Osteoporosis Flashcards
Bones consist of _____, _____, and _______
collagen fibers
hydroxyapatite
bone proteins
hydroxyapatite is __________ in combination with ______
salts of calcium and phosphate
hydroxyl ions
bone proteins (2) ?
osteocalcin
osteopontin
compact bones in the shaft of long bones
conical bone
spongey bone found in the knobby ends of long bones, iliac crest, vertebrae, wrists, scapulas, and regions of bone that line the marrow
trabecular bone
trabecular bone provides _____ that is exposed to ______ from the ______
increased loss of this bone with _______, it is more responsive to ______
surface area
circulating fluids
marrow
aging
estrogen
cell responsible for formation of bone tissue
does this through synthesis of ____ and _____
osteoblast
collagen
bone proteins
cell associated with the resorption and removal of bone
this occurs through release of ______ and _____
osteoclasts
acids
proteolytic enzymes
- Where is calcium found?
- what occurs when calcium intake in inadequate
99% of calcium is found in skeleton
1% in extracellular fluid
serum Ca decreases=> parathyroid hormone (PTH) levels increase=> stimulates osteoclast activity to=> pull Ca from the bone to maintain normal serum levels
increases intestinal Ca absorption
Calcitriol (active vitamin D)
The skeleton grows until mature ______ is achieved
At this time, bone formation____ bone resorption
Completed in females by ~ ______ and males ~ ______
height
>
age 18
age 20
Process where bone is continuously resorbed and reformed through the action of osteoclasts & osteoblasts
bone remodeling
bone remodeling is initiated by ________
cytokines, interleukin-1
respiration means _____
bone loss
Young, healthy adults=> resorption & formation are ________
Older adults=>_________ with increased resorption=> _____
balanced, and bone mass is maintained
bone loss
A measurement of the mineral content of bone per unit of bone
Measured by _____________
Bone mineral density (BMD)
Bone Densitometry (DEXA)
- Maximum amount & density of bone accumulated ?
- Bone _____ continues to accumulate after the length stops.
- Peak bone mass is reached by ~age ____
- Greater in_______
peak bone mass
mass
30
men
secondary osteoporosis is caused by what diseases and conditions?
Hyperparathyroidism
Chronic kidney disease
Chronic malabsorption
Chronic immobilization
secondary osteoporosis is caused by what medications?
Corticosteroids
Phenytoin (Dilantin)
Heparin
Methotrexate
Proton pump inhibitors (e.g., Prilosec)
Risk factors for Osteoporosis include…
Age, especially > ____years
______ gender
Hypothalamic amenorrhea
_________ of osteoporosis
_______ depletion from Menopause or Early oophorectomy
Ethnicity: __________
________ depletion
60
Female
Family history
Estrogen
Asian or Caucasian
Androgen
Risk Factors for Osteoporosis
________ that adversely affect bone or calcium metabolism
_______ smoking
Lack of _______
______ weight
_______
Inadequate __________ intake
Excessive ______ intake
Medications
Cigarette
exercise
Under
Sarcopenia
calcium or vitamin D
alcohol
Lifestyle Modification
- Adequate intake of ________ and ________ to meet the DRIs
- Decrease ______ intake to moderate level
- _______ cessation
- Increase exercise:
______________=>intensive walking, jogging, cycling, walking stairs
___________ (e.g., lifting weights, resistance bands, squats, planks, push-ups)
_____________
Ca & Vitamin
alcohol
Smoking
Weight-bearing aerobic activity
Resistance training
Balance exercises
calcium recommendation for
9-18
19-50
51-70
>70
1300 mg
1000 mg
1000 mg for males & 1200 mg for females
1200 mg
calcium consumption ????????????
???????? idk what she said ab this
Sources high in Calcium
dairy products
fortified foods (OJ, soy milk, cereals)
Tofu
Sardines
sources that are sources of calcium but are a lil less
salmon
turnip and collard greens
soybeans
almonds
legumes
kale
broccoli
foods with _____ mg or more of calcium is a good source. However, we can only absorb _____ mg at one time.
200 mg
500 mg
Factors that enhance Ca Absorption
Vitamin D
Lactose
- spread calcium throughout the day to maximize absorption
Factors that decrease Ca Absorption
oxalates
Potatoes
excessive insoluble fiber
zinc supplements
examples of oxalates
spinach
rhubarb
nuts
chocolate
celery
beets
examples of phtates
legumes
nuts
seeds
whole grains
Mean intake for females > 12 yrs _______ meet the DRI
Average intake for:
Age 12-19 yrs: _____ mg/d females; _____ mg/d males
Age > 20 yrs: ____ mg/d females; ____ mg/d males
Age > 70 yrs: ______ mg/d females; _______ mg/d males
does not
822
1105
842
1056
771
933
Indications that may require calcium supplements
osteopenia or osteoporosis
inadequate intake
lactose intolerance
malabsorption
medications that decrease Ca absorption (e.g., corticosteroids)
absorption of calcium is optimal when taken ____________ which may include _______.
should choose a supplement that has the _______ sign
individual doses off ≤500 mg
vitamin D
United States Pharmacopeia (USP)
__________=> contains the most Ca per tablet; ____% elemental calcium
__________=> ____% elemental calcium; most efficient absorption
Calcium Carbonate
40%
Calcium Citrate
20%
calcium carbonate example
Caltrate
Oscal
Viactiv
calcium citrate example
Citracal
Tolerable Upper Intake Level (UL): Calcium
__________ mg (age 19-50 yo)
________ mg (>51 yo)
2500
2000
excessive calcium intake can result in
________
Deficiency of____ & other minerals
Hypercalcemia can cause:
__________ of soft tissues and blood vessels
_________ and ________ symptoms
Kidney stones
iron
calcification
constipation & nausea
______________ enhances Ca absorption
1,25 dihydroxvitamin D
Risk of vitamin D deficiency due to=>
inadequate exposure to _____, inadequate ______ vitamin D, or impaired _________ of vitamin D (___________)
sun
dietary
activation (kidney disease)
Sources of vitamin D:
Ultraviolet rays from the sun
Egg yolks
Fortified milk
Cheese, yogurt
Fatty fish: salmon, tuna, mackerel, sardines, & catfish
Some mushrooms
Fortified soy milk, fortified OJ
Older adults often require supplementation
mean reccommendations of vitamin D
15 ug
Avoid excessive vitamin D supplementation
- can cause _______________
hypercalcemia
1 mcg = _____ IU
40
Vitamin K required for the maturation process of __________ which is involved in the __________ process
osteocalcin
bone mineralization
Individuals at risk for deficiency of vitamin K
- ____________ may have inadequate consumption of vitamin K
- ___________ therapy
- __________
Elderly individuals
Antibiotic
Malabsorption
Dietary Sources of Vitamin K
Green leafy vegetables: spinach, broccoli, collard, mustard, & turnip greens, kale
Green tea
Canola & soybean oil
High intake of dietary sodium increases urinary ____ excretion
Avoid foods with > _____ mg Na per serving
Ca
300
Adequate protein intake is needed for optimal bone health
Recommend _______ for protein
Higher intakes may be beneficial for _________
However, excessive consumption may increase urinary ____ excretion
the RDA
older adults
Ca
Alcohol is toxic to _______ at high doses
Intake of >___ drinks/d for an extended period is associated with lower _______ and increase risk of ________
Moderate intake is believed to have ________ effect on bone
osteoblasts
3
bone density
osteoporosis
no detrimental
Relationship with osteoporosis and caffeine ?
Ingestion of caffeine causes short-term increase in_________
Drinking > _____ cups of coffee/day may interfere with _______________
has not been clearly established
urinary calcium excretion
3
calcium absorption and cause bone loss
Drugs for preventing and treating osteoporosis are usually recommended to be taken along with:
_______________
_______________
Ideally both would be achieved from dietary sources, but if not, supplements should be used
Calcium (1000-1200 mg/day)
Vitamin D (800-1000 IU/d)
Inhibit osteoclast-mediated bone resorption
FDA-approved for prevention & treatment of osteoporosis in ___________ women
___________ are also approved for use in male osteoporosis
bisphosphates
post-menopausal women
Alendronate & risedronate
bisphosphate examples
Alendronate (Fosamax)
Risedronate (Actonel)
Ibandronate (Boniva)
Side effects of Bisphosphates
GERD
esophagitis
estrogen Agonist Stimulate estrogen receptors in bone tissue which ____________
decreases bone reabsorption
Estrogen Agonists are FDA approved for both prevention & treatment of osteoporosis in_________women
Little effect on ______ or ______ tissue
postmenopausal
breast or uterine
Estrogen Agonists Example
Raloxifene (Evista)
____________ is Low doses of a synthetic, modified parathyroid hormone
Teriparatide (Forteo)
Teriparatide (Forteo) Increases _______________=> which is a _______ process
FDA-approved for treatment of osteoporosis in _______ women & males at high risk for ___________
osteoblastic formation of new bone tissue
anabolic
post-menopausal
fracture
Medications for Osteoporosis
Estrogen Agonists
- Raloxifene (Evista)
Bisphosphates
- Alendronate (Fosamax)
- Risedronate (Actonel)
- Ibandronate (Boniva)
Teriparatide (Forteo)
