~'~ ,- -'-;-' _- ---' ,;-

'=-'
ROLE OF NUTRITION IN THE
PREVENTION OSTEOPOROSIS
By
AMAL AHMED EL BADAWY, MD
INTRODUCTION
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Prevention oI Osteoporosis is very important as there
are treatments Ior osteoporosis, but no cure.
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The best preventive measure is to build up the
strongest bones possible during childhood and
adolescence.
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--'~'
HAT IS PREVENTION?
-'-;-' _--'-
Prevent the occurrence
~=' _-~
Arrest its progress.
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Early detection and prompt treatment
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FACTS ABOUT BONES
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Bones are living tissue,
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the skeleton grows continually Irom birth to
the end oI the teen years,
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reaching a maximum strength and size around
the age oI 20.
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Some ages are particularly important Ior
accelerated growth oI the skeleton:
From birth to two years.
Years oI puberty, age 11 to 14 in girls and 13 to
17 in boys.
'=' ~- ~'- '~=`' ='-- :
-~'= _= ~`' ~
~ 11 _' 14 ~ '-' _ 13 _' 17 ~' _
IMPORTANCE OF BONE MASS
--=-' ---' --
It is estimated that a 10 increase of
peak bone mass reduces the risk of an
osteoporotic fracture during adult life
by 50.
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~- '=-' ~'~ ~ ,~- ;-= 50 % ,-
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hat determines bone mass?
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Genetics accounts Ior 60 to 80.
~~= `'' 60 - 80 %
nvironmental Iactors such as nutrition and
exercise also play a role.
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Model
How osteoporotic fracture occurs?
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Trauma
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Low
bone
mass/
impaired
bone
quality
nadequate peak
bone mass
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Early
menopausal
bone loss
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Decrease in
bone
mass/bone
Quality
' _ --
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Calcium/
vitamin D
deficiency
~ -~'- -~'' --
Other
Factors
='
Fractures
~
Five Steps to Bone Health and
Osteoporosis Prevention
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Developed by American National
Osteoporosis Foundation
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Step 1
Get your daily
recommended amounts
of calcium and vitamin
D.
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~ -~'- -~'' ~
Use MyPyramid.gov
to heIp pIan an
overaII heaIthy diet
Step 2
Engage in regular
weight-bearing
exercise.
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Even simpIe activities such as
waIking, stair cIimbing and
dancing can strengthen bones.
Step 3
Avoid smoking and
alcohol
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12 oz. 5 oz.
1.5 oz.
MyPyramid.gov recommends
no more than 1 drink per day
for women and 2 for men.
Step 4
Talk to your
doctor about
bone health.
=-= ~~'
Step 5
Have a bone density
test and take
medication when
appropriate.
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What Nutrients do we need to build
bone?
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Calcium -~'
Vitamin D ~ -~'-
Proteins -
Vitamin C -~'-
Manganese --=-~
How to Calculate your ideal body
weight?
BMI weight in Kg / height in m
BMI values:
Underweight, BMI 18.5
Normal weight, BMI 18.5-24.9
Overweight, BMI 25-29.9
Obesity, BMI 30 or greater
Sparing use oI sparing use
red meat and butter oI white rice bread
pasta, potatoes
1-2 Ca dairy, supplement
1-3 nuts , legumes 1-2 Iish, poultry
2-3 serving Iruits Plant oil
Vegetable in abundance Whole grain
Daily exercise
Calcium requirements vary by age
$ource: The 2004 $urgeon General's Report on Bone Health and Osteoporosis:
What t Means to You at http://www.surgeongeneral.gov/library/bonehealth
If this is your age
Then you need
this much calcium
each day (mg)
0 to 6 months 210
7 to 12 months 270
1 to 3 years 500
4 to 8 years 800
9 to 18 years 1,300
19 to 50 years 1,000
Over 50 years 1,200
rowth
spurt
Common calcium rich foods
Dairy:
Milk (1 cup): ~ 300 mg
Yogurt (175 mL): ~300 mg ,~'
Canned Fish:
Canned salmon with bones (3 oz): ~ 200 mg ~'~
Canned sardines with bones (3 oz): ~ 250 mg -~'~
Dark green vegetables and dried beans.
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Limit calcium to 500 mg at a time
,- ;-~-'--' -,= --,V 500 -=';-' ,--' _- =-
Our bodies can best handle
about 500 mg calcium at one
time from food and/or
supplements.
- V' J-'-' -=~-V ~=-' 500 =-
=--
Spread your calcium sources
throughout the day.
;--' ,'-- _-- -,=-' _,;
500
mg
Increase amount slowly
Start supplements with 500 mg
calcium daily for about a week,
gradually adding more.
~ -'-' 500 _;~ --- =-
Gas and constipation can be side
effects: 4'~-; ','- ;-=
Increase fluids and high fiber foods.
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Try a different type of supplement
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Vitamin D necessary for calcium absorption
;-~-'--' '~-V ,V - ,--'--
Choose a supplement with vitamin D
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Avoid going over a daily combined
total of 2,000 IU or 50 mcg from food
and supplements.
,- -,=-' --,V 2000 J----' ,- -=;
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It`s not necessary to consume calcium
and vitamin D at the same time
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-;-' ,--
Vitamin D is Iike a key
that unIocks the door
and Iets caIcium
into the body.
ou need more vitamin D as you age
ge
DaiIy
vitamin D
needs in
InternationaI
Units (IU)
600 IU
200 IU
400 IU
0
100
200
300
400
500
600
up to 50 51-70 over 70
Vitamin D from sunlight exposure
,-~-' ~; - ,--'--
Vitamin D is manufactured in the skin following direct
exposure to sun.
- ,--'--- ,;-- ,-~-- ,-'
Amount varies with time of day,
season, latitude and skin
pigmentation.
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1015 minutes exposure of hands, arms and face 23
times/week may be sufficient (depending on skin
sensitivity).
,- 10 _-' 15 ,- ,----'; ,--',--'; ,----- ---- 2 _-' 3 ,--- ,--;~ ',-
_-'- ,;-- ,
Clothing, sunscreen, window glass and pollution reduce
amount produced.
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$ource: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org
PROTEINS
,-;,-'
During growth, we need caloric intake and
protein, vit D and calcium to insure bone
development.
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~-~ --= '=' ~- '~-
High protein
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xcessively high
protein diets could
increase urinary
excretion of calcium.
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J;-'
HAT FOODS CAN INTERFER ITH
BONE HEALTH?
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Excessive sodium
;--;~-'
Oxalic acid
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Fiber
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Excessive sodium, Oxalic acid and Fiber
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Sodium increase urinary calcium
excretion
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Oxalic acid present in foods such as
spinach and chocolate: Binds calcium in
those foods
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=-- -=V' -- ,- ^~'~-'
Excessive fiber-such as from overusing
fiber supplements-could interfere with
calcium absorption.
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hat is the impact of smoking, coffee, soft
drinks?
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'=-'
Smoking: may aIIect the attainment oI peak
bone mass, -~=' ' _= `- ~-
Coffee: There is no evidence in a reasonable
amount ~~ '-~ -``
Soft Drink: excessive consumption oI soIt
drinks. - '-~ .'-
ho should not use Nutrition for
Osteoporosis ?
---' _-- --- , =-V ,-
Those with:
a strong family history oI osteoporosis
_-'= _-' -~
or previous fractures should consult a
physician.
-=' -'~`' =- ~ ~=
Conclusion and recommendations
'-~;-'; >=-'
The prevention oI osteoporosis begins
with optimal bone mass acquisition
during growth.
-~=' ' -'- -'~ -''
Proper nutrition plays the central role.
-' _~--' ~' .`~ -~' .`~
hat else to prevent osteoporosis?
'~- '-'-
In addition to nutrition we need to:
Increase the general level of physical activity
-,=-' -'-,
Avoid smoking
,-=--' ,- --'
And other identified avoidable risk factors.
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-=-' ',~' = V' ,;,-,;--' - =;-~-'
The good news: Osteoporosis is preventable
for most people!
Start building healthy
bones while young.
--=-' ---' -'-
Healthy diet and
lifestyle are important
for BOTH men and
women.
_=~ '-= '=-; _=~ -'--
'--~-'; J'=,--
THANK OU
',-~