Balance osteoporosis

Four of the main-group cations are essential in human nutrition (Table A). Of these, the most important is Ca2+. About 90% of the calcium in the body is found in bones and teeth, largely in the form of hydroxyapatite, CatOH)2 - SCa PO. Calcium ions in bones and teeth exchange readily with those in the blood about 0.6 g of Ca2+ enters and leaves your bones every day. In a normal adult this exchange is in balance, but in elderly people, particularly women, there is sometimes a net loss of bone calcium, leading to the disease known as osteoporosis. 

Oral calcium has long been used for the treatment of osteoporosis, both in the form of dietary and pharmacological supplements. In patients with calcium deficiency, oral calcium at doses of 1000-1500 mg/day corrects a negative calcium balance and suppresses PTH secretion. Sufficient calcium intake is most important for the acciual of peak bone mass in the young, but is also considered the basis of most anti-osteoporotic regimens. In the elderly, supplementation with oral calcium and vitamin D reduces the risk of hip fracture by about 30 4-0%. 

In extensive studies of the effect of fluoride In patients with osteoporosis carried out In this Research Unit, a therapeutic dally dose of 45 mg fluoride per day was used as sodium fluoride. The main effect of fluoride on calcium metabolism was a decrease of the urinary calcium, while the fecal calcium did not change and the calcium balance also remained unchanged. Also, the Intestinal absorption of calcium remained unchanged during the high fluoride Intake (Table I), The decrease In urinary calcium, Induced by sodium fluoride, may be due to decreased bone resorption, a very desirable effect for patients with osteoporosis. 

In terms of mineral content, potato is best known as an important source of dietary potassium, which plays a fundamental role in acid-base regulation and fluid balance and is required for optimal functioning of the heart, kidneys, muscles, nerves, and digestive systems. Health benefits of sufficient potassium intake include reduced risk of hypokalemia, osteoporosis, high blood pressure, stroke, inflammatory bowel disease (IBD), kidney stones, and asthma. A high intake of potassium and low intake of sodium have been hypothesized to reduce the risk of stroke (Larsson et al., 2008 Swain et al., 2008). However, most American women 31-50 years old consume no more than half of the recommended amoimt of potassium and men s intake is only moderately higher (lOM, 2004). 

An extensive literature review has provided a useful assessment of the benefit to harm balance of raloxifene (20). The findings were reassuring. One large fracture prevention trial provided the best evidence that raloxifene 60 mg/day for 3 years reduced the relative risk of vertebral fractures by 30-50% in women with prevalent fractures or osteoporosis. The extraskeletal effects of raloxifene include a reduction in total cholesterol and low density lipoprotein cholesterol concentrations. Raloxifene was not associated with endometrial hyperplasia, and there was a 72% reduction in the incidence of invasive breast cancer. Adverse events associated with raloxifene included an increase in the absolute risk of venous thromboembolism and increased risks of hot... 

The use of tamoxifen to prevent breast cancer has been reviewed (8). The merits of using tamoxifen to prevent mammary carcinoma in women who have never had the disease but are believed to be at high risk have been disputed (9), but it is clear that it would involve very long treatment and that one s view of the adverse effects might need to be revised for this class of users. The available data after 5,10, and 15 years of follow up confirmed an increase in the incidence of endometrial cancer and of thromboembolic complications and suggested ocular toxicity, but these effects were not common and should be more than balanced by the reduced risk of coronary heart disease and osteoporosis (8). 

The primary roles and the recommended daily intake of major and trace minerals are listed in Table 38-3. Similar to vitamins, these minerals are typically obtained from dietary sources. Specific minerals may likewise be included in various multivitamins and other dietary supplements, with the intent that these minerals will promote good health and prevent disease. Again, there is generally no need for mineral supplements for most people eating a reasonably balanced diet. On the other hand, mineral supplements can be helpful in specific situations where the body s need for a mineral may exceed dietary supply. Some examples of appropriate supplementation include calcium supplements for people with osteoporosis (see Chapter 31), potassium supplements for people on diuretics (see Chapter 21), and iron supplements for people with certain anemias. Hence, mineral supplements may be helpful in certain individuals, but the dose and type of supplement should be adjusted carefully. 

Osteoporosis is a disease or metabolic disturbance, particularly in postmenopausal women, that indicates a need for a very high dietary calcium intake. High calcium requirements appear to be related to the very high protein intake of the modem Western diet. A decreased protein intake, as can be obtained on a total vegetarian (vegan) diet, can allow for calcium balance, in a variety of age groups, from one third to one fifth the amount of daily calcium required with a Western diet. 

The American Cancer Society states that there does not seem to be any relationship between caffeine and cancer. However, other adverse effects for women remain a concern, such as the possibility that large amounts of caffeine could contribute to osteoporosis (thinned and fragile bones), particularly in elderly women. As caffeine is a diuretic, which increases loss of fluids and electrolytes in the urine, it could rob the body of calcium. Nevertheless, a study published in 2001 concluded that the net effect of carbonated sodas on the body s calcium is negligible, and that the loss of calcium in urine due to carbonated drinks is too small to affect calcium balance. 

Many symptoms of aluminum toxicity are similar to those of Alzheimer s disease and osteoporosis. This suggests that long-term accumulation of aluminum in the brain may contribute to the development of Alzheimer s disease. In addition, an unidentified protein not found in normal brain tissue has been discovered in the brain tissue of Alzheimer s patients. Because aluminum is excreted by the kidneys, toxic amounts of aluminum also may impair kidney function. People who worked in aluminum smelting plants for long periods have been found to experience dizziness, impaired coordination, and losses of balance and energy. Accumulation of aluminum in the brain was cited as a possible cause for these symptoms as well. This has caused concern, especially as it relates to neurotoxicology (Alzheimer s disease).19-21... 

Insufficient intakes of Mn and Cu resulted in significant abnormalities in both serum and bone mineral levels within twelve months. Why a chronic deficiency of trace elements should result in conditions of osteopenia is not at present clear. It has been suggested that osteopenia is associated with an increased rate of bone resorption (33). Others have implicated decreased bone formation or osteoblast activity in some forms of osteoporosis (34). What is obviously at issue is a balance between the rate of bone resorption and that of bone synthesis (35-37). Bow that equilibrium dynamic is affected by trace elements will be discussed below. 

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