Dem Bones Sue Stred Sue Stred - a pediatric endocrinologist Will - PDF document

Dem Bones – Sue Stred Sue Stred - a pediatric endocrinologist Will not address HRT and Fosamax (i.e. medical) type stuff Promotes bone mineral density:  Race: black (strongest) > white > Asian (most frail)  Body weight (as you grow and gradually add weight, bones can take it better)  Weight-bearing exercise  Muscles pulling on weight-bearing bones (LOLs doing arm curls with soup cans) (Can be modulated)  Calcium intake  Vitamin D intake  Vitamin D receptor genotype (vit D is hormone and nutrient)(can’t be modified)  Estrogen  Growth hormone Risk factors for low bone density (50% white women will have fracture)  Over 65  White or Asian  Underweight for height  Lack of own estrogen  Close relative with osteoporosis  Broken bone after age 50 (not trauma)  Loss >1.5” of height Critical time to deposit into bone mineral “retirement account” Peak bone mass about age 24 (range from when start puberty), very little can modify after that So if gonadal removal and don’t start HRT right away, lower peak bone mass Limit bone mineral accrual:  Malabsorption (celiac disease)  Rheumatoid arthritis  Spinal cord injury  Radiation injury  Estrogen deficiency  Pharmacologic doses of corticosteroids (long term prednisone) Deplete bone mineral once accrued:  Smoking [ THE most important factor; some dr won’t operate on you if a smoker]  >2 drinks of alcohol several times a week (some indication for caffeine, too)  Hyperthyroidism  Heparin  Select anti-convulsants  Pharmacologic doses of corticosteroids

Dem Bones – Sue Stred What can you do today?  Quit smoking  Weight-bearing exercise  Review meds with PCP (do I still need, need this level, side effects, etc)  Adequate calcium intake  Adequate vit D stores (to keep the calcium in body) Weight-Bearing Exercise  BEST: Pounding – running, tennis, basketball, jumping rope, step aerobics, vigorous dancing (such as zumba, hip-hop)  GOOD: Weight-bearing – walking, chores, dance (such as ballroom)  NOT GOOD ALONE: Weight Off-Loading – bicycling, swimming (like astronauts who can’t stand for 3 months after returning because body depletes mineral stores if not using it) Recommended Amount of Intake by Age: 4-8 800 mg 9-18 1300 mg (1200-1500) 19-50 1000 mg 51+ 1200 mg Dietary Sources:  Dairy products – Yogurt (best, esp Greek yogurt b/c some fluid removed), milk, desserts made with milk (pudding, etc)  Beverages fortified with calcium – OJ, soy milk, some nut milks  Canned sardines with bones (and canned salmon with bones) Supplements:  Calcium carbonate is most common (tums; generally least expensive)  Calcium citrate (Citrical)  Tablets are bulky (if brand claims to be “smallest” then you just have to take more – read the bottle)  New liquid forms Calcium carbonate (take at end of meals):  Best absorbed if spaced out over day  Best absorbed when taken with food  Deficiency of vitamin D leads to inefficient absorption  Older adults tend to absorb less Choice dependent on other meds:  If take PPI med (Prilosec, Nexium, etc) turns down amount of acid in stomach, which body needs to absorb calcium carbonate, so absorb less  Calcium gluconate and calcium citrate will be absorbed better than calcium carbonate  ______ [missed something]

Dem Bones – Sue Stred What is Vit D?  Essential fat soluble both hormone and nutrient  Promote absorption of calcium and phosphorus (prevent rickets, osteoporosis) Ergocalciferol = vit D 2 Cholecalciferol = vit D3 How much vit D?  Ideal is now considered in the 30-40 range (it has been going up) Benefits vit D supplements?  Deficiency produce myopathy (poor muscle control and strength)  ______ [missed something]  ______ [missed something] Vit D Source: Milk, for OJ, sardines, egg yolk, liver Supplements:  Calcium: gummies, tums, citracal  Vit D: tablets, drops  Combo: Viactiv (Walmart make own version), Wellesse *Anyone over about age 6 can take these Downsides:  Constipation and burping  Magnesium supplements can prevent constipation issue (and if magnesium deficient, can’t hold onto calcium as well) If take thyroid replacement drugs can’t take at same time