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Osteoporosis: It’s More Than Calcium

Osteoporosis: It’s More Than Calcium. Jeanne Freeman, PhD, CHES CSU Chico Lori Turner, PhD, RD University 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.

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Osteoporosis: It’s More Than Calcium

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  1. Osteoporosis:It’s More Than Calcium Jeanne Freeman, PhD, CHES CSU Chico Lori Turner, PhD, RD University of Arkansas

  2. Target Audience • Target: Adult men and women (ages 18-65)

  3. Learning Objectives • Describe the process of bone remodeling. • Describe the two types of bone tissue. • Identify groups at risk for osteoporosis development.

  4. Learning Objectives • Identify positive and negative nutritional practices. • Identify positive and negative lifestyle behaviors. • List medications that increase risk for osteoporosis development.

  5. Introduction • Osteoporosis is a public health concern • Epidemic levels • Costs of bone fragility • Morbidity, mortality, loss of function • Rehabilitation, institutionalization, cost of living Barefield, 1996; Boughton, 1999; Lappe, 1994; NIH, 2000; Turner, Taylor, & Hunt, 1998; Ullom-Minnich, 1999

  6. Introduction • Multifactorial condition • Called the “silent thief” Notelovitz, 1993; Siddiqui, Shetty, & Duthie, 1999; Boughton, 1999;

  7. Bone Remodeling • Two stages • Formation • Resorption • Two types of bone • Trabecular • Cortical Boughton, 1999; Notelovitz, 1993; PDR, 1999; Smith, 1993; Wardlaw, 1993

  8. Types of Osteoporosis • Primary • Both genders • Type I • Type II • Secondary • Result of other disease or medications Donohue, 1999; Glaser & Kaplan, 1997; Kulak, et al., 2000; NIH, 2000; NOF, 2000; Peterson, 2001

  9. Osteoporosis: Who it Targets! • Gender • Both men and women • Age • Development in early 20s and 30s • Risk factors • Risk is not age or gender dependent Aufdemorte, 1991; Hart & Dip, 1996; Hsieh, et al., 2001; Mark & Link, 1999; Moon, 2000; Tokar, et al., 2003

  10. Prevention is the Key • Building strong bones during childhood • Peak bone mass (PBM) • Impact of menopause • Age of attainment • Prevention should occur throughout the lifespan! Cromer & Harel, 2000; Katz et al., 1998; Mark & Link, 1999; Masi & Bilezikian, 1997; NIH, 2000; PDR, 1999

  11. Diet and Osteoporosis – Positive Effects • Calcium • Deficiency • Maximize intakes • Healthy People 2010 • Adequate intakes • Children through older adults Gennari, 2001; Gerrior, et al., 1998; IOM, 1997; Krall & Dawson-Hughes, 1999; Weaver & Heaney, 1999;

  12. Diet and Osteoporosis – Positive Effects • Calcium • Sources • Dairy products • Fortified foods • Calcium supplements • Groups at risk for deficiency Ervin et al., 1999; Fleming & Heimbach, 1994; Recker et al., 1992; Sutton, 2000; Wardlaw & Weese, 1995

  13. Diet and Osteoporosis – Positive Effects • Vitamin D • Fat-soluble vitamin • Key to opening “bone” door • Recommendations • Sources Combs, 1998; Dowd, 2001; Vieth, 1999; Willhite, 1998

  14. Diet and Osteoporosis – Positive Effects • Fluoride • Osteoblast activity • To be used in combination • Vitamin K • Bone tissue proteins • Sources Combs, 1998; Dowd, 2001; Pak et al., 1997; Sowers et al., 1986; Swaminathan, 1999; Willhite, 1998

  15. Diet and Osteoporosis – Positive Effects • Phosphorus • Crystal structure of bones • Deficiency • Magnesium • Sources • Role in bone formation Combs, 1998; Dowd, 2001; Gennari, 2001; Heaney, 2000; Robbins & New, 1997

  16. Diet and Osteoporosis – Negative Effects • Protein • Calcium excretion • Recommended protein intake • Sodium • Calcium excretion • Recommended sodium intake Devine et al., 1995; Lau & Woo, 1998; Krall & Dawson-Hughes, 1999; NAP, 2000; Powers et al., 1999

  17. Diet and Osteoporosis – Negative Effects • Caffeine • Consumption in U.S. • Framingham study • Urinary calcium loss • Beverage replacement • Impact on young people Barone & Grice, 1994; Conlisk & Galuska, 2000; Kiel et al., 1990; Lloyd et al., 1997; Packard & Recker, 1996

  18. Diet and Osteoporosis – Questionable Effects • Soy and isoflavones • Chemical structure like estradiol • May reduce bone turnover • Animal studies have not been consistent with human models • Questions still unanswered regarding soy impact Alekel et al., 2000; Anderson, 1999; Heaney et al., 2000; Messina, 1999; Messina et al., 2002; Ross et al., 1991

  19. Lifestyle Factors and Osteoporosis – Physical Activity • Two types of exercise • Weight-bearing exercise • Resistance exercise • Number of repetitions • Vague exercise recommendations • Benefits of exercise ACSM, 1995; NOF, 2000; Taaffe et al., 1997

  20. Lifestyle Factors and Osteoporosis – Physical Activity • Research among older populations • Fracture risk • Cardiorespiratory fitness • Types of activities Mitchell et al., 1999; Turner et al., 1998

  21. Lifestyle Factors and Osteoporosis – Physical Activity • Research among younger populations • Athletes vs. sedentary groups • Impact on bone density • Caution for athletes • Amenorrhea ACSM, 1995; Kanders et al., 1988; Sabatini, 2001; Snow-Harter et al., 1992; Turner et al., 2000

  22. Lifestyle Factors and Osteoporosis – Alcohol Intake • Suppression of bone formation • Increased fracture risk • Low estrogen • Poor nutrition • Calcium • Vitamin D • Balance difficulties Arden, 1997; Laitinen et al., 1993; Slemenda et al., 1992; Thomas, 1997 Wardlaw & Weese, 1995

  23. Lifestyle Factors and Osteoporosis – Cigarette Smoking • Decreases serum estrogen levels • Decreased bone formation • Reduced calcium absorption • Low body weight • Bone density loss • Increased fractures • Benefits of smoking cessation Cornuz et al., 1999; Hollenbach et al., 1993; Mazess & Barden 1991; Thomas, 1997; Wardlaw & Weese, 1995

  24. Heredity and Osteoporosis • Familial connection • Genetics vs. environment • Twin studies • Mother-daughter studies • Lack of osteoporosis family history does not equate to lack of risk! Lindsay & Dempster, 1985; Slemenda et al., 1990; Snow-Harter & Gillis, 1996; Tudor-Locke & McColl, 2000

  25. Ethnicity and Osteoporosis • Fracture risk • Caucasian • Asian • Lifestyle differences • African American • Hispanic • Ethnicity is more than skin color! Fujita, 1994; Lau et al., 2001; Luckey et al., 1996; Mackelvie et al., 2001; Tudor-Locker & McColl, 2000

  26. Medical History and Osteoporosis • Corticosteroids/glucocorticoids • Medical conditions warranting use of steroids • Hamper bone formation • Calcium malabsorption • Architectural integrity of bone • Need for patient education Eastell, 1995; Lucasey, 2001; Reid, 1997; Yosipovitch et al., 2001; Walsh et al., 1996; Wong et al., 2000

  27. Medical History and Osteoporosis • Depo-Provera (DMPA) • Contraceptive technique • Side effects • Significant bone density loss • Use with caution • Patient education Cromer et al., 1996; Cundy & Reid, 1997; Kass-Wolfe, 2001; Mark, 1994

  28. Medical History and Osteoporosis • Oral contraceptives • Research is controversial • Studies citing positive impact • Studies citing lack of impact • Group who might benefit from oral contraceptive use Collins et al., 1988; Cooper et al., 1993; Kleerekoper et al., 1991; Van Winter & Bernard, 1998

  29. Medical History and Osteoporosis • Eating disorders • Anorexia nervosa • Nutritional intake • Physical activity • Bulimia nervosa • Amenorrhea • Previous anorexia nervosa Beals et al., 1999; Clark, 1997; Hartman et al., 2000; Seidenfeld & Rickert, 2001; Treasure & Serpell, 2001

  30. Summary • Osteoporosis is multifaceted • Diet, heredity, and ethnicity • Lifestyle factors, medication use, and eating disorders • Education and the dissemination of information is needed!

  31. Online Resources • National Institutes of Health • http://health.nih.gov/result.asp/488 • National Osteoporosis Foundation • http://www.nof.org

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