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Treatment in Nutrition-Related Disorders: Osteoporosis & Osteopenia

Instructor: Christina Poyourow

Christina is a Registered Dietitian and has a master's degree in Nutrition

In this lesson you will learn about osteoporosis and osteopenia, and how various nutritional therapies can be used for treatment, management, and prevention of these diseases.

What is Osteoporosis and Osteopenia?

Geoff is a registered dietitian who works in a long-term acute care facility. The majority of his patients are older than 65 years of age and female. Geoff is often consulted by the attending physician to provide nutrition assessments and counseling to patients with osteoporosis or osteopenia. The treatment of these two conditions requires medical, pharmacological, and nutritional interventions.

Osteoporosis is a disease of the skeletal system characterized by low bone mineral density, resulting in bones becoming weak and brittle over time. The process of bone turnover is normal and occurs throughout life. However, after the age of 30-35, the process of bone breakdown, or resorption, begins to exceed the rate of bone formation. This means that one loses more bone than the body can rebuild.

The acceleration of the breakdown of bone tissue continues throughout life, at approximately 10 percent per decade. Women, however, are more vulnerable to this process than men, because bone loss accelerates very quickly during the first five to eight years after menopause. In fact, of the 30-50 million individuals living with osteoporosis in the United States, approximately 80 percent are women. One half of women, and one quarter of men will suffer from a bone fracture as a result of osteoporosis at some point in their life.

Osteopenia is a weakening and softening of bone tissue and is less severe than osteoporosis. However, if osteopenia goes untreated, it can become osteoporosis.

Risk factors of both osteoporosis and osteopenia include tobacco use, being female, family history, a lack of exercise, use of steroid or anti-seizure drugs, and malnutrition. It may also be caused by diseases that may affect vitamin and mineral malabsorption, such as celiac disease.

Malnutrition, Protein, and Bone Health

Geoff is conducting a nutrition assessment on an 85 year old woman, Janine, with osteopenia. His patient has had a recent 10 pound weight loss, and expresses that she has been only eating half of the amount of food she is served because she doesn't like the taste of it. She has also been feeling tired and depressed.

Geoff determines that Janine meets criteria for protein-energy malnutrition, or an inadequate intake of protein and/or calories as compared to estimated nutritional requirements. There are different criteria that may be used to diagnose malnutrition, such as BMI, weight change, and muscle loss.

Malnutrition negatively affects bone health in relation to sarcopenia and frailty.

  • Sarcopenia is a loss of skeletal muscle and a loss of physical functioning, including strength.
  • Frailty is defined as a loss of strength, physical functioning, and endurance which negatively impacts mortality.

Protein-energy malnutrition can cause both sarcopenia and frailty. Malnutrition can also lead to vitamin and mineral deficiencies.

Inadequate protein intake can hinder the development of new bone tissue to replace tissue that is lost in the aging process, causing low bone mineral density, or the concentration of bone mineral in bone tissue. Low bone mineral density can increase the risk of fractures. Often patients may be unaware that they have low bone mineral density, as it can be asymptomatic.

Higher protein intake can also improve the absorption of calcium and increase lean body mass, which positively affects bone health. As it appears that Geoff's patient has not been consuming enough protein to meet her estimated requirements, Geoff should recommend a protein supplement and explain to Janine the importance of consuming enough calories and protein to support good bone health.

Vitamin D, Calcium, and Bone Health

The relationship between vitamin D, calcium, and bone health is complex. Elderly people are at an increased risk for both vitamin D and calcium deficiencies. This is because they generally consume less food than younger populations, have reduced absorption rates, and are exposed to less sunlight.

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