Week 11 - Osteoporosis and Arthritis

Question 1

What is Arthritis?

Answer 1

Inflamed joints characterised by pain, swelling and stiffness.
Over 100 types of arthritis currently identified.
Joint damage, deformity and loss of mobility cause disability and reduced quality of life.

Question 2

Most common - arthritis?

Answer 2

osteoarthritis
rheumatoid arthritis
gout

Question 3

Common cause of disability in older adults:

Answer 3

osteoarthritis

Question 4

What is osteoarthritis? prevalence, sufferers

Answer 4

most common form of arthritis
8% prevalence in aus, 12% in indigenous Aus
60% sufferers are female

main symptoms: pain, swelling, joint stiffness

characteristic features: cartilage loss, bony outgrowths, slow progression

Question 5

Osteoarthritis - Risk Factors:

Answer 5

non-modifiable:
- age, female, family history

strong, modifiable:
overweight, inactivity, joint trauma

Question 6

Obesity-specific mechanisms for osteoarthritis include:

and what % weight loss improves inflammation?

Answer 6

• mechanical stress
• loss of muscle mass and strength
• systemic inflammation

5% weight loss improves inflammation

Question 7

What is rheumatoid arthritis?

Answer 7

• auto-immune condition
• can affect other body parts and organs as well as joints
• typically characterised by periodic flares and occasional remissions
• more common between 30-65 years but can occur at any age
• 2% prevalence rate in Australians/4% indigenous

Question 8

Abstinence from smoking may reduce risk of what?

Answer 8

rheumatoid arthritis among postmenopausal women

Question 9

Rheumatoid Arthritis - omega-3

Answer 9

• number of studies indicate that omega-3 fatty acids ameliorate symptoms of RA
• 3g DHA and EPA per day for analgesia of arthritis

unclear if omega-3 fatty acids prevent RA - trend towards a protective effect from fish consumption, RR per 30g/day

Question 10

Rheumatoid Arthritis - omega-3 - Arthritis Australia recommends:

Answer 10

• consumption of oily fish 2-3 times per week

- those with rheumatoid arthritis may benefit from 2.7g / day DHA and EPA

Question 11

Dietary Associations Under Investigation:

Answer 11

possibly protective:

• moderate alcohol consumption
• vitamin D
• breastfeeding

possibly causative:

• caffeine
• red meat
• obesity (effect on hormones)

Question 12

What is gout?

Answer 12

• form of arthritis characterised by deposits of uric acid crystals in joints.
• uric acid is not excreted effectively
• commonly affects men aged 40-50 years
• rare in females
• rapid onset
• attack typically lasts a week, can progress to a chronic condition if not managed

Question 13

Gout - Risk Factors

Answer 13

• Family history
• Alcohol
• Dehydration
• Overweight
• Fasting or crash dieting

Question 14

Gout - Preventive Factors:

Answer 14

• Vitamin C
• Low fat dairy products
• or linked to insulin
• evidence for dietary protection of arthritis is currently very weak

Question 15

Gout - best advice at the moment:

Answer 15

• Maintain a healthy weight
• Quit smoking
• Eat a varied, balanced diet according to AGTHE
• Cardiovascular prevention

Question 16

What is osteoporosis?

Answer 16

• A systemic skeletal disease that causes the bones to become thin, weak and fragile.
• Density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture.
• Spine, hip and wrist most commonly affected.

Question 17

Bone Composition:

Answer 17

Cortical Bone: dense, compact

Trabecular Bone: spongy, porous bone / faster rate of turnover

Question 18

Osteoporosis Impact - Symptoms/Physiological:

Answer 18

Disfiguring, painful, debilitating, cascade effect of fractures, fractures associated with morbidity and early mortality

Question 19

Osteoporosis Impact - Australia/Outcomes:

Answer 19

• 25% of those who sustain a hip fracture die within 11 months
• 50% require long-term help with routine activities and cannot walk unaided
• 25% require full-time nursing home care

Question 20

Assessing Bone Health:

Answer 20

Dual Energy X-Ray Absorptiometry (DXA):

- Compares bone density to a 30 year old healthy adult
T-Score / Diagnosis:
\+ 1 to -1: Normal
-1 to -2.5: Poor Bone Density
below -2.5: Osteoporosis

Question 21

Osteoporosis: Non-modifiable Risk Factors

Answer 21

Ethnicity: more common in caucasian, asian and hispanic populations.
Less common in African-American populations

Age
Female gender
Family History

Question 22

Osteoporosis - Age

Answer 22

Birth - 20 yrs = bone growth
12 - 30 yrs = development of bone growth
Most people reach peak bone mass in their 20s
30-40 yrs bone loss commences, continues throughout life

Question 23

Osteoporosis - Gender

Answer 23

Men have greater bone density than women at maturity. Women have greater bone losses than men in later life - decline in calcium absorption post menopause.
Men develop bone problems about 10 years later in life.
Diabetes and some diabetes medication associated with more rapid bone demineralisation.

Question 24

Osteoporosis - Modifiable Risk Factors:

Answer 24

Excess alcohol
Smoking
Low BMI
Sedentary lifestyle
Low calcium, vitamin D
Mediterranean diet

Question 25

Osteoporosis - Alcohol

Answer 25

- bone density is higher in moderate drinkers - consumption of more than 2 standard drinks increases risk of osteoporotic and hip fractures in men and women - Possible explanations: - low bone mass because alcohol has toxic effect on bone-forming osteoblasts - alcohol affects PTH, calcitonin and growth hormone - increased fluid losses - excess calcium excretion - liver damage interferes with vitamin D metabolism - alcoholics have poor dietary intake

Question 26

Osteoporosis - Smoking

Answer 26

- Dose-response relationship between smoking and risk of hip fracture - smokers have lower bone density - second-hand smoke may also be damaging - possible explanations: smoking reduces levels of oestrogen, other bone-related hormones, smokers are thinner / exercise less

Question 27

Osteoporosis - Body Weight

Answer 27

Women with higher BMI have slightly higher bone mineral density: - Increased load on skeleton, oestrogen - Higher intakes of nutrients BMI >26-28 may be protective BMI 22-24 may have greater risk

Question 28

Osteoporosis - Physical Activity

Answer 28

Helps develop peak bone mass, minimise bone loss weight-bearing and high impact exercise require to stimulate bone formation: walking/running, skipping, lifting weights, jumping short duration, intense exercise builds bone most efficiently exercise that improves posture and balance protects from falls - yoga tai chi etc.

Question 29

Osteoporosis - Calcium: | (what is the supplement if RDI cannot be achieved?

Answer 29

- Most older men and women are unlikely to meet the RDI. | - When the RDI cannot be achieved, a daily supplement of 500-600mg/day is recommended.

Question 30

Osteoporosis - Vitamin D

Answer 30

- Well established link with Vit D deficiency, reduced bone mineral density and increased risk of fracture. - Severe vitamin D deficiency also assoc. with loss of lower extremity muscle mass and strength and impaired balance in the elderly. - Most australian adults are unlikely to obtain more than 5-10% of their vitamin D requirement from dietary sources.

Question 31

Adequate vitamin D is considered to be: | And supplementations:

Answer 31

>50nmol/L at least 600IU/day for people under 70 at least 800IU/day for people over 70 sun avoiders may require 1000-2000 IU/day

Question 32

Osteoporosis - Nutrition - Potentially Beneficial

Answer 32

Protein: required for bone tissue growth, repair and development Boron: may enhance calcium absorption and oestrogen metabolism Iron, Manganese, Vitamin C, Zinc: required for enzymes involved in formation of bone matrix

Question 33

Osteoporosis - Nutrition - Potentially Adverse:

Answer 33

Caffeine: may interfere with calcium absorption (possibly neutralised in presence of adequate calcium) Protein: high protein intake may interfere with calcium status Fibre, Oxalates: negative impact on calcium absorption Sodium: increases urinary calcium loss (neutralised in presence...) Vitamin A: required for bone growth but excessive amounts of retinol increases bone breakdown and interferes with Vitamin D

Question 34

Fruit and vegetables - bone health

Answer 34

Improves - likely due to increased intake of magnesium, vitamin C and vitamin K

Question 35

Osteoporosis - EATING DISORDERS:

Answer 35

Osteoporosis develops in about 30-50% of cases of anorexia nervosa. Reduced calcium intake accelerates mineral loss from bone. Oestrogen deficiency prevents development of peak bone mass and hastens bone loss. Low body weight therefore reduced load bearing.

Question 36

Osteoporosis - Preventative Strategies:

Answer 36

- Consume a varied diet - Lifetime diet adequate in calcium - Lifetime adequate vitamin D status - Be physically active - Avoid smoking - Moderate alcohol consumption