Normal bone accretion and effects of nutritional disorders in childhood

Although osteoporosis is usually considered to be a health concern of the elderly, increased attention is being paid to children and adolescents who are at risk for developing this devastating disease. As osteoporosis is a preventable condition with no identified cure, focus has been placed on modifiable areas in a young person's life that may prevent the development of the disease. A child or adolescent's nutrition is an example of such an area. This review examines factors influencing normal bone development and emphasizes the importance of the adolescent years as a time for peak bone accretion. Current methods to evaluate skeletal status are examined, including the challenges that arise in interpreting bone densities in children who have growing bones. Children and adolescents who are at high risk for osteoporosis are discussed, with an emphasis on groups in whom poor nutrition likely mediates bone loss. Two models of malnutrition, anorexia nervosa and the female athlete triad, are discussed, with emphasis on the way in which each has deleterious effects on the adolescent skeleton. The promotion of skeletal health is ultimately the encouragement of good general health principles for all young people. Approaches for working with children and adolescents are reviewed, including literature supporting each strategy.     

Preventing osteoporosis

Providing practical advice on the prevention of osteoporosis in childhood, adolescence and adulthood, this contribution offers a number of useful suggestions in calcium intake, vitamin D supply, exercise, prevention and protection against falls, early diagnosis and effective medication. The prevention of osteoporosis begins with optimal bone mass acquisition during growth. Bones are living tissue, and the skeleton grows continually from birth to the end of the teen years, reaching a maximum strength and size (peak bone mass) in early adulthood. An efficient way of preventing osteoporotic fractures is to build up the strongest bones possible during childhood and adolescence. In adulthood, there are also necessary steps to take in the prevention of osteoporosis building strong bones in youths is also applicable to adults to prevent excessive bone loss.     

Einfluss von k?rperlicher Aktivit?t und Sport auf die Knochengesundheit im Lebenslauf

Physical activity and exercise are important determinants for metabolic and cardiovascular health. They also play an important role for bone health in childhood, adolescence, and adulthood. This review summarizes results from observational and intervention studies which evaluated the association between physical activity/exercise and bone health in different life course stages. In childhood and adolescence, physical activity and exercise induce improved bone accrual. In adulthood, mainly in postmenopausal women, long-term exercise programs reduce age-related bone loss. Especially weight-bearing activities seem to have an important osteogenic effect. Children and adolescent show a higher bone accrual until 5 years after cessation of an exercise program compared to their peers, who do not participate in an exercise program. In contrast, adults who quit exercising have a higher decrease in bone stiffness compared to adults who never exercised. This effect was particularly seen in postmenopausal women. Continuous physical activity and exercise over the life course and the implementation of exercise programs in schools and community-based intervention programs can help prevent or even reduce osteoporosis and osteoporosis-related fractures. Due to the lack of prospective longitudinal studies, the supposed long-term sustainable protective effect of physical activity and exercise in childhood and adolescent on bone health in later adulthood is not well established.     

Children's bone health and meeting calcium needs

One in two women and one in five men suffer from osteoporotic fractures after the age of 50. Enabling children and young people to develop strong bones and achieve their maximum potential bone mass will help prevent undue bone loss and osteoporosis in later life. Although 70-80% of peak bone mass is genetically determined, the remainder is determined by dietary and environmental factors. The most important dietary factor for bone health is calcium, which in the UK is obtained mainly from dairy foods (45%) and cereal-based foods (27%). In the UK one-quarter of teenage girls consume insufficient calcium to meet their minimum dietary requirements. The majority of teenage boys and girls fail to meet the UK Government's targets for calcium intakes. This is an important public health issue as 90% of peak bone mass is attained by the age of approximately 18 years in girls and 20 years in boys. Health professionals need to be aware of the importance of childhood and adolescence for building healthy bones and to work with this age group to promote the dietary and lifestyle factors that contribute to bone health and peak bone mass. They could usefully include advice on including three helpings of calcium in the diet each day, as highlighted in the current "3-a-Day" campaign.     

Exercise and physical activities for the prevention of osteoporotic fractures: a review of the evidence

According that osteoporosis is the common condition in an aging society such as in Japan, much progress has been made in understanding the treatment and prevention of osteoporosis. Among potential risk factors, exercise and physical activities have been recognized as lifestyle factors that might influence the risk of osteoporosis and osteoporotic fractures. To assess the relationship between exercises including physical activities and the risk for low bone mass and osteoporosis-related fractures, a literature search over past 13 years was conducted. Accumulating evidence indicates that exercises decrease the risk for hip fractures among middle aged and older men and women. Exercises also help to maintain muscle strength, muscle volume, balance, and joint flexibility, which might prevent falls and fall-related fractures. One randomized controlled trial showed back-stretching exercise reduced the risk for vertebral fractures. The literature search also indicates that high-impact and/or weight-bearing exercise might increase the bone density in the elderly and the peak bone mass among young women, while there is no association between moderate or lower-impact exercise and bone mineral density. Future research should be required to evaluate the types and quantity of physical activity needed for the prevention of osteoporosis.     

Decreasing the incidence of osteoporosis-related injuries through diet and exercise.

Osteoporosis is the most common systemic bone disorder in the United States. It affects 15 million people--primarily women--causing thousands of injuries and deaths per year at a cost estimated at +3.8 billion annually. Two important factors in preventing osteoporosis are regular exercise and adequate calcium intake throughout life. Studies have shown that the average daily consumption of calcium by premenopausal and postmenopausal American women is between one-third and one-half that needed to maintain a positive calcium balance and prevent the loss of bone mass. This proposal elaborates the following specific ways that our health care and educational institutions can change these prospects: a screening program for women of all ages, to identify those most at risk for developing osteoporosis; an increase in the recommended daily dietary allowance for calcium; a public information campaign about osteoporosis, using television and radio; an investigation of the feasibility of calcium additives in the American diet; and the establishment of an organization to develop educational programs and monitor research in osteoporosis prevention. Now is the time to make the appropriate efforts to better the prospects for millions to enjoy a long and healthier life.     

Inulin-type fructans and bone health: state of the art and perspectives in the management of osteoporosis

If the primary role of diet is to provide sufficient nutrients to meet the metabolic requirements of an individual, there is an emerging rationale to support the hypothesis that, by modulating specific target functions in the body, it can help achieve optimal health. Regarding osteoporosis prevention, since Ca is most likely to be inadequate in terms of dietary intake, every strategy targeting an improvement in Ca absorption is very interesting. Actually, this process may be susceptible to manipulation by fermentable substrates. In this light, inulin-type fructans are very interesting, even if we need to gather more data targeting bone metabolism before health professionals can actively advocate their consumption to prevent senile osteoporosis. Besides targeting the prevention of postmenopausal osteoporosis, inulin-type fructans still remain a source for putative innovative dietary health intervention. Indeed, given in combination with isoflavones, they may have a potential for maintaining or improving the bone mass of human subjects, by modulating the bioavailability of phyto-oestrogens.     

Preventive and nutritional factors of osteoporosis

In osteoporosis there is a reduction in the protein and mineral matrix of the bone, with an increase in the risk of fracture, especially of some bones. The present paper discusses some of the preventive factors relating to nutrition and life style. The acquisition of bone mass in infancy and adolescence is fundamental, carrying out a reasonable amount of exercise and a minimum exposure to sunlight, together with a high consumption of calcium proceeding from dairy products. The pharmacological supplement of calcium would be justified when the ingestion of milk and its derivatives is low in the juvenile and perimenopausal ages, as well as in cloistered or institutionalised persons, for whom vitamin D supplements should be added. Avoiding the following risks, smoking, the abusive consumption of alcohol, intense weight loss and diets that are extremely hypercaloric, a sedentary lifestyle and excessive exercise would all be other preventive measures for osteoporosis.     

Diet and bone health

The aim of this report is to bring together, in a user‐friendly format, the progress and results of recent European Union funded projects that have investigated some of the nutritional aspects of bone health. This report provides an overview of some of the reasons why nutrition is important for healthy bones and focuses on the prevention of osteoporosis. As an introduction, some background information on bone physiology, and the nutrients which are needed for healthy bones, is provided.     

围绝经期女性骨质疏松症的膳食营养策略

妇女进入围绝经期以后,由于卵巢功能减退,雌激素波动性下降,会减少对钙的吸收,同时破骨过程增加,新生骨骼无法及时形成,骨骼密度降低,容易引起骨质疏松症。骨质疏松症重在预防,膳食营养与骨质疏松症关系密切,其是预防骨质疏松症的重要措施之一。该文分析不同营养物质在预防骨质疏松症中的作用,阐述科学合理饮食和运动,预防围绝经期女性骨质疏松症。     

Bone disease in female athletes

Regular exercise and physical activity have many health benefits for both females and males. In particular, weight-bearing exercise has a protective effect on the skeleton, and can even be osteogenic (stimulating to bone formation). However, achievement of optimal bone mineral density and regulation of bone maintenance depend upon a combination of mechanical, hormonal and dietary factors. Adequate hormonal status (oestrogen and progesterone), and sufficient nutrition (calcium, protein, and other bone-building materials) are essential. For young women with components of the Female Athlete Triad (such as disordered eating, amenorrhea and other forms of menstrual dysfunction), one or more of these may be lacking, and decreased bone density can result. With an effort to maximize peak bone mineral density in the young athlete and to preserve or restore gonadal function during the reproductive years, the complications of altered bone mineral density and frank osteoporosis can be avoided.     

Contributions of dietary calcium and physical activity to primary prevention of osteoporosis in females.

In the United States and many Western nations, increasing prevalence of osteoporotic fracture is contributing to the health care system burden, and costs and needs for medical services are predicted to increase significantly by the beginning of the 21st century. Recent reports investigating developmental changes in skeletal mass of adolescent girls and young women under different experimental or ecological conditions support the contention that modification of environmental factors, especially dietary calcium and physical activity, can favorably modulate bone mass and bone density compared to controls. The peripubertal period, starting as early as 10 years of age, seems to be most responsive to modification of environmental/lifestyle factors, whereas potential gains of bone mass during late adolescence and early adulthood, although smaller, may be more readily achieved through improved dietary calcium intakes and regular exercise programs. Scientific evidence in support of these beneficial effects on bone is presented as part of the rationale for prevention of osteoporotic fractures. Also discussed is the need for a national policy to prevent osteoporosis through primary prevention strategies focused at young girls prior to puberty. The goal would be for every prepubertal girl, over the next decade, to achieve peak bone mass (and density) of the spine, hips and other bones by age 20, i.e., early adulthood. A second target group for national policy should be women in their 20s. Attainment of the goal to gain 3-5% additional bone mass during this decade would prolong the time before the fracture threshold range (low bone mass) is reached in the postmenopausal decades.     

Biomarkers of bone health appropriate for evaluating functional foods designed to reduce risk of osteoporosis

Osteoporosis is a growing global problem. The health care costs and decreased productivity and quality of life are staggering. Much research is invested in life-style approaches to build peak bone mass during growth to prevent osteoporosis as well as to treat the disease in later life. Functional foods have enjoyed a niche in bone health. Foods fortified with Ca are most popular. Other bone nutrients such as vitamin D, Mg and vitamin K are sometimes added. Future products are likely to include enhancers of Ca absorption such as inulin or whey proteins. Dietary factors that reduce urinary Ca loss (plant proteins) or suppress bone resorption (possibly phyto-oestrogens) are also gaining attention. Methodologies for evaluating the effectiveness of functional foods on bone health include measures of bone quality such as bone densitometry or measures of Ca metabolism, particularly absorption. Biochemical markers for bone turnover are less satisfactory for diet-related effects. Use of a rare isotope, 41Ca, and accelerator mass spectrometry offers a new approach for assessing the ability of functional foods to suppress bone resorption.     

成都市中老年人指骨骨密度现况调查及影响因素分析

目的 了解成都市中老年人骨密度水平现状,并分析其影响因素.方法 随机抽样选取四川省人民医院体检中心健康体检人群共1954例.采用问卷调查收集人口学资料、慢性病史、饮食、运动等情况,现场测量指骨骨密度.结果 随着年龄增长,骨密度水平明显下降,且同年龄段的女性骨密度水平低于男性(P<0.05).男性年龄>65岁、女性年龄>...     

Brittle bones, pain and fractures--lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT)

Osteoporosis has been labelled the disease of the 21st century. Over the past couple of centuries there have been various notions of this disease in medicine. In the present medical discourse, the emphasis is on prevention rather than treatment, making osteoporosis into a major risk factor for bone fractures. In Norway, osteoporosis is a particularly prevalent condition, leading to bone mass measurements being included in several large health surveys. In a follow-up study of the second round of the Nord-Trøndelag Health Study (HUNT), women aged 55–75 years were invited to participate in focus groups to talk about their experiences in relation to their bone density measurements. Findings from these focus groups show that osteoporosis is perceived as a disease characterized by brittle bones, pain and fractures. The physical appearance of a hunchbacked old woman is a dominant way of portraying the disease. It is mainly perceived as prevalent among women, but evidence that men can get it is provided through the example of a famous male athlete who became osteoporotic. Causal explanations for the disease are dominated by culturally shaped anecdotal evidence wherein medical knowledge has been included. Limits to lay constructions of osteoporosis based on such evidence are discussed. Talking about osteoporosis across generations the women applied different explanations for the condition over time. In doing so, they also showed that they have adopted the morality of the new public health where the individual has control over her health through self-governance. Whereas this was no option for their grandmothers, their grandchildren's generation was seen as one failing to meet their obligations to become healthy citizens. The lay construction of osteoporosis can thus be seen as one that has developed from a situation where osteoporotic persons were perceived as victims of harsh circumstances to one of individual responsibility.     

Impact and risk factors of post-stroke bone fracture

Bone fracture occurs in stroke patients at different times during the recovery phase, prolonging recovery time and increasing medical costs. In this review, we discuss the potential risk factors for post-stroke bone fracture and preventive methods. Most post-stroke bone fractures occur in the lower extremities, indicating fragile bones are a risk factor. Motor changes, including posture, mobility, and balance post-stroke contribute to bone loss and thus increase risk of bone fracture. Bone mineral density is a useful indicator for bone resorption, useful to identify patients at risk of post-stroke bone fracture. Calcium supplementation was previously regarded as a useful treatment during physical rehabilitation. However, recent data suggests calcium supplementation has a negative impact on atherosclerotic conditions. Vitamin D intake may prevent osteoporosis and fractures in patients with stroke. Although drugs such as teriparatide show some benefits in preventing osteoporosis, additional clinical trials are needed to determine the most effective conditions for post-stroke applications.     

Education and Phone Follow-Up in Postmenopausal Women at Risk for Osteoporosis

Introduction

Postmenopausal osteoporosis remains a substantially underdiagnosed and undertreated disease. There is a lack of knowledge among older individuals of the appropriate measures to slow or prevent bone mineral density (BMD) loss, particularly in regard to their own personal risk of osteoporosis. Bone densitometry combined with education about osteoporosis improves self-reported daily calcium intake and utilization of hormone replacement therapy (HRT). This prospective unblinded randomized controlled trial was undertaken to determine the effect of nurse education plus follow-up phone care on initiation of and persistence with antiresorptive drug therapy, increases in calcium intake, and increases in weight-bearing exercise in postmenopausal women at high risk for osteoporosis, independent of bone densitometry testing.

Methods

The target study population was female patients of a large, multispecialty community practice aged ≥50 years. Study participants were not on HRT or antiresorptive drug therapy, were ≥5 years post menopause, had a score of ≥8 on the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire. A total of 310 patients were enrolled and 287 (92.9%) completed the study. Participants underwent bone densitometry at study entry. They were then randomly assigned to one of two groups: (i) the usual care group who were given two educational brochures regarding osteoporosis; and (ii) the nurse education group who received these brochures plus a 15 minute one-on-one education regarding osteoporosis with a nurse. Both groups were told to follow up with their primary care physician. Those receiving nurse education also had telephone follow-up with the nurse educator at 3, 6, and 9 months. Telephone surveys of all participants were performed at 12 months after bone densitometry to assess self-reported initiation of and persistence with antiresorptive drug therapy after bone densitometry, self-reported changes in calcium intake, and weight-bearing exercise habits.

Results

Nurse education plus phone care follow-up had no effect on commencement of antiresorptive drug therapy (odds ratio [OR] 1.18, 95% CI 0.69, 2.04) or persistence with antiresorptive drug therapy (OR 1.05, 95% CI 0.56, 1.97). Nurse education plus phone care follow-up was associated with improved self-reported calcium intake (OR 2.18, 95% CI 1.36, 3.49) and exercise frequency (OR 1.89, 95% CI 1.11, 3.21).

Conclusion

Nurse education plus follow-up phone care does not improve utilization of drug therapy to prevent BMD loss or osteoporotic fracture, although it does improve the use of nonpharmacologic preventive measures for osteoporosis. Other strategies beyond patient education and follow-up phone care will be required to increase appropriate utilization of osteoporosis drug therapy.

     

Importance of vitamin D, calcium and exercise to bone health with specific reference to children and adolescents

Summary The optimisation of skeletal health during the life cycle is critical, especially if we are to reduce the continuing rise in osteoporosis – 1 in 2 women and 1 in 5 men over the age of 50 years will suffer an osteoporotic fracture. The foundations of adult bone health are laid down in the early years; therefore, optimisation of bone health in the young is fundamental. Although genetics play a major role, accounting for 70–75% of bone strength, other lifestyle and nutrition factors are known to be highly influential. Calcium (Ca) and vitamin D play critical roles in bone mineralisation as well as generally being key nutrients in health. All living cells require Ca to survive, with the majority (99%) of Ca being found in bones and teeth and the remainder in soft tissues and body fluids. Vitamin D is the generic term for two molecules: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). The former is derived by ultraviolet (UV) irradiation of ergosterol, which is distributed in plants and fungi. The latter is formed from the effect of UV irradiation on the skin. The principal role of vitamin D is to support the serum Ca concentration within narrow limits. Vitamin D is crucial for maximising gut absorption of calcium via vitamin D dependent Ca receptors. It is estimated that adequate vitamin D status increases Ca absorption to 30–40% of intake compared with only 10–15% absorption without adequate vitamin D. Intakes of Ca are a concern among certain groups of the population, for example a high proportion (>12%) of teenage boys and girls fail to meet the lower reference nutrient intake for Ca. For vitamin D, there are no dietary reference values for the age group 4–64 years as it is considered that UV exposure provides sufficient quantities of vitamin D, but there is now mounting evidence of widespread vitamin D insufficiency in the population. Weight‐bearing physical activity is beneficial to the skeleton but clarification is needed of the exact type, intensity and duration required for optimal bone mass. The role of othermicronutrients on bone metabolism remains to be fully quantified. This review investigates the current evidence of the impact of dietary and lifestyle factors on bone health, with specific reference to children and adolescents and with a focus on vitamin D, Ca and weight‐bearing exercise.