Nutritional Science Notes May 3, 2016 – Chapter 15

15.1: Bone Development and Maintenance

Bone is continually being built, broken down, and reshaped. This process of removing and replacing
bone is referred to as remodeling. Remodeling is vital for bone health because it allows bones to grow
normally and to repair and replace damaged (e.g., with very small cracks) or brittle areas. Three main
types of bone cells function in bone growth and remodeling: osteoblasts, osteocytes, and osteoclasts.
Osteoblasts are bone-building cells that product collagen and add minerals to form healthy bone. Some
of the fully mineralized osteoblasts mature to form osteocytes, the most numerous cells in bones.
Osteocytes are biochemically active; they can take up calcium from the blood and release it back into
the blood, as well as help bone become denser, if needed.

In contrast, osteoclasts are cells on the surface that dissolve bone (termed bone resorption) by
releasing acid and enzymes. During times of growth, total osteoblast activity exceeds osteoclast activity,
so we make more bone than we break down.

Women experience even greater bone loss when estrogen levels fall in menopause because estrogen
inhibits bone breakdown by decreasing osteoclast activity. Women can experience an additional 20%
loss of bone in the first 5 to 7 years following menopause. Absent or irregular menses in younger
women, which can occur because of very low body weight, eating disorders, or the female athlete triad,
signal low estrogen levels and a likelihood of substantial bone loss before middle age. When the rate of
bone loss exceeds the rate at which bone is rebuilt, bone mass and bone strength decline, and the risk
of fracture rises greatly. Significant bone mass loss, known as osteoporosis, is discussed in Medical
Perspective: Osteoporosis.

Teeth consist of a hard, yellowish tissue called dentin, which is covered with enamel in the crown and
cementum in the root. Enamel, the hardest substance in the body, is almost entirely hydroxyapatite
crystals. Produced before the tooth erupts, enamel is not a living tissue and, unlike bone, does not
undergo remodeling. Enamel can be easily damaged by acids produced by bacteria in the mouth from
the metabolism of sugars and carbohydrates. This damage is known as dental caries, or cavities.
Repairing dental caries requires the skills of a dentist.

15.2: Calcium (Ca)

Calcium is an essential mineral for normal bone and tooth development. The calcium deficiency disease
osteoporosis, or “porous bone,” has been known since early history. Archeologists have even discovered
4000-year-old Egyptian mummies with the classic sign of osteoporosis – a dowager’s hump, or curved
spine. Calcium also has many industrial applications – one is as plaster of Paris, which was first used to
set broken bones 1000 years ago.

Developing and maintaining bones are calcium’s major functions in the body. Calcium also is required
for blood clotting, the transmission of nerve impulses, muscle contraction, and cell metabolism. When a
diet is deficient in calcium, osteoclasts release calcium from the bone, so that it can enter the blood and
be used for these other critical functions. A supply of calcium is vital to all cells, not just to bone cells.

When a nerve impulse reaches its target site – such as a muscle, other nerve cells, or a gland – the
impulse is transmitted across the synapse, the junction between the nerve and its target cells.
In an entirely different process, nerve impulses develop spontaneously if insufficient calcium is available,
leading to what is called hypo calcemic tetany. This condition is characterized by muscle spasms because
the muscles receive continual nerve stimulation. Inadequate parathyroid hormone release or action is
the typical cause of hypocalcemia (low blood calcium).

Dairy products, such as milk and cheese, provide a rich supply of bioavailable calcium and make up just
over half the calcium in U.S. diets.

The RDA for calcium, established in 2010, is based on promoting bone growth and maintenance. For
most adults, the RDA is 1000 mg/day, but it increases to 1200 mg/day for women over age 50 and men
over age 70. During infancy and through late adolescent years, when bone development is rapid and
intense, calcium recommendations are set high to support osteoblast activity. For instance, adolescents
need 1300 mg/day to allow for increases in bone mass during this time of rapid growth. The DV used on
food and supplement labels is 1000 mg.

Calcium absorption occurs along the length of the intestinal tract. However, absorption is most efficient
in the upper part of the small intestine because its slightly acidic pH helps keep the calcium dissolved in
its ionic form. Intestinal contents become more alkaline as they pass through the intestine; thus, calcium
absorption decreases at the terminal end of the small intestine and colon, although some still occurs via
passive diffusion. In addition, active vitamin D hormone – 1,25 (OH) vitamin D – promotes and regulates
the active transport of calcium that occurs in the upper intestinal tract. When an individual has poor
vitamin D status, calcium absorption is reduced.

This hormone raises blood calcium levels by working with 1,25 (OH) vitamin D to increase the kidney’s
reabsorption of calcium, rather than excretion in the urine. Parathyroid hormone also helps increase
calcium absorption indirectly by promoting the synthesis of 1,25 OH vitamin D. In addition, parathyroid
hormone often works in conjunction with 1,25 OH vitamin D to release calcium from bones. A medical
condition known as hyperparathyroidism can cause persistently elevated blood calcium.
Hyperparathyroidism must be diagnosed and treated by a physician.

Researchers have examined links between calcium intake and the risks of a wide array of diseases.
Overall, the benefits of a diet providing adequate calcium extend beyond bone healthy. Both calcium
and dairy products may protect against the development of colon cancer. Dietary calcium also may
protect against the formation of calcium oxalate kidney stones. Calcium binds oxalate in the small
intestine, preventing its absorption and concentration in the kidneys. A calcium rich diet (800 to 1200
mg/day) may help decrease blood pressure.

The UV for calcium is 2500 mg/day for adults ages 19 to 50 and 2000 mg/day for those over age 50. The
UL is based on the potential for increased risk of developing kidney stones and hypercalcemia at higher
intakes. Normally, the small intestine prevents the absorption of excess calcium; however, in some
individuals, high amounts of calcium can cause hypercalcemia. Excessive dietary calcium also may cause
irritability, headache, kidney failure, and decreased absorption of other minerals. Ordinarily, calcium in
food and usual doses of calcium supplements do not pose a health threat because this mineral is
present in relatively modest amounts.
Loss of bone in the spin leads to compression fractures in the vertebrae, loss of height, and eventually
kyphosis (dowager’s hump). A simple and very accurate test to identify osteoporosis is a dual energy X-
ray absorptiometry bone scan.

An adequate intake of calcium, vitamin D, phosphorus, magnesium, potassium, and numerous other
nutrients is needed throughout life to build and maintain healthy bones.

15.3: Vitamin D

The most active form of vitamin D, calcitrol, has several important functions.

The best food sources of vitamin D are fatty fish, cod liver oil, fortified milk, and some fortified breakfast
cereals. In North America, milk is generally fortified with 10 ug of vitamin D per quart. Although eggs,
butter, liver, and a few brands of margarine contain some vitamin D, large servings must be eaten to
obtain an appreciable amount of the vitamin. Thus, these foods are not considered a significant source.

This change allows vitamin D to enter the bloodstream for transport to the liver and kidneys, where it
undergoes conversion to its bioactive form (calcitriol). For many individuals, sun exposure provides 80 to
100% of the vitamin D required by the body.

In 1997, the Food and Nutrition Board set an Adequate Intake for vitamin D of 5 ug/day for people
under age 541, 10 ug/day for people between 51 and 70, and 15 ug/day for older adults.

Following the consumption of foods containing vitamin D, about 80% of the vitamin is incorporated into
micelles in the small intestine, absorbed, and transported to the liver by chylomicrons through the
lymphatic system. Wen vitamin D enters the general circulation, it is bound to a vitamin D-binding
protein for transport to muscle or adipose cells for storage or to the liver and kidneys.

Vitamin D Toxicity

15.4: Phosphorus (P)

In addition to being a major component of bones and teeth, phosphorus is critical to the function of
every cell in the body. As HPO