116
bone health
52 investigator-controlled calcium intervention studies two showed
better bone balance at high intakes, greater bone gain during growth, reduced bone loss in the eldery, or reduced fracture risk.
High calcium intakes bone health.
Most studies: based on dairy calcium. Higher calcium = higher dairy intakes Connection between dairy
BACKGROUND
Osteoporosis Skeletal fragility Characterized by
lifetime.
Body's demand for calcium greatest during childhood
osteoporosis.
formation is diminished.
Bone matrix: osteoblast cells. Bone resorption: osteoclast cells. Bone remodeling Influenced by nutritional and
hormonal factors.
Calcium and vitamin: Required for normal bone growth.
bone loss.
Testosterone in men: Related to male osteoporosis.
Dual energy X-ray absorptiometry (DXA): Gold standard. Diagnosis BMD is less than or equal to 2.5 standard
deviations (T - Score).
WHO: Criteria for the Diagnosis of Osteoporosis (1) CATEGORY
Normal Osteopenia Osteoporosis Severe Osteoporosis CRITERIA (EXPRESSED AS T - SCORE)
Patient BMD 1 SD of average peak young adult BMD (T-score, 0 to -1)
Patient BMD between 1 SD and 2.5 SD below average peak young adult BMD (T-score, -1 to -2.5) Patient BMD 2.5 SD below average peak young adult BMD (T-score, 2.5) Patient BMD 2.5 SD below average peak young adult BMD with fragility fractures
complications.
Wrist fractures from falls also are common. Spinal fractures can occur without any fall or injury
recovery.
fracture Post-menopausal woman not receiving HRT Premature menopause at <45 year or male hypogonadism Age > 65 year Planned or current CS use of > 6 months Low BMI: < 20 kgum2 History of low trauma maternal hip fracture at < 60 year Other causes of osteoporosis, e.g. alcohol excess, RA, Hyperparathyroidism, thyrotoxicosis
abnormalities develop with deficiencies of protein, ascorbic acid, vitamin D, magnesium, zinc, copper and manganese.
materials synthesis of the extracellular material: composes > 95% of the substance of bone.
Bulk materials: calcium, phosphorus and protein.
phosphate crystals.
Calcium is lost through shed skin, hair, nails, sweat, urine
and digestive secretions (range 4-8 mmol) depending physical activity and dietary constituents.
losses blood calcium levels begin to fall increased secretion of parathyroid hormone (PTH): resorbs bone and releases into blood.
This is relationship between low calcium intake and low
FIGURE.. Plots of the cumulative incidence of fractures, redrawn from the studies of Chapuy et al (17) (right) and Dawson-Hughes et al (18) (left). In both cases, the upper line represents the placebo control subjects and the lower line represents the subjects treated with calcium and vitamin D. The shaded zones represent the reduction of fracture risk, which, as can be readily seen, starts with the beginning of treatment
calcium source.
Several
approaches to estimate the average requirement for maximal retention during adolescence and for zero balance during maturity.
Results were in the range of 35 to 40 mmol/d for growth
women, a group in whom bone loss is predominantly related to estrogen withdrawal, not to nutrition.
Six controlled trials used dairy products as the calcium
recommended.
At all ages, males consume more calcium than females,
(CSFII) 199496 indicate that only 12% of females ages 12 to 19 and 32% of similar aged males are meeting 100% of the AI (Adequate Intakes) for calcium.
According to this same survey, only 16% of women ages 20 to 29
years, 14% of women ages 30 to 39 years, and 11.5% of women 40 to 49 years are meeting 100% of the AI for calcium.
Although less than 15% of older adults are consuming 100% of the
calcium AI, more men than women are meeting calcium recommendations.
mass
by
calcium
rapidly
declines
after
adolescence.
FIGURE... Percentage of Individuals Meeting 100 Percent of the 1997 AIs for Calcium by Gender and Age, Two-Day Average 19941996
Not only are milk and other dairy foods calcium-dense foods
providing in many cases about 300 mg calcium per serving, but these foods also contain other nutrients important to health.
Milk and other dairy foods contain vitamins D, A, and B12,
Fat Carbohydrate
Minerals
12.6 4.6
Calcium Phosphorus
Zinc Magnesium Iron
72.1 32.4
16.2 15.8 1.8 26.1
Vitamins
Riboflavin
Vitamin B 12
21.6
Vitamin A
Vitamin B 6 Folate Thiamin Vitamin E Ascorbic Acid Niacin
15. 3
8.7 6.2 4.7 2.8 2.5 1.2
Because milk and other dairy foods are excellent sources of calcium as
well as many other essential nutrient, their intake improves the overall nutritional quality of the diet.
A longitudinal study involving 64 postmenopausal women in Australia
found that the women who were randomly assigned to receive 1,000 mg of additional calcium per day by consuming fat free milk powder increased not only their calcium intake, but also their intake of other essential nutrients such as protein, potassium, phosphorus, magnesium, riboflavin, thiamin and zinc.
increased calcium intake, consuming the fat free skim milk powder improved the womens total diet as well.
often be a poor diet, not just in respect to calcium, but for many other nutrients as well.
diet.
Nondairy foods: salmon with bones, green leafy vegetables and
Calcium-fortified
individuals who cannot meet their calcium needs from foods naturally containing this mineral.
Their use does not correct the poor dietary patterns of food selection
1. 2. 3. 4. 5.
6.
7. 8.
Heaney RP. Calcium, Dairy Products and Osteoporosis. Journal of the American College of Nutrition 2000; 19: 83S-99S. Heaney RP. Bone Health. American Journal of Clinical Nutrition 1997; 85: 300S-303S. Miller GD, Jarvis JK, McBean LD. The Importance of Meeting Calcium Needs with Foods. Journal of the American College of Nutrition 2001; 20: 168S-185S Yeap SS, Hosking DJ. Management of Corticosteroid - Induced Osteoporosis. Rheumatology 2002; 41: 10881094 Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Effect of Calcium Supplementation on Bone Loss in Postmenopausal Women. N Engl J Med 1993; 328: 460464. Cumming RG, Cummings SR, Nevitt MC, Scott J, Ensrud KE, Vogt TM, Fox K: Calcium Intake and Fracture Risk: Results from The Study of Osteoporotic Fractures. Am J Epidemiol 1997; 145: 926934. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and Calcium to Prevent Hip Fractures in Elderly Women. N Engl J Med 1992; 327: 163742. Suleiman S, Nelson M, Li F, Buxton-Thomas M, Moniz C: Effect of Calcium Intake and Physical Activity Level on Bone Mass and Turnover in Healthy, White, Postmenopausal Women. Am J Clin Nutr 1997; 66: 937943.