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NUTR 425 > Nutrition and Osteoporosis > Flashcards

Nutrition and Osteoporosis Flashcards

1
Q

2 diff tissue types in bone

A

cortical (80%) and trabecular (20%)

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2
Q

bone is organic matrix composed of ___ fibres with _____ salt deposits and crystallized ____ ions

A

collagen; calcium and phosphate; hydroxyl

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3
Q

bones help maintain _____ in the ECF

A

physiologic concentrations of P and Ca

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4
Q

calcium content in the body totals ___ g and hydroxyapatite makes up ___% of total available calcium

A

1100-2000; 99

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5
Q

where is the remaining 1% of Ca?

A

in ECF an regulates various biochem events

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6
Q

normal serum concentration of Ca (total):

A

2.1-2.5 mmol/L

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7
Q

normal serum concentration of P:

A

0.8-1.5 mmol/L

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8
Q

P content in body totals ___g and ___% found in bones

A

500-800; 85-90

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9
Q

maintaining Ca and P homeostasis is complex cuz requires balance of:

A

diet intake, fecal/urinary losses, flux in/out of bone

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10
Q

primary hormones involved in Ca and P regulation:

A

PTH and vit D (calcitriol)

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11
Q

other hormones involved in Ca and P regulation:

A

calcitonin, cortisol, growth and thyroid hormone

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12
Q

how does PTH work?

A

stim osteoclasts (bone remodelling, urinary loss of calcium)

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13
Q

most common bone disease in humans characterized by decreased bone density, deteriorations of bone microarchitecture (qualitY)

A

osteoporosis

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14
Q

osteoporosis ^ susceptibility to:

A

fractures, pain, morbidity

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15
Q

first step on way to osteoporosis:

A

osteopenia (low bone mass)

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16
Q

2 types of primary osteoporosis:

A

type 1 estrogen-androgen deficient OP, type 2 age-related OP

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17
Q

what is type 1 primary>

A

occurs in women within few years of menopause from loss of trabecular (spongy) bone tissue and cessation of ovarian production of estrogen

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18
Q

what is type 2 primary?

A

occurs >70 yrs, hormonal regulatory processes that govern bone remodelling gradually change in ageing so imbalance tween bone formation and resorption occurs (uncoupling)

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19
Q

secondary OP occurs in relation to:

A

drugs or med conditions that ^ bone loss

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20
Q

risk factors for osteoporosis:

A

Caucasian/Asian, small body size and thin bones ,low BMD, personal hx fracture after age 50 (or in parent/sibling), age 65+, abnormal absence of menstrual periods, low estrogen, low testosterone, glucocorticoid therapy > 3 months, alcoholism, low lifelong Ca and D intake, physical inactivity, poor health/frailty, current smoking

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21
Q

risk factors relate to:

A

development of peak BMD, remineralization/demineralization once peak BMD achieved

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22
Q

diseases associated with ^ risk of osteoporosis:

A

GI, genetic, endocrine, hypogonadal states, miscellaneous

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23
Q

drugs associated with ^ risk osteoporosis:

A

glucocorticoids, anticonvulsants, barbiturates, heparin, lithium, methotrexate, PPI, SSRI, thiazolidinediones

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24
Q

BMD best measured using ____ and results compared to ____ diagnostic T score criteria

A

DXA; WHO

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25
Q

T score shows:

A

how much measured BMD is higher or lower than BMD of a healthy 30 year old adult

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26
Q

normal T score is ___, low BM is ____, osteoporosis is ____ and severe is ____

A

-1 or greater; between -1 and -2.5; -2.5 or less; -2.5 or less with 1+ fractures

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27
Q

key nutrients of consideration are:

A

calcium, vit D, protein, sodium, caffeine

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28
Q

other nutrients and food comps important:

A

P (essential for normal bone structure and function), trace minerals, vit A, Vit K (help develop and maintain bone), fibre, alcohol, soy

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29
Q

when ingested in excess, these nutrients and food comps adversely affect bone metabolism:

A

vitamin A (UL 3000mcg retinol), sodium (UL > 2300mg), alcohol, caffeine

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30
Q

primary bone forming mineral that is required for achieving peak bone mass, maintaining bone mass, minimizing bone mineral loss, decreasing incidence of OP related fractures

A

Ca

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31
Q

decreased Ca intake –> ___ serum Ca –> ____ PTH –>stimulate bone ____ to ____ serum Ca

A

decreased; increased; resorption; increase

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32
Q

DVs assume ____ mg/day for Ca

A

1100

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33
Q

primary function of vitamin D:

A

^ serum Ca and P concentrations via promotion of absorption via GIT, promoting reabsorption by kidney, stem osteoclast function (bone resorption)

34
Q

serum ____ is a good indicator of vitamin D status total body stores

A

25-hydroxycholecalciferol

35
Q

reference values for vit D deficient ___, relative insufficient___, optimal ___, toxic ____

A

<25; 25-70; 70-250; >250 (nmol/L)

36
Q

what is the RDA for most life stage/gender groups:

A

15 mcg or 600 IU

37
Q

what is RDA for vit D for adults 70 yrs +?

A

20 mcg or 800 IU

38
Q

bone strength is due to:

A

cable like tensile strength from collagen, hardness from hydroxyapatite

39
Q

trabecular bone predominantly in ______ and is less dense than cortical

A

knobby ends of long bones

40
Q

trabecular bone is exposed to ____ and lined by more cells than cortical, it is more responsive to factors like _____

A

circulating fluids from bone marrow; estrogen

41
Q

which type of bone loss is largely responsible for occurrence of fractures (esp spine)?

A

trabecular

42
Q

cortical bone contains ____ that run parallel with shaft axis

A

osteon (vertical Haversian systems)

43
Q

what is in centre of each osteon?

A

canal that contains artery that supplies bone tissues with nutrients and O2, vein for removing wastes, nerve for returning afferent relays to brain

44
Q

what is BMC?

A

bone mineral content; measurement of bone mineral found in a specific area, measured in grams

45
Q

what is BMD?

A

bone mineral density; describes mineral content of bone per unit/area of bone, measured in g/cm^2 (ie. BMC/bone area)

46
Q

osteoclasts in charge of ___, osteoblasts in charge of _____

A

bone breakdown/resorption via enzymes and acid; bone formation, synth matrix proteins (osteocalcin, collagen type 1), bone mineralization, lining cells (regulate passage of Ca in/out of cell, respond to hormones by synth proteins that activate osteoclasts)

47
Q

what are osteocytes?

A

cells inside bone that are derived from osteoblasts that sense pressures/cracks in bone are to direct where osteoclasts dissolve the bone

48
Q

what is bone reabsorption?

A

resorption of bone tissue , process by which osteoclasts break down tissue in bones and release the minerals, resulting in transfer of calcium from bone tissue to blood

49
Q

osteoclasts and osteoblasts communicate via:

A

cytokine signalling

50
Q

term applied to the growth of the skeleton until mature height is achieved

A

bone modelling

51
Q

bone modelling is done at age ___ in F and ____ in M

A

16-18; 18-20

52
Q

amount of bony tissue present at end of skeletal maturation

A

peak bone mass (around age 30)

53
Q

what influences peak bone mass?

A

diet, physical activity, race, genetics

54
Q

process by which bone mass continues to accumulate after bones stop growing at 18-20 years:

A

consolidation (filling in of osteons in shaft of long bones)

55
Q

what is the major physiological effect of estrogen?

A

inhibit bone resorption

56
Q

process in which bone is resorbed continuously thru osteoclast action and reformed thru action of osteoblasts

A

bone remodeling

57
Q

process of bone remodelling:

A

activated by preosteoclatic cells in bone marrow, cytokines released from bone-lining cells which trigger activity of precursor stem cells in bone marrow–>preosteoclatic cells migrate from bone marrow to bone surfaces while differentiating into mature osteoclasts –>cover specific area of bone tissue and release acids and proteolytic enzymes which form small cavities on surface of bone and resorb bone mineral and matrix on surface of bone–>rebuilding/formation involves secretion of collagen and other matrix proteins by osteoblasts–>collagen polymerizes to form mature triple stranded fibres and other matrix proteins secreted –>salts of Ca and phosphate begin to precipitate on the collagen fibres developing into the hydroxyapatite-

58
Q

resorption is ___ and refilling is ___

A

fast (days); slow (months)

59
Q

major sources of P

A

high protein foods, whole grains, processed foods

60
Q

why concern about diet high in P and low in Ca?

A

cuz impair usual homeostatic mechanisms that come into play when diet Ca is limited (focus on P rich carbonated beverages), but not proven experimentally and negligible effect on Ca excretion

61
Q

consume up to __mg of caffeine

A

400

62
Q

why is their prob with using coffee as surrogate for caffeine?

A

confounding factors in coffee, don’t define how big a cup of coffee is, how much caffeine in cup of coffee depends on type brewed, what is put in it

63
Q

theories of protein influence on OP:

A

OP and hip fractures common in countries with excess meat and dairy consumption (correlation); high protein diets are high acid so ^ Ca excretion and might have deleterious effect on bone (but sci not support theories, actually ^ protein might have + effect on bone)

64
Q

positive effect of high protein intake:

A

muscle health and strength reduce fall and fracture risk, a.a. for bone matrix, ^ intestinal Ca absorption, increase in circulating IGF-1, decrease serum PTH

65
Q

high Na causes ______

A

increased urinary Ca excretion

66
Q

why OP common in chronic alcoholism?

A

nutrient displacement (poor Ca and vit D intake), ^ PTH, toxic effect on osteoblasts, increase risk of falls

67
Q

why physical activity good for bone?

A

regular wt bearing and muscle strengthening exercise slows rate of bone loss, increase BMD, reduce fall risk, protect spine

68
Q

in assessment, should get these anthropometrics:

A

ht, wt, bone structure, wt history, BMI

69
Q

in assessment, get these biochem/med tests:

A

vitamin D (total, 25-hydroxy), DXA bone density

70
Q

in assessment, get these clinical (client hx and NFPE):

A

age, sex, gender, smoker, PA, med history, meds, overweight/obese, frailty, kyphosis

71
Q

in assessment , get these dietary:

A

vit D, Ca, protein, Na, caffeine, alcohol, supplements, food and nutrition related attitudes

72
Q

common nutrition probs in osteoporosis:

A

inadequate vit D and/or Ca intake, altered GI function, predicted food/med interaction, malnutrition, excess alcohol, food and nutrition related knowledge deficits, physical inactivity

73
Q

for adults 50+ yrs, calcium should be ____mg and vit D for adults at moderate risk should be _____IU

A

1200; 800-2000

74
Q

Ca supplements may ^ risk for ___

A

MI

75
Q

acute ^ in serum Ca (supplements) may contribute to _____

A

vascular calcification (deposit of calcium phosphate into CV structures) –>predictive biomarkers of CVD, ^ blood coagulation, ^ arterial stiffness

76
Q

clinical approach to Ca supplementation :

A

individualized, complete diet hx/calcium calculator, counsel to meet Ca requirements via diet but if not achievable consider supplement of no more than 500mg/day, educate on risks and benefits, liaise with physician

77
Q

most common Ca supplement that is least expensive and needs to be taken with meals and interferes with iron absorption

A

calcium carbonate

78
Q

type of Ca supplement can be taken any time:

A

Ca citrate

79
Q

considerations for pt and clinicians when supplementing :

A

cost, form, non medicinal ingredients, taste/tolerance/side effects

80
Q

antiresorptive drugs:

A

bisphosphonates (bind to surface of bones to slow down resorbing, don’t take with food or supplements), RANK ligand inhibitor (inhibit development and activation of osteoclasts, injection)

81
Q

hormone therapies:

A

estrogen +/- progesterone , PTH therapy (bone formation therapy–>activates osteoblasts), SERMS (selective estrogen receptor modulators, non-hormonal and blocks effects of estrogen in uterus and breast, used for ppl with high cancer risk), calcitonin (slows down osteoclast activity)

NUTR 425 (15 decks)

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