پوکی استخوان

1. 1
OSTEOPOROSIS
SAJJAD MORADI
PhD student of nutritional sciences
School of Nutrition & Food sciences
Isfahan University of Medical
Sciences(IUMS)

2. Contents
Basic Concepts
Introduction
Risk Factors
Incidence and burden
Future Directions
2

3. Defining Osteoporosis
“systemic skeletal disease characterized by low
bone mass and microarchitectural deterioration of
bone tissue, leading to enhanced bone fragility and
a consequent increase in fracture risk”
True Definition: bone with lower density and
higher fracture risk
3WHO Scientific Group on the Prevention and Management of Osteoporosis (2000 : Geneva, Switzerland) (2003).

4. Basic Concepts
Bone mineral density (BMD)
T score
Z score
Osteopenia
Osteoporosis
4
Dual-energy X-ray absorptiometry (DXA or DEXA)
Average bone mineral density = BMC / W [g/cm2]
BMC = bone mineral content = g/cm
W = width at the scanned line

5. 5
WHO Scientific Group on the Prevention and Management of
Osteoporosis (2000 : Geneva, Switzerland) (2003).

6. 6

7. 7

8. Introduction
Early-life skeletal development
Manifests itself late in life
Both dietary and usual lifestyle
 Most important region for
osteoporosis diagnosis
8
Karasik, D., et al(2003)
Environmental factors
contribute approximately 20% to the
variance in bone
density measurements (Ralston and
Uitterlinden, 2010)

9. Risk Factors
9
 Age
 Estrogen deficiency
 Testosterone deficiency
 Family history/genetics
 Female sex
 Low calcium/vitamin D intake
 Poor exercise
 Smoking
 Alcohol
 Low body weight/anorexia
Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K (1985) Risk factors for postmenopausal
osteoporosis. The American journal of medicine 78 (1):95-100

10. Hyperthyroidism
Hyperparathyroidism
Liver and renal disease
Low sun exposure
Medications (antiepileptics,
heparin)
Malignancies (metastatic disease;
multiple myeloma can present as
osteopenia!)
10
Risk Factors
Seeman E, Melton LJ, O'Fallon WM, Riggs BL (1983) Risk factors for spinal osteoporosis in men. The
American journal of medicine 75 (6):977-983

11. 11Present Knowledge in Nutrition 2012

12. Incidence and burden
200 million women
 A 10% loss of bone mass in
the vertebrae can double the
risk of vertebral fractures
 A 10% loss of bone mass in
the hip can result in a 2.5
times greater risk of hip
fracture
8.9 million fractures
annually
12https://www.iofbonehealth.org/facts-statistics

13. Incidence and burden
13
1 in 3 women aged over 50
1 in 5 men aged over 50
 By 2050, the worldwide
incidence of hip fracture in
men is projected to increase by
310% and 240% in women,
compared to rates in 1990
https://www.iofbonehealth.org/facts-statistics

14. Prevalence of osteoporosis in Iran
Older than 30 years of age, both osteoporosis and osteopenia are
common problems
 17% = osteoporosis
 35% =osteopenia
Iranian Multicenter osteoporosis Study (IMOS)
Two-thirds of women low BMI = 1 in every 4 osteoporosis
Half of men low BMI = 1 in 5 every osteoporosis
14
Osteoporosis in Iran,Mirhashemi and et al , 2017
Larijani et al2006 Peak bone mass of Iranian population: The Iranian multicenter
osteoporosis study. Journal of Clinical Densitometry 9 (3):367-374

15. Pathophysiology of Osteoporosis
Functional declines of several organ systems
Declines in Estrogen and Androgen Production
Declines in Intestinal Calcium Absorption
Declines in Renal Function
Reduced Renal Formation of 1,25-Dihydroxyvitamin D
Increased Secretion of Parathyroid Hormone
15
Heaney RP (1998) Pathophysiology of osteoporosis. Endocrinology and metabolism clinics of North
America 27 (2):255-265

16. 16Present Knowledge in Nutrition 2012

17. Studies of Nutritional Factors Affecting
Bone of Older Adults
Observational Reports
Randomized Controlled Trials (RCTs)
Meta-Analyses
Studies
Future Directions
17

18. Observational Reports
Nordin (1960) suggested that calcium intakes of 800–1000mg of
calcium were optimal for bone health of practically all populations
and that Asian diets containing 500mg or so per day were grossly
inadequate
Matkovic et al. (1979) supported the benefit of consuming a high-
calcium diet based on milk and other dairy foods on bone mass
compared with a non-dairy-consuming population in Yugoslavia
18Present Knowledge in Nutrition 2012

19. Observational Reports
Dietary pattern
Dietary acid load (DAL)
Dietary inflammatory index (DII)
Dietary diversity index (DDI)
19

20. Randomized Controlled Trials (RCTs)
Calcium plus Vitamin D
 Jackson et al., 2006
Calcium (1000 mg/day) plus vitamin D (400IU/day) for an average
period of 7 years
Modestly greater BMD at the hip, but no reduction in hip or
vertebral fractures.
20Present Knowledge in Nutrition 2012

21. Chapuy et al., 1992 - based in Lyon, France
Non-vertebral fractures were reduced following 1 year of therapy
with daily calcium phosphate and vitamin D supplements
1000 mg for calcium, 600 mg for phosphorus, and 800 IU for
vitamin D
Chung et al., 2009
>300IU of vitamin D and >1000 mg of calcium
21
Randomized Controlled Trials (RCTs)
Present Knowledge in Nutrition 2012

22. Randomized Controlled Trials (RCTs)
Calcium Alone
Reid and colleagues (2006), RCT in postmenopausal women living
in Auckland, New Zealand
calcium supplementation (1000 mg/day), 5 year
Riis and co-researchers in Denmark showed that calcium
(1000mg per day) postmenopausal women, 2 year
22Present Knowledge in Nutrition 2012

23. Meta-Analyses
Tang et al., 2007 , 17 randomized trials
Calcium supplementation (>1200mg/day) alone on fracture risk found that
older subjects (>50 years) had the greatest reduction of fractures (p < 0.05)
when they had low baseline calcium intake (<700 mg/day) and low serum 25-
hydroxyvitamin D (<25mmol/L) that presented fractures.
23Present Knowledge in Nutrition 2012

24.  Reid et al. 2008 first reported that elevated intakes of calcium
alone (>800mg/day) significantly lowered the risk of non-vertebral
fractures.
Reid et al. 2010; Avenell et al., 2010; DIPART analysis,
2010, vitamin D supplementation alone was not beneficial in
fracture reduction
24
Meta-Analyses
Present Knowledge in Nutrition 2012

25. Critical nutrients needed to support bone health in late
life with or without physical activity programs
 Nutrient requirements of other ethnic groups, especially African-
Americans
 Several prospective RCT investigations of single nutrients or
combinations of nutrients, beyond simply calcium and vitamin D,
would advance understanding of the essential roles of these
nutrients. high phosphate intakes, vitamin K in two or three
different forms
25
Future Directions
Present Knowledge in Nutrition 2012

26. Protein itself from high-quality sources rich in sulfates
and phosphates
There is emerging evidence that dried fruits, such as
prunes, provide significant amounts of vitamin K,
manganese, boron, copper and potassium which could
help to support bone health.
Just 50 g of prunes daily have been found to reduce
bone resorption after six months, postmenopausal
women.
26
Future Directions
Jennette Higgs et al, 2017, Nutrition and osteoporosis prevention DOI: 10.1302/2058-5241.2.160079

27. The role of magnesium in bone metabolism
 Iron, copper and selenium
27
Future Directions
Present Knowledge in Nutrition 2012

28. 28