Postmenopausal survivors of breast cancer at risk for osteoporosis: nutritional intake and body size

Postmenopausal survivors of breast cancer for whom hormone replacement therapy is contraindicated are at risk for development of osteoporosis. The primary purpose of this article is to describe, in a sample of 30 postmenopausal survivors of breast cancer, their calcium and vitamin D intake compared with recommended dietary guidelines for those nutrients for postmenopausal women not taking hormone replacement therapy and the body mass index of these women as nutritional status risk factors for development of osteoporosis. Bone health and presence of osteoporosis were determined by bone mineral density testing of the spine, hip, and forearm. To obtain calcium and vitamin D intake, including supplements, 3-day diet records were completed; height and weight measures were used to calculate body mass index. The sample participants ranged in age from 42 to 65 years; the majority (56%) had been menopausal or off hormone replacement therapy for 5 years or less, and 70% had completed breast cancer treatment for 5 years or less (except tamoxifen). The majority (63%) were of medium body frame size; 30% were of small frame size. The mean body mass index (27.3) and mean weight (160 lbs) indicate that these women, as a group, were over-weight. Although a large percent (63%) were taking calcium supplements, the mean daily intake (diet and supplements) of calcium (1,353 mg) and vitamin D (403 IU) was less than the recommended dietary guidelines for these nutrients in this population. At study entry, 80% of the women were osteopenic (60%) or osteoporotic (20%) and none was receiving treatment/prevention for osteoporosis; only 1 had a previous known osteoporosis diagnosis. This is a special group of women for whom screening and preventive strategies for osteoporosis are imperative.     

Factors determining calcium intake in elderly women of Appalachia.

BACKGROUND: Although it has been recommended that women aged 65 and older consume at least 1,500 mg of calcium daily, no studies are available that define the factors associated with adequate intake. METHODS: We studied 184 elderly women to determine the relationship between foodstuff calcium consumption and anthropomorphic measurements and numerous life-style changes. RESULTS: The mean foodstuff calcium consumption was 563.4 mg/day, with significantly higher intake noted in women who snacked daily, did not skip meals, drank one or more servings of milk daily, and ate yogurt daily. Dietary calcium intake was also dependent on socioeconomic status and personal attitudes toward milk. CONCLUSIONS: All elderly women in this study underachieved the recommended dietary calcium intake of 1,500 mg/day. Widescale public education to promote more positive attitudes among elderly women is crucial. The evidence from this study recommends calcium supplements with vitamin D for virtually all elderly women.     

Calcium and bone health in children: a review.

The recent national survey shows that dietary calcium intake is variable in children and adolescents, with about half consuming less than the intake recommended by the Recommended Dietary Allowances or the National Institutes of Health Consensus Panel on Optimal Calcium Intake. Osteoporosis is a major disease in adults, resulting in 1.5 million fractures and over $10 billion in medical expenditures annually. Osteoporosis is of growing interest in the research, public health, and health consumer-lay communities and to the many primary care and specialty physicians and other health care professionals who work directly with patients with osteoporosis. Treatment of osteoporosis to prevent fracture is improving with newly introduced medications and approaches, but it is not as effective as needed. Effective prevention strategies are critical to decreasing the morbidity and mortality of the disease. Peak bone mass, obtained during childhood and adolescent growth, is one of the major determinants for the risk of developing osteoporosis and fracture. Genetic potential, gender, ethnic origins, nutritional factors such as calcium and vitamin D intake, growth patterns, and physical activity influence the accretion of bone mineral during childhood and determine the peak bone mass. Randomized, placebo-controlled intervention trials conducted in healthy children who are consuming amounts of dietary calcium in accordance with the US recommendations show that bone mass can be increased by calcium supplementation. Retrospective studies in adults suggest that childhood calcium intake is associated with risk of later osteoporosis and fracture. In addition, common childhood clinical conditions, such as low calcium intake related to lactose intolerance or the use of glucocorticoid medications for chronic illness, are risk factors for the development of osteoporosis in childhood, not just in adulthood. An approach for physicians and other pediatric care providers for screening children for low dietary calcium intake, low bone density, and other osteoporosis risk factors using dual-energy X-ray absorptiometry and the use of calcium supplementation in clinical care are presented.     

Osteoporosis and the elderly

Osteoporosis causes significant morbidity and some mortality among the elderly. Although increasing bone content should reduce the rate of osteoporotic fracture, attention should also be paid to other factors (such as falling). Loss of bone mass is a universal phenomenon with aging, and currently we are not able to use risk factor analysis to accurately predict which people are likely to suffer osteoporotic fracture. Bone densitometry cannot be recommended as a useful screening test in elderly patients. When deciding about treatment of osteoporosis in the elderly, it should be noted that few studies have included patients over 75 years of age and that prevention of bone loss is more effective than restoration of lost bone. Although high-dose calcium appears ineffective, patients ingesting low amounts of calcium should be counselled to increase their daily intake to at least 800 mg. Estrogens are very effective at preserving bone mass at least up to age 70 years, and their use is associated with a reduction in hip fractures. Vitamin D at a dose of 600 to 800 IU per day should be given to elderly subjects who do not get significant exposure of their skin to sunlight. Other specific recommendations regarding the prevention and treatment of osteoporosis await the results of further investigation.     

Nutritional care and management for osteoporosis

A significant point of nutritional care and management for osteoporosis is that calcium and vitamin D are recommended to be actively administered on top of sufficient intake of energy and the other nutrients including protein. Daily intake of calcium and vitamin D is encouraged at least 800 mg and 10 to 20 microg, respectively. Calcium and vitamin D are also important for maximizing the effect of osteoporosis drug therapy. Supplement of calcium or vitamin D could be a supportive measure, when their necessary amount is difficult to be consumed.     

That old hip. The osteoporosis process

Osteoporosis is a major health concern that will contribute to an increasing number of hip fractures as the population ages. Researchers are continuing to evaluate the role that decreased level of estrogen at menopause and prolonged calcium insufficiency play in the development of osteoporosis. In addition, many health care recommendations are aimed at maximizing peak bone mass and preventing bone loss to decrease the chance of hip fracture. New studies are evaluating the efficacy of experimental medications to rebuild bone mass once osteoporosis has developed. Current prevention guidelines include adequate calcium and vitamin D intake and moderate exercise. At menopause, estrogen replacement therapy is recommended for those younger than 50 years or considered at high risk for developing osteoporosis. All people are encouraged to decrease the risk of fracture by evaluating their home environment for hazards that might contribute to falls. Nursing needs to develop new strategies and interventions to educate the public about osteoporosis, improve the quality of life for persons with osteoporosis, and decrease the osteoporotic hip fracture mortality rate. Will it rise to the challenge?     

Osteoporosis diet

Bone requires a wide variety of nutrients to develop normally and to maintain itself after growth. Most important--in the sense that bony abnormalities are associated with their deficiencies--are protein, calcium, phosphorus, vitamin D, C and K, zinc, manganese and copper. The nutrients most likely to be deficient in citizens of industrialized countries are calcium and vitamin D. In this review of the current literature about nutritional aspects of osteoporosis, we have focused on factors influencing calcium requirement: the principal interacting nutrients are sodium, protein, caffeine, fiber, oxalate, phytate, and the acid/alkaline ash character of the overall diet. Fiber and caffeine decrease calcium absorption from the gut and typically exert relatively minor effects, while sodium, protein and the acid/alkaline balance of the diet increase urinary excretion of calcium and are of much greater significance for the calcium homeostasis. Alkali buffers, whether vegetables or fruits reverse this urinary calcium loss. As long as accompanied by adequate calcium intake, protein-rich diet is not deleterious to bone: a calcium-to-protein ratio of 20:1 (mg calcium/g protein) is recommended. Whether a nutrition-based therapeutic approach to osteoporosis is feasible in the near future is yet unclear: at least there are some recent promising data from in-vitro as well as from rat studies showing that extracts taken from various vegetables, mainly from the onion family inhibit bone resorption in a dose-dependent manner.     

Efficiency of calcium and vitamin D3 in the treatment of steroid osteoporosis in patients with hormone dependent bronchial asthma

AIM: To study effects of calcium (1000 mg/day) and vitamin D3 (Calcium-D3 Nikomed, 400 IN/day) in the treatment of steroid osteoporosis. MATERIALS AND METHODS: Calcium-D3 Nikomed was used in combined treatment of 20 patients with hormone-dependent bronchial asthma (BA) receiving glucocorticoid tablets in daily dose 5-40 mg (prednisolone calculation), mean dose 20.4 mg. Density of bone tissue was measured by CT of the lumbar spine (L2-L4), concentrations of osteocalcine and 25 (OH) vitamin D3--by radioimmunoassay, serum and 24-h urine calcium--by atomic-absorption spectrophotometry and selective ionometry. RESULTS: Calcium-D3 Nikomed intake for 6 months (2 tablets a day) resulted in decline of ossalgia, inhibition of bone tissue density loss, elevation of D3 vitamin 25 (OH) concentration in blood serum. Concentrations of osteocalcine, blood and 24-h urine calcium were close to the baseline. Therapeutic effect of physiological doses of vitamin D3 may be due to normalization of cholecalcipherol metabolism, activation of calcium intestinal absorption and suppression of bone resorption entailed by long-term administration of glucocorticoid tablets. CONCLUSION: High clinical efficiency and absence of side effects recommend calcium-D3 Nikomed for management of steroid osteoporosis in patients with hormone-dependent bronchial asthma.     

Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment

BACKGROUND: Osteoporosis and fragility fractures in men account for substantial health care expenditures and decreased quality of life. OBJECTIVE: This article reviews the most current information about the epidemiology, diagnosis, prevention, and treatment of osteoporosis in men. METHODS: Relevant literature was identified through a search of MEDLINE (1966-June 2003) limited to English-language studies in men. The search terms included fractures, bone density, or osteoporosis plus either epidemiology, diagnosis, prevention, control, or therapy. Additional search terms included specific subtopics (eg, bisphosphonates, calcium, exercise, parathyroid hormone). The authors contributed additional relevant publications. RESULTS: Morbidity after fragility fracture is at least as high in men as in women, and the rate of fracture-related mortality 1 year hip fracture is approximately double in men compared with women. The bioavailable fraction of testosterone slowly declines into the ninth decade in men. There is evidence that the effect of estrogen on bone is greater than that of testosterone in men. Diagnosing osteoporosis in men is complicated by a lack of consensus on how it should be defined. Significant risk factors for osteoporosis or fracture include low bone mineral density, previous fragility fracture, maternal history of fracture, marked hypogonadism, smoking, heavy alcohol intake or alcoholism, low calcium intake, low body mass or body mass index, low physical activity, use of bone-resorbing medication such as glucocorticoids, and the presence of such conditions as hyperthyroidism, hyperparathyroidism, and hypercalciuria. Prevention is paramount and should begin in childhood. During adulthood, calcium (1000-1500 mg/d), vitamin D (400-800 IU/d), and adequate physical activity play crucial preventive roles. When treatment is indicated, the bisphosphonates are the first choice, whereas there is less support for the use of calcitonin or androgen therapy. Parathyroid hormone (1-34) is a promising anabolic therapy. There is also strong evidence for the use of bisphosphonates for the treatment of glucocorticoid-induced osteoporosis.     

Pharmacy-based bone mass measurement to assess osteoporosis risk

OBJECTIVE: To evaluate elderly women's knowledge of their skeletal status, assess adequacy of calcium intake, determine the prevalence of low bone density, and determine whether peripheral bone density testing led to medical interventions in a group of rural, elderly Wisconsin women recruited in community pharmacies. DESIGN: Recruiting notices were posted in each pharmacy, and eligible women were enrolled in the order in which they volunteered. Each completed a fracture-risk questionnaire. Calcaneal bone density was measured within the following 6 weeks, using peripheral dual-energy X-ray absorptiometry. Mail surveys were used to assess interventions subsequent to the womens' study participation. SETTING: The study was conducted at 5 community pharmacies in rural Wisconsin. RESULTS: Of 133 women, 20% had calcaneal osteoporosis, defined as a T score < or =2.5 (calcaneal bone density <2.5 SDs below the young reference database). Thirty percent of women met National Osteoporosis Foundation (NOF) treatment criteria based on heel bone density and NOF-designated risk factors. Of those meeting treatment criteria, 75% were unaware of their low bone mass. Half of the women received <1200 mg/d of calcium, the recommended dose for osteoporosis prevention. Those who were taking a calcium supplement were much more likely to receive the recommended amount. Women who had discussed bone density test results with their physicians were more likely to receive central dual energy X-ray absorptiometry (DXA) measurements and/or start antiresorptive therapy than women who did not. CONCLUSIONS: Rural, elderly Wisconsin women are at substantial risk for osteoporosis, based on calcaneal bone density, but most are unaware of their risk. Compounding this risk is low calcium intake. Community screening of rural, elderly women by peripheral bone density measurement can lead to medical interventions in such individuals.     

Calcium and bone

ObjectiveEvaluate the role of calcium on bone health.MethodsReview of literatures on calcium and bone development during childhood and bone health in adulthood and older age.ResultsCalcium intake influences skeletal calcium retention during growth and thus affects peak bone mass achieved in early adulthood. Increased calcium intake is associated with increased bone mineral accretion rate up to a threshold level in all ethnic groups. The minimum intake to achieve maximal retention is 1140 mg/day for white boys and 1300 mg/day for white girls. Calcium also plays a role in preventing bone loss and osteoporotic fractures in later life. Meta-analyses report that calcium supplementation reduce bone loss by 0.5–1.2% and the risk of fracture of all types by at least 10% in older people. Low calcium intake is a widespread problem across countries and age groups.ConclusionAdequate calcium intake throughout lifetime is important for bone health and the prevention of osteoporosis and related fractures.     

Management of glucocorticoid-induced osteoporosis in male veterans

OBJECTIVE: To determine whether glucocorticoid-induced osteoporosis in male veterans was managed in accordance with American College of Rheumatology (ACR) guidelines. These guidelines recommend bone mineral density (BMD) determination at the initiation of long-term therapy with prednisone > or =7.5 mg/d, provision of hormone replacement therapy as needed, calcium and vitamin D supplementation as necessary, and antiresorptive therapy for low BMD. DESIGN: Patients receiving prednisone > or =7.5 mg/d throughout a predefined six-month period were identified through a hospital pharmacy database. Electronic and paper chart review was carried out to determine whether BMD measurement by dual-energy X-ray absorptiometry had been performed. Supplemental calcium and vitamin D intake was assessed for each patient. In addition, pharmacy records were reviewed to determine whether antiresorptive therapy was prescribed for patients with low BMD. SETTING: The Wm. S. Middleton Veterans Affairs Medical Center, Madison, WI. RESULTS: Seventy-two men met study criteria. They had been receiving oral prednisone treatment for a median of 30 months (range 6-74); mean daily dosage during the six-month study period was 12.5 mg (range 7.5-37.5). Extensive record review revealed that only six patients (8%) received recommended calcium and vitamin D, and only 43 (60%) had a BMD determination. Of those 43 men, 32 had T-scores below -1, therefore meeting ACR criteria for recommended antiresorptive therapy. However, only 12 of these 32 patients were prescribed antiresorptive therapy. Although this study was not designed to evaluate differences among clinics, there appeared to be better adherence to ACR guidelines for patients cared for in a rheumatology specialty clinic than in other clinics at the institution. CONCLUSIONS: Adherence to ACR guidelines for management of glucocorticoid-induced osteoporosis was poor. Efforts to improve the prevention and management of glucocorticoid-induced osteoporosis in male veterans are warranted.     

Nutritional factors in osteoporosis

Nutritional factors are important but correctable factors in the pathogenesis of osteoporosis. The rate of bone loss in the elderly can be reduced and the peak bone mass in the young can possibly be increased by dietary manipulation, thereby reducing the risk of fracture. Dietary manipulation likely to be of benefit are increased calcium intake, increased vitamin D intake, moderate reduction in intake of salt protein, caffeine and phosphate and increased intake of potassium and magnesium. The possible mechanisms by which these dietary factors influence bone metabolism are discussed.     

A cross-sectional survey of calcium intake in relation to knowledge of osteoporosis and beliefs in young adult women

This investigation found that young adult women (n = 265) were very likely (80.6%) to have accurate knowledge about osteoporosis but also typically had a low calcium intake (454 mg/day). The women in this study believed that they were at risk of osteoporosis but felt that prevention was difficult. Meanwhile, they held the opinion that osteoporosis is not serious and that taking preventative measures would not be worthwhile. The factors that most strongly affected the intake of calcium by women were, in order, knowledge, number of children, self-rated health score, Body Mass Index, graduation from high school, experience of bone density examination and family history. These seven items accounted for 31.8% of the variation in calcium intake.     

Management of male osteoporosis: report of the UK Consensus Group

Although osteoporosis is generally regarded as a disease of women, up to 30% of hip fractures and 20% of vertebral fractures occur in men. Risk factors for osteoporotic fractures in men include low body mass index, smoking, high alcohol consumption, corticosteroid therapy, physical inactivity, diseases that predispose to low bone mass, and conditions increasing the risk of falls. The key drugs and diseases that definitely produce a decrease in bone mineral density (BMD) and/or an increase in fracture rate in men are long-term corticosteroid use, hypogonadism, alcoholism and transplantation. Age-related bone loss may be a result of declining renal function, vitamin D deficiency, increased parathyroid hormone levels, low serum testosterone levels, low calcium intake and absorption. Osteoporosis can be diagnosed on the basis of radiological assessments of bone mass, or clinically when it becomes symptomatic. Various biochemical markers have been related to bone loss in healthy and osteoporotic men. Their use as diagnostic tools, however, needs further investigation. A practical approach would be to consider a bone density more than one SD below the age-matched mean value (Z < -1) as an indication for therapy. The treatment options for men with osteoporosis include agents to influence bone resorption or formation and specific therapy for any underlying pathological condition. Testosterone treatment increases BMD in hypogonadal men, and is most effective in those whose epiphyses have not closed completely. Bisphosphonates are the treatment of choice in idiopathic osteoporosis, with sodium fluoride and anabolic steroids to be used as alternatives.      

Osteoporosis in chronically ill children

Gains in bone mass are very rapid during adolescence and peak bone mass, the most important determinant of osteoporosis, is attained by early adulthood. Glucocorticoids, widely used in children with chronic illness, are known to impact bone mass and quality. In addition, disease and treatment‐related factors, nutrient and hormone deficiencies and decreased physical activity may all negatively affect bone mass accrual. Although decreased bone density is increasingly recognized in chronically ill children, current knowledge of the epidemiology, diagnosis and optimal treatment of pediatric secondary osteoporosis is limited. In addition to bone densitometry, biochemical and radiographic tests should be used in the diagnosis of osteoporosis. Bone histomorphometry may be needed in selected situations. At risk children should be advised to ensure sufficient calcium and vitamin D intake and weight bearing physical activity. Growth and pubertal development require careful assessment because of their close correlation with bone formation. Given limited experience with bisphosphonates, it seems prudent to target antiresorptive therapy to those children who have developed symptomatic disease. Ideally this should be done in controlled settings. Early identification and adequate intervention, in selected cases with bisphosphonates, is needed in order to prevent deleterious skeletal complications of osteoporosis in chronically ill children.     

Osteoporosis in chronically ill children

Gains in bone mass are very rapid during adolescence and peak bone mass, the most important determinant of osteoporosis, is attained by early adulthood. Glucocorticoids, widely used in children with chronic illness, are known to impact bone mass and quality. In addition, disease and treatment-related factors, nutrient and hormone deficiencies and decreased physical activity may all negatively affect bone mass accrual. Although decreased bone density is increasingly recognized in chronically ill children, current knowledge of the epidemiology, diagnosis and optimal treatment of pediatric secondary osteoporosis is limited. In addition to bone densitometry, biochemical and radiographic tests should be used in the diagnosis of osteoporosis. Bone histomorphometry may be needed in selected situations. At risk children should be advised to ensure sufficient calcium and vitamin D intake and weight bearing physical activity. Growth and pubertal development require careful assessment because of their close correlation with bone formation. Given limited experience with bisphosphonates, it seems prudent to target antiresorptive therapy to those children who have developed symptomatic disease. Ideally this should be done in controlled settings. Early identification and adequate intervention, in selected cases with bisphosphonates, is needed in order to prevent deleterious skeletal complications of osteoporosis in chronically ill children.     

Health behaviors in breast cancer survivors experiencing bone loss

PURPOSE: To describe the baseline healthy lifestyle behaviors (dietary, calcium, vitamin D, caffeine and alcohol intake, smoking history, and physical activity) of postmenopausal breast cancer survivors (BCS); and to identify any relationship of healthy lifestyle behaviors with bone mineral density (BMD) at the forearm, total hip and spine, L1-L4. DATA SOURCES: Self-reported responses to a demographic and health status questionnaire, to a 3-day Diet Record, and to the 7-Day Physical Activity Questionnaire-Adapted provided data for the lifestyle behaviors. Baseline BMD (g/cm(2)) was determined with dual-energy x-ray absorptiometry (DEXA). Height, weight, and body mass index (BMI) were also measured in each of the 249 postmenopausal BCS. CONCLUSIONS: There was an imbalance between consumed kilocalories and expenditure of energy. The majority of BCS were overweight or obese. They consumed less fruit and vegetable servings than recommended by the new 2005 U.S. Department of Agriculture's dietary guidelines, less dairy products, below average recommended grains and fiber, less protein and carbohydrate intake, and a slightly higher fat gram intake. Approximately, 43% did not take any supplemental calcium, with 46% taking less than 1000 mg a day. Likewise, 52.59% consumed less than 400 IU of vitamin D with both supplemental and dietary intake. This group of BCS consumed below accepted levels of caffeine and alcohol. Only 18 BCS continued to smoke. This group spent an average of 10.36 h in light (sedentary) activities on a daily basis. There were significant negative relationships with bone mass (g/cm(2)) at the total hip and daily intake of caffeine/mg and daily grams of alcohol. Weight and BMI both demonstrated a significant relationship with bone mass (g/cm(2)) at the total hip, spine L1-L4, and the forearm. IMPLICATIONS FOR PRACTICE: The healthcare provider must incorporate appropriate teaching strategies, intensive counseling, and coaching, along with a support mechanism, to enable BCS to understand the importance of a healthy diet, calcium, and vitamin D supplement, and a regular strength/weight program that will be integrated into their daily lifestyle. Early DEXA screens should be part of the protocol with BCS, and there is a particular need for forearm DEXA screens to be included in the treatment protocol for BCS.     

几种药物干预骨质疏松模型大鼠股骨的剪切力学特性☆

背景:剪切力学性能指标是对药物治疗后骨质疏松质量评价的一种可靠方法。目的:建立骨质疏松动物模型,比较不同药物干预骨质疏松模型大鼠后的剪切力学性能变化。方法:将60只大鼠分别设为正常对照组10只,其余50只去除双侧卵巢法复制骨质疏松动物模型,再随机分为5组:模型组不用药,复方中药组大鼠每日给服中药0.9g/kg、阿仑膦酸钠组大鼠每日给服阿仑膦酸钠1mg/kg、维生素K组大鼠每日给服维生素K0.1mg/kg、钙剂组大鼠每日给服逸得乐2mg/kg。各组大鼠股骨在电子万能试验机上进行剪切力实验。结果与结论:正常对照组、复方中药组、阿仑膦酸钠组、维生素K组大鼠股骨最大剪切力、最大剪应力均显著高于模型组(P<0.05)。钙剂组大鼠最大剪切力、最大剪应力与模型组比较差异无显著性意义。复方中药组大鼠最大剪切力、最大剪应力与正常对照组比较,差异无显著性意义。提示:中药、西药、维生素K治疗动物骨质疏松模型大鼠均有一定疗效,钙剂效果不明显,中药的效果最好。     

Osteoporosis, osteomalacia, rickets, and Paget's disease

Although the common form of osteoporosis associated with aging can be treated, it is best to avoid the problem by not letting the disease develop. Osteomalacia is caused by inadequate or delayed mineralization of bone and is treated by correcting the abnormal intake, loss, or metabolism of vitamin D, phosphate, and calcium. Paget's disease is characterized by osteoclastic resorption of bone with new bone laid down in a disorganized fashion.