Nutrition and Bone Health
Departemen Ilmu Gizi
BLOK DERMATOMUSKULOSKELETAL
FK-UISU, 2009
• Adequate nutrition is essential for the
development and maintenance of the
skeleton
• Bone disease complex etiologies
development of disease ↓ by providing
adequate amounts of nutrients
• 65 years 25% of the population by 2020
• ↑ risk osteoporosis and (doubling or
tripling) hip fracture
Bone Mass and Bone Density
• Bone mass bone mineral content (BMC)
assesing amount of bone accumulated
before the cessation of growth
• Bone density describe bone after the
developmental period is completed
Calcium Metabolism
Calcium Homeostasis
Peak bone mass (PMB)
• PMB reach 30 years
• Long bone stop growing in length age 18
(females) and age 20 (males)
• Man > woman
• Hereditary
• Dietary calcium intakes
• Weight-bearing physical activity
• Body weight
Loss of bone mass
• Age is important
• Age 40 BMD diminish gradually (both
sexes)
• Loss after age 50 (women) or the time of
the menopause 1-2% per year over the
next decade
• Man lower rate than women (same age)
• But age 70 same for both
Difference between normal bone
and osteoporotic bone
Nutrition and Bone
• Calcium, phosphat, and vitamin D
• Micronutrient
• Phytoestrogens
Recommended Intakes of Bone-
Related Nutrition for Adults
• Calcium : 1500 mg/day for postmenopausal
women, 1000-1200 for younger women
• Vitamin D: 600-1000 units
• Magnesium : 400-600 mg
• Manganese: 2-5 mg
• Zinc: 15 mg
• Boron: 3 mg
• Copper:2-3 mg
• Vitamin K: 500 mcg
Calcium Intake
• Food sources are recommended first for
supplying calcium needs because of the
coingestion of other essensial nutrients
Sources:
• Calcium from food
• Calcium from supplement
• Calcium from fortification food
Calcium from food
• Calcium from food is
generally good, but from
a few foods such as
spinach it may be lower
• Wheat bread may be a
good source of calcium
• Green leafy vegetables
such as broccoli, kale,
bok choy, and soy bean
(lower with oxalate)
• Dairy products: high-
calcium milk, cheeses,
yoghurt (best)
• Calcium in selected
foods:
– Tofu
– Yoghurt
– Sardines
– Collard greens,cooked
– Cheese
– Non-fat milk
– Pudding, vanilla
– Whole milk
– Custard
– Buttermilk
– Ice-milk
– Spinach
Calcium from supplement
• Significant increases in spinal and total
body BMD
• Good but it seems more likely that keeping
the gains in BMD accrued before age 20
• Best: combination of regular physical
activity and a reasonable consistent daily
calcium intakes
Calcium bioavailability from calcium
supplement
• Depends on the anion used, but in
market good bioavailability
• Calcium citrate malate absorbed
efficient than calcium carbonate and other
calcium supplements
• Calcium carbonate constipying effect
(minimize by dividing dose and taking
more fluids and fibers)
Effect of supplement
• High dose calcium supplement may
reduce the absorption of nonheme iron
and possibly zinc. Magnesium, and other
divalent cations
Potential Risks Associated with
Excessive Calcium Supplementation
• Contamination of bone meal or dolomite
supplements with cadmium, mercury, arsenic, or
lead
• Urinary tract or renal stones in susceptible
individuals
• Hypercalcemia or milk alkali syndrome from
extremely high intakes (>4000 mg/day)
• Deficiency of iron and other mineral divalent
cations resulting from decreased absorption
• Constipation
Calcium fortification of food
• Another way to increase the consumption
of calcium by females
• Orange juice and many brands of non-
dairy milks at avout 300 mg/ cup of juice
and to breadds and other foods
• Food preferable
Vitamin D
• Vitamin D intake: adequate vit D intake is
important excess need is avoided
• Sun light exposure for skin
• Calcium and vitamin D supplements are
often given
Rickets
Phosphat intake
• Calcium and Phosphat = 1:1 needed for
mineralization
• High phosphorus bone loss
• Consumption 1000 mg to 1200 mg/day
(females), 1200-1400 mg/day (male)
Protein intake
• Anabolic effect
• High dietary proteinno effect
• Low dietary protein Low serum albuminlow
IGF-1 and serum calcium vulnerable fracture
• 1 g/kg per day
• Animal protein rise urinary losses of calcium
(acid)
• Plant proteinlittle effect (neutral or basic urin)
Magnesium intake
• Little effect, but suggest adequate intakes
of Mg improves BMD
Vitamin K intake
• Osteocalcin needs vitamin K
• Vitamin K supplementation retard bone
loss
Intakes of other dietary component
• Dietary fiber: excessive intake
depression calcium absorption
• Potassium bicarbonatesufficient to
neutralize endogenous acid
• Vegetarian diet beneficial effect buy
provides less calcium than animal protein
• Isoflavon (phytoestrogen) soybean
lower lifetime exposure for estrogens
• Caffein and carbonated beverages
excessive intakes deterious effect on
BMD
• Intakes of colaslower BMD
• Alcoholadverse effect
Intakes of other dietary component
Osteopenia and Osteoporosis
• Osteopenia: When BMD falls sufficiently
below healthy values (1 SD) according
WHO standard
• Osteoporosis: When BMD becomes so
low (greater than 2.5 SDs below healthy
values)
Nutrition management
• Adequate calcium intake
• Adequatevitamin D intake from food,
supplement, and sun exposure
• Avoidance of excess phophorus
• A balance diet that procides adequate
protein, energy, and micronutrients
• Exercise
Prevention
• Three factors influenced (for women): diet,
exercise, and estrogen
• Diet calcium from food (including
fortified food), adequate intake of vitamin
D either from sun exposure or foods or
supplement
• Engaging in regular weight-bearing
exercise
• Estrogen (before 50)
The end