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23 Osteoporosis
Pages 615-626

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From page 615...
... Approximately 20% of women in the United States suffer one or more osteoporotic fractures by age 65, and as many as 40% sustain fractures after age 65. Osteoporosis is not frequently observed in men and black women until after age 60, after which fracture rates progressively increase in these groups.
From page 616...
... EVIDENCE ASSOCIATING DIETARY FACTORS WITH OSTEOPOROSIS Epidemiologic and Clinical Studies Calcium Absorption and Balance Calcium balance generally reflects the degree tO which bone formation is coupled with resorption (see Chapter 13~. Thus, negative balances are recorded when bone resorption exceeds formation, and positive balances occur when bone formation exceeds bone resorption.
From page 617...
... As discussed in Chapter 13, calcium supplementation should therefore not be used as a substitute for sex hormone replacement, which prevents postmenopausal bone loss in most patients and appears to restore intestinal calcium absorption toward no~al (Gallagher et al., 1980a)
From page 618...
... These investigators found that the calciuric effect of natural protein was much smaller than that produced by purified proteins. Using a series of regression equations generated from the dietary intake and calcium balance data recorded in their study, they calculated that a 50% increase in natural protein intake would lead to a negative calcium balance of 32 mg/day an amount that approaches the 40 mg/day negative balance needed to account for the mean ~ to i.5% loss in skeletal mass per year observed in postmenopausal women.
From page 619...
... In contrast to the apparent inability of rather dramatic changes in dietary phosphorus to influx ence calcium balance in normal human subjects, there is considerable evidence in animals that diets containing relatively larger quantities of phosphorus than calcium cause hyperparathyroidism and bone loss. Almost all the reports concern young growing or aged animals and thus differ from investigations in humans, which in general focus on young or middle-aged adults (see Chapter 13~.
From page 620...
... Long-term use of estrogen has been reported to reduce rates of new vertebral deformities and fractures (Ettinger et al., 1985; Gordan et al., 1973; Lindsay et al., 1980; Riggs et al., 1982~. It is not clear, however, whether postmenopausal women not taking estrogen who lose cortical bone rapidly have lower serum concentrations of estrogen than those who lose cortical bone slowly (Aloia et al., 1983; Avioli, 1981; Riis et al., 1984~.
From page 621...
... Other Medical Conditions Patients with noninsulin-dependent diabetes mellitus are not at increased risk for hip fracture (Heath et al., 1980~; however, some people with insulin-dependent diabetes have less bone mass than expected for their age (Hui et al., 1985~. Other medical conditions that may aggravate bone loss and increase the incidence of fracture associated with aging include primary hyperparathyroidism, hyperthyroidism (spontaneous or iatrogenic)
From page 622...
... Increased calcium intake is inferior to estrogen in slowing cortical bone Toss during the period of rapid bone toss after menopause, and it has even less or no effect on the loss of trabecular bone. In contrast, estrogen prevents trabecular bone loss almost completely in most patients.
From page 623...
... 1979. Intestinal calcium absorption and serum vitamin O metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium.
From page 624...
... 1982. An epidemiologic study of hip fracture in postmenopausal women.
From page 625...
... 1987. Dietary calcium intake and rates of bone loss in women.
From page 626...
... 1987. Does calcium supplementation prevent postmenopausal bone loss: a double-blind controlled clinical study.


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