THIS SECTION IS ON OSTEOPOROSIS.

OSTEOPOROSIS IS A LOSS OF BONE MINERAL DENSITY.

NOW, WHAT THAT MEANS IS THAT THERE'S A LOSS

OF THE MINERALS IN BONE

AND THAT THOSE MINERALS ARE CALCIUM AND PHOSPHATE.

WHAT HAPPENS IS THAT THE BONE BECOMES VERY THIN,

VERY RIGID, AND VERY FRAIL.

I'M GONNA START BY TALKING ABOUT THE MOST IMPORTANT RISK FACTOR

WHICH IS PEAK BONE MASS.

PEAK BONE MASS IS THE MAXIMUM AMOUNT

OF BONE MASS THAT YOU'LL ACHIEVE IN YOUR LIFETIME.

IT USUALLY PEAKS AT ABOUT 18 YEARS OF AGE.

IF WE LOOK AT BOYS AND GIRLS AND THEIR DEVELOPMENT OF BONE MASS,

THE ACCRUAL OF BONE MASS DURING THESE YEARS,

YOU CAN SEE HOW MUCH IS ACCRUED RIGHT ABOUT UP UNTIL 18.

NOW YOU'LL NOTICE FROM 18 TO ABOUT 30,

THERE'S STILL A LITTLE BIT THAT CAN BE ADDED, BUT NOT MUCH.

MOST OF IT IS ACHIEVED BY 18,

AND IT'S SUBSTANTIAL DURING THE TEENAGE YEARS.

FROM AGE 30--

SO LET'S GET TO AGE 30--

YOU CAN SEE IT'S PRETTY STEADY, RIGHT?

THERE'S NOT A LOT OF LOSS.

BUT ONCE YOU GET TO 50, MEN WILL HAVE A SLIGHT DECLINE,

AND WOMEN HAVE THIS DRAMATIC DECLINE.

SO YOU CAN SEE IT'S DEFINITELY A SHARPER CURVE DOWN.

IF YOU DON'T GET UP TO THESE HIGH

POINTS HERE DURING YOUR YOUNGER YEARS,

MEANING THAT YOU DON'T ACHIEVE YOUR PEAK BONE

MASS OR YOU ACHIEVE A MUCH LOWER RATE--

SO MAYBE YOU'RE DOWN HERE--

WHEN--

IF ESPECIALLY PARTICULARLY IF YOU'RE A FEMALE,

YOU'RE GONNA TAKE THE SAME DIVE.

BUT INSTEAD OF BEING INTO A SAFE RANGE,

IT'S GONNA BE INTO AN OSTEOPOROTIC RANGE.

THE MAIN RISK OF OSTEOPOROSIS IS FRACTURE.

YOU PROBABLY HEARD ABOUT THAT, HIP FRACTURES IN AN 85-YEAR-OLD.

A LOT OF THEM DON'T RECOVER AFTER THAT.

THEY WILL NEVER GET OUT OF THE HOSPITAL.

WE DON'T WANT TO GET TO THAT POINT.

THE PROBLEM IS IS THAT YOU DON'T REALLY

THINK ABOUT THAT WHEN YOU'RE 12 YEARS OLD.

SO HOPEFULLY YOUR PARENTS ARE THINKING ABOUT THAT.

SO AS THE BONE IS GROWING AND DEVELOPING, WHAT'S IMPORTANT?

WELL, THEY FOUND THERE'S A DIRECT CONNECTION TO

THE NUMBER OF FRUITS AND VEGETABLES THAT ARE EATEN.

NOW, REMEMBER, YOU CAN OBTAIN GROWTH CALCIUM FROM--

AND A LITTLE BIT OF PHOSPHOROUS WITH FRUITS,

VEGETABLES, LEGUMES.

YOU DON'T ALWAYS HAVE TO HAVE DAIRY.

THE AMOUNT OF VITAMIN D, VERY--

AND REMEMBER WE GET VITAMIN D FROM SUNSHINE.

BUT THIS ALL DEPENDS ON WHERE YOU LIVE,

SO IF YOU'RE NORTH OF THAT 37TH PARALLEL,

MEANING HUMBOLDT COUNTY, THEN IT'S UNLIKELY THAT

YOU'LL GET ENOUGH SUNSHINE IN THE WINTERTIME.

PROTEIN, NOW PROTEIN HAS BEEN DEBATED.

IT'S VERY IMPORTANT DURING THE GROWING YEARS,

BUT TOO MUCH PROTEIN AS ADULTS HAS BEEN

ASSOCIATED WITH LOSS OF CALCIUM IN THE URINE,

BUT NOT NECESSARILY OSTEOPOROSIS.

SO IT'S INTERESTING.

YOU NEED ENOUGH PROTEIN BECAUSE YOU NEED

PROTEIN TO BUILD THE PROTEINS IN THE BONE.

AND THEN THE CALCIUM IS--

ACTUALLY USES THE MINERAL TO MAKE IT MORE RIGID OR STURDY.

THE-- WE DON'T WANT TOO MUCH PROTEIN,

SO THERE IS A CAREFUL BALANCE HERE.

AND THEN CARBONATED BEVERAGES, NOW,

I HAVE A QUESTION MARK BY THIS BECAUSE THERE IS A DIRECT

CORRELATION BETWEEN THE NUMBER OF SODAS THAT CHILDREN AND DRINK

AND THEIR INABILITY TO REACH AN ADEQUATE PEAK BONE MASS.

BUT IT'S NOT CLEAR WHETHER

IT'S ACTUALLY THE CARBONATED BEVERAGES--

AND THAT MEANS SODA.

MOST OF THE TIME IN THE STUDIES, IT'S BEEN SODA--

OR IF IT'S THE DISPLACEMENT OF MILK.

SO INSTEAD OF--

THEY WEREN'T DRINKING MILK.

MILK HAS CALCIUM AND IS FORTIFIED WITH

VITAMIN D. BUT INSTEAD THEY'RE DRINKING SODA.

SO THERE IS A RELATIONSHIP.

WE'RE JUST NOT SURE EXACTLY THE

CAUSAL FACTOR OF THAT RELATIONSHIP.

SOMETHING ELSE THAT'S INTERESTING IS WHEN

BONE MINERAL CONTENT OR BONE MINERAL DENSITY,

HOW MUCH MINERAL CONTENT IS IN THE BONE AND YOU

LOOK AT PHYSICAL ACTIVITY VERSUS WATCHING TELEVISION,

THE MORE PHYSICAL ACTIVITY, PARTICULARLY IN CHILDREN--

SO THIS IS THE TIME WHEN YOU WANT TO ACHIEVE PEAK BONE MASS--

THE GREATER THE BONE MINERAL CONTENT,

HOW MUCH CALCIUM AND PHOSPHOROUS IS IN THOSE BONES.

THE MORE TV WATCHING,

THE LOWER THE BONE MINERAL CONTENT--

DIRECT CORRELATIONS HERE. OKAY?

AGAIN, POSITIVE, NOT NECESSARILY SURE,

BUT IT'S A DEFINITELY A CONTRIBUTING FACTOR.

SO THERE ARE MODIFIABLE AND NON-MODIFIABLE RISK FACTORS.

AND WHAT DOES THAT MEAN?

THE NON-MODIFIABLE RISK FACTORS ARE FACTORS WE CANNOT CHANGE.

IF YOU'RE FEMALE, YOU CAN'T CHANGE THAT,

BUT YOU'RE GONNA BE AT GREATER RISK

FOR DEVELOPING OSTEOPOROSIS.

AS WE GET OLDER, WE'RE GONNA BE AT A GREATER RISK.

REMEMBER, RIGHT AROUND THE AGE OF 50,

GONNA HAVE A DECLINE IN BONE MARROW CONTENT.

WE CAN'T AVOID THAT AS WE GET OLDER,

THOSE THAT AUTOMATICALLY ALREADY HAVE A SMALLER FRAME--

CAUCASIANS ARE AT A GREATER RISK--

FAMILY HISTORY, PERSONAL HISTORY OF A FRACTURE,

AS WELL AS ESTROGEN DEFICIENCY.

MODIFIABLE RISK FACTORS--

NOW I ALREADY MENTIONED SOME,

AND THESE WERE IN CHILDREN WHEN THEY'RE GROWING--

BUT FOR ADULTS, SEDENTARY LIFESTYLE.

EXERCISE IS EXTREMELY IMPORTANT FOR BUILDING BONE MASS.

POOR NUTRITION DEFINITELY HAS AN IMPACT,

PARTICULARLY IN CHILDHOOD BUT ALSO AS ADULTS.

REMEMBER I TALKED ABOUT HOW WE WANT TO KEEP THAT--

OUR BODY KEEPS BLOOD CALCIUM IN VERY TIGHT CONTROL.

IF THE BLOOD CALCIUM'S LOW, ABSORPTION RATE INCREASES,

AND OUR BONE STARTS GETTING BROKEN DOWN

TO RELEASE CALCIUM IN THE BLOODSTREAM.

SO IF YOU NEED CALCIUM FOR OTHER FUNCTIONS AND YOU'RE

NOT TAKING IN ANY IN YOUR DIET, YOUR BODY'S JUST

GONNA BE PULLING THAT CALCIUM OUT OF BONE.

VICE VERSA IS ALSO TRUE.

IF YOU'RE TAKING IN A LOT OF CALCIUM,

THEN YOUR ABSORPTION RATE MIGHT DECREASE.

BUT YOU'RE ALSO GONNA TAKE THAT CALCIUM AND PUT IT INTO

THE BONE CREATING MORE BONE, STRONGER BONE,

EVEN IN YOUR LATER YEARS.

NOW, ONE IMPORTANT FACTOR IS THAT YOU CAN'T CATCH UP.

YOU'RE ALWAYS GONNA BE ON A DECLINE,

BUT YOU CAN SLOW THE DECLINATION,

THE DECREASE OF BONE MINERAL LOSS.

SO YOU'RE NOT GONNA BE BUILDING UP BONE

AFTER AGE 50 OR EVEN AFTER AGE 30,

BUT YOU CAN SLOW THAT PROGRESSIVE LOSS THAT IS

INEVITABLE BY CONSUMING ADEQUATE AMOUNTS OF CALCIUM AND VITAMIN

D. REMEMBER VITAMIN D INCREASES THE ABSORPTION OF CALCIUM.

ADEQUATE AMOUNTS OF PROTEIN, NOT TOO MUCH,

AND LIMITING THE AMOUNT OF SODIUM 'CAUSE TOO MUCH

SODIUM HAS BEEN ASSOCIATED WITH LOSSES OF CALCIUM.

SMOKING, USING TOBACCO,

DEFINITELY ASSOCIATED WITH AN INCREASED RISK OF OSTEOPOROSIS,

AS WELL AS EXCESSIVE ALCOHOL USE.

NOW, WHEN YOU THINK ABOUT YOUR RISK OF OSTEOPOROSIS,

THINK ABOUT, DID YOU ACHIEVE PEAK BONE MASS?

THAT'S PROBABLY THE SINGLE MOST IMPORTANT RISK.

AND THEN WHAT ARE YOU DOING TODAY?

AND WHAT TYPE OF CHANGES CAN YOU MAKE TO HELP REDUCE YOUR RISK?

ARE YOU GETTING ENOUGH CALCIUM?

ARE YOU GETTING ENOUGH VITAMIN D?

DO YOU HAVE A SEDENTARY LIFESTYLE?

COULD YOU EXERCISE MORE?

ARE YOU GETTING ENOUGH FRUITS AND VEGETABLES IN YOUR DIET?

CAN YOU LIMIT YOUR SMOKING?

AND THEN HAVE MODERATE ALCOHOL INTAKE.

I WANT TO TALK A LITTLE BIT ABOUT A CONTROVERSY OF

CALCIUM SUPPLEMENTATION BECAUSE THE U.S. PREVENTATIVE TASK FORCE

ACTUALLY DOESN'T RECOMMEND CALCIUM SUPPLEMENTATION

UNLESS SOMEONE IS AT RISK FOR OSTEOPOROSIS OR HAS OSTEOPENIA.

NOW, THIS IS BASED ON RESEARCH THAT INDIVIDUALS

WHO HAVE TAKEN CALCIUM, WITH OR WITHOUT VITAMIN D,

ENDED UP WITH A GREATER RISK OF HEART DISEASE.

SO-- AND THIS INTERESTING.

I MEAN, HERE WE'RE DOING A GOOD JOB PROTECTING OUR BONES,

BUT NOW I END UP DEVELOPING HEART DISEASE.

AND SO THIS IS RESEARCH THAT CAME OUT IN 2011.

THERE HAVE BEEN SOME OTHER STUDIES.

SOME HAVE SUPPORTED THIS.

SOME HAVE NOT.

BUT A LOT OF THE RESEARCH IS SUGGESTING THAT THERE IS A

CONCERN ABOUT SUPPLEMENTING WITH CALCIUM 'CAUSE THE

CALCIUM IS ENDING UP IN THE WRONG PLACE.

WHEN CALCIUM COMES INTO THE BODY--

AND WE'LL JUST SAY THAT THIS GUY HERE IS CALCIUM--

IT DOESN'T KNOW WHERE TO GO.

DOES IT GO TO THE HEART?

DOES IT GO TO SOFT TISSUES, THE TENDON, THE BONE?

IT DOESN'T REALLY KNOW WHERE TO GO.

SO THERE MIGHT BE ANOTHER FACTOR HERE.

WE THINK, OH, YOU'RE GETTING ADEQUATE CALCIUM,

BUT IT'S GOTTA GO TO THE RIGHT PLACE.

IF YOU'RE SUPPLEMENTING, MAYBE IT'S GOING TO THE HEART.

AND HERE'S SOMETHING THAT WE TALKED ABOUT EARLIER,

IS VITAMIN K2 AND HOW VITAMIN K2 AND VITAMIN D WORK TOGETHER IN

BRINGING CALCIUM INTO THE BODY AND THEN TELLING IT WHERE TO GO.

REMEMBER, VITAMIN D REGULATES BLOOD CALCIUM.

IT INCREASES THE ABSORPTION OF CALCIUM.

YOU NEED VITAMIN D TO HAVE CALCIUM

BE ABSORBED INTO THE BLOODSTREAM.

BUT ONCE IT'S IN THE BLOODSTREAM, WHERE DOES IT GO?

THIS IS WHERE VITAMIN K2 COMES IN.

VITAMIN K2 IS NECESSARY TO BUILD THE PROTEINS WHICH

HELP DIRECT CALCIUM TO THE RIGHT PLACE,

BASICALLY TELL IT, PULL IT OUT OF THE SOFT TISSUES,

AND THEN BRING IT INTO THE BONE.

THAT'S AN IMPORTANT FACTOR AND WHERE WE

HAD TALKED ABOUT VITAMIN K2 IN THE PAST.

BUT THIS IS SOMETHING NEW AND SOMETHING

WE'LL BE SEEING FURTHER RESEARCH ON.

AND THIS IS THE END OF OUR SECTION ON OSTEOPOROSIS.