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