 dihydroxy vitamin (D3 calcitriol)

If serum calcium falls, ____ increases reabsorption from the ___ and ____ and ___ increases gut absorption and initiates ____ for bone breakdown

PTH, kidney, bone, calcitriol, osteoclastic activity

Hypercalcemia: increased _____- occurs primarily as a result of -____

serum calcium, hyperparathyroidism

Bone modeling: the growth of the ___ until mature ___ is achieved

skeleton, height

Bone modeling typically is completed in females by ____ and in males by _____

16-18 yrs, 18-20 yrs

Peak bone mass (PBM) is reached by approximately ____

30 yoa

The long bones stop growing in length by ___ yrs but bone mass continues to accumulate for a few more years, a process known as ____

18-20, consolidation

Bone modeling: PBM (peak bone mass) is related to appropriate ____, ____, and ____

nutrient intake, physical activity, genetics

Bone formation begins in the ___, therefore, there is more focus on ____

embryo, maternal nutrition

Additional preventive interventions for bone modeling such as ____, ____, and avoidance of ____, should be initiated at age ___ and continued through early _____

adequate calcium intkae, exercising, tobacco and alcohol, 9-10, 20s

PBM is diminished in cases of…

anorexia nervosa

Bone remodeling is a process in which bone is ___ continuously through the action of ___ and reformed through the action of the ____

resorbed, osteoclasts, osteoblasts

The remodeling process is initiated by the activation of ____ in the bone marrow

preosteoclastic cells

Approximately ___ of the total bone surface is involved in remodeling at any given time

4%

The resorptive process is ___, and is completed within ____, whereas the rebuilding or formation is ____

rapid, a few days, slow

When the resorption and formation phases are in balance, the same amount of ____ exists at the completion of the formation phase at the ___ of the resorption phase

bone tissue, beginning

With aging, osteoclastic resorption becomes relatively ___ than formation by ____- this ___ between formation and resorption is referred to as ___ of the osteoblastic and osteoclastic activity

greater, osteoblast, imbalance, uncoupling

By age ___, BMD (bone mineral density) begins to _____ in both sexes

40, diminish gradually

Bone loss increases greatly in women after ____- trabecular bone is lost at a much higher rate than ____

menopause, cortical bone

Men continue to have bone loss after age 40, but at a much ___ than women until the age of ____

lower rate, 65-80

The loss of bone can continue throughout ____, eventually leading to ____ or ___, however not all older persons have poor ____

aging, osteopenia or osteoporosis, bone health

Age-related primary osteoporosis occurs at ~age ___ and ____. Many women lose several ___ between 50and 80 years.

70 and beyond, inches of height,

Although age-related osteoporosis affects both sexes, women are affected much more ____ because they have a ___ than men.

severely, smaller skeletal mass

Secondary osteoporosis: results when an identifiable ___ or ___ causes loss of bone tissue

drug, disease process

Types of osteoporosis

age-related primary osteoporosis, secondary osteoporosis, estrogen-androgen deficient osteoporosis

Estrogen-androgen deficient osteoporosis: occurs in women within a few years of ___ from loss of ____ and decreased ____ production of ____

menopause, trabecular bone tissue, ovarian, estrogens

Rarely, men may develop _____ if they have a significant decline in androgen production

androgen deficient osteoporosis

Causes and risk factors for osteoporosis

• a____

• g____

• e____

• c____ s____

• e____ i____ of a____ or c____

• lack of w____-b____ e____

• loss of m____

• a____

• family history of o____ or hip f____

• inadequate n____ i____

• prolonged use of certain m____

• s____

• u____

• g____ disease

■Age

■Gender

■Ethnicity: white or Asian

■Cigarette smoking

■Excessive intake of alcohol or caffeine

■Lack of weight-bearing exercise

■Loss of menses – estrogen depletion from menopause or early oophorectomy

■Ammenorrhea

■Family history of osteoporosis or hip fracture

■Inadequate nutrient intake (calcium, vitamin D, vit C, vit A, B1, B6, B12, E, and K)

■Prolonged use of certain medications – a number of medication contribute adversely to osteoporosis, either by interfering with calcium absorption or by actively promoting calcium loss (Box 23.3)

■Sarcopenia

■Underweight, low body mass index, low body fatness

■Genetic disease

Bone densitometry measures bone mass on the basis of ____ of ___ produced by x-ray tubes

tissue absorption of photons

DEXA, available in most ____ and many ____, measures total body and regional _____, such as the lumbar ___ and the proximal _____

hospitals, clinics, skeletal sites, vertebrae, femur (hip)

Results of ____ measurements are expressed as ____ and ____

DEXA, T-scores, Z-scores

DEXA is a _____ tool

diagnostic

Ultrasound instruments measure the velocity of ____ transmitted through ___ and broadband ultrasound attenuation (BUA). Ultrasound measurements are considered….

sound waves, bone, screening tools

Nutrition and bone: need adequate amounts of…

• c____

• p____

• vitamin ____

• vitamin ____

• vitamin ____

• c____

• p____

• m____

• other ____

–Calories

–Protein

–Vitamin A

–Vitamin D (800 IU/day)

–Vitamin K

–Calcium (1000 – 1200 mg/day)

–Phosphate

–Magnesium

–Other trace minerals

Nutrition and bone: other dietary components

• ____

• ____

• ____ f____

• ____ and isoflavones

• high ____ or alkaline diets

• ____

• ____ diets

• Alcohol

• Caffeine

• Dietary Fiber

• Soy and Isoflavones

• High Acid or Alkaline Diets

• Sodium

• Vegetarian Diets

Vitamin D: main function is to maintain ____ and ___ levels within a constant range

serum calcium and phosphorus

Vit D stimulates intestinal _____ and activity of _____ in ____

calcium transport, osteoclasts in bone

Vit D may have a role in ___ and ____

muscle tone, fall prevention

An individual’s vitamin D status depends mostly on ____ and secondarily on ____

sunlight exposure, dietary intake

A daily vit D supplement is recommended with…

800 IU

Mg and Vit D are essential for ____ of various ____

physiological function, organs

Mg assists in the activation of ____- regulates ___ and ___ homeostasis, influences growth and maintenance of ____

vit D, Ca and phosphate, bone

All enzymes that metabolize vit D require…

Mg

Deficiency in either magnesium or vit D is associated with…

various disorders

RDA for magnesium:

310-420 mg/d

Consumption of natural foods has…

decreased

SAD contains about ___ of the RDA for Mg, so ___ of the population is consuming a Mg-deficient diet

50%, 3/4

Treatment for osteoporosis: MNT: calcium ____mg/day, vit D ____ units/day, and _____, as well as a ___ emphasizing the key nutrients

1000, 1000, magnesium, healthy diet

Treatment for osteoporosis: exercise: exercises that exert ___ against potentially weak bones are not recommended, such as ___ or ____

strong force, sit-ups or twisting

Exercises for osteoporosis should focus on ___, ___, ___, ___, and ___ and ___ stabilization

posture, balance, gait, coordination, hip and trunk

Daily ____ exercises for osteoporosis, weight-bearing aerobic exercise ____, resistance training ____

balance, 5x+/week, 2x+/week

FDA drug treatments: bisphosphonates, peptide hormones, ___, estrogen agonists or selective estrogen receptor modulators (____)

estrogen

FD