BONE LOSS: HOW TO KEEP BONES STRONG IN THE LONG RUN. Bariatric Surgery Support Group 2017

Size: px

Start display at page:

Download "BONE LOSS: HOW TO KEEP BONES STRONG IN THE LONG RUN. Bariatric Surgery Support Group 2017"

Joshua Horton
6 years ago
Views:

1 BONE LOSS: HOW TO KEEP BONES STRONG IN THE LONG RUN Bariatric Surgery Support Group 2017

2 Bones-What s Their Purpose? Structural Function Provides mobility, support and protection for the body Adapts to provide adequate strength and mobility so that bones do not break Reservoir Function Storehouse for essential minerals Calcium and Phosphorus Sodium, other minerals, protein collagen

3 Calcium and Phosphorus Essential for functioning of other body systems Storehouse must be called upon in time of need Must keep levels of calcium and phosphorus in balance is critical for the function of all body organs particularly nerve and muscle function (heart is a muscle)

withdrawn from bone stores to serve the other necessary vital

4 Think of Bone as a Bank When we take in enough calcium and phosphorus we store it in the bones When the body needs more it is withdrawn from bone stores to serve the other necessary vital functions Too many withdrawals weaken bone Can lead to bone disorders and fractures

5 So What s the Issue? Before Surgery: 40 80% of patients are deficient in Vitamin D already Vitamin D is essential to absorption of calcium Calcium deficiencies initially have no physical effect and no obvious signs are seen, but The body will compensate to keep serum levels normal at the expense of bone integrity (parathyroid hormone) Long-term deficiencies lead to bone loss, osteopenia (softening of bone), osteoporosis and fractures Post-op patients over 1 year out report feeling great and usually stop taking supplements as they believe there are no problems

6 Osteoporosis According to the CDC: 16% of women over the age of 50 have osteoporosis Real men get osteoporosis too 2 million American men have osteoporosis and 12 million are at risk And these are not bariatric patients!

7 A Thousand Words

8 Why is Surgery Risky for Bones? Many patients are vitamin D deficient before surgery Need to take vitamins and calcium prior to surgery Weight loss increases bone turnover Balance between calcium and phosphorus becomes unequal and cannot keep up Angle of joints change as weight is lost and this increases wear and tear Decreased intake of vital nutrients Absorption of fewer vital nutrients Hormonal changes

Impact of Nutrition Nutrients that are important for bone health Calcium major structural element in bones and teeth Critical to muscle contraction, nerve impulses and hormone secretion Vital in

9 Impact of Nutrition Nutrients that are important for bone health Calcium major structural element in bones and teeth Critical to muscle contraction, nerve impulses and hormone secretion Vital in proper functioning of movement, heart and brain function Vitamin D necessary for absorption of calcium in small intestine Without enough, bones become thin and brittle Protein for protein collagen (the glue that holds it all together)

10 Calcium and Bariatric Surgery Dietary intake decreases Active absorption requires good vitamin D stores Low stomach acid Surgically caused or by acid blockers Calcium needs stomach acid to be absorbed Depending on the type of calcium ingested, it may not be efficiently absorbed Carbonate and citrate Studies show citrate is more readily absorbed

ASMBS Calcium Intake Guidelines Gastric Bypass 1500-2000 mg/day as calcium citrate Sleeve -

11 ASMBS Calcium Intake Guidelines Gastric Bypass mg/day as calcium citrate Sleeve mg/day as calcium citrate These levels are over and above diet to assure adequate intake

Vitamin D Levels Levels are determined by both production and by intake Production is dependent on sun exposure and can be greatly altered by: Clothing Time spent in

12 Vitamin D Levels Levels are determined by both production and by intake Production is dependent on sun exposure and can be greatly altered by: Clothing Time spent in the sun Sunscreen Skin color Obesity and bioavailability to convert ASMBS Guidelines are now 3000 units/day for all surgeries May be higher for those with deficiencies

Protein Role in Bone Health Protein is vital for bone integrity Growing evidence that a low protein diet has a detrimental effect on bone loss Appears to decrease intestinal calcium uptake

13 Protein Role in Bone Health Protein is vital for bone integrity Growing evidence that a low protein diet has a detrimental effect on bone loss Appears to decrease intestinal calcium uptake May increase parathyroid hormone levels which leads to increased bone loss On the other hand Too much protein can cause calcium to be lost through the kidneys so you want enough but not in excess

14 Protein and Bariatric Surgery Dietary intake may be decreased by: Certain protein intolerance dairy intolerance, shellfish allergy, etc. Decreased volume need to make sure at least 60 gm/day of high quality protein so always eat protein first Decreased appetite may need to supplement with protein shake Increased restriction may make protein more difficult to digest Tenderize Marinate Slow cooker

walk Resistance Training Weights, machines or resistance bands

15 Prevention of Bone Loss Weight Bearing Exercise Ranges from a high level aerobics or jogging to playing tennis, or simply going for a walk Resistance Training Weights, machines or resistance bands employs the muscle pulling against the bone in order to keep the bones strong

Salmon Legumes Soy Nuts/Seeds Fortified Foods

16 Prevention Nutrition Guidelines for key nutrients Calcium, Vit D and Protein Dairy Greens Sardines Salmon Legumes Soy Nuts/Seeds Fortified Foods Supplementation 2 Journey Vitamins a day 3 Journey Calcium a day

making cells) Increase parathyroid hormones which leaches

17 Bad for Our Bones Smoking Increases bone loss Decreases intestinal calcium absorption Alcohol Kills osteoblasts (bone making cells) Increase parathyroid hormones which leaches calcium from bone Affects liver which interferes with activation of vitamin D

Lab Testing Routine Lab Testing essential for prevention Every 6 months first year, then minimum annually Get a bone density scan every 2 3 years Only 14-59% of post op patients

18 Lab Testing Routine Lab Testing essential for prevention Every 6 months first year, then minimum annually Get a bone density scan every 2 3 years Only 14-59% of post op patients continue to take supplements long-term Rand, et al. South Med J.1194; 87: months post op only 5% of patients reported taking calcium Damms-Machado, Obes Surg, March 9, 2012

19 In Summary Bone health is very important after bariatric surgery and can be impacted by Lifestyle Diet and Nutrition Adherence Lifelong support and follow up are key to helping to avoid potential future bone issues

Osteoporosis The Silent Disease

Joel Johnson, Yr, Subtask, Biology ER., 7/9/5 Osteoporosis The Silent Disease What is Osteoporosis? Osteoporosis is a disease which causes bones to become brittle, which increases the risk of broken bones.