Krause\'s Food and the Nutrition Care Process 14th edition Chapter 24 Case Study
ID: 82439 • Letter: K
Question
Krause's Food and the Nutrition Care Process 14th edition Chapter 24 Case Study
Liz B. is a 73-year-old white woman who is seeing her doctor for a regular physical. She is married and retired, but volunteers for several organizations and watches her grandchildren two mornings a week. She and her husband play golf about once a week during the spring, summer, and fall. She weighs 130 pounds and always thought she was 5’6”. However, when she was measured at this physical, she was 5’4”. Because of her age and height loss, she has a dual-energy x-ray absorptiometry (DEXA) measurement that shows that she has low bone mineral density (BMD) values of her proximal femur and lumbar vertebrae (both values are classified as osteoporotic according to World Health Organization definitions). A chest x-ray also revealed two vertebral fractures. However, she has no pain in her back or neck.
The RDN and Liz discuss her diet, concluding that her diet is low in calcium and vitamin D, but high in sodium. Along with suggestions to decrease her sodium intake and increase her fruit and vegetable intake, she is advised to start taking supplements of calcium (1000 mg/day) and vitamin D (800 units/day). They discuss avoiding high-impact exercise affecting the spine because of the low bone mass and existing vertebral fractures, but increasing flexibility, balance, and posture exercises. Be- cause of the DXA results, she also begins on a bisphosphonate drug in addition to the calcium and vitamin D supplements. She receives base- line tests of bone turnover, to be rechecked in 6 months and an appoint- ment for another DXA in 1 year.
After 1 year on the medication, supplements, diet and exercise changes, Liz has another DXA. Her BMD has improved to the osteopenia level, and she is taken off the bisphosphonate medication.
Nutrition Diagnostic Statement:
Inadequate calcium and vitamin D intake related to avoidance of dairy products as evidenced by diet history revealing less than 20% of esti- mated requirements. NOTE: This may be resolved once she starts taking supplements.
1. If Liz want to increase her calcium through fortified foods rather than a supplement, how would you counsel her?
2. If Liz’s sodium intake if high, what would you advise her to eat less frequently?
3. How does the medication, bisphosphonate work to improve/maintain bone mass for Liz?
4. The WHO’s risk algorithm (FRAX) needs what data to calculate score?
5. What risk factors does Liz have for developing osteoporosis?
6. What medications will increase risk for osteoporosis?
7. What two hormones regulate calcium concentration?
8. When did Liz reach her peak bone mass?
9. In talking with Liz, you outline foods that interfere with calcium absorption, what are they?
10. What are the National Osteoporosis Foundation’s universal guidelines for all adults for the prevention of osteoporosis?
Explanation / Answer
We can answer only 4 subparts.
1. To increase her calcium through fortified foods rather than through supplements, Liz has to eat foods which are rich in calcium like Milk, Sardines, Kale, yoghurt, broccoli, and cheese.
2. If the intake of sodium is high, the foods which she should avoid would be:
3. Bisphosphonates reduce the rate of bone turnover and resorption. They increase the mineral density of the bone, improve structural and material properties of the bone. In this way, the mass of the bone gradually improves with supplements of bisphosphonates.
4. The non bone mineral density is needed to calculate the score of FRAX.
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