Bones

Normal bone density- left, 
Osteoporosis bone density- right

People with Cystic Fibrosis are prone to developing osteoporosis and osteopenia. Bones play a variety of roles in the body such as providing structure, protecting organs, storing calcium, and more. Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue that results in an increase in bone fragility and susceptibility to fracture. Minerals that build strong bones are calcium, phosphorus, fluoride, and magnesium. Osteopenia develops when the bones have insufficient amounts of these minerals. Bones become brittle and weak.

There are a number of factors that can affect bone health

• calcium deficiency- diminishes bone density, increases risk of fractures
• physical activity- inactive people have an increased risk of osteoporosis
• certain medications- prednisone,  SSRIs, anti-seizure medications 
• alcohol and tobacco use- alcohol can interfere with the body's ability to absorb calcium

In CF, these bone diseases can happen at any age and as you get older, the risk increases. 

The malabsorption caused by CF affects the amount of vitamins and mineral the body is able to absorb. Vitamin D is a fat soluble vitamin and is vital to bone health in addition to calcium. It is important to take the correct amount of enzymes and maintain a nutritious diet to ensure healthy bones. 

Bone Density Scan- the most common and accurate way uses a dual-energy x-ray absorptiometry (DXA or DEXA) scan. DXA uses low-dose x-rays. (a chest x-ray has more radiation)

2 types of DXA 

• Central DXA- lie on a soft table and the scanner passes over your lower spine and hip. This scan is the best test to predict your risk of fractures.
• Peripheral DXA (p-DXA)- The smaller machines measure the bone density of smaller bones like wrists, fingers, legs.

Recommended Dietary Allowances
(RDAs) for Calcium

a few foods high in calcium *values are approximate and vary based off of flavor, freshness, serving size, etc

• 1 c whole milk 290 mg
• 1/2 c almonds 190 mg
• 1 c spinach 240 mg
• 6 oz calcium fortified orange juice 261 mg
• 3 oz canned salmon 181 mg
• 1 c plain yogurt 415 mg

*It is important that you discuss any changes in your vitamin regimen, dosage, and frequency with your doctor and/or dietitian. Blood work ordered by your physician and help determine whether or not you are deficient in vitamins.

More Info

Vitamin D

Routine blood work can show a deficiency in vitamin D, which is a very common problem. Often times, we lack adequate exposure to natural sunlight which plays a crucial role in maintaining proper vitamin D levels. Another cause of deficiency is an abnormal digestive process, like malabsorption caused by CF.

Deficiency of vitamin D can cause  hyperparathyroidism, osteoporosis, and osteomalacia. It can also negatively impact cell growth, bone growth, hormone regulation, affect the nervous and immune systems.

Sunlight is important in maintaining normal  levels because the sun synthesizes vitamin D from natural UV rays. It's converted to an active form by the kidneys and liver. About 10-15 minutes of sunlight is enough to absorb a daily dose.

Vitamin D enhances the immune system's functioning, aids in strengthening muscles, teeth, and bones, and facilitates the absorption of other vitamins.

The CF Clinic in Dallas requests labs (blood work) every visit. My vitamin D levels have always been low, despite taking a supplement daily.

Vitamin D enriched foods include:
(IU- International Units)

1 lg egg- 44 IU
raw white mushrooms- 164IU
1/2 fillet sockeye salmon- 1,400IU
camembert cheese- 44IU
1c of whole milk 124 IU 
 4 pieces of sushi 14 IU 
1 serving of tofu 157 IU 
1 serving of canned salmon 547 IU
1 packet of oatmeal 154 IU
1 serving canned tuna 234 IU 
1 c vanilla yogurt 122 IU
1 serving swordfish 566 IU

Always check with your doctor before you make any changes in your diet or the vitamins you take. While you don't want to be deficient, you don't want to have an overload either.


NIH

Always,

B.