Member - Academy Of Nutrition & Dietetics. USA.
Orthopaedic Disorders Nutrition
Introduction
Bones-These mould our body structure and safeguard our organs allowing us to walk, jog, run, carry and perform many other functionalities. To perform these functions smoothly a regular nutrient-rich diet is obligatory. Most common diseases of the bone like osteoporosis and osteomalacia (impaired mineralization due to calcium and vitamin D deficiency) have complex diagnosis and can be reduced or prevented with proper nutrition balance throughout the lifecycle of a person. Surveys show that in 2010, over 258,000 people over the age of 65 were admitted for hip fracture. Researchers have found that almost 1,000 fractures happen every hour due to osteoporosis. Though bone-building nutrients are necessary after the onset of osteoporosis, the advantages of calcium and other nutrients intake during childhood and young adulthood are still significant in the period of bone growth.
Bone Structure and Physiology
A bone refers to an organ (femur) and a tissue (trabecular bone tissue). Bone tissues are of two types namely trabecular and cortical. The bone has an organic component primarily of collagen and an inorganic component of bone mineral composed of various salts. The collagen strands give bone its tensile strength and hydroxyapatite crystals give bone its compression strength.
The skeleton is made of 80% of cortical bone tissue and 20% of trabecular or cancellous bone tissue. Shafts of the long bones contain cortical bone tissue. The less dense tissue, the trabecular tissue, is present in the knobby ends of the long bones, iliac crest of pelvis, scapulas, wrists, vertebrae and the regions of the bones that line the marrow. Osteoblast, a type of bone cell, is responsible for bone tissue formation. Other bone cells namely osteoclasts and osteocytes are involved in reabsorption of bone tissue.
Calcium Homeostasis
Bone tissue is the major storehouse of calcium and other minerals required by other tissues of the body. Calcium homeostasis, the process of maintenance of constant serum calcium concentration, entrusts this bone tissue source of calcium when nutritional calcium is deficient. Homeostatic mechanism regulating blood calcium concentration is achieved through parathyroid hormone (PTH) and 1,25 dihydroxy vitamin D3 (calcitriol), which are calcium-regulating hormones. Though calcium levels are maintained in the initial decades, urinary calcium losses occur following menopause whereas intestinal absorption of calcium does not increase to compensate for this loss.
Calcitriol which increases intestinal calcium absorption is critical during prepubertal and post pubertal growth years of children whose calcium intake is not self-sufficient. Calcitriol also participates in new bone formation process and suppression of bone degradation.
Bone Modeling and Remodeling
Bone modeling refers to skeletal growth until mature height is reached. The long bones elongate and widen due to internal changes and external expansions in their structures. In this process of growth, new tissues are formed first and old tissue resorption follows. Bone modeling is achieved in boys by the age of 18 to 20 and in girls by 16-18 years of age.
After skeletal growth reaches its adult size, it completely regenerates itself every 10 years. This process is called remodeling where old bones are replaced with new ones. Remodeling is perfect in young healthy adults and may become imbalanced as we age, where the number of bones removed does not equal the number of bones replaced, resulting in loss in bone strength which may lead to bone diseases.
Bone Mass
Bone mass is generally associated with bone mineral content (BMC) but not bone mineral density (BMD). BMC is the amount of bone accumulated before growth stops whereas BMD is used to define bone after developmental period is complete.
Peak bone mass (PBM) is attained around 30 years of age. Diet, physical activity and strain loading play a vital role in defining BMD cessation. Consuming ample calcium in the form of oral diet or supplements gives way to increased bone accumulation at a young age. PMC is greater in men than women. Engaging in physical activity helps to gain bone mass and maintain this mass later in life in both men and women.
Age plays a significant role in evaluating BMD. BDD starts declining after 40 years of age in both sexes with increasing bone loss in women aged 50 and above. There is 1% to 2% decrease constantly in post menopausal women every year thereafter until the age of 70, where loss rates neutralize in both sexes again. Aged women lose around 300 mg of calcium via urine and feces everyday which should be compensated through diet modifications.
Nutrition and Bone
Though we have repeatedly been discussing about the prominent role of calcium, vitamin D and phosphate in defining bone structure and functions, there are a couple of other micronutrients that help in bone health.
Calcium Intake
The adequate intake (AI) level for calcium from 11 years to adolescence (19 years) is 1300 mg/day in both sexes. Girls and women generally do not meet the required AI levels compared to men, who reduce their calcium intake after 50 years of age. Around 500 mg/day stays in deficit daily which should be remunerated with diet. Calcium supplements come into picture only if the dietary levels do not meet the age-specific AI.
High calcium bioavailability can be acquired from foods such as soybeans, kale, broccoli and bread whereas spinach and few other oxalate-rich foods are low in calcium bioavailability. Dairy sources such as cheese, milk and yoghurt and non-dairy sources such as almonds, tofu, green leafy vegetables and calcium-fortified milk and juices are excellent food choices.
Vitamin D Intake
For complete calcium absorption our body needs vitamin D. The RDA recommends around 600 international units (IUs) a day for the age group of 19-70 years and 800 IUs a day for people above 71 years. Sunlight exposure, though critical for vitamin D synthesis, remains an insufficient source of vitamin D. Oily fishes such as tuna and sardines, egg yolks and fortified milks are excellent sources of vitamin D. If your vitamin D analysis does not meet the required levels you can always go for supplements after consulting your doctor.
Phosphate Intake
Phosphate salt is present in almost all the foods we eat and the simple act of eating helps us meet the required phosphate levels (1000-12000 mg/day for adult females and 1200-1400 mg/day for males).
Protein Intake
Protein intake has been suggested at approximately 1 g/kg of body weight which maintains PTH concentration within a healthy range if calcium intake is almost near the recommended levels.
Vitamin K Intake
Vitamin K is imperative for bone health. Vitamin K supplements help to retard bone loss in postmenopausal women. Supplements have been suggested here as most of the people do not consume dark-green leafy vegetables which are good sources of vitamin K.
Other Sources
Trace elements like boron, copper, fluoride, iron, manganese and zinc help in bone health. It is better to have normalized intake of dietary fiber and sodium to prevent calcium loss. Potassium bicarbonate helps to decrease bone resorption and increase bone formation.
Osteopenia and Osteoporosis
Osteoporosis and osteopenia can affect anyone at any age. These diseases are very smart in the sense that, there are no outright signs indicating their onset. The first visible indication may be a broken bone. Women are almost four times more likely to develop osteoporosis and almost twice likely to have hip fractures than men. But this scenario changes with aging as both genders lose bone mass and become vulnerable.
Osteopenia is the forerunner of osteoporosis. Osteopenia is decreased bone density but not low enough to be classified as osteoporosis. This low bone density increases the chance of a fracture. People with osteopenia are always at a higher risk of developing osteoporosis. When the bone density is very low compared to normal value it is called osteoporosis. Even a cough or a sneeze can cause a fracture. Almost 25 million women and 12 million men are osteoporotic.
Etiology
Osteoporosis
Low BMD is the primary cause of osteoporosis. This low values maybe due to excessive acceleration of resorption or suboptimal peak bone mass that result in fragile bones after menopause. There are other important causes of osteoporosis as given below:
Osteopenia
Family history, lack of physical activity, smoking, consuming excess alcohol and fizzy drinks, exposure to radiation, chemotherapy, certain medicines, eating disorders and metabolism problems which inhibit the body from utilizing the required amounts of vitamins and minerals are contributing factors for osteopenia.
Treatment for Osteoporosis
Primary prevention is when you try to safeguard yourself from osteoporosis before the disease sets in, typically in adults before the age of 50. Secondary prevention is a treatment following the onset of osteoporosis. Please check the list below for a variety of treatment options available:
Treatment for Osteopenia
Lifestyle modifications are the best to prevent or treat osteopenia. Increase your calcium and vitamin D intake. Quit smoking and reduce alcohol use. Cut back on your salt and caffeine consumption as they contribute to bone and calcium loss. Resort to medication when all the other options are ruled out. Bisphosphonates, raloxifene and hormone replacement are few suggested medications.
Other Diseases
Osteogenesis Imperfecta (OI): OI is a genetic disorder where bones break easily. Hence this is also called as ‘brittle bone disease’. Genetic disorder fails to produce the required amount of collagen which leads to weak bones that break easily. Symptoms of OI include brittle teeth, malformed bones, curved spine, hearing loss, triangular face and sclera (whites of the eye) that look blue, purple or grey. Treatment includes physical therapy, use of wheelchair, surgery, braces and other aids. Surgery includes inserting metal rods inside the long bones to strengthen them.
Osteomyelitis: This is characterized by infection of the bones. Diabetes, rheumatoid arthritis, intravenous drug use and hemodialysis are few reasons for Osteomyelitis. Treatment focuses on stopping infection and treating the infected area with surgery, antibiotics or both.
Osteoarthritis: Osteoarthritis is the most prevalent form of arthritis affecting people worldwide. It occurs when the protective cartilage at the ends of the bone wear away. This disease is due to obesity, aging joints and injury. Surgery, medication and physical therapy are few treatment options available.
Introduction
Bones-These mould our body structure and safeguard our organs allowing us to walk, jog, run, carry and perform many other functionalities. To perform these functions smoothly a regular nutrient-rich diet is obligatory. Most common diseases of the bone like osteoporosis and osteomalacia (impaired mineralization due to calcium and vitamin D deficiency) have complex diagnosis and can be reduced or prevented with proper nutrition balance throughout the lifecycle of a person. Surveys show that in 2010, over 258,000 people over the age of 65 were admitted for hip fracture. Researchers have found that almost 1,000 fractures happen every hour due to osteoporosis. Though bone-building nutrients are necessary after the onset of osteoporosis, the advantages of calcium and other nutrients intake during childhood and young adulthood are still significant in the period of bone growth.
Bone Structure and Physiology
A bone refers to an organ (femur) and a tissue (trabecular bone tissue). Bone tissues are of two types namely trabecular and cortical. The bone has an organic component primarily of collagen and an inorganic component of bone mineral composed of various salts. The collagen strands give bone its tensile strength and hydroxyapatite crystals give bone its compression strength.
The skeleton is made of 80% of cortical bone tissue and 20% of trabecular or cancellous bone tissue. Shafts of the long bones contain cortical bone tissue. The less dense tissue, the trabecular tissue, is present in the knobby ends of the long bones, iliac crest of pelvis, scapulas, wrists, vertebrae and the regions of the bones that line the marrow. Osteoblast, a type of bone cell, is responsible for bone tissue formation. Other bone cells namely osteoclasts and osteocytes are involved in reabsorption of bone tissue.
Calcium Homeostasis
Bone tissue is the major storehouse of calcium and other minerals required by other tissues of the body. Calcium homeostasis, the process of maintenance of constant serum calcium concentration, entrusts this bone tissue source of calcium when nutritional calcium is deficient. Homeostatic mechanism regulating blood calcium concentration is achieved through parathyroid hormone (PTH) and 1,25 dihydroxy vitamin D3 (calcitriol), which are calcium-regulating hormones. Though calcium levels are maintained in the initial decades, urinary calcium losses occur following menopause whereas intestinal absorption of calcium does not increase to compensate for this loss.
Calcitriol which increases intestinal calcium absorption is critical during prepubertal and post pubertal growth years of children whose calcium intake is not self-sufficient. Calcitriol also participates in new bone formation process and suppression of bone degradation.
Bone Modeling and Remodeling
Bone modeling refers to skeletal growth until mature height is reached. The long bones elongate and widen due to internal changes and external expansions in their structures. In this process of growth, new tissues are formed first and old tissue resorption follows. Bone modeling is achieved in boys by the age of 18 to 20 and in girls by 16-18 years of age.
After skeletal growth reaches its adult size, it completely regenerates itself every 10 years. This process is called remodeling where old bones are replaced with new ones. Remodeling is perfect in young healthy adults and may become imbalanced as we age, where the number of bones removed does not equal the number of bones replaced, resulting in loss in bone strength which may lead to bone diseases.
Bone Mass
Bone mass is generally associated with bone mineral content (BMC) but not bone mineral density (BMD). BMC is the amount of bone accumulated before growth stops whereas BMD is used to define bone after developmental period is complete.
Peak bone mass (PBM) is attained around 30 years of age. Diet, physical activity and strain loading play a vital role in defining BMD cessation. Consuming ample calcium in the form of oral diet or supplements gives way to increased bone accumulation at a young age. PMC is greater in men than women. Engaging in physical activity helps to gain bone mass and maintain this mass later in life in both men and women.
Age plays a significant role in evaluating BMD. BDD starts declining after 40 years of age in both sexes with increasing bone loss in women aged 50 and above. There is 1% to 2% decrease constantly in post menopausal women every year thereafter until the age of 70, where loss rates neutralize in both sexes again. Aged women lose around 300 mg of calcium via urine and feces everyday which should be compensated through diet modifications.
Nutrition and Bone
Though we have repeatedly been discussing about the prominent role of calcium, vitamin D and phosphate in defining bone structure and functions, there are a couple of other micronutrients that help in bone health.
Calcium Intake
The adequate intake (AI) level for calcium from 11 years to adolescence (19 years) is 1300 mg/day in both sexes. Girls and women generally do not meet the required AI levels compared to men, who reduce their calcium intake after 50 years of age. Around 500 mg/day stays in deficit daily which should be remunerated with diet. Calcium supplements come into picture only if the dietary levels do not meet the age-specific AI.
High calcium bioavailability can be acquired from foods such as soybeans, kale, broccoli and bread whereas spinach and few other oxalate-rich foods are low in calcium bioavailability. Dairy sources such as cheese, milk and yoghurt and non-dairy sources such as almonds, tofu, green leafy vegetables and calcium-fortified milk and juices are excellent food choices.
Vitamin D Intake
For complete calcium absorption our body needs vitamin D. The RDA recommends around 600 international units (IUs) a day for the age group of 19-70 years and 800 IUs a day for people above 71 years. Sunlight exposure, though critical for vitamin D synthesis, remains an insufficient source of vitamin D. Oily fishes such as tuna and sardines, egg yolks and fortified milks are excellent sources of vitamin D. If your vitamin D analysis does not meet the required levels you can always go for supplements after consulting your doctor.
Phosphate Intake
Phosphate salt is present in almost all the foods we eat and the simple act of eating helps us meet the required phosphate levels (1000-12000 mg/day for adult females and 1200-1400 mg/day for males).
Protein Intake
Protein intake has been suggested at approximately 1 g/kg of body weight which maintains PTH concentration within a healthy range if calcium intake is almost near the recommended levels.
Vitamin K Intake
Vitamin K is imperative for bone health. Vitamin K supplements help to retard bone loss in postmenopausal women. Supplements have been suggested here as most of the people do not consume dark-green leafy vegetables which are good sources of vitamin K.
Other Sources
Trace elements like boron, copper, fluoride, iron, manganese and zinc help in bone health. It is better to have normalized intake of dietary fiber and sodium to prevent calcium loss. Potassium bicarbonate helps to decrease bone resorption and increase bone formation.
Osteopenia and Osteoporosis
Osteoporosis and osteopenia can affect anyone at any age. These diseases are very smart in the sense that, there are no outright signs indicating their onset. The first visible indication may be a broken bone. Women are almost four times more likely to develop osteoporosis and almost twice likely to have hip fractures than men. But this scenario changes with aging as both genders lose bone mass and become vulnerable.
Osteopenia is the forerunner of osteoporosis. Osteopenia is decreased bone density but not low enough to be classified as osteoporosis. This low bone density increases the chance of a fracture. People with osteopenia are always at a higher risk of developing osteoporosis. When the bone density is very low compared to normal value it is called osteoporosis. Even a cough or a sneeze can cause a fracture. Almost 25 million women and 12 million men are osteoporotic.
Etiology
Osteoporosis
Low BMD is the primary cause of osteoporosis. This low values maybe due to excessive acceleration of resorption or suboptimal peak bone mass that result in fragile bones after menopause. There are other important causes of osteoporosis as given below:
- Race: Whites and Asians are at an increased risk of osteoporosis.
- Menstrual Status: End of menstruation and loss of menses at any age is a major determinant of osteoporosis due to loss of estrogen hormone which accelerates bone loss.
- Body weight: Small-framed and thin people of both sexes are at increased risk as they have less bone mass to draw from as they age.
- Family history: If your mother or father has had a hip fracture you are surely prone to osteoporosis. It is said to be genetic.
- Medications: The use of certain medications like thyroid drugs, steroids, antacids and other drugs increases the chance of osteoporosis.
- Dietary and Lifestyle choices: Sedentary lifestyle, excess tobacco and alcohol use increase your risk of acquiring the disease. Low calcium intake and lack of sufficient vitamin D levels also elevate the risk of osteoporosis.
Osteopenia
Family history, lack of physical activity, smoking, consuming excess alcohol and fizzy drinks, exposure to radiation, chemotherapy, certain medicines, eating disorders and metabolism problems which inhibit the body from utilizing the required amounts of vitamins and minerals are contributing factors for osteopenia.
Treatment for Osteoporosis
Primary prevention is when you try to safeguard yourself from osteoporosis before the disease sets in, typically in adults before the age of 50. Secondary prevention is a treatment following the onset of osteoporosis. Please check the list below for a variety of treatment options available:
- Exercise: Weight bearing exercises are the best for osteoporosis. Brisk walk, swimming and dancing are all examples of this exercise form which helps to avoid or minimize the risk of breaking your bones.
- Diet: Increased calcium and vitamin D intake make your bones stronger through your life. Calcium intake of 1000 mg/day in premenopausal women and 1200 mg/day in postmenopausal women are the recommended values. Sufficient vitamin D levels in elderly are almost impossible to achieve and hence must be compensated using supplements.
- Medication: Bisphosphonates reduce the risk of fracture and maintain bone density. Alendronate, etidronate, risedronate and pamidronate are examples of bisphosphonates. For aged people with insufficient calcium and vitamin D, supplements are recommended. Parathyroid hormone (PTH) produced naturally in the body is actively involved in forming new bones. PTH treatment is used to stimulate cells to create new bones. But this is used only when bone density is very low and other treatments are not working.
- Hormone Replacement Therapy (HRT): Though HRT has been proved to maintain bone density it is often not recommended due to its varied side effects.
Treatment for Osteopenia
Lifestyle modifications are the best to prevent or treat osteopenia. Increase your calcium and vitamin D intake. Quit smoking and reduce alcohol use. Cut back on your salt and caffeine consumption as they contribute to bone and calcium loss. Resort to medication when all the other options are ruled out. Bisphosphonates, raloxifene and hormone replacement are few suggested medications.
Other Diseases
Osteogenesis Imperfecta (OI): OI is a genetic disorder where bones break easily. Hence this is also called as ‘brittle bone disease’. Genetic disorder fails to produce the required amount of collagen which leads to weak bones that break easily. Symptoms of OI include brittle teeth, malformed bones, curved spine, hearing loss, triangular face and sclera (whites of the eye) that look blue, purple or grey. Treatment includes physical therapy, use of wheelchair, surgery, braces and other aids. Surgery includes inserting metal rods inside the long bones to strengthen them.
Osteomyelitis: This is characterized by infection of the bones. Diabetes, rheumatoid arthritis, intravenous drug use and hemodialysis are few reasons for Osteomyelitis. Treatment focuses on stopping infection and treating the infected area with surgery, antibiotics or both.
Osteoarthritis: Osteoarthritis is the most prevalent form of arthritis affecting people worldwide. It occurs when the protective cartilage at the ends of the bone wear away. This disease is due to obesity, aging joints and injury. Surgery, medication and physical therapy are few treatment options available.