Mar 31 Health - Osteoporosis 2 Flashcards
Protein and Bone Health:
Expert Consensus review published in 2018 Main findings: (4 things)
“Dietary protein above the RDA (≥0.8 g/kg/d) may be beneficial for bone”
Hip fracture risk is modestly decreased with higher dietary protein intakes, provided
calcium intakes are adequate.
BMD appears to be positively associated with dietary protein intakes.
Protein and calcium combined in dairy products has beneficial effects on bone health.
The benefit of dietary protein on bone outcomes seems to require adequate calcium
intakes.
Study within the Expert Consensus CaMOS Study: (2 things)
- Low protein intake (< 12% TEE) was associated with increased fragility
fracture risk - Dairy protein was associated with higher total hip BMD in men and women 50+ y.
Importance of Protein x Ca
- BMD improved with increasing protein intake, as long as current recommended intakes of calcium and vitamin D are met.
NEW Osteoporosis Canada 2023 Updated Nutrition Guidelines: (2 things)
- Osteoporosis Canada endorses the RDA for calcium, vitamin D and protein.
- Dietary patterns and the optimal level of dietary protein for fracture prevention are areas for future study.
Exercise Recommendations for Older Adults
Canadian Society for Exercise Physiology (CSEP): (4 things)
- 150 mins of moderate to vigorous aerobic PA
- Muscle strengthing 2 times a week
- several hours of light PA including standing
-PA that challenges balance
NEW Osteoporosis Canada 2023 Updated Exercise Guidelines
Prioritize:
- Prioritize balance, functional, and resistance training ≥ twice weekly.
- Other activities encouraged, but not replace balance, functional, and resistance training.
- Progression: ↑ exercise difficulty, pace, frequency, volume (sets, reps) or resistance over time.
– Progressive overload
– Individualized approach - Seek exercise advice and guidance from professionals
– CEP and CPT (CSEP training)
– Physiotherapist/Occupational Therapist
Medication Treatment of Osteoporosis
(Name 2)
What do they do?
(2 things)
Bisphosphonates: Alendronate, Risedronate
– Anti-resorptive therapy -> Inhibit/reduce osteoclast function – promote osteoclast apoptosis
- prevent uncoupled bone breakdown
- Bind to the mineral matrix of the bone, particularly at sites of active bone remodeling
Hormone Replacement Therapy -> anti-resorptive therapy
– Replacement of estrogen in post menopausal females
– Early stages of menopause
Bone Health Athlete Considerations: (2 things)
- Low Energy Availability (LEA)
- Relative Energy Deficiency in Sport (RED-S)
Energy Availability:
Energy is expended during several fundamental physiological processes: (name 7)
Energy expended for one of these processes is not available for others
- Cellular maintenance/metabolism
- Thermoregulation
- Growth
- Reproduction
- Cognitive function
- Immunity
- Locomotion
Energy Availability =
Energy consumed from diet (kcals) minus Energy burned from exercise (kcals)
then divided by Kg of Fat Free Mass
Low Energy Availability =
- Energy replete (“normal”) =
- Low EA =
“inadequate energy intake relative to exercise energy expenditure, leaving inadequate energy to support the functions required by the body to maintain optimal health and performance.”
- Energy replete (“normal”) = 45 kcal/kg FFM/day
- Low EA = < 30 kcal/kg FFM/day
Relative Energy Deficiency in Sport (RED-S):
- Syndrome resulting from chronic low energy availability causing impaired physiological functioning
Female Athlete Triad:
(2 things)
Disordered eating, Amenorrhea, Poor bone health
- First described in 1992 by the American
College of Sports Medicine. - Further defined as a clinical entity referring to relationship between energy availability, menstrual function, and bone mineral density.
LEA Prevalence and Risk Factors:
Highest risk factor sports:
Risk factors:
Prevalence of LEA ranges from 22-58% depending on sport, population and is not just for females.
Highest risk factor sports:
* Sports involving high training volumes
* Sports involving Weight classes/low body weight
* Sports involving aesthetics and/or are subjectively assessed
Risk factors:
* Calorie restriction, Exercise for prolonged periods of time, Pressure to lose weight to improve performance, Competitive nature, Training even when injured or sick, Traumatic event, Change in coaching personnel, other life stressors
RED-S Symptoms: (Name 7)
Symptoms:
* Reduced bone mass
* Frequent injuries (stress fractures)
- Menstrual irregularities
- Fatigue
- Problems controlling body temp
- Problems with sleep
- Sport performance issues
RED-S Treatment: (name 4)
Treatment:
* Increase energy intake (~300-600kcal
per day)
* Reduce energy expenditure
* Combination of both
* Counselling (to try to address
underlying factors)
Overview: RED-S/LEA and Bone
Metabolic/Hormonal changes path:
Restrictive eating or Elevated caloric
expenditure -> Metabolic/Hormonal
changes -> Suppressed RMR and Reduced bone formation -> Compromised skeletal health, Fractures and Increased risk for osteoporosis
Overview: RED-S/LEA and Bone
Menstrual Irregularities – low estrogen path:
Restrictive eating or Elevated caloric
expenditure -> Menstrual Irregularities
– low estrogen -> Infertility and Increased bone resorption -> Compromised skeletal health, Fractures and Increased risk for osteoporosis
