1. Diet and Bone Health Lisa Reid Student Dietitian

2. Overview Bone loss Who is at risk? Diet for healthy bones Factors to consider to reduce bone loss

3. What is bone loss? Decrease in calcification or reduced density of the bones. This can lead to osteoporosis and an increased risk of broken bones. Risk Factors: – Altered body weight – Some medical conditions that may increase your risk – Some medicines increase your risk – Genes – Age – Race – Gender – Alcohol – Smoking

4. Factors to consider for healthy bone Calcium Vitamin D Exercise

5. Calcium: the key to strong bones and lifelong bone health Calcium is one of the essential nutrients necessary for healthy bone development. Bones contain most of our body’s calcium, so they act as the body’s 'reservoir' of calcium. Our bodies cannot make calcium, and if blood calcium levels fall, the body will compensate for this by drawing calcium out of bones and putting it into the blood. Calcium is also excreted by the body daily.

6. How much Calcium do we need? BDA July 2014 GroupCalcium (mg) per day Adolescents800 (girls) 1000 (boys) Adults700 Breastfeeding mums1250 Women post menopause1200 Coeliac Disease1000-1500 Osteoporosis1000 Inflammatory Bowel Disease1200

7. Calcium sources: Dairy Foods Milk yoghurts cheese Other sources Green Vegetables Beans Nuts and Seeds Other Calcium fortified products e.g. cereals, mineral water Dried fruit e.g. figs, apricots Bread

8. Calcium supplements If an adequate calcium intake is not achieved by diet alone on a regular basis a calcium supplement may be required Doses of no greater than 500mg at a time Best taken with food Be aware of side-effects Possible drug interactions

9. Vitamin D: is essential for bone health It helps increase the absorption of calcium from the stomach, regulates the amount of calcium in the blood and strengthens the skeleton. Vitamin D also assists with bone development and strength.

10. How much Vitamin D do we need? GroupVitamin D (µg/day) per day 0-6months8.5 6months- 3 years7 Women during pregnancy and lactation 10 Adults over 6510 NICE guidelines 2014

11. Vitamin D sources: Sunlight Food sources Egg yolk Fortified breakfast cereals and margarine Oily fish Red Meat Liver

12. Factors to consider to reduce bone loss: Maintain a healthy weight Minimise calcium-draining substances

13. Maintain a healthy weight Underweight: Weight loss can cut the amount of oestrogen (a hormone that helps to protect your bones) in your body. Losing too much weight too fast under a crash diet can increase your risk of osteoporosis. Obesity: Can reduce bone forming cells and can lead to bone loss

15. Minimise calcium-draining substances Caffeine: limit your caffeine intake Alcohol: too much can increase your risk of fracture Fizzy drinks: avoid drinking regularly Salt: too much can contribute to calcium loss and bone breakdown Phytates and Oxalates: avoid adding raw bran Smoking: try to stop

16. Summary Calcium and Vitamin D Exercise and be active Maintain a healthy weight Drink alcohol in moderation Minimise calcium-draining substances

17. References http://www.nhs.uk/Livewell/fitness/Pages/strongbones.aspx accessed 11/02/15 http://www.nhs.uk/Livewell/fitness/Pages/strongbones.aspx https://www.nos.org.uk/health-professionals accessed 11/01/15 https://www.bda.uk.com/foodfacts/home accessed 11/01/15 http://jeanhailes.org.au/health-a-z/bone-health/calcium accessed 11/02/15 http://jeanhailes.org.au/health-a-z/bone-health/calcium http://www.nfcr.org/bone-loss accessed 11/01/15 accessed 11/02/15 http://www.nfcr.org/bone-loss accessed 11/01/15 http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000506.htm accessed 11/02/15 http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000506.htm NICE guidelines [PH56] Vitamin D: increasing supplement use among at-risk groupsPublished date: November 2014 Cao J: Effects of obesity on bone metabolism. J Orthop Surg Res. 2011

18. Thanks for listening!