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 BoneRelated 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: highcalcium 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 nondairy 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

Intakes of other dietary component

Caffein and carbonated beverages
excessive intakes deterious effect on
BMD
Intakes of colaslower BMD
Alcoholadverse effect

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