ENSURING BETTER BONE HEALTH

According to National Institute of Health

Bone is a living, growing tissue, made mostly of collagen. Collagen is a protein that provides a soft framework, and calcium phosphate is a mineral that adds strength and hardens the framework.

And…

This combination of collagen and calcium makes bone strong and flexible enough to withstand stress.

More than 99 percent of the body's calcium is contained in the bones and teeth. The remaining one percent is found in blood.

Why Bone Health is So Important?

Bones support body and facilitate movement.

They protect brain, heart, and other organs from injury.

National Institute of Health

What Affects Bone Health?

• The amount of calcium in diet. A diet low in calcium contributes to diminished bone density, early bone loss and an increased risk of fractures.

• Physical activity. People who are physically inactive have a higher risk of osteoporosis than do their more-active counterparts.

Mayo clinic

Tobacco and alcohol use.  Smoking is a key lifestyle risk factor for bone loss and fractures1. Similarly, alcohol consumption has major harmful effects on bone development and maintenance at all ages2.

What Affects Bone Health?

Reference:1. Review article, The Effects Of Smoking On Bone Health Peter K. K. WONG, Jemma J. CHRISTIE And John D.

Wark Clinical Science (2007)2. Alcohol’s Harmful Effect on Bone, H. WAYNE SAMPSON, P, National Institute on Alcohol Abuse and

Alcoholism.

What Affects Bone Health?

Gender and size- Woman are at greater risk of osteoporosis as they have less bone tissue than men. Similarly extremely thin people (with a BMI of 19 or less) or with small body frame are also prone, as they have less bone mass to draw from as age increases.

Reference

Public Health Rep. 1989 Sep-Oct; 104(Suppl): 14–20. Risk factors for osteoporosis and associated fractures. JL Kelsy

And The Most Important-Age After mid-30’s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too.

Bones can weaken early in life without a healthy diet and the right kinds of physical activity.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

Weak Bone Leads To…

Osteoporosis

Arthritis

FractureA Series of Health Issues

Consequences of Weak Bones One out of two women and one out of

eight men will be affected by osteoporosis in their lifetime- Foundation for Osteoporosis Research and Education

An estimated 14 million men in the United States currently have low bone mass or osteoporosis- Foundation for Osteoporosis Research and Education

Hip fractures account for 300,000 hospitalizations annually- The 2004 Surgeon General’s Report on Bone Health and Osteoporosis

The National Institutes of Health-Osteoporosis and Related Bone Diseases, States

According to NIN study

Prevalence of osteoporosis & osteopenia In India – WHO criteria

Area Porosis PeniaNormal

F Neck 29% 52% 19% Spine 43% 43% 14%

A woman’s hip fracture risk equals her combined risk of breast, uterine and ovarian cancer.

Reference: National Osteoporosis Foundation Web site; retrieved July 2005

And The Situation Is More Grim For Women

But The Good News Is

Almost all these conditions are not only preventable but also treatable

Simple Steps towards Healthier Bone

The National OsteoporosisFoundation (NOF) recommends FIVE simple steps to bone health.

Step 1

Get your daily recommended amounts of calcium and vitamin D.

•low intake of calcium, may be responsible for the high prevalence of osteoporosis-NIN

•The WHO Expert Committees recommended 100 Units (2.5 µg) /d for adult males in 1988 and increased them later in 2005 to 200 Units (5 µg)/d.

NIN Recommendation for calcium (mg/day)

18

So It’s Important To Remember

Some age groups need MORE or LESS than 100% DV for calcium and vitamin D.

• Calcium requirements vary by age:• More is needed as we grow older • Need is highest during rapid growth of

adolescence.

• Vitamin D requirements increase as we age.

• 100% DV for calcium and Vitamin D are based on 1,000 mg calcium and 400 IU vitamin D.

19

And Also more vitamin D as you age

Age

Daily vitamin D needs in International Units (IU)

600 IU

200 IU

400 IU

0

100

200

300

400

500

600

up to 50 51-70 over 70

Dairy Products Help Meet RDA According to American Journal of Clinical

Nutrition, it is difficult to meet current recommendations for calcium intake without the consumption of dairy foods or supplements therefore, there has been a concerted effort recently by some investigators to recommend increased dairy food consumption, even among lactose-intolerant persons

Reference:

American Society for Clinical Nutrition Dairy foods and bone health: examination of the evidence Roland Weinsier & Carlos Krumdieck

Dairy Products Help Meet RDA Adequate intake for calcium cannot be

met with dairy-free diets while meeting other nutrient recommendations. To meet the adequate intake for calcium without large changes in dietary patterns, calcium-fortified foods are needed.

Reference: Journal of American Dietetic Nutrition. Meeting adequate intake for dietary calcium without dairy foods in adolescents aged 9 to 18 years. Department of Nutrition, Harvard University School of Public Health, USA.

Step 2

Engage in regular weight-bearing exercise.

Exercise across the life span should be encouraged in order to maximize peak bone mass & reduce age related bone loss. Epidemiological evidence suggests that being active can nearly halve the incidence of hip fractures in the older population-British Journal of Sports Medicine

Step 3

Avoid smoking & excessive alcohol

One in eight hip fractures is attributable to cigarette smoking-WHO

Data suggest that ethanol may be responsible for osteoblastic dysfunction resulting in diminished bone formation and reduced bone mineralization-The American Journal of MedicineEthanol reduces bone formation and may cause osteoporosis Departments of Gastroenterology and Endocrinology, Royal North Shore Hospital, Australia

Step 4

Talk to your doctor about bone health.

Step 5

Have a bone density test and take medication when appropriate.

In contrast to National Osteoporosis Foundation recommendations, only a small minority of high-risk women (12%-34%) get BMD test-The Journal of American Medical Association

26

Assess calcium and vitamin D intake by using food and supplement labels.

Also…

27

Nutrition labels & calcium

FDA uses “Percent Daily Value” (% DV) to describe amount of calcium needed by general U.S. population daily

100% DV for calcium = 1,000 mg

Look for this label: “Nutrition Facts” on foods “Supplement Facts” on

vitamin/mineral supplements

28

An easy way to meet calcium needs is consuming 3 cups (8 oz.) each day of fat-free or low-fat* milk or equivalent milk products in combination with a healthy diet. Children ages 2–8 years need 2 cups.

* Fat-free and low-fat are for health but not for calcium

differences

% Daily Value calcium: Milk group

Yogurt1 cup (8 oz.) = 30% DV

Milk1 cup = 30% DV

Cheese1 ½ oz. natural/2 oz. processed = 30% DV

Milk pudding1/2 cup = 15% DV

Frozen yogurt, vanilla, soft serve½ cup = 10% DV

Ice cream, vanilla½ cup = 8% DV

Soy or rice milk, calcium-fortified1 cup = varies—check label

Choose fat-free or low fat most often

And These Would Take Care Of Vitamin D

Main dietary sources of vitamin D are:

• Fortified milk (400 IU per quart)

• Some fortified cereals

• Cold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp)

• Some calcium and vitamin/mineral supplements

Vitamin D from sunlight exposure

Vitamin D is manufactured in skin following direct exposure to sun.

Amount varies with time of day, season, latitude and skin pigmentation.

10–15 minutes exposure of hands, arms and face 2–3 times/week may be sufficient (depending on skin sensitivity).

Clothing, sunscreen, window glass and pollution reduce amount produced.

Source: National Osteoporosis Foundation Web site; retrieved July 2005

Conclusion

Bone Health Building Blocks

Thank You