Osteoporosis Case Study

Read through the case study below and answer the questions that follow. 

Grading criteria: See individual questions

Case Study

Ms. B is a 20 year old Chinese-American student who is 5 feet 5 inches tall and 105
pounds. She lives in Florida and is on the track team, plays golf and has a very active
lifestyle. Ms. B does not eat meat and lives in a large house with many other female
college students. She rarely drinks milk because she believes she is lactose intolerant.

Here is a sample of her daily intake:

One bagel with 2 ounces cream cheese

1/2 cup grape juice
Two ounces of cooked pasta with two tablespoons of Italian dressing
8 baby carrots
one large apple
16-ounce lemon-lime soda
one cup cooked rice w/half cup mixed vegetables and 1/4 cup teriyaki sauce
one piece French bread with one teaspoon margarine
peach cobbler (3x3 inch slice) with 1/2 cup ice cream
1/2 bag of regular microwave popcorn
1 cup Gatorade

NUTRIENT COMPOSITION OF DIET (based on the Diet Analysis Plus Software

analysis)

NUTRIENT AMOUNT % of Recommended Intake

Calories 1860 97%
Protein 38 grams 100%
Vitamin A 2611 RE 326%
Thiamin 1.24 mg 113%
Riboflavin 1.04 mg 95%
Niacin 11.91 mg 85%
Vitamin B-6 .78 mg 60%
Vitamin B-12 .67mcg 28%
Folate 309 mcg 77%
Vitamin C 26.65 mg 44%
Vitamin D .27 mcg 5%
Vitamin E 7 mg 90%
Calcium 337 mg 34%
Phosphorus 703 mg 100%
Iron 12 mg 81%
Magnesium 219 mg 71%
Sodium 4710 mg 197%
Zinc 4.83 mg 40%
Caffeine none  
Alcohol none  
Food Group Servings Calorie Breakdown
8 servings grains
2.4 servings vegetables 8% protein
2.2 servings fruits 60% carbohydrate
0 servings protein rich foods 32% fat
(meats, legumes, etc).      11% saturated fat
1.5 servings dairy 0% alcohol
10.3 servings fats, oils, sweets

Questions:

1.  What is the stage of bone development for this client?  (gaining bone? peak bone
mass? losing bone?) (2 points)

 Gaining bone. Bone mass typically reaches its peak around age 30, plus she is continuing
to increase appositional growth through her exercise.

 2.  Identify a minimum of 10 risk factors for osteoporosis and indicate (based on the
client's profile and nutrient intake) which of these risk factors applies to this client.  Use
your text and the module 7 lecture as your primary sources. Be sure to cite any additional
sources that you use. After listing the risk factor, determine if it is applicable to this
client and explain your answer. I have filled in the first row as an example.  Risk factors
will include dietary factors and other non-diet related factors. (1 point each for a total of
10 possible points)

Applicability to Client  (yes or no with one sentence

Risk Factor
explanation)
gender YES - females are at increased risk and Ms. B is a female
 
 No- osteoblast activity should still outweigh osteoclast activity
at her age since she has not reached peak bone mass.
 Age
 
 Yes- Asians and white people tend to be more at risk and she
is Asian.
 Ethnicity
   No-Alcohol can cause bones to become thin. However, no
 alcohol has been listed in her daily intake.
 Alcohol
   Yes- She seems to be small with a lower body weight, which
means her bones are smaller and can suffer a greater loss when
 Body frame they start breaking down.
 No-She has an active lifestyle. Especially being on the track
  team, she puts a lot of stress on the bones in her legs, which
will increase the circumference of those bones via Wolff’s Law
 Bone Density of remodeling. This makes the bones harder to fracture and
harder to break down.
 Yes- She is only getting 34% of the recommended intake and
  rarely drinks milk. Calcium stimulates calcitonin, which
stimulates osteoblasts to build bone and store the calcium. Low
Low Calcium Intake calcium intake reduces osteoblast activity and increases risk for
osteoporosis.
   No-smoking reduces calcium absorption and estrogen, both of
which stimulate bone growth. However, Mrs. B has no history
 Smoking of smoking according to the above information.
 No-She is only getting 5% of the recommended intake of
  Vitamin D in her diet, which is vital for calcium absorption.
However, she lives in Florida which is a sunny state and is on
 Low Vitamin D Intake the track team, meaning she probably gets most of her
necessary Vitamin D from sun exposure.
 
 No-She is not at menopausal age and should have plenty of
estrogen, which promotes osteoblasts to build bone.
 Low Sex Hormones
 No- steroid medication can have negative effects on calcium
 
absorption and vitamin D synthesis, which leads to bone loss.
However, Mrs. B is not on these medications according to the
 Corticosteroids
information above.
 Yes-She is getting over 100% of the recommended intake of
High salt intake sodium, which puts her at risk of calcium being lost in urine,
which decreases bone growth.
 
 
 

3. What specific changes would you recommend to this client to lower her risk for
osteoporosis? (2 points)

 Increase calcium intake. Even if she believes she is lactose intolerant and cannot
consume many dairy products, she still needs to increase her calcium intake, and calcium
supplements can help with that. Certain foods like kale and broccoli can also provide her
with more calcium.

Increase arm bone density by doing exercises like lifting weights. Being on the track
team means her legs are probably sufficiently dense enough to reduce osteoporosis risk,
so she should help her upper body as well, and golf may not be a high enough impact
sport. Her small frame is a risk so she should counter it with strong bones.

Reduce salt intake. She can use reduced sodium teriyaki sauce and eat popcorn that has
not been salted, or find a snack that has less sodium such as granola bars.

4. Do you think this client is completely lactose intolerant?  Why or why not? (2 points)

Probably not. It would be likely she has or will develop some intolerance because of her
Asian background, but despite not drinking milk she is still consuming dairy in the form
of ice cream and cream cheese. If these products are not causing problems, she is
probably not completely lactose intolerant.

 5. Identify two other changes that this client should make in their diet (beyond those
necessary to reduce risk of osteoporosis).  Do not name nutrients you have already
addressed above. Be specific about the nutrient change needed and how it could be
accomplished via food intake. (4 points)

Take B-12 supplements. Vitamin B-12 is essential for many roles in the body, including
red blood cell formation and because Mrs. B does not eat meat, she is only consuming
28% of the recommended intake. Supplements will provide her with the nutrients she
needs.

Cut the soda. She is consuming two high-sugar drinks, the soda and the Gatorade. If she
really wants a sweet drink, she should get rid of at least one. Both have around the same
calories but between the two, Gatorade can provide her with potassium and electrolytes
after exercising and lots of soda can have corrosive properties with very little nutritional
value, making it the worse of the two. She should drink water instead to keep herself
sufficiently hydrated while reducing sugar intake.

 SOURCES 

https://www.health.ny.gov/publications/1985/index.htm

Lecture Notes

Nutrition Science and Applications textbook

Human Anatomy and Physiology 10th edition textbook