osteoporosis: it’s more than calcium jeanne freeman, phd, ches csu chico lori turner, phd, rd...
TRANSCRIPT
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Osteoporosis:It’s More Than Calcium
Jeanne Freeman, PhD, CHESCSU Chico
Lori Turner, PhD, RDUniversity of Arkansas
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Target Audience
Target: Adult men and women (ages 18-65)
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Learning Objectives
Describe the process of bone remodeling.
Describe the two types of bone tissue.
Identify groups at risk for osteoporosis development.
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Learning Objectives
Identify positive and negative nutritional practices.
Identify positive and negative lifestyle behaviors.
List medications that increase risk for osteoporosis development.
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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
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Notelovitz, 1993; Siddiqui, Shetty, & Duthie, 1999; Boughton, 1999;
Introduction
Multifactorial condition
Called the “silent thief”
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Boughton, 1999; Notelovitz, 1993; PDR, 1999; Smith, 1993; Wardlaw, 1993
Bone Remodeling
Two stagesFormationResorption
Two types of boneTrabecularCortical
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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
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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
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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!
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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
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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
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Combs, 1998; Dowd, 2001; Vieth, 1999; Willhite, 1998
Diet and Osteoporosis – Positive Effects Vitamin D
Fat-soluble vitaminKey to opening “bone” doorRecommendationsSources
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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
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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
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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
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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
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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
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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
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Mitchell et al., 1999; Turner et al., 1998
Lifestyle Factors and Osteoporosis – Physical Activity Research among older
populationsFracture riskCardiorespiratory fitnessTypes of activities
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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
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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
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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
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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!
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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!
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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
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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
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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
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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
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Summary
Osteoporosis is multifacetedDiet, heredity, and ethnicityLifestyle factors, medication
use, and eating disorders Education and the
dissemination of information is needed!
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Online Resources
National Institutes of Healthhttp://health.nih.gov/result.asp/
488
National Osteoporosis Foundationhttp://www.nof.org