Departemen Ilmu Gizi

FK USU
Micronutrient in bone
health

How to find the sources

Recommendations and
sources
Nutrients:
 Calcium, phosphat, and vitamin D
 Phytoestrogens
 Calcium : 1500 mg/day for postmenopausal
women, 1000-1200 for younger women
 Vitamin D: 600-1000 units
 Magnesium : 400-600 mg
 Manganese: 2-5 mg
 Zinc: 15 mg
 Boron: 3 mg
 Copper:2-3 mg
 Vitamin K: 500 mcg
 Food sources are recommended first for
supplying calcium needs because of the
coingestion of other essensial nutrients
Sources:
 Calcium from food
 Calcium from supplement
 Calcium from fortification food
 Calcium from food is
generally good, but from a
few foods such as spinach
it may be lower
 Wheat bread may be a
good source of calcium
 Green leafy vegetables
such as broccoli, kale, bok
choy, and soy bean (lower
with oxalate)
 Dairy products: high-
calcium milk, cheeses,
yoghurt (best)
 Calcium in selected foods:
 Tofu
 Yoghurt
 Sardines
 Collard greens,cooked
 Cheese
 Non-fat milk
 Pudding, vanilla
 Whole milk
 Custard
 Buttermilk
 Ice-milk
 Spinach
↑  enhance  inhibit
 Stomach acid
 Lack of stomach acid
 Vitamin D
 Vitamin D deff
 Lactose (in infants
 High P intake
only)  Phytates in seeds,
nuts, grains
 Oxalates in beet green,
rhubarb, spinach,
sweet potaoes
 Significant increases in spinal and total
body BMD
 Good but it seems more likely that
keeping the gains in BMD accrued before
age 20
 Best: combination of regular physical
activity and a reasonable consistent
daily calcium intakes
Depends on the anion used, but in market
good bioavailability

Calcium citrate malate  absorbed efficient

than calcium carbonate and other calcium
supplements

Calcium carbonate constipying effect

(minimize by dividing dose and taking more
fluids and fibers)
 High dose calcium supplement may
reduce the absorption of nonheme
iron and possibly zinc. Magnesium,
and other divalent cations
 Contamination of bone meal or dolomite
supplements with cadmium, mercury, arsenic, or
lead
 Urinary tract or renal stones in susceptible
individuals
 Hypercalcemia or milk alkali syndrome from
extremely high intakes (>4000 mg/day)
 Deficiency of iron and other mineral divalent cations
resulting from decreased absorption
 Constipation
 Another way to increase the
consumption of calcium by females
 Orange juice and many brands of non-
dairy milks at avout 300 mg/ cup of juice
and to breadds and other foods
 Food preferable
 Vitamin D intake: adequate vit D intake
is important excess need is avoided
 Sun light exposure for skin
 Calcium and vitamin D supplements are
often given
Sumber Kandungan vitamin D
Sumber alami:
Salmon
Segar, di alam 600-1000 SI (D3)
Segar, ternak 100-250 SI (D3 dan D2)
Kalengan 300-600 SI (D3)
Sarden, kalengan 300 SI (D3)
Mackerel, kalengan 250 SI (D3)
Tuna, kalengan 230 SI (D3)
Minyak ikan kod 400-1000 SI (D3)
Jamur shittake dan jamur kancing 100-1600 SI (D2) dan 40 SI
Kuning telur 20 SI (D3 dan D2)
Paparan sinar matahari, radiasi UV B 3000 SI (D3)
Makanan fortifikasi
Susu 100 SI /240 mL (D3)
Jus jeruk 100 SI /240 mL (D3)
Formula susu bayi 100 SI /240 mL (D3)
Yoghurt 100 SI /240 mL (D3)
Mentega 50 SI /100 gr (D3)
Margarin 430 SI /100 gr (D3)
Keju 100 SI /85 gr (D3)
Sereal sarapan pagi 100 SI /porsi (D3)
Suplemen
Bentuk resep
Vitamin D2 (Ergocalciferol) 50.000 SI /kapsul
Drisdol (vitamin D2) suplemen cairan 8000 SI /mL
Bentuk jualan di toko obat
Multivitamin 400 SI
Vitamin D3 400, 800, 1000, dan 2000 SI
15
 Kebutuhan vitamin D

Golongan umur (tahun) AKG (g)

10-12 5
13-15 5
16-18 5
19-29 5
30-49 5
50-64 10
Lebih dari 65 15

16
 Calcium and Phosphat = 1:1 needed
for mineralization
 High phosphorus  bone loss
 Consumption 1000 mg to 1200 mg/day
(females), 1200-1400 mg/day (male)
 Anabolic effect
 High dietary proteinno effect
 Low dietary protein Low serum
albuminlow IGF-1 and serum calcium
vulnerable fracture
 1 g/kg per day
 Animal protein rise urinary losses of calcium
(acid)
 Plant proteinlittle effect (neutral or basic
urin)
  Little effect, but suggest adequate
intakes of Mg improves BMD

Vitamin K intake
• Osteocalcin needs vitamin K
• Vitamin K supplementation  retard bone
loss
 Dietary fiber: excessive intake
depression calcium absorption
 Potassium bicarbonatesufficient to
neutralize endogenous acid
 Vegetarian diet beneficial effect buy
provides less calcium than animal protein
 Isoflavon (phytoestrogen) soybean
lower lifetime exposure for estrogens
 Caffein and carbonated beverages
excessive intakes deterious effect on
BMD
 Intakes of colaslower BMD
 Alcoholadverse effect
 Adequate calcium intake
 Adequatevitamin D intake from food,
supplement, and sun exposure
 Avoidance of excess phophorus
 A balance diet that procides adequate
protein, energy, and micronutrients
 Exercise
 Three factors influenced (for women):
diet, exercise, and estrogen
 Diet  calcium from food (including
fortified food), adequate intake of
vitamin D either from sun exposure or
foods or supplement
 Engaging in regular weight-bearing
exercise
 Estrogen (before 50)