Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis

Characterizing low femoral neck BMD in Qatar Biobank participants using machine learning models

BACKGROUND

Identifying determinants of low bone mineral density (BMD) is crucial for understanding the underlying pathobiology and developing effective prevention and management strategies. Here we applied machine learning (ML) algorithms to predict low femoral neck BMD using standard demographic and laboratory parameters.

METHODS

Data from 4829 healthy individuals enrolled in the Qatar Biobank were studied. The cohort was split 60% and 40% for training and validation, respectively. Logistic regression algorithms were implemented to predict femoral neck BMD, and the area under the curve (AUC) was used to evaluate model performance. Features associated with low femoral neck BMD were subjected the statistical analysis to establish associated risk.

RESULTS

The final predictive model had an AUC of 86.4% (accuracy 79%, 95%CI: 77.98-80.65%) for the training set and 85.9% (accuracy 78%, 95% CI: 75.92-80.61%) for the validation set. Sex, body mass index, age, creatinine, alkaline phosphatase, total cholesterol, and magnesium were identified as informative features for predicting femoral neck BMD. Age (odds ratio (OR) 0.945, 95%CI: 0.945-0.963, p < 0.001), alkaline phosphatase (OR 0.990, 95%CI: 0.986-0.995, p < 0.001), total cholesterol (OR 0.845, 95%CI: 0.767-0.931, p < 0.001), and magnesium (OR 0.136, 95%CI: 0.034-0.571, p < 0.001) were inversely associated with BMD, while BMI and creatinine were positively associated with BMD (OR 1.116, 95%CI: 1.140-1.192, p < 0.001 and OR 1.031, 95%CI: 1.022-1.039, p < 0.001, respectively).

CONCLUSION

Several biological determinants were found to have a significant global effect on BMD with a reasonable effect size. By combining standard demographic and laboratory variables, our model provides proof-of-concept for predicting low BMD. This approach suggests that, with further validation, an ML-driven model could complement or potentially reduce the need for imaging when assessing individuals at risk for low BMD, which is an important component of fracture risk prediction.

CLINICAL TRIAL NUMBER

Not applicable.

Osteoporosis: What every nurse should know

ABSTRACT

Osteoporosis awareness is important for nurses, their patients, families, and communities. Over 2 million osteoporosis fractures occur in the US every year, and up to one-third of patients die within a year of experiencing a hip fracture. Up to 80% of patients with hip fractures never fully regain pre-fracture independence. This article discusses osteoporosis risk factors, screening and treatment recommendations, self-help measures, and potential care gaps.

Bone Health for Gynaecologists

Osteoporosis, the most common bone disorder, profoundly impacts women's health, especially during postmenopausal phases. Characterised by diminished bone mineral density (BMD), it increases the risk of fractures, affecting mobility, quality of life, and potentially mortality. The present review analyses the intricate interactions among physiological alterations, diseases, and medications that lead to bone mineral density reduction in women. It underscores the importance of gynaecologists in the prevention, diagnosis, and management of osteoporosis via early risk assessment, suitable hormone treatment, and lifestyle modifications. Essential considerations encompass the categorisation of osteoporosis into primary (age-related) and secondary (attributable to diseases or pharmacological treatments) types, with particular emphasis on predisposing conditions such as premature menopause, hormone deficits, and cancer therapies. The significance of diagnostic instruments such as DXA and novel methodologies like trabecular bone score and quantitative ultrasonography is emphasised for precise evaluation and surveillance. The review also addresses nutritional methods, physical exercise, and pharmaceutical interventions, including hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMs), and other anti-resorptive drugs, to preserve bone health. This review highlights the important role of gynaecologists in maintaining women's bone health, promoting a proactive strategy to avert osteoporosis-related complications and enhance long-term results.

Difference in Bone Density in Young Women With Normal Occlusion and Malocclusion

Introduction Acquisition of higher peak bone mass in young women may prevent postmenopausal osteoporosis. Many factors, including nutritional intake, influence peak bone mass. The masticatory ability associated with nutritional intake may be lower in young women with malocclusion than in those with normal occlusion. We investigated the difference in bone mineral density (BMD) and nutritional intake between younger women with normal occlusion and malocclusion. Methods This study involved 45 women (mean age, 20.8 years) with normal occlusion and 49 women (mean age, 21.3 years) with malocclusion. Calcaneal BMD was measured by quantitative ultrasound. All participants completed the Food Frequency Questionnaire (FFQ). Differences in BMD, body mass index (BMI), and FFQ-obtained nutrient values between the two groups were analyzed with an independent t-test. Multiple regression analysis was also conducted to assess the association between BMD and nutrient values in both participants with normal occlusion and malocclusion. Results Participants with malocclusion tended to have lower BMD than those with normal occlusion (p = 0.10). The former had significantly higher vitamin A intake and lower sunlight exposure time than the latter. In the malocclusion group, participants with normal BMI had significantly higher BMD than those with both higher and lower BMI (p = 0.009 and p = 0.004, respectively). High vitamin B12 intake was also associated with higher BMD in this group (p = 0.031). Conclusions Malocclusion in young women influenced calcaneal BMD through nutritional intake, sunlight exposure, and BMI. Orthodontic treatment in young women with malocclusion may contribute to obtaining higher peak bone mass.

The Impact of Hypomagnesemia on the Long-Term Evolution After Kidney Transplantation

BACKGROUND/OBJECTIVES

Magnesium plays a crucial role in immune function, influencing immunoglobulin synthesis, antibody-dependent cytolysis, and other immune processes. In renal transplant patients, magnesium deficiency is primarily induced by calcineurin inhibitor treatment, through the reduction of magnesium transporter proteins in the renal tubules, leading to magnesium loss.

METHODS

To assess the correlation between serum magnesium levels and the long-term outcomes of renal graft and transplant recipients, we conducted a retrospective study on 87 patients who have had a transplant for more than 5 years, a period considered immunologically stable. We evaluated laboratory parameters such as glycemia, creatinine, total protein, and C-reactive protein (CRP), as well as demographic data, primary kidney disease, donor type, comorbidities, and infection incidence.

RESULTS

This study revealed clinical stability at over 5 years post-transplantation, with no significant differences between the 5-15 and over-15-years groups with regard to major comorbidities, except for HCV infection (p = 0.018). Reduced magnesium levels were associated with impaired renal function (p = 0.017) and inflammatory syndrome (p = 0.012). Viral infections were correlated with living donor grafts (p = 0.05), hypoproteinemia, and decreased eGFR (estimated glomerular filtration rate), while bacterial infections, namely urinary tract infections (UTIs), were linked to reduced eGFR (p = 0.05, p = 0.046). Female patients with hypomagnesemia had a higher incidence of recurrent UTIs (p = 0.03).

CONCLUSIONS

Hypomagnesemia correlates with increased infection risk in patients who received a renal transplant more than 5 years ago but does not significantly impact glycemic control or cardiovascular health.

Nutrition and Osteoporosis Prevention

PURPOSE OF REVIEW

Osteoporosis affects 50% of women and 20% of men after the age of 50. Fractures are associated with significant morbidity, increased mortality and altered quality of life. Lifestyle measures for fragility fracture prevention include good nutrition including adequate protein and calcium intakes, vitamin D sufficiency, and regular weight bearing physical exercise.

RECENT FINDINGS

Dietary protein is one of the most important nutritional considerations as it affects bone mineral density, trabecular and cortical microstructure, and bone strength. When calcium intake is sufficient, higher dietary protein intake is associated with lower risk of fracture. Dairy products are a valuable source of calcium and high quality protein. Dairy product consumption, particularly fermented dairy products, are associated with a lower risk of hip fracture and vegan diets are associated with increased fracture risk. Other dietary factors associated with reduced fracture risk include at least 5 servings per day of fruits and vegetables, regular tea drinking, adherence to a Mediterranean diet and other dietary patterns which provide fibers, polyphenols and fermented dairy products. Such dietary patterns may confer health benefits through their effect on gut microbiota composition and/or function. A balanced diet including minerals, protein, fruits and vegetables is an important element in the prevention of osteoporosis and of fragility fracture.

Association Between Combined Polymetallic Exposure and Osteoporosis

Combined polymetallic exposure may be an influential factor in osteoporosis. This study aimed to explore the association between polymetallic combined exposure and osteoporosis. A total of 2115 participants were included. Plasma concentrations of 22 metals were determined by inductively coupled plasma mass spectrometry. Osteoporosis was defined as a T ≤  - 2.5. The least absolute shrinkage and selection operator (LASSO) regression, binary logistics regression, and Bayesian kernel machine regression (BKMR) model were used to explore the association between plasma metals and osteoporosis. LASSO regression showed that 10 metals were associated with osteoporosis in the total population (magnesium, calcium, manganese, nickel, cobalt, arsenic, selenium, rubidium, cadmium, aluminum) and women (magnesium, calcium, molybdenum, nickel, cobalt, arsenic, selenium, rubidium, cadmium, aluminum), and four metals associated with men (magnesium, cobalt, aluminum, iron). Logistics regression showed that in total population, magnesium (ORQ3 = 0.653, 95% CI = 0.446-0.954) was negatively correlated with osteoporosis, while aluminum (ORQ2 = 1.569, 95% CI = 1.095-2.248, ORQ4 = 1.616, 95% CI = 1.109-2.354) and cadmium (ORQ4 = 1.989, 95% CI = 1.379-2.870) were positively correlated; in women, magnesium (ORQ3 = 0.579, 95% CI = 0.379-0.883) was negatively correlated with osteoporosis, while aluminum (ORQ2 = 1.563, 95% CI = 1.051-2.326, ORQ4 = 1.543, 95% CI = 1.024-2.326) and cadmium (ORQ3 = 1.482, 95% CI = 1.003-2.191, ORQ4 = 1.740, 95% CI = 1.167-2.596) were positively correlated. BKMR model showed that combined polymetallic exposure had an overall positive effect on osteoporosis, magnesium was negatively associated with osteoporosis, and cadmium, selenium, and aluminum were positively associated with osteoporosis. Metal mixtures in plasma were associated with osteoporosis risk. Magnesium may reduce the risk of osteoporosis, while cadmium, selenium, and aluminum may increase the risk of osteoporosis. Future studies needed to explore correlations and mechanisms.

The role of magnesium in the pathogenesis of osteoporosis

Magnesium (Mg), a nutritional element which is essential for bone development and mineralization, has a role in the progression of osteoporosis. Osteoporosis is a multifactorial disease characterized by significant deterioration of bone microstructure and bone loss. Mg deficiency can affect bone structure in an indirect way through the two main regulators of calcium homeostasis (parathyroid hormone and vitamin D). In human osteoblasts (OBs), parathyroid hormone regulates the expression of receptor activator of nuclear factor-κ B ligand (RANKL) and osteoprotegerin (OPG) to affect osteoclast (OC) formation. In addition, Mg may also affect the vitamin D3 -mediated bone remodeling activity. vitamin D3 usually coordinates the activation of the OB and OC. The unbalanced activation OC leads to bone resorption. The RANK/RANKL/OPG axis is considered to be a key factor in the molecular mechanism of osteoporosis. Mg participates in the pathogenesis of osteoporosis by affecting the regulation of parathyroid hormone and vitamin D levels to affect the RANK/RANKL/OPG axis. Different factors affecting the axis and enhancing OC function led to bone loss and bone tissue microstructure damage, which leads to the occurrence of osteoporosis. Clinical research has shown that Mg supplementation can alleviate the symptoms of osteoporosis to some extent.

Gastric Cancer Survivorship: Multidisciplinary Management, Best Practices and Opportunities

PURPOSE

Gastric cancer is the 5th most common malignancy worldwide. As early detection increases and treatments for gastric cancer improve, the number of gastric cancer survivors grows.

METHODS

Here, we review the diagnosis and management of gastric cancer and discuss important considerations for gastric cancer survivorship including cancer surveillance, weight loss, malnutrition, fatigue, specific complications related to surgery and radiation, quality of life in gastric cancer survivorship, health behavior, and models of survivorship.

RESULTS

Multimodality therapy with chemotherapy and surgery can result in chronic toxicities in multiple organ systems. This emphasizes the need for a multidisciplinary survivorship care model including cancer surveillance, management of chronic toxicities, and optimization of modifiable risk factors with long-term involvement of appropriate providers.

CONCLUSION

Adequately caring for gastric cancer survivors requires a coordinated, multidisciplinary approach.

The Dutch multidisciplinary guideline osteoporosis and fracture prevention, taking a local guideline to the international arena

BACKGROUND

In 2018, a grant was provided for an evidence-based guideline on osteoporosis and fracture prevention based on 10 clinically relevant questions.

METHODS

A multidisciplinary working group was formed with delegates from Dutch scientific and professional societies, including representatives from the patient's organization and the Dutch Institute for Medical Knowledge. The purpose was to obtain a broad consensus among all participating societies to facilitate the implementation of the updated guideline.

RESULTS

Novel recommendations in our guideline are as follows: - In patients with an indication for DXA of the lumbar spine and hips, there is also an indication for VFA. - Directly starting with anabolic drugs (teriparatide or romosozumab) in patients with a very high fracture risk; - Directly starting with zoledronic acid in patients 75 years and over with a hip fracture (independent of DXA); - Directly starting with parenteral drugs (denosumab, teriparatide, zoledronic acid) in glucocorticoid-induced osteoporosis with very high fracture risk; - A lifelong fracture risk management, including lifestyle, is indicated from the start of the first treatment.

CONCLUSION

In our new multidisciplinary guideline osteoporosis and fracture prevention, we developed 5 "relatively new statements" that are all a crucial step forward in the optimization of diagnosis and treatment for fracture prevention. We also developed 5 flowcharts, and we suppose that this may be helpful for individual doctors and their patients in daily practice and may facilitate implementation.

The association between serum magnesium and chronic kidney disease in Chinese adults: a cross-sectional study

BACKGROUND

Magnesium (Mg) is both an essential macro-element and a known catalyst, and it plays a vital role in various physiological activities and mechanisms in relation to chronic kidney disease (CKD). However, epidemiological evidence involving this is limited and not entirely consistent. This study aims to explore the association of serum Mg concentrations with the risk of CKD among general Chinese adults.

METHODS

A total of 8,277 Chinese adults were included in the wave of 2009 from the China Health and Nutrition Survey (CHNS). The primary outcome was the risk of CKD, which was defined as the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multivariable logistic regression model was used to examine the relationship of serum Mg concentrations with the risk of CKD.

RESULTS

Included were 8,277 individuals, with an overall CKD prevalence of 11.8% (n = 977). Compared with the first quartile of serum Mg, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for participants in the second, third, and fourth quartiles of serum Mg were 0.74 (0.58, 0.93), 0.87 (0.69, 1.11) and 1.29 (1.03, 1.61), respectively. Similar results were observed in our several sensitivity analyses. Restricted cubic spline analysis demonstrated a nonlinear (similar "J"-shaped) association between serum Mg concentrations and the risk of CKD (Pnonlinearity <0.001), with a threshold at around a serum Mg value of 2.2 mg/dL.

CONCLUSIONS

Our results suggested a similar "J"-shaped association between serum Mg concentration and the risk of CKD among Chinese adults. Further large prospective studies are needed to verify these findings.

The association between dietary approaches to stop hypertension diet and bone mineral density in US adults: evidence from the National Health and Nutrition Examination Survey (2011-2018)

This study aimed to investigate the relationship between the dietary approaches to stop hypertension (DASH) dietary patterns and bone mineral density (BMD) in adults residing in the United States. To achieve this, data from the National Health and Nutrition Examination Survey (NHANES) database for 2011-2018 were utilized. This study utilized the NHANES database from 2011 to 2018, with a sample size of 8,486 US adults, to investigate the relationship between the DASH diet and BMD. The DASH diet was assessed based on nine target nutrients: total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium and potassium. The primary outcome measures were BMD values at the total BMD, thoracic spine, lumbar spine, and pelvis. Multivariable linear models were employed to analyze the association between the DASH diet and BMD. Interaction tests, subgroup, and sensitivity analysis were also followed. A negative correlation was observed between the DASH diet and total BMD (OR: - 0.003 [95%CI: - 0.005, - 0.001), pelvic (OR: - 0.005 [95%CI: - 0.007, - 0.002]), and thoracic BMD (OR: - 0.003 [95%CI: - 0.005, - 0.001]). However, the DASH diet does not appear to have a particular effect on lumbar spine BMD (OR: - 0.002 [95%CI: - 0.004, 0.001]). Similarly, when the DASH diet was categorized into tertiles groups, the relationship with total BMD, pelvic BMD, thoracic BMD, and lumbar spine BMD remained consistent. Furthermore, we performed a sensitivity analysis by converting BMD to Z-scores, and the results remained unchanged. Subgroup analyses and interaction tests indicated no significant dependence of BMI, gender, smoking, hypertension, and diabetes on the observed association (all p for interactions > 0.05). The DASH diet has been identified as potentially reducing total BMD, while specifically impacting thoracic and pelvic BMD. However, it appears to have no significant effect on lumbar spine BMD.

Magnesium: a scoping review for Nordic Nutrition Recommendations 2023

Magnesium is a divalent ion involved in a range of biochemical reactions and cellular functions. The metabolism and requirements for magnesium are still insufficiently understood. In the Nordic Nutrition Recommendations from 2012, a recommended intake was set based on balance studies. However, the average requirement (AR) was not set. Functional indicators of magnesium status have been lacking. This scoping review reveals new research activity related to the beneficial effect of magnesium intake on several health outcomes (cardiovascular disease, diabetes and some cancers). Based on meta-analyses of cohort studies and Randomized Controlled Trials (RCTs), as well as on plausible mechanisms, a causal association is suggested. However, the optimal intake cannot be set based on these study designs and no new balance studies were found.

Recent advances in the identification of related factors and preventive strategies of hip fracture

Hip fracture is the most devastating type of osteoporosis-related fracture, and is a major worldwide public health problem with a high socioeconomic burden, morbidity rate, and mortality rate. Thus, it is crucial to uncover the risk factors and protective factors to create a hip fracture prevention strategy. In addition to a briefly review of some well accepted risk and protective factors of hip fracture, this review mainly summarized the recent advances in the identification of emerging risk or protective factors for hip fracture, in terms of regional differences in medical services, diseases, drugs, mechanical load, neuromuscular mass, genes, blood types, cultural differences. This review provides a comprehensive review of the associated factors and effective prevention measures for hip fracture, and discusses issues that need further investigation. These issues include the determination of the influencing mechanism of risk factors triggering hip fracture and their interlinked correlation with other factors, as well as the confirmation or correction of emerging factors associated with hip fracture, particularly those that are still controversial. These recent findings will aid in optimizing the strategy for preventing hip fracture.

Association between Serum Magnesium and Fractures: A Systematic Review and Meta-Analysis of Observational Studies

Magnesium, an essential cation for numerous cellular processes, is a major component of bone. However, its relationship with the risk of fractures is still uncertain. The present systematic review and meta-analysis aim to investigate the impact of serum Mg on the risk of incident fractures. A systematic search was conducted using several databases including PubMed/Medline and Scopus from inception to 24 May 2022, including observational studies investigating serum Mg and the incidence of fractures considered as outcomes. Abstract and full-text screenings, data extractions, and risk of bias assessments were conducted by two investigators independently. Any inconsistencies were resolved by consensus with a third author. The Newcastle-Ottawa Scale was used to assess the study quality/risk of bias. Among 1332 records initially screened, 16 were retrieved as full-texts; of them, four papers were included in the systematic review with a total of 119,755 participants. We found that lower serum Mg concentrations were associated with a significantly higher risk of incident fractures (RR = 1.579; 95%CI: 1.216-2.051; p = 0.001; I2 = 46.9%). Our systematic review with meta-analysis suggests a strong association of serum Mg concentrations with incident fractures. Further research is needed to confirm our results among other populations and to assess whether serum Mg is potentially relevant in the prevention of fractures, which continue to increase and represent a significant health burden due to the associated disability.

Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review

Purpose of Review

Magnesium is an essential mineral for bone metabolism, but little is known about how magnesium intake alters fracture risk. We conducted a narrative review to better understand how magnesium intake, through supplementation, diet, or altering the concentration of dialysate magnesium, affects mineral bone disease and the risk of fracture in individuals across the spectrum of kidney disease.

Sources of Information

Peer-reviewed clinical trials and observational studies.

Methods

We searched for relevant articles in MEDLINE and EMBASE databases. The methodologic quality of clinical trials was assessed using a modified version of the Downs and Black criteria checklist.

Key Findings

The role of magnesium intake in fracture prevention is unclear in both the general population and in patients receiving maintenance dialysis. In those with normal kidney function, 2 meta-analyses showed higher bone mineral density in those with higher dietary magnesium, whereas 1 systematic review showed no effect on fracture risk. In patients receiving maintenance hemodialysis or peritoneal dialysis, a higher concentration of dialysate magnesium is associated with a lower concentration of parathyroid hormone, but little is known about other bone-related outcomes. In 2 observational studies of patients receiving hemodialysis, a higher concentration of serum magnesium was associated with a lower risk of hip fracture.

Limitations

This narrative review included only articles written in English. Observed effects of magnesium intake in the general population may not be applicable to those with chronic kidney disease particularly in those receiving dialysis.

Relationship of multiple metals mixture and osteoporosis in older Chinese women: An aging and longevity study

Osteoporosis has become a major health problem in older women. Previous studies have linked individual metals exposure with osteoporosis, but combined effects remain inconclusive. We aimed to explore the individual and combined association between multiple metals mixture and osteoporosis risk in older Chinese women. A total of 2297 older women (aged ≥60) from the Hongshuihe region of Guangxi, southern China included. We measured 22 blood metal levels through inductively coupled plasma mass spectrometry. And osteoporosis was defined as a T score ≤ -2.5. The least absolute shrinkage and selection operator (LASSO) penalized regression, and Bayesian kernel machine regression (BKMR) models were performed to explore the association between blood metals and osteoporosis risk. Of 2297 older women, there were 829 osteoporosis and 1468 non-osteoporosis participants. The median age was 71 and 68 years old in the osteoporosis and the non-osteoporosis group, respectively. In the single-metal model, rubidium and vanadium were negatively associated with osteoporosis (P for trend = 0.02 and 0.002, respectively), and lead presented the reverse trend (P for trend = 0.01). The LASSO penalized regression model selected nine metals (calcium, cadmium, cobalt, lead, magnesium, rubidium, strontium, vanadium and zinc), which were included in the subsequent analysis. And the multiple-metal model presented a consistent trend with the single-metal model using the selected metals. Furthermore, we performed BKMR to explore the combined effect, and found an overall negative effect between metals mixture and osteoporosis risk when all the metals were fixed at 50th, and rubidium and vanadium were the main contributors. In addition, blood Rb and V were significantly negatively related to OP risk with other metals at different levels (25th, 50th and 75th percentiles). The study suggests metal mixture exposure and osteoporosis risk in older Chinese women, and further studies need to be conducted.

Associations of the Dietary Magnesium Intake and Magnesium Depletion Score With Osteoporosis Among American Adults: Data From the National Health and Nutrition Examination Survey

Objectives

The study aimed to explore the associations between dietary magnesium (Mg) intake and magnesium depletion score (MDS) among American adults with osteoporosis.

Methods

The continuous data from the National Health and Nutrition Examination Survey 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 were merged to ensure a large and representative sample and a total of 14,566 participants were enrolled for the analysis. The weighted multivariate linear regression model was performed to assess the linear relationship between dietary Mg intake and osteoporosis. Further, the non-linear relationship was also characterized by smooth curve fitting (SCF) and weighted generalized additive model (GAM). In addition, the odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between the MDS and osteoporosis were assessed by weighted logistic regression models.

Results

After adjusting all covariates, the weighted multivariable linear regression models demonstrated that the dietary Mg intake negatively correlated with osteoporosis, especially in participants aged 55 years or older. In addition, the non-linear relationship characterized by SCF and weighted GAM showed that the dietary Mg intake presented an L-shaped association with osteoporosis among females aged 55 years or older. Moreover, the weighted logistic regression model demonstrated that compared with MDS 0, the OR between MDS ≥3 and osteoporosis was 2.987 (95% CI 1.904, 4.686) in the male-middle intake group. Moreover, compared with MDS 0, the ORs between MDS ≥3 and osteoporosis was 5.666 (95% CI 3.188, 10.069) in the female-low intake group and 1.691 (95% CI 1.394, 2.051) in the female-middle intake group.

Conclusion

The present study indicated that in people with a daily intake of Mg level below the recommended daily intake (RDI), the dietary Mg intake and Mg bioavailability represented by MDS have a negative correlation with osteoporosis. According to the results, the combination of MDS and dietary Mg intake may be more comprehensive and rigorous in screening the population with osteoporosis. Therefore, early monitoring and interventions for osteoporosis may be necessary for those with insufficient dietary Mg intake or high MDS scores.

Targeting Sirt1, AMPK, Nrf2, CK2, and Soluble Guanylate Cyclase with Nutraceuticals: A Practical Strategy for Preserving Bone Mass

There is a vast pre-clinical literature suggesting that certain nutraceuticals have the potential to aid the preservation of bone mass in the context of estrogen withdrawal, glucocorticoid treatment, chronic inflammation, or aging. In an effort to bring some logical clarity to these findings, the signaling pathways regulating osteoblast, osteocyte, and osteoclast induction, activity, and survival are briefly reviewed in the present study. The focus is placed on the following factors: the mechanisms that induce and activate the RUNX2 transcription factor, a key driver of osteoblast differentiation and function; the promotion of autophagy and prevention of apoptosis in osteoblasts/osteoclasts; and the induction and activation of NFATc1, which promotes the expression of many proteins required for osteoclast-mediated osteolysis. This analysis suggests that the activation of sirtuin 1 (Sirt1), AMP-activated protein kinase (AMPK), the Nrf2 transcription factor, and soluble guanylate cyclase (sGC) can be expected to aid the maintenance of bone mass, whereas the inhibition of the serine kinase CK2 should also be protective in this regard. Fortuitously, nutraceuticals are available to address each of these targets. Sirt1 activation can be promoted with ferulic acid, N1-methylnicotinamide, melatonin, nicotinamide riboside, glucosamine, and thymoquinone. Berberine, such as the drug metformin, is a clinically useful activator of AMPK. Many agents, including lipoic acid, melatonin, thymoquinone, astaxanthin, and crucifera-derived sulforaphane, can promote Nrf2 activity. Pharmacological doses of biotin can directly stimulate sGC. Additionally, certain flavonols, notably quercetin, can inhibit CK2 in high nanomolar concentrations that may be clinically relevant. Many, though not all, of these agents have shown favorable effects on bone density and structure in rodent models of bone loss. Complex nutraceutical regimens providing a selection of these nutraceuticals in clinically meaningful doses may have an important potential for preserving bone health. Concurrent supplementation with taurine, N-acetylcysteine, vitamins D and K2, and minerals, including magnesium, zinc, and manganese, plus a diet naturally high in potassium, may also be helpful in this regard.

Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

Background

Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium.

Aim

Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the effectiveness of supplementing Sucrosomial^® magnesium associated with therapeutic exercise on the outcome of these patients.

Methods

We divided the study into two parts. In the first part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise.

Results

Half of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a significant improvement in blood levels of magnesium (2.11 ± 0.15 vs. 1.94 ± 0.11; p < 0.05), on the NRS scale (5.7 ± 0.81 vs. 6.6 ± 1.18; p < 0.05), the Tinetti scale (17.3 ± 1.15 vs. 15.2 ± 2.98; p < 0.05) and the SarQoL questionnaire (47.3 ± 5.21 vs. 44.9 ± 5.54; p < 0.05).

Conclusions

More attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifiable risk factors for osteoporosis.

Associations of dietary intakes of calcium, magnesium and soy isoflavones with osteoporotic fracture risk in postmenopausal women: a prospective study

The role of dietary factors in osteoporotic fractures (OFs) in women is not fully elucidated. We investigated the associations between incidence of OF and dietary calcium, magnesium and soy isoflavone intake in a longitudinal study of 48 584 postmenopausal women. Multivariable Cox regression was applied to derive hazard ratios (HRs) and 95 % confidence intervals (CIs) to evaluate associations between dietary intake, based on the averages of two assessments that took place with a median interval of 2⋅4 years, and fracture risk. The average age of study participants is 61⋅4 years (range 43⋅3–76⋅7 years) at study entry. During a median follow-up of 10⋅1 years, 4⋅3 % participants experienced OF. Compared with daily calcium intake ≤400 mg/d, higher calcium intake (>400 mg/d) was significantly associated with about a 40–50 % reduction of OF risk among women with a calcium/magnesium (Ca/Mg) intake ratio ≥1⋅7. Among women with prior fracture history, high soy isoflavone intake was associated with reduced OF risk; the HR was 0⋅72 (95 % CI 0⋅55, 0⋅93) for the highest (>42⋅0 mg/d) v. lowest (<18⋅7 mg/d) quartile intake. This inverse association was more evident among recently menopausal women (<10 years). No significant association between magnesium intake and OF risk was observed. Our findings provide novel information suggesting that the association of OF risk with dietary calcium intake was modified by Ca/Mg ratio, and soy isoflavone intake was modified by history of fractures and time since menopause. Our findings, if confirmed, can help to guide further dietary intervention strategies for OF prevention.

Impact of magnesium on bone health in older adults: A systematic review and meta-analysis

BACKGROUND

Magnesium plays a key role in bone health and may, therefore, represent an interesting nutrient for the prevention of bone loss and osteoporosis. The aim of this systematic review and meta-analysis was to investigate the impact of magnesium intake from any source on bone mineral density (BMD), bone mineral content (BMC), bone turnover markers, and fracture risk in older adults.

METHODS

A systematic search was conducted using Embase, Medline Ovid and Cochrane Central from database inception to October 2020. All studies that related magnesium intake with bone health outcomes among adults aged ≥60 years were included. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias assessments. Authors were contacted for missing data.

RESULTS

Once 787 records were screened, six cohort studies, one case-control study and five cross-sectional studies were included. Qualitative evaluation demonstrated a positive trend between higher magnesium intake and higher hip and femoral neck BMD. Meta-analysis of four studies showed a significant positive association between magnesium intake and hip BMD (pooled beta: 0.03, 95% CI: 0.01-0.06, p < 0.05).

CONCLUSIONS

This systematic review indicates that a higher magnesium intake may support an increase in hip and femoral neck BMD. Due to limited research no associations with BMD at other sites or fractures were found. There is a need for properly designed cohort studies to determine the association between magnesium intake and bone health in older adults. Next, large and long-term randomized controlled trials in older adults are needed to determine whether an increase in magnesium (supplementation) intake can improve bone health. The combination of several bone nutrients (calcium, vitamin D, protein, magnesium and potentially more) may be needed for the most optimal effect on bone health and to delay or prevent the development of osteoporosis.

Risk Factors Analysis of Bone Mineral Density Based on Lasso and Quantile Regression in America during 2015-2018

This study aimed to explore the risk factors of bone mineral density (BMD) in American residents and further analyse the extent of effects, to provide preventive guidance for maintenance of bone health. A cross-sectional study analysis was carried out in this study, of which data validity was identified and ethics approval was exempted based on the National Health and Nutrition Examination Survey (NHANES) database. Candidates' demographics, physical examination, laboratory indicators and part of questionnaire information were collected and merged from NHANES in 2015-2016 and 2017-2018. The least absolute shrinkage selection operator (lasso) was used to select initial variables with "glmnet" package of R, quantile regression model to analyze influence factors of BMD and their effects in different sites with "qreg" code in Stata. Among 2937 candidates, 17 covariates were selected by lasso regression (λ = 0.00032) in left arm BMD, with 16 covariates in left leg BMD (λ = 0.00052) and 14 covariates in total BMD (λ = 0.00065). Quantile regression results displayed several factors with different coefficients in separate sites and quantiles: gender, age, educational status, race, high-density lipoprotein (HDL), total cholesterol (TC), lead, manganese, ethyl mercury, smoking, alcohol use and body mass index (BMI) (p < 0.05). We constructed robust regression models to conclude that some demographic characteristics, nutritional factors (especially lipid levels, heavy metals) and unhealthy behaviors affected BMD in varying degrees. Gender and race differences, Low-fat food intake and low exposure to heavy metals (mostly lead, manganese and mercury) should be considered by both clinical doctors and people. There is still no consensus on the impact of smoking and alcohol use on bone mineral density in our study.

Associations of Dietary Intakes of Calcium, Magnesium, and Soy Isoflavones With Bone Fracture Risk in Men: A Prospective Study

The role of dietary factors in osteoporotic fractures in men is underinvestigated. We examined the associations of dietary intakes of calcium, magnesium, and soy isoflavones with risk of osteoporotic fractures in the Shanghai Men's Health Study. Included in this prospective study were 61,025 men aged 40 to 74 years at study enrollment (2002–2006). The cohort was followed up via in‐person surveys for occurrence of bone fractures, major diseases, and survival status. Multivariable Cox regression was applied to evaluate the associations of variables under study (ie, dietary intakes of calcium, magnesium, and soy isoflavones) with incidence of osteoporotic and non‐osteoporotic fractures, measured by hazard ratio (HR) and 95% confidence interval (CI). During a median follow‐up of 9.5 years, 1.2% and 3.4% of participants experienced osteoporotic or non‐osteoporotic fractures, respectively. Dietary calcium intake was inversely associated with risk of osteoporotic fractures with adjusted HRs of 0.78 (95% CI 0.60–1.02) and 0.27 (95% CI 0.13–0.56), respectively, for intake levels of 401 mg/d and >1000 mg/d versus ≤400 mg/d. Higher magnesium intake was associated with increased risk of osteoporotic fractures after adjusting for dietary calcium intake, with HRs of 1.27 (95% CI 0.97–1.66) and 2.21 (95% CI 1.08–4.50), respectively, for intakes of 251 mg/d and >450 mg/d versus intake ≤250 mg/d. High soy isoflavone intake was associated with a 25% reduction of osteoporotic fracture risk (HR = 0.73, 95% CI 0.56–0.97 for soy isoflavone intake >45.2 mg/d versus <21.7 mg/d). Dietary intakes of calcium, magnesium, or soy isoflavones were unrelated to the risk of non‐osteoporotic fractures. Our study added to the evidence that dietary calcium intake was inversely associated with a reduced risk of osteoporotic fractures in a dose–response fashion, while high magnesium intake was associated with an increased risk. Our study also revealed a novel association between higher soy isoflavone consumption and osteoporotic fractures in men. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Dietary risk factors for hip fracture in adults: An umbrella review of meta-analyses of prospective cohort studies

AIM

To summarise the totality of evidence regarding dietary risk factors for hip fracture in adults, evaluating the quality of evidence, to provide recommendations for practice and further research.

DESIGN

Systematic review of meta-analyses of prospective cohort studies.

ELIGIBILITY CRITERIA

Systematic reviews with meta-analyses reporting summary risk estimates for associations between hip fracture incidence and dietary exposures including oral intake of a food, food group, beverage, or nutrient, or adherence to dietary patterns.

INFORMATION SOURCES

Medline, Embase, Web of Science, and the Cochrane Library from inception until November 2020.

DATA SYNTHESIS

The methodological quality of systematic reviews and meta-analyses was assessed using AMSTAR-2, and the quality of evidence for each association was assessed using GRADE. Results were synthesised descriptively.

RESULTS

Sixteen systematic reviews were identified, covering thirty-four exposures, including dietary patterns (n = 2 meta-analyses), foods, food groups, or beverages (n = 16), macronutrients (n = 3), and micronutrients (n = 13). Identified meta-analyses included 6,282 to 3,730,424 participants with between 322 and 26,168 hip fractures. The methodological quality (AMSTAR-2) of all systematic reviews was low or critically low. The quality of evidence (GRADE) was low for an inverse association between hip fracture incidence and intake of fruits and vegetables combined (adjusted summary relative risk for higher vs lower intakes: 0.92 [95% confidence interval: 0.87 to 0.98]), and very low for the remaining thirty-three exposures.

CONCLUSION

Dietary factors may play a role in the primary prevention of hip fracture, but the methodological quality of systematic reviews and meta-analyses was below international standards, and there was a lack of high-quality evidence. More long-term cohort studies reporting absolute risks and robust, well-conducted meta-analyses with dose-response information are needed before policy guidelines can be formed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020226190.

MR-PheWAS for the causal effects of serum magnesium on multiple disease outcomes in Caucasian descent

Magnesium is integral to many physiological processes, whereas variations in its levels, even within the normal range, can have critical implications for health. To explore the broad clinical effects of varying serum magnesium levels, we performed a two-sample Mendelian randomization and phenome-wide association study (MR-PheWAS) in the UK Biobank cohort. In total, MR-PheWAS analysis implicated a causal role of serum magnesium levels in five disease groups and six disease outcomes. In addition, our study indicated the gender-specific effects of nine disease groups/outcomes in MR estimated effects. The protein-protein interaction network demonstrated an interaction between the serum magnesium-associated gene DCDC1 and the cataract- associated gene PAX6. The present study verified several previously reported disease outcomes and identified novel potential disease outcomes for serum magnesium levels. The DCDC1 gene and the PAX6 gene may be the new targets for promoting the treatments of cataracts using magnesium intervention.

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MR-PheWAS implicates a causal role of serum Mg in 11 disease groups/outcomes

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Our study indicates gender-specific effects of 9 disease groups/outcomes

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Mg intervention may promote cataracts treatments through the DCDC1 and PAX6 genes

Role of diet in osteoporosis incidence: Umbrella review of meta-analyses of prospective observational studies

An umbrella review and meta-analysis were conducted to summarize evidence for the association between dietary factors and the incidence of osteoporosis in adults. Only systematic reviews or meta-analyses were eligible for this study. Two researchers independently performed reading, data extraction, and quality evaluation of the included literature. The outcomes included in this study were all associated with osteoporosis, including osteoporotic fractures and low bone density. A total of 54 studies were included in this study, with 83 adjusted hazard ratios on diet, dairy group (n = 13), alcohol (n = 2), tea (n = 6), coffee (n = 3), micronutrient (n = 31), dietary pattern (n = 21), and foods (n = 7) regarding the incidence of osteoporosis. Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) quality assessment method was used in this study. The high, medium, low and very low quality studies accounted for 27.7, 41, 21.7 and 9.6% of this study, respectively. Based on the included literature studies in this umbrella review, it was found that dietary factors have a relevant impact on the incidences of human osteoporosis, appropriate consumption of dairy products, vegetables, fruits, and micronutrients, as well as reduced intake of alcohol and coffee, can reduce the risk of osteoporosis.

Dysmagnesemia Is the Most Common Disturbance of the Calcium-Magnesium-Phosphorous Balance among Older Hospitalized People in Warsaw

The elderly are at great risk of developing life-threatening disturbances in calcium–magnesium–phosphate homeostasis because of comorbidities, long-term medication use, and dietary deficiencies, but it is still not known how often they occur in this group of patients. This study aimed to assess the prevalence of these disturbances in a group of hospitalized patients over 65 years of age according to age and sex. The study was conducted between January 2018 and September 2020 at the Central Clinical Hospital in Warsaw. A total of 66,450 calcium, magnesium, phosphate, and vitamin D concentration results were included in the analysis. Dysmagnesemia was present in 33% of the calcium results, dyscalcemia, dysphosphatemia, and dysvitaminosis D—in 23.5%, 26%, and 70% of the results, respectively. The magnesium concentration was found to be age-dependent, and older people were found to be at higher risk of developing abnormal magnesium concentrations (p < 0.001). Sex influenced the occurrence of abnormal magnesium (p < 0.001), vitamin D (p < 0.001), and calcium (p < 0.00001) concentrations, with hypercalcemia and hypervitaminosis D disorders being significantly more common in women (p < 0.0001). In conclusion, disorders of the calcium–magnesium–phosphate metabolism are common in hospitalized patients over 65 years of age, and the concentrations of these substances should be routinely monitored in this group.

Magnesium Picolinate Improves Bone Formation by Regulation of RANK/RANKL/OPG and BMP-2/Runx2 Signaling Pathways in High-Fat Fed Rats

Magnesium (Mg) deficiency may affect bone metabolism by increasing osteoclasts, decreasing osteoblasts, promoting inflammation/oxidative stress, and result in subsequent bone loss. The objective of the present study was to identify the molecular mechanism underlying the bone protective effect of different forms of Mg (inorganic magnesium oxide (MgO) versus organic magnesium picolinate (MgPic) compound) in rats fed with a high-fat diet (HFD). Forty-two Wistar albino male rats were divided into six group (n = 7): (i) control, (ii) MgO, (iii) MgPic, (iv) HFD, (v) HFD + MgO, and (vi) HFD + MgPic. Bone mineral density (BMD) increased in the Mg supplemented groups, especially MgPic, as compared with the HFD group (p < 0.001). As compared with the HFD + MgO group, the HFD + MgPic group had higher bone P (p < 0.05) and Mg levels (p < 0.001). In addition, as compared to MgO, MgPic improved bone formation by increasing the levels of osteogenetic proteins (COL1A1 (p < 0.001), BMP2 (p < 0.001), Runx2 (p < 0.001), OPG (p < 0.05), and OCN (p < 0.001), IGF-1 (p < 0.001)), while prevented bone resorption by reducing the levels of RANK and RANKL (p < 0.001). In conclusion, the present data showed that the MgPic could increase osteogenic protein levels in bone more effectively than MgO, prevent bone loss, and contribute to bone formation in HFD rats.

Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society

OBJECTIVE

To review evidence regarding osteoporosis screening, prevention, diagnosis, and management in the past decade and update the position statement published by The North American Menopause Society (NAMS) in 2010 regarding the management of osteoporosis in postmenopausal women as new therapies and paradigms have become available.

DESIGN

NAMS enlisted a panel of clinician experts in the field of metabolic bone diseases and/or women's health to review and update the 2010 NAMS position statement and recommendations on the basis of new evidence and clinical judgement. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees.

RESULTS

Osteoporosis, especially prevalent in older postmenopausal women, increases the risk of fractures that can be associated with significant morbidity and mortality. Postmenopausal bone loss, related to estrogen deficiency, is the primary contributor to osteoporosis. Other important risk factors for postmenopausal osteoporosis include advanced age, genetics, smoking, thinness, and many diseases and drugs that impair bone health. An evaluation of these risk factors to identify candidates for osteoporosis screening and recommending nonpharmacologic measures such as good nutrition (especially adequate intake of protein, calcium, and vitamin D), regular physical activity, and avoiding smoking and excessive alcohol consumption are appropriate for all postmenopausal women. For women at high risk for osteoporosis, especially perimenopausal women with low bone density and other risk factors, estrogen or other therapies are available to prevent bone loss. For women with osteoporosis and/or other risk factors for fracture, including advanced age and previous fractures, the primary goal of therapy is to prevent new fractures. This is accomplished by combining nonpharmacologic measures, drugs to increase bone density and to improve bone strength, and strategies to reduce fall risk. If pharmacologic therapy is indicated, government-approved options include estrogen agonists/antagonists, bisphosphonates, RANK ligand inhibitors, parathyroid hormone-receptor agonists, and inhibitors of sclerostin.

CONCLUSIONS

Osteoporosis is a common disorder in postmenopausal women. Management of skeletal health in postmenopausal women involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of osteoporosis or fracture. For women with osteoporosis, lifelong management is necessary. Treatment decisions occur continuously over the lifespan of a postmenopausal woman. Decisions must be individualized and should include the patient in the process of shared decision-making.

Nutritional intake and bone health

Osteoporotic or fragility fractures affect one in two women and one in five men who are older than 50. These events are associated with substantial morbidity, increased mortality, and an impaired quality of life. Recommended general measures for fragility fracture prevention include a balanced diet with an optimal protein and calcium intake and vitamin D sufficiency, together with regular weight-bearing physical exercise. In this narrative Review, we discuss the role of nutrients, foods, and dietary patterns in maintaining bone health. Much of this information comes from observational studies. Bone mineral density, microstructure-estimated bone strength, and trabecular and cortical microstructure are positively associated with total protein intake. Several studies indicate that fracture risk might be lower with a higher dietary protein intake, provided that the calcium supply is sufficient. Dairy products are a valuable source of these two nutrients. Hip fracture risk appears to be lower in consumers of dairy products, particularly fermented dairy products. Consuming less than five servings per day of fruit and vegetables is associated with a higher hip fracture risk. Adherence to a Mediterranean diet or to a prudent diet is associated with a lower fracture risk. These various nutrients and dietary patterns influence gut microbiota composition or function, or both. The conclusions of this Review emphasise the importance of a balanced diet including minerals, protein, and fruit and vegetables for bone health and in the prevention of fragility fractures.

Cross-Talks between the Cardiovascular Disease-Sarcopenia-Osteoporosis Triad and Magnesium in Humans

Magnesium (Mg) is a pivotal and very complex component of healthy aging in the cardiovascular-muscle-bone triad. Low Mg levels and low Mg intake are common in the general aging population and are associated with poorer outcomes than higher levels, including vascular calcification, endothelial dysfunction, osteoporosis, or muscle dysfunction/sarcopenia. While Mg supplementation appears to reverse these processes and benefit the triad, more randomized clinical trials are needed. These will allow improvement of preventive and curative strategies and propose guidelines regarding the pharmaceutical forms and the dosages and durations of treatment in order to optimize and adapt Mg prescription for healthy aging and for older vulnerable persons with comorbidities.

Lean mass, magnesium, faecal calprotectin and glucocorticoid exposure as risk factors for low bone mineral density in inflammatory bowel disease patients

BACKGROUND AND AIM

Low bone mineral density (BMD) is a common complication in patients with inflammatory bowel disease (IBD). However, debates are ongoing with regard to the other involved factors, especially in younger patients. This study aimed to evaluate the parameters that contribute to decreased BMD, focusing on premenopausal women and men aged <50 years.

METHODS

This study included 81 patients with IBD and 81 age-, sex- and BMI-matched controls. Blood tests were conducted on IBD patients, and a dual-energy X-ray absorptiometry (DXA) scan was performed on both groups.

RESULTS

Low BMD and fragility fracture were found to be more prevalent in IBD patients than in healthy subjects (49.3% vs 23.4%, P = 0.001 and 9.8% vs 1.2%, P = 0.01, respectively). Patients with low BMD were older, with a longer disease duration, higher faecal calprotectin (FC) levels and lower magnesium and lean mass (appreciated as appendicular skeletal muscle index (ASMI)). Multiple regression analysis revealed that ASMI, age and use of glucocorticoids were the independent parameters for decreased BMD. Although 91.3% of the patients had a 25-hydroxy vitamin D level of <30 ng/mL, it was not a statistically significant factor for decreased BMD.

CONCLUSION

In our study, the levels of vitamin D did not seem to have an important impact on BMD. Conversely, FC, magnesium and lean mass are important factors, suggesting that good control of disease, adequate magnesium intake and increased lean mass can have a good impact on bone metabolism in patients with IBD.

Dietary interventions for better management of osteoporosis: An overview

Osteoporosis is a public health concern and a cause of bone loss, increased risk of skeletal fracture, and a heavy economic burden. It is common in postmenopausal women and the elderly and is impacted by dietary factors, lifestyle and some secondary factors. Although many drugs are available for the treatment of osteoporosis, these therapies are accompanied by subsequent side effects. Hence, dietary interventions are highly important to prevent osteoporosis. This review was aimed to provide a comprehensive understanding of the roles of dietary nutrients derived from natural foods and of common dietary patterns in the regulation of osteoporosis. Nutrients from daily diets, such as unsaturated fatty acids, proteins, minerals, peptides, phytoestrogens, and prebiotics, can regulate bone metabolism and reverse bone loss. Meanwhile, these nutrients generally existed in food groups and certain dietary patterns also play critical roles in skeletal health. Appropriate dietary interventions (nutrients and dietary patterns) could be primary and effective strategies to prevent and treat osteoporosis across the lifespan for the consumers and food enterprises.

Diet Modulates the Effects of Genetic Variants on the Vitamin D Metabolic Pathway and Bone Mineral Density in Mexican Postmenopausal Women

BACKGROUND

Macro- and micronutrients, such as proteins, vitamin D, and calcium (Ca), are important dietary factors that can modify bone mineral density (BMD). Genetic factors can interact with diet, affecting an individual's predisposition to osteoporosis.

OBJECTIVES

This study aimed to evaluate the associations between macro- and micronutrient intakes and BMD in Mexican postmenopausal women, and their interactions with genetic polymorphisms involved in the vitamin D metabolic pathway.

METHODS

We analyzed data from 317 postmenopausal women from the Health Workers Cohort Study, a longitudinal cohort studied in Cuernavaca, Mexico. Postmenopausal women participated in 2 data collection waves (2004-2006 and 2010-2011), with a mean time of 6.4 years. Dietary intake was assessed with a semi-quantitative FFQ. BMD (femoral neck, hip, and lumbar spine) was measured by DXA. Hybrid mixed-effects regression models were used to assess the associations of dietary macro- and micronutrients on BMD, after adjusting for confounding factors and for diet and single nucleotide polymorphism interactions.

RESULTS

At baseline, the median age was 57 years (IQR, 50-64). Mean femoral neck, hip, and lumbar spine BMDs decreased over time. We observed statistically significant longitudinal associations for diet (Ca, vitamin D, magnesium, phosphorus, and protein intake) and BMD. Increases of vitamin D, Ca, and protein intakes by 1 SD were associated with mean increases in the femoral neck BMD (0.083 SD, 0.064 SD, and 0.130 SD, respectively). Multiple significant interactions were identified between several loci (CYP2R1, CYP24A1, CYP27B1, VDR, and DHCR7/NADSYN1) and diet for BMDs (femoral neck, hip, and lumbar spine), mainly for protein intake.

CONCLUSIONS

Our data support associations of vitamin D, Ca, protein, phosphorous, and magnesium consumption with BMD in Mexican postmenopausal women and suggest possible gene-diet interactions. These results could facilitate future personalized nutrition recommendations to help prevent low BMD.

Impact of serum magnesium and bone mineral density on systemic fractures in chronic hemodialysis patients

Introduction

Bone mineral density (BMD) measured with dual-energy X-ray absorptiometry (DXA) can be used to predict fractures, but its clinical utility has not been fully established in chronic kidney disease (CKD) patients. Magnesium is an essential trace element. Although magnesium is associated with the risk of fractures in non-CKD populations, the relationship is unknown in CKD patients.

Methods

BMD and serum magnesium levels were measured in 358 stable outpatients undergoing maintenance hemodialysis therapy. The primary outcome was fragility fracture. Patients were divided into groups according to the median level of magnesium and the normal threshold value of lumbar spine BMD.

Results

During the median follow-up period of 36 months, 36 (10.0%) fractures occurred. The cumulative incidence rates of fractures were 17.6% and 5.2% [adjusted hazard ratio (aHR) 2.31, 95% confidence interval (CI) 1.03–5.17, P = 0.030] in the lower (<2.6 mg/dL) and higher (≥2.6 mg/dL) magnesium (Mg) groups, respectively, and 21.2% and 7.3% (aHR 2.59, 95% CI 1.09–6.16, P = 0.027) in the low- and high-BMD groups, respectively. The lower-Mg and low-BMD group had a 9.21-fold higher risk of fractures (95% CI; 2.35–47.00; P = 0.0010) than the higher-Mg and high-BMD group. Furthermore, adding both magnesium levels and lumbar spine BMD levels to the established risk factors significantly improved the prediction of fractures (C-index: 0.784 to 0.830, p = 0.041).

Discussion/Conclusions

The combination of serum magnesium and lumbar spine BMD can be used for fracture risk stratification and synergistically improves the prediction of fractures in CKD patients.

Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency

Magnesium plays an important role in many physiological functions. Habitually low intakes of magnesium and in general the deficiency of this micronutrient induce changes in biochemical pathways that can increase the risk of illness and, in particular, chronic degenerative diseases. The assessment of magnesium status is consequently of great importance, however, its evaluation is difficult. The measurement of serum magnesium concentration is the most commonly used and readily available method for assessing magnesium status, even if serum levels have no reliable correlation with total body magnesium levels or concentrations in specific tissues. Therefore, this review offers an overview of recent insights into magnesium from multiple perspectives. Starting from a biochemical point of view, it aims at highlighting the risk due to insufficient uptake (frequently due to the low content of magnesium in the modern western diet), at suggesting strategies to reach the recommended dietary reference values, and at focusing on the importance of detecting physiological or pathological levels of magnesium in various body districts, in order to counteract the social impact of diseases linked to magnesium deficiency.

Cardiovascular safety of calcium, magnesium and strontium: what does the evidence say?

Calcium, magnesium and strontium have all been implicated in both musculoskeletal and cardiovascular health and disease. However, despite these three elements being closely chemically related, there is marked heterogeneity of their characteristics in relation to cardiovascular outcomes. In this narrative review, we describe the relevant evidential landscape, focusing on clinical trials where possible and incorporating findings from observational and causal analyses, to discern the relative roles of these elements in musculoskeletal and cardiovascular health. We conclude that calcium supplementation (for bone health) is most appropriately used in combination with vitamin D supplementation and targeted to those who are deficient in these nutrients, or in combination with antiosteoporosis medications. Whilst calcium supplementation is associated with gastrointestinal side effects and a small increased risk of renal stones, purported links with cardiovascular outcomes remain unconvincing. In normal physiology, no mechanism for an association has been elucidated and other considerations such as dose response and temporal relationships do not support a causal relationship. There is little evidence to support routine magnesium supplementation for musculoskeletal outcomes; greater dietary intake and serum concentrations appear protective against cardiovascular events. Strontium ranelate, which is now available again as a generic medication, has clear anti-fracture efficacy but is associated with an increased risk of thromboembolic disease. Whilst a signal for increased risk of myocardial infarction has been detected in some studies, this is not supported by wider analyses. Strontium ranelate, under its current licence, thus provides a useful therapeutic option for severe osteoporosis in those who do not have cardiovascular risk factors.

Effect of Silicon Supplementation in Diets with Different Calcium Levels on Balance of Calcium, Silicon and Magnesium, and Bone Status in Growing Female Rats

Silicon (Si) is important for the growth and development of bone and connective tissues. This study aimed to evaluate the effect of Si supplementation on the balance of calcium (Ca), Si, magnesium (Mg), and bone status in growing female rats fed diets with different Ca levels. Sixty 6-week-old female Wistar rats were divided into 6 groups and fed diets with different levels of Ca (0.1, 0.5, 1.5%) and Si (5, 500 ppm) for 10 weeks. Experimental groups were as follows: Low-Ca group (LCa; 0.1% Ca), Low-Ca with Si supplementation group (LCaSi), adequate-Ca group (ACa; 0.5% Ca), adequate-Ca with Si supplementation group (ACaSi), high-Ca group (HCa; 1.5% Ca), and high-Ca with Si supplementation group (HCaSi). Si retention significantly increased by Si supplementation and significantly decreased by high-Ca diet (1.5%). Mg retention significantly decreased by high-Ca diet. Serum Ca and Si contents were not significantly different among the 6 groups. Low-Ca diet significantly increased serum osteoclain and C-telopeptide cross-link of type 1 collagen (CTx) levels, and Si supplementation significantly decreased CTx levels in the low-Ca diet group. Bone mineral density was significantly increased along with Ca increase in the diet, but was decreased by Si supplementation in the high-Ca diet. Rats in the adequate-Ca diet group had a significant increase in strength of tibia after Si supplementation. These findings indicate that the effect of Si supplementation on bone metabolism may differ according to the Ca-intake level in growing females. Although further research is needed, when supplementing Si to improve bone health in growing females, Ca-intake level should be considered.

Going to the roots of reduced magnesium dietary intake: A tradeoff between climate changes and sources

Magnesium is essential in plants where it is associated with chlorophyll pigments and serves as a cofactor of enzymes implicated in photosynthesis and metabolism. It is an essential nutrient for animals, involved in hundreds metabolic reaction and crucial for the biological activity of ATP. Not surprisingly, magnesium deficiency is detrimental for the health of plants and animals. In humans, subclinical magnesium deficiency is common and generates chronic inflammation, which is the common denominator of a wide range of mental and physical health problems from metabolic diseases to cognitive impairment, from osteopenia and sarcopenia to depression. It is ascertained that magnesium content in fruits and vegetables dropped in the last fifty years, and about 80% of this metal is lost during food processing. As a consequence, a large percentage of people all over the world does not meet the minimum daily magnesium requirement. In this scoping review, we summarize how agronomic and environmental factors, including global warming, affect magnesium content and availability in the soil and, consequently, in the food chain, with the aim of attracting the interest of botanists, agronomists, animal and human nutritionists and physicians to work on a strategy that grants adequate magnesium intake for everybody.

Hypomagnesemia and incidence of osteoradionecrosis in patients with head and neck cancers

BACKGROUND

We aimed to determine whether hypomagnesemia predicts osteoradionecrosis development in patients with squamous cell carcinoma of the oropharynx and oral cavity who received platinum-based concurrent chemoradiation with or without induction therapy.

METHODS

We reviewed data from patients with head and neck cancers who had undergone chemoradiation with weekly cisplatin/carboplatin between January 1, 2010 and December 31, 2014 at our institution. Pathologic features, laboratory test results, disease stage, and social histories were recorded. The association between hypomagnesemia and osteoradionecrosis was analyzed controlling for known confounding factors.

RESULTS

Hypomagnesemia during cancer treatment was associated with osteoradionecrosis development (HR = 2.72, P = .037) independent of total radiation dose (HR = 1.07, P = .260) and smoking history (HR = 2.05, P = .056) among the patients who received platinum-based induction chemotherapy followed by concurrent chemoradiation.

CONCLUSIONS

Hypomagnesemia was predictive of the development of osteoradionecrosis in patients with cancers of the oropharynx and oral cavity receiving platinum-based induction followed by concurrent chemoradiation.

The Association Between the Concentration of Serum Magnesium and Postmenopausal Osteoporosis

Background: Osteoporosis is the most common and widespread chronic skeletal metabolic disease in the world and can lead to catastrophic fractures. Therefore, it is important to look for factors that can be modified or controlled to prevent osteoporosis. Although serum Mg is believed to be associated with osteoporosis in many individuals, there are conflicting reports on the association between serum Mg and osteoporosis. Therefore, this meta-analyses aimed to explore the association between the concentration of serum Mg and osteoporosis as well as that between the concentration of serum Mg and osteopenia.

Methods: Articles were searched in PubMed. We also reviewed the reference lists of the relevant publications and reviews as of December 2019. Finally, 11 eligible studies involving 2,776 postmenopausal women were selected. We performed subgroup analysis, and publication bias was assessed.

Results: According to the forest plot analysis, postmenopausal women with osteoporosis had a lower concentration of serum Mg than normal controls [standardized mean difference (SMD) = −0.56, 95% confidence interval (CI) = −1.02 to −0.09]. However, this result was not applicable to those with osteopenia (SMD = −0.30, 95% CI = −0.69 to 0.09). The subgroup analysis by geographical location found a similar pattern in European postmenopausal women with osteoporosis (SMD = −0.73, 95% CI = −1.322 to −0.143), but not in Asian (SMD = −0.007, 95% CI = −0.381 to 0.394). The subgroup analysis by site of bone mineral density (BMD) showed the serum Mg concentration of postmenopausal women with osteoporosis (BMD of femur) was lower than in healthy controls (SMD = −0.44, 95% CI = −0.77 to −0.12), and BMD of the spine group had the same conclusion (SMD = −0.78, 95% CI = −1.36 to −0.19). Besides, the serum Mg concentration of postmenopausal women with osteoporosis was lower than that of the normal bone mass group in the studies those included more than 50 postmenopausal women with osteoporosis (SMD = −0.57, 95% CI = −1.04 to −0.11). We also found postmenopausal women under the age of 60 with osteoporosis had a lower concentration of serum Mg than the healthy controls (SMD = −0.61, 95% CI = −1.09 to −0.13).

Conclusion: Postmenopausal women with osteoporosis have a lower concentration of serum Mg. However, the association between the concentration of serum Mg and osteopenia needs further confirmation.

Magnesium oxide and hip fracture in the elderly: a population-based retrospective cohort analysis

Using national insurance claims of Taiwan, we found that magnesium oxide (MgO) use is associated with an increased risk of hip fracture in the elderly. Further studies are warranted to explore the mechanisms associated with MgO use that lead to hip fracture.

PURPOSE

The purpose of this study was to investigate the association between MgO use and hip fracture risk in the elderly (age > 65 years).

METHODS

This nationwide population-based retrospective study was conducted from 1996 to 2013. Individuals with (n = 26,069) and without (n = 26,069) MgO use were enrolled after propensity score matching. Primary outcome was a hip fracture. After adjusting for age, sex, comorbidities, and medications, multivariate Cox proportional hazards regression models were used to calculate incidences and risk of hip fracture [hazard ratio (HR)].

RESULTS

During the mean follow-up duration of 4.8 years in the MgO cohort and 5.7 years in the non-MgO cohort, respectively 1547 and 1107 cases developed a hip fracture. MgO use was identified as a risk factor for hip fracture in both univariate [crude HR, 1.68; 95% confidence interval (CI), 1.55-1.81; p < 0.001] and multivariate [adjusted HR (aHR), 1.66; 95% CI, 1.54-1.80; p < 0.001] Cox proportional hazards regression models. The cumulative incidence of hip fracture was significantly higher in the MgO cohort than in the non-MgO cohort (1.23 per 100 person-years vs. 0.74 per 100 person-years, logrank test, p < 0.001).

CONCLUSION

MgO use is an independent risk factor for hip fracture in the elderly.

Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases

The chronic character of inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.

Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health

Supplementation with calcium (Ca) and/or vitamin D (vitD) is key to the management of osteoporosis. Other supplements like vitamin K2 (VitK2) and magnesium (Mg) could contribute to the maintenance of skeletal health. This narrative review summarizes the most recent data on Ca, vitD, vitK2 and Mg supplementation and age-related bone and muscle loss. Ca supplementation alone is not recommended for fracture prevention in the general postmenopausal population. Patients at risk of fracture with insufficient dietary intake and absorption could benefit from calcium supplementation, but it needs to be customized, taking into account possible side-effects and degree of adherence. VitD supplementation is essential in patients at risk of fracture and/or vitD deficiency. VitK2 and Mg both appear to be involved in bone metabolism. Data suggest that VitK2 supplementation might improve bone quality and reduce fracture risk in osteoporotic patients, potentially enhancing the efficacy of Ca ± vitD. Mg deficiency could negatively influence bone and muscle health. However, data regarding the efficacy of vitK2 and Mg supplementation on bone are inconclusive.

Magnesium and health outcomes: an umbrella review of systematic reviews and meta-analyses of observational and intervention studies

PURPOSE

To map and grade all health outcomes associated with magnesium (Mg) intake and supplementation using an umbrella review.

METHODS

Umbrella review of systematic reviews with meta-analyses of observational studies and randomized controlled trials (RCTs) using placebo/no intervention as control group. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects and excess significance. For meta-analyses of RCTs, outcomes with a random-effect p value < 0.005 and a high-GRADE assessment were classified as strong evidence.

RESULTS

From 2048 abstracts, 16 meta-analyses and 55 independent outcomes were included (36 in RCTs and 19 in observational studies). In RCTs of Mg versus placebo/no active treatment, 12 over 36 outcomes reported significant results (p < 0.05). A strong evidence for decreased need for hospitalization in pregnancy and for decreased risk of frequency and intensity of migraine relapses in people with migraine was observed using the GRADE assessment. In observational studies, 9/19 outcomes were significant (p < 0.05). However, only one outcome presented highly suggestive evidence (lower incidence of type 2 diabetes in people with higher Mg intake at baseline) and one suggestive (lower incidence of stroke associated with higher Mg intake at baseline).

CONCLUSION

Strong evidence according to the GRADE suggests that Mg supplementation can decrease the risk of hospitalization in pregnant women and reduce the intensity/frequency of migraine. Higher Mg intake is associated with a decreased risk of type 2 diabetes and stroke with highly suggestive and suggestive evidence, respectively, in observational studies.

Lipid Profile and Risk of Bone Fracture: A Systematic Review and Meta-Analysis of Observational Studies

Purpose: Earlier studies have linked lipid profile to osteoporotic fractures; however, to our knowledge, no study had summarized available data on this relationship. We aimed to summarize the current evidence on the association between lipid profile and bone fractures. Material and Methods: A systematic search of PubMed and Scopus was done to find relevant published studies until March 2018. To combine effect sizes, we applied fixed- or random-effects analysis, where appropriate. Cochran's Q test and I² were used to assess between-study heterogeneity. Results: Overall, 11 studies (seven prospective, three cross-sectional and one case-control studies) were included in the current systematic review. Out of them, 10 studies with a total sample size of 60,484 individuals, aged 25 years or more, were used in the meta-analysis. The results showed that total cholesterol concentration was positively associated with risk of bone fracture; such that a 50-mg/dl increase in plasma level of TC was associated with 15% greater odds of bone fracture (combined effect size: 1.15, 95% CI: 1.02-1.30, P = .02). Furthermore, we found that individuals with a decreased level of HDL (<40 mg/dl) had a lower risk of bone fracture compared with those with a normal level (≥40 mg/dl) (combined effect size: 0.82, 95% CI: 0.71-0.96, P = .01). No significant association was found between plasma level of TG and LDL with the risk of bone fractures either in prospective or cross-sectional studies. Conclusions: We found that plasma levels of total cholesterol were positively associated with bone fractures. In addition, decreased levels of HDL were associated with an increased risk of osteoporotic fractures. Abbreviations: TG: triglycerides, TC: total cholesterol, HDL: high-density lipoprotein, LDL: low-density lipoprotein, OR: odds ratio, RR: relative risk, HR: hazard ratio, DXA: dual-energy X-ray absorptiometry, ICD: International Classification of Diseases, SD: standard deviation.

The relationship between magnesium and osteoarthritis of knee: A MOOSE guided systematic review and meta-analysis

The impact of magnesium on risk of knee osteoarthritis (KOE) is still under investigation. This meta-analysis evaluated the relationship between magnesium and risk of KOE.A comprehensive search was performed to identify retrospective cohort study or cross-sectional study of the association between magnesium and KOE from the Cochrane library, PubMed, and Embase. The search time limit was from the establishment of the database to December 2018. Two evaluators selected the literature, extracted the data, and evaluated the quality of the literature according to the inclusion and exclusion criteria, independently. Meta-analysis was performed using RevMan 5.3 software and publication bias was assessed using Begg and Egger test and funnel plot.Finally, 6 studies were included with a total of 15,715 participants. Although higher daily intake of magnesium was associated with a significantly reduced risk of fracture in patients with KOE (OR = 0.66, 95%CI: 0.56, 0.78; P < .00001), it was not significant for lowering the risk of KOE (OR = 0.80; 95% CI: 0.61, 1.04; P = .1). Meta-analysis also showed that population with higher serum magnesium levels had significantly lower risk of KOE (odds ratio (OR) = 0.84; 95% confidence interval (CI): 0.72, 0.98; P = .03). Further subgroup analysis showed that the relationship between serum magnesium level and KOE risk was significantly affected by serum magnesium level (P = .006 for quartiles 4 vs 1).Higher level of magnesium intake was not associated with lower risk of KOE. However, higher daily intake of magnesium may be inversely associated with risk of fracture in KOE patients.

Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review

Objectives: The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D.Study Design: Scoping review.Settings/Participants: Human adult subjects with a SCI/D.Outcome measures: Strategies to identify persons with SCI/D at risk for osteoporotic fractures, nonpharmacological and pharmacological therapies for osteoporosis and management of appendicular fractures.Results: 226 articles were included in the scoping review. Risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis, in particular hyperparathyroidism, hyperthyroidism, vitamin D insufficiency and hypogonadism, should be considered. Current antiresorptive therapies for treatment of osteoporosis have limited efficacy. Use of surgery to treat fractures has increased and outcomes are good and comparable to conservative treatment in most cases. A common adverse event following fracture was delayed healing.Conclusions: Most of the research in this area is limited by small sample sizes, weak study designs, and significant variation in populations studied. Future research needs to address cohort definition and study design issues.