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Lanyan A, Marques-Vidal P, Métrailler A, Gonzalez Rodriguez E, Hans D, Shevroja E, Lamy O. Relationship between dietary characteristics and heel quantitative ultrasound parameters in postmenopausal women from the OsteoLaus cohort. Sci Rep 2024; 14:1638. [PMID: 38238451 PMCID: PMC10796405 DOI: 10.1038/s41598-024-51774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
The role of dietary patterns in the development of osteoporosis is unclear. The heel quantitative ultrasound (QUS) is a potential alternative to Dual X-Ray Absorptiometry. Nutrients, foods, dietary patterns and compliance to dietary guidelines were compared between the lowest and the highest tertiles of QUS parameters [Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS), Stiffness Index (SI)], using data from the OsteoLaus cohort. Participants in the highest tertiles of QUS parameters (385 for BUA, 397 for SOS, 386 for SI) were younger, of higher body weight, and had less major osteoporotic fractures. Women in the highest tertiles of SI and BUA consumed more fat (35.1 ± 0.4 vs 33.9 ± 0.4 and 34.9 ± 0.4 vs 33.8 ± 0.4 gr/day for SI and BUA, respectively, p < 0.05), and complied less frequently with dairy intake guidelines [odds ratio (95% confidence interval): 0.70 (0.53-0.92) and 0.72 (0.55-0.95) for SI and BUA, respectively, p < 0.05] than women in the lowest tertile. No differences were found regarding dietary patterns, healthy dietary scores, or compliance to dietary guidelines. Postmenopausal women in the highest QUS tertiles were younger, of higher weight and BMI, consumed more monounsaturated fatty acids and less dairy and calcium than women in the lowest tertiles. No differences were found between QUS tertiles regarding dietary patterns.
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Affiliation(s)
- A Lanyan
- Bone Diseases CENTER, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - P Marques-Vidal
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - A Métrailler
- Bone Diseases CENTER, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - E Gonzalez Rodriguez
- Bone Diseases CENTER, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - D Hans
- Bone Diseases CENTER, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - E Shevroja
- Bone Diseases CENTER, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - O Lamy
- Bone Diseases CENTER, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Nyakundi PN, Némethné Kontár Z, Kovács A, Járomi L, Zand A, Lohner S. Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews. Nutrients 2023; 15:3742. [PMID: 37686773 PMCID: PMC10489979 DOI: 10.3390/nu15173742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple foods for household use. In April 2023, we systematically searched Ovid MEDLINE, Embase, Epistemonikos and the Cochrane Database of Systematic Reviews for systematic reviews investigating the effects of vitamin D fortification of food in general populations of any age. We used Cochrane methodology and assessed the methodological quality of included studies using AMSTAR (A MeaSurement Tool to Assess Systematic Reviews). We assessed the degree of overlap among reviews. All outcomes included in systematic reviews were assessed. The protocol is registered in PROSPERO (registration number: CRD42023420991). We included 27 systematic reviews out of 5028 records for analysis. Overall, 11 out of 12 systematic reviews calculating pooled estimates reported a significant increase in serum 25(OH)D concentrations. The mean change in serum 25(OH)D concentrations per additional 100 units of vitamin D ranged from 0.7 to 10.8 nmol/L. Fortification of food with vitamin D showed a reduction in the prevalence of vitamin D deficiency based on high-certainty evidence. Parathormone (PTH) levels were described to decrease, bone mineral density to increase, while the effects on other bone turnover markers were inconsistent. Fortification did not significantly impact most anthropometric parameters, but it seemed to positively influence lipid profiles. In summary, fortification of food with vitamin D results in a reduction of vitamin D deficiency and might increase serum 25(OH)D concentrations, to varying extents depending on the fortified vehicle and population characteristics. Additionally, fortification may have a positive impact on bone turnover and lipid metabolism but may only have a limited effect on anthropometric parameters.
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Affiliation(s)
- Patrick Nyamemba Nyakundi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | | | - Attila Kovács
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Luca Járomi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Afshin Zand
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Szimonetta Lohner
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
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Métrailler A, Hans D, Lamy O, Gonzalez Rodriguez E, Shevroja E. Heel quantitative ultrasound (QUS) predicts incident fractures independently of trabecular bone score (TBS), bone mineral density (BMD), and FRAX: the OsteoLaus Study. Osteoporos Int 2023:10.1007/s00198-023-06728-4. [PMID: 37154943 PMCID: PMC10382398 DOI: 10.1007/s00198-023-06728-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/16/2023] [Indexed: 05/10/2023]
Abstract
This study aimed to better define the role of heel-QUS in fracture prediction. Our results showed that heel-QUS predicts fracture independently of FRAX, BMD, and TBS. This corroborates its use as a case finding/pre-screening tool in osteoporosis management. INTRODUCTION Quantitative ultrasound (QUS) characterizes bone tissue based on the speed of sound (SOS) and broadband ultrasound attenuation (BUA). Heel-QUS predicts osteoporotic fractures independently of clinical risk factors (CRFs) and bone mineral density (BMD). We aimed to investigate whether (1) heel-QUS parameters predict major osteoporotic fractures (MOF) independently of the trabecular bone score (TBS) and (2) the change of heel-QUS parameters over 2.5 years is associated with fracture risk. METHODS One thousand three hundred forty-five postmenopausal women from the OsteoLaus cohort were followed up for 7 years. Heel-QUS (SOS, BUA, and stiffness index (SI)), DXA (BMD and TBS), and MOF were assessed every 2.5 years. Pearson's correlation and multivariable regression analyses were used to determine associations between QUS and DXA parameters and fracture incidence. RESULTS During a mean follow-up of 6.7 years, 200 MOF were recorded. Fractured women were older, more treated with anti-osteoporosis medication; had lower QUS, BMD, and TBS; higher FRAX-CRF risk; and more prevalent fractures. TBS was significantly correlated with SOS (0.409) and SI (0.472). A decrease of one SD in SI, BUA or SOS increased the MOF risk by (OR(95%CI)) 1.43 (1.18-1.75), 1.19 (0.99-1.43), and 1.52 (1.26-1.84), respectively, after adjustment for FRAX-CRF, treatment, BMD, and TBS. We found no association between the change of QUS parameters in 2.5 years and incident MOF. CONCLUSION Heel-QUS predicts fracture independently of FRAX, BMD, and TBS. Thus, QUS represents an important case finding/pre-screening tool in osteoporosis management. The change in QUS over time was not associated with future fractures, making it inappropriate for patient monitoring.
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Affiliation(s)
- Antoine Métrailler
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and Lausanne University, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
| | - Didier Hans
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and Lausanne University, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
| | - Olivier Lamy
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and Lausanne University, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and Lausanne University, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
| | - Enisa Shevroja
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and Lausanne University, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland.
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Ruiz-García A, Pallarés-Carratalá V, Turégano-Yedro M, Torres F, Sapena V, Martin-Gorgojo A, Martin-Moreno JM. Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials. Nutrients 2023; 15:nu15081810. [PMID: 37111028 PMCID: PMC10146299 DOI: 10.3390/nu15081810] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs. RESULTS Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants' mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91-0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87-1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes. CONCLUSIONS The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.
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Affiliation(s)
- Antonio Ruiz-García
- Lipids and Cardiovascular Prevention Unit, Pinto University Health Center, 28320 Madrid, Spain
- Department of Medicine, European University of Madrid, 28670 Madrid, Spain
| | - Vicente Pallarés-Carratalá
- Health Surveillance Unit, Castellón Mutual Insurance Union, 12003 Castellón, Spain
- Department of Medicine, Universitat Jaume I, 12006 Castellón, Spain
| | | | - Ferran Torres
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona Bellaterra, 08193 Barcelona, Spain
| | - Víctor Sapena
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona Bellaterra, 08193 Barcelona, Spain
| | | | - Jose M Martin-Moreno
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain
- Biomedical Research Institute INCLIVA, Clinic University Hospital, 46010 Valencia, Spain
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Xu J, Li S, Zeng Y, Si H, Wu Y, Zhang S, Shen B. Assessing the Association between Important Dietary Habits and Osteoporosis: A Genetic Correlation and Two-Sample Mendelian Randomization Study. Nutrients 2022; 14:nu14132656. [PMID: 35807838 PMCID: PMC9268345 DOI: 10.3390/nu14132656] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/18/2022] Open
Abstract
Objective: Osteoporosis (OP) is the most common bone disease. The genetic and metabolic factors play important roles in OP development. However, the genetic basis of OP is still elusive. The study aimed to explore the relationships between OP and dietary habits. Methods: This study used large-scale genome-wide association study (GWAS) summary statistics from the UK Biobank to explore potential associations between OP and 143 dietary habits. The GWAS summary data of OP included 9434 self-reported OP cases and 444,941 controls, and the GWAS summary data of the dietary habits included 455,146 participants of European ancestry. Linkage disequilibrium score regression (LDSC) was used to detect the genetic correlations between OP and each of the 143 dietary habits, followed by Mendelian randomization (MR) analysis to further assess the causal relationship between OP and candidate dietary habits identified by LDSC. Results: The LDSC analysis identified seven candidate dietary habits that showed genetic associations with OP including cereal type such as biscuit cereal (coefficient = −0.1693, p value = 0.0183), servings of raw vegetables per day (coefficient = 0.0837, p value = 0.0379), and spirits measured per month (coefficient = 0.115, p value = 0.0353). MR analysis found that OP and PC17 (butter) (odds ratio [OR] = 0.974, 95% confidence interval [CI] = (0.973, 0.976), p value = 0.000970), PC35 (decaffeinated coffee) (OR = 0.985, 95% CI = (0.983, 0.987), p value = 0.00126), PC36 (overall processed meat intake) (OR = 1.035, 95% CI = (1.033, 1.037), p value = 0.000976), PC39 (spirits measured per month) (OR = 1.014, 95% CI = (1.011, 1.015), p value = 0.00153), and servings of raw vegetables per day (OR = 0.978, 95% CI = (0.977, 0.979), p value = 0.000563) were clearly causal. Conclusions: Our findings provide new clues for understanding the genetic mechanisms of OP, which focus on the possible role of dietary habits in OP pathogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Bin Shen
- Correspondence: ; Tel.: +86-138-8187-8767; Fax: +86-028-85423438
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Millar CL, Kiel DP, Hannan MT, Sahni S. Dairy food intake is not associated with spinal trabecular bone score in men and women: the Framingham Osteoporosis Study. Nutr J 2022; 21:26. [PMID: 35538577 PMCID: PMC9092785 DOI: 10.1186/s12937-022-00781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies reported that dairy foods are associated with higher areal bone mineral density (BMD) in older adults. However, data on bone texture are lacking. We determined the association of dairy food intake (milk, yogurt, cheese, milk + yogurt and milk + yogurt + cheese) with spinal trabecular bone score (TBS). METHODS In this cross-sectional study, a validated semi-quantitative food frequency questionnaire was used to assess dairy food intake (servings/wk). TBS, an analysis of bone texture, was calculated from dual energy X-ray absorptiometry (DXA) scans. Sex-specific multivariable linear regression was used to estimate the association of dairy food intake (energy adjusted via residual methods) with each bone measure adjusting for covariates. RESULTS Mean age of 4,740 participants was 49 (SD: 13) years and mean milk + yogurt + cheese intake was 10.1 (SD: 8.4) servings/week in men and 10.9 (SD: 8.0) servings/week in women. There were no associations between dairy food intake and spinal TBS in adjusted models. CONCLUSIONS In this cohort of primarily healthy adults, dairy intake was not associated with bone texture.
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Affiliation(s)
- Courtney L Millar
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, 1200 Centre Street, Boston, MA, 02131, USA
| | - Douglas P Kiel
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, 1200 Centre Street, Boston, MA, 02131, USA
| | - Marian T Hannan
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, 1200 Centre Street, Boston, MA, 02131, USA
| | - Shivani Sahni
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, 1200 Centre Street, Boston, MA, 02131, USA.
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Millar CL, Kiel DP, Hannan MT, Sahni S. Dairy Food Intake Is Not Associated with Measures of Bone Microarchitecture in Men and Women: The Framingham Osteoporosis Study. Nutrients 2021; 13:nu13113940. [PMID: 34836198 PMCID: PMC8622947 DOI: 10.3390/nu13113940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Previous studies reported that dairy foods are associated with higher areal bone mineral density (BMD) in older adults. However, data on bone strength and bone microarchitecture are lacking. We determined the association of dairy food intake (milk, yogurt, cheese, milk + yogurt, and milk + yogurt + cheese, servings/week) with high resolution peripheral quantitative computed tomography (HR-pQCT) measures of bone (failure load, cortical BMD, cortical thickness, trabecular BMD, and trabecular number). This cross-sectional study included participants with diet from a food frequency questionnaire (in 2005–2008 and/or 1998–2001) and measurements of cortical and trabecular BMD and microarchitecture at the distal tibia and radius (from HR-pQCT in 2012–2015). Sex-specific multivariable linear regression estimated the association of dairy food intake (energy adjusted) with each bone measure adjusting for covariates. Mean age was 64 (SD 8) years and total milk + yogurt + cheese intake was 10.0 (SD 6.6) and 10.6 (6.4) servings/week in men and women, respectively. No significant associations were observed for any of the dairy foods and bone microarchitecture measures except for cheese intake, which was inversely associated with cortical BMD at the radius (p = 0.001) and tibia (p = 0.002) in women alone. In this cohort of primarily healthy older men and women, dairy intake was not associated with bone microarchitecture. The findings related to cheese intake and bone microarchitecture in women warrant further investigation.
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Fonseca Santos RK, Santos CB, Reis AR, Brandão-Lima PN, de Carvalho GB, Martini LA, Pires LV. Role of food fortification with vitamin D and calcium in the bone remodeling process in postmenopausal women: a systematic review of randomized controlled trials. Nutr Rev 2021; 80:826-837. [PMID: 34368851 DOI: 10.1093/nutrit/nuab055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover. OBJECTIVE To discuss effects of the intake of vitamin D-fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women. DATA SOURCES PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as "grey literature". Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used. DATA EXTRACTION Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations. DATA ANALYSIS Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (-0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL. CONCLUSIONS The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women. PROSPERO REGISTRATION NUMBER CRD42019131976.
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Affiliation(s)
- Ramara Kadija Fonseca Santos
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Cynthia Batista Santos
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Aline Rocha Reis
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Paula Nascimento Brandão-Lima
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Gabrielli Barbosa de Carvalho
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Ligia Araújo Martini
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Liliane Viana Pires
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
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Liu C, Kuang X, Li K, Guo X, Deng Q, Li D. Effects of combined calcium and vitamin D supplementation on osteoporosis in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Food Funct 2020; 11:10817-10827. [PMID: 33237064 DOI: 10.1039/d0fo00787k] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of the present study was to explore whether combined calcium and vitamin D supplementation is beneficial for osteoporosis in postmenopausal women. METHODS We searched the PubMed, Cochrane library, Web of science and Embase databases and reference lists of eligible articles up to Feb, 2020. Randomized controlled trials (RCTs) evaluating the effect of combined calcium and vitamin D on osteoporosis in postmenopausal women were included in the present study. RESULTS Combined calcium and vitamin D significantly increased total bone mineral density (BMD) (standard mean differences (SMD) = 0.537; 95% confidence interval (CI): 0.227 to 0.847), lumbar spine BMD (SMD = 0.233; 95% CI: 0.073 to 0.392; P < 0.001), arms BMD (SMD = 0.464; 95% CI: 0.186 to 0.741) and femoral neck BMD (SMD = 0.187; 95% CI: 0.010 to 0.364). It also significantly reduced the incidence of hip fracture (RR = 0.864; 95% CI: 0.763 to 0.979). Subgroup analysis showed that combined calcium and vitamin D significantly increased femoral neck BMD only when the dose of the vitamin D intake was no more than 400 IU d-1 (SMD = 0.335; 95% CI: 0.113 to 0.558), but not for a dose more than 400 IU d-1 (SMD = -0.098; 95% CI: -0.109 to 0.305), and calcium had no effect on the femoral neck BMD. Subgroup analysis also showed only dairy products fortified with calcium and vitamin D had a significant influence on total BMD (SMD = 0.784; 95% CI: 0.322 to 1.247) and lumbar spine BMD (SMD = 0.320; 95% CI: 0.146 to 0.494), but not for combined calcium and vitamin D supplement. CONCLUSION Dairy products fortified with calcium and vitamin D have a favorable effect on bone mineral density. Combined calcium and vitamin D supplementation could prevent osteoporosis hip fracture in postmenopausal women.
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Affiliation(s)
- Chunxiao Liu
- Institute of Nutrition and Health, Qingdao University, Qingdao 266021, China.
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The effect of vitamin D fortified products on anthropometric indices: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 41:101242. [DOI: 10.1016/j.ctcp.2020.101242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 01/19/2023]
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11
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Ong AM, Kang K, Weiler HA, Morin SN. Fermented Milk Products and Bone Health in Postmenopausal Women: A Systematic Review of Randomized Controlled Trials, Prospective Cohorts, and Case-Control Studies. Adv Nutr 2020; 11:251-265. [PMID: 31603185 PMCID: PMC7442363 DOI: 10.1093/advances/nmz108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/08/2019] [Accepted: 09/13/2019] [Indexed: 12/30/2022] Open
Abstract
Milk and milk product consumption is positively associated with bone mineral density (BMD). Emerging evidence suggests that fermented milk products (FMPs) may have specific beneficial effects on skeletal health. We conducted a systematic review and meta-analysis to assess the effect of FMPs on bone health indicators in postmenopausal women given their increased risk for osteoporosis and fragility fractures. Electronic databases were searched for randomized controlled trials (RCTs) and prospective cohort and case-control studies that examined the relation between FMPs and bone health outcomes (fracture incidence, BMD, BMD T-score, and percentage change in bone turnover markers) in postmenopausal women. Two reviewers independently conducted abstract and full-text screenings and data extractions. Risk of bias was assessed using the RoB 2.0 tool and the Newcastle-Ottawa scale for interventional and observational studies. Pooled RRs were obtained using a random-effects model by the DerSimonian-Laird method. Three RCTs, 3 prospective cohorts, and 3 case-control studies met the inclusion criteria. Results of the meta-analysis of 3 cohort studies (n = 102,819) suggest that higher yogurt consumption was associated with reduced hip fracture risk (pooled RR: 0.76; 95% CI: 0.63, 0.92, I2 = 29%), but no difference in hip fracture risk was found between higher and lower cheese consumption (pooled RR: 0.89; 95% CI: 0.73, 1.10, I2 = 0%). Case-control studies revealed that cheese intake had either a null or a protective effect against osteoporosis (BMD T-score ≤-2.5). Daily yogurt or cheese intervention (<2 mo) decreased bone resorption marker concentrations, but had no effect on bone formation markers. In postmenopausal women, of the FMPs studied, only greater yogurt consumption was associated with a reduced risk of hip fracture compared with low or no intake. Daily cheese intake may be associated with higher BMD T-scores, but evidence was limited. Additional and longer-term trials examining these relations are warranted.
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Affiliation(s)
- Angel M Ong
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kai Kang
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada,Department of Research and Surveillance Evaluation, Shanghai Center for Health Promotion, Jingan Area, Shanghai, China
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Suzanne N Morin
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada,Address correspondence to SNM (e-mail: )
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12
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Impact of calcium, vitamin D, vitamin K, oestrogen, isoflavone and exercise on bone mineral density for osteoporosis prevention in postmenopausal women: a network meta-analysis. Br J Nutr 2020. [DOI: 10.1017/s0007114519002290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AbstractThe aim of this network meta-analysis is to compare bone mineral density (BMD) changes among different osteoporosis prevention interventions in postmenopausal women. We searched MEDLINE, Embase and Cochrane Library from inception to 24 February 2019. Included studies were randomised controlled trials (RCT) comparing the effects of different treatments on BMD in postmenopausal women. Studies were independently screened by six authors in three pairs. Data were extracted independently by two authors and synthesised using Bayesian random-effects network meta-analysis. The results were summarised as mean difference in BMD and surface under the cumulative ranking (SUCRA) of different interventions. A total of ninety RCT (10 777 participants) were included. Ca, vitamin D, vitamin K, oestrogen, exercise, Ca + vitamin D, vitamin D + vitamin K and vitamin D + oestrogen were associated with significantly beneficial effects relative to no treatment or placebo for lumbar spine (LS). For femoral neck (FN), Ca, exercise and vitamin D + oestrogen were associated with significantly beneficial intervention effects relative to no treatment. Ranking probabilities indicated that oestrogen + vitamin D is the best strategy in LS, with a SUCRA of 97·29 % (mean difference: +0·072 g/cm2 compared with no treatment, 95 % credible interval (CrI) 0·045, 0·100 g/cm2), and Ca + exercise is the best strategy in FN, with a SUCRA of 79·71 % (mean difference: +0·029 g/cm2 compared with placebo, 95 % CrI –0·00093, 0·060 g/cm2). In conclusion, in postmenopausal women, many interventions are valuable for improving BMD in LS and FN. Different intervention combinations can affect BMD at different sites diversely.
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13
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Tangestani H, Djafarian K, Emamat H, Arabzadegan N, Shab-Bidar S. Efficacy of vitamin D fortified foods on bone mineral density and serum bone biomarkers: A systematic review and meta-analysis of interventional studies. Crit Rev Food Sci Nutr 2019; 60:1094-1103. [DOI: 10.1080/10408398.2018.1558172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hadith Tangestani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kurosh Djafarian
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hadi Emamat
- Student Research Committee, Department and Faculty of Nutrition Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Arabzadegan
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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14
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Jennings A, Cashman KD, Gillings R, Cassidy A, Tang J, Fraser W, Dowling KG, Hull GLJ, Berendsen AAM, de Groot LCPGM, Pietruszka B, Wierzbicka E, Ostan R, Bazzocchi A, Battista G, Caumon E, Meunier N, Malpuech-Brugère C, Franceschi C, Santoro A, Fairweather-Tait SJ. A Mediterranean-like dietary pattern with vitamin D3 (10 µg/d) supplements reduced the rate of bone loss in older Europeans with osteoporosis at baseline: results of a 1-y randomized controlled trial. Am J Clin Nutr 2018; 108:633-640. [PMID: 30007343 PMCID: PMC6134287 DOI: 10.1093/ajcn/nqy122] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/15/2018] [Indexed: 01/14/2023] Open
Abstract
Background The Mediterranean diet (MD) is widely recommended for the prevention of chronic disease, but evidence for a beneficial effect on bone health is lacking. Objective The aim of this study was to examine the effect of a Mediterranean-like dietary pattern [NU-AGE (New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe)] on indexes of inflammation with a number of secondary endpoints, including bone mineral density (BMD) and biomarkers of bone and collagen degradation in a 1-y multicenter randomized controlled trial (RCT; NU-AGE) in elderly Europeans. Design An RCT was undertaken across 5 European centers. Subjects in the intervention group consumed the NU-AGE diet for 1 y by receiving individually tailored dietary advice, coupled with supplies of foods including whole-grain pasta, olive oil, and a vitamin D3 supplement (10 µg/d). Participants in the control group were provided with leaflets on healthy eating available in their country. Results A total of 1294 participants (mean ± SD age: 70.9 ±4.0 y; 44% male) were recruited to the study and 1142 completed the 1-y trial. The Mediterranean-like dietary pattern had no effect on BMD (site-specific or whole-body); the inclusion of compliance to the intervention in the statistical model did not change the findings. There was also no effect of the intervention on the urinary biomarkers free pyridinoline or free deoxypyridinoline. Serum 25-hydroxyvitamin D significantly increased and parathyroid hormone decreased (P < 0.001) in the MD compared with the control group. Subgroup analysis of individuals with osteoporosis at baseline (site-specific BMD T-score ≤ -2.5 SDs) showed that the MD attenuated the expected decline in femoral neck BMD (n = 24 and 30 in MD and control groups, respectively; P = 0.04) but had no effect on lumbar spine or whole-body BMD. Conclusions A 1-y intervention of the Mediterranean-like diet together with vitamin D3 supplements (10 µg/d) had no effect on BMD in the normal age-related range, but it significantly reduced the rate of loss of bone at the femoral neck in individuals with osteoporosis. The NU-AGE trial is registered at clinicaltrials.gov as NCT01754012.
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Affiliation(s)
- Amy Jennings
- Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Kevin D Cashman
- Cork Center for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences,Department of Medicine, University College Cork, Cork, Ireland
| | - Rachel Gillings
- Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Aedin Cassidy
- Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Jonathan Tang
- Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - William Fraser
- Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Kirsten G Dowling
- Cork Center for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences
| | - George L J Hull
- Cork Center for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences
| | | | | | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Elzbieta Wierzbicka
- Department of Human Nutrition, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | | | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, “Rizzoli” Orthopedic Institute, Bologna, Italy
| | - Giuseppe Battista
- Department of Experimental, Diagnostic, and Speciality Medicine, Alma Mater Studorium, University of Bologna, Bologna, Italy
| | | | | | - Corinne Malpuech-Brugère
- Université Clermont Auvergne, Institut National de la Recherche Agronomique (INRA), Unité de Nutrition Humaine, Centre de Recherches en Nutrition Humaine (CRNH) d'Auvergne, Clermont-Ferrand, France
| | | | - Aurelia Santoro
- Interdepartmental Center “L Galvani”,Department of Experimental, Diagnostic, and Speciality Medicine, Alma Mater Studorium, University of Bologna, Bologna, Italy
| | - Susan J Fairweather-Tait
- Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Address correspondence to SJF-T (e-mail: )
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15
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van Dongen LH, Kiel DP, Soedamah-Muthu SS, Bouxsein ML, Hannan MT, Sahni S. Higher Dairy Food Intake Is Associated With Higher Spine Quantitative Computed Tomography (QCT) Bone Measures in the Framingham Study for Men But Not Women. J Bone Miner Res 2018; 33:1283-1290. [PMID: 29480959 PMCID: PMC7254869 DOI: 10.1002/jbmr.3414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022]
Abstract
Previous studies found that dairy foods were associated with higher areal bone mineral density (BMD). However, data on bone geometry or compartment-specific bone density is lacking. In this cross-sectional study, the association of milk, yogurt, cheese, cream, milk+yogurt, and milk+yogurt+cheese intakes with quantitative computed tomography (QCT) measures of bone were examined, and we determined if associations were modified by serum vitamin D (25-OH D, tertiles) or age (<50 versus ≥50 years). Participants were 1522 men and 1104 women (aged 32 to 81 years, mean 50 years [men]; 55 years [women]) from the Framingham Heart Study with measures of dairy food intake (servings/wk) from a food-frequency questionnaire, volumetric BMD (vBMD, integral and trabecular, g/cm3 ), cross-sectional area (CSA, cm2 ), and estimated vertebral compressive strength (VCS, N) and 25-OH D (radioimmunoassay). Sex-specific multivariable linear regression was used to calculate the association of dairy food intake (energy adjusted) with each QCT measure, adjusting for covariates. Mean milk intake ±SD was 6 ± 7 servings/week in both men and women. In men, higher intake of milk, milk+yogurt, and milk+yogurt+cheese was associated with higher integral (p = 0.001 to 0.006) and trabecular vBMD (p = 0.006 to 0.057) and VCS (p = 0.001 to 0.010). Further, a higher cheese intake was related with higher CSA (p = 0.049). In women, no significant results were observed for the dairy foods, except for a positive association of cream intake with CSA (p = 0.016). The associations appeared to be stronger in older men. Across 25-OH D tertiles, dairy was positively associated with bone health. In summary, men with higher intakes of milk, milk+yogurt, and milk+yogurt+cheese had higher trabecular and integral vBMD and VCS but not CSA. Dairy intake seems to be most beneficial for older men, and dairy continued to have positive associations among all 25-OH D levels. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Laura H van Dongen
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sabita S Soedamah-Muthu
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,Institute for Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Marian T Hannan
- Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Shivani Sahni
- Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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16
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Abstract
Fermented milk products like yogurt or soft cheese provide calcium, phosphorus, and protein. All these nutrients influence bone growth and bone loss. In addition, fermented milk products may contain prebiotics like inulin which may be added to yogurt, and provide probiotics which are capable of modifying intestinal calcium absorption and/or bone metabolism. On the other hand, yogurt consumption may ensure a more regular ingestion of milk products and higher compliance, because of various flavors and sweetness. Bone mass accrual, bone homeostasis, and attenuation of sex hormone deficiency-induced bone loss seem to benefit from calcium, protein, pre-, or probiotics ingestion, which may modify gut microbiota composition and metabolism. Fermented milk products might also represent a marker of lifestyle promoting healthy bone health.
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Affiliation(s)
- René Rizzoli
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, 1211, Geneva 14, Switzerland.
| | - Emmanuel Biver
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, 1211, Geneva 14, Switzerland
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17
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Sahni S, Soedamah-Muthu SS, Weaver CM. Higher milk intake increases fracture risk: confounding or true association? Osteoporos Int 2017; 28:2263-2264. [PMID: 28567536 DOI: 10.1007/s00198-017-4088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/10/2017] [Indexed: 12/13/2022]
Affiliation(s)
- S Sahni
- Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St, Boston, MA, 02131, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - S S Soedamah-Muthu
- Division of Human Nutrition, Wageningen University, HELIX, Building 124, room 1063, Stippeneng 4, WE, 6708, Wageningen, The Netherlands
| | - C M Weaver
- Department of Nutrition Science, Purdue University, STON 214, 700 W. State Street, West Lafayette, IN, 2059, USA
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18
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Sahni S, Mangano KM, Kiel DP, Tucker KL, Hannan MT. Dairy Intake Is Protective against Bone Loss in Older Vitamin D Supplement Users: The Framingham Study. J Nutr 2017; 147:645-652. [PMID: 28250192 PMCID: PMC5368576 DOI: 10.3945/jn.116.240390] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/14/2016] [Accepted: 02/03/2017] [Indexed: 01/16/2023] Open
Abstract
Background: Previous studies showed beneficial effects of specific dairy foods on bone health in middle-aged adults.Objective: We examined the association of milk, yogurt, cheese, cream, fluid dairy (milk + yogurt), and milk + yogurt + cheese intakes with bone mineral density (BMD) and 4-y percentage of change in BMD [▵%BMD; femoral neck, trochanter, and lumbar spine (LS)]. We further assessed whether these associations were modified by vitamin D supplement use in this cohort of older adults.Methods: Food-frequency questionnaire responses, baseline BMD (hip and spine, n = 862 in 1988-1989), and follow-up BMD (n = 628 in 1992-1993) were measured in the Framingham study, a prospective cohort study of older Caucasian men and women aged 67-93 y. Outcomes included baseline BMD and ▵%BMD. Dairy-food intakes (servings per week) were converted to energy-adjusted residuals, and linear regression was used, adjusting for covariates. These associations were further examined by vitamin D supplement use.Results: The mean age of the participants was 75 y. In the full sample, dairy-food items were not associated with BMD (P = 0.11-0.99) or with ▵%BMD (P = 0.29-0.96). Among vitamin D supplement users, but not among nonusers, higher milk, fluid dairy, and milk + yogurt + cheese intakes were associated with higher LS BMD (P = 0.011-0.009). Among vitamin D supplement users, but not among nonusers, higher milk + yogurt + cheese intakes were protective against trochanter BMD loss (P = 0.009).Conclusions: In this population of older adults, higher intakes of milk, fluid dairy, and milk + yogurt + cheese were associated with higher LS BMD, and a higher intake of milk + yogurt + cheese was protective against trochanter BMD loss among vitamin D supplement users but not among nonusers. These findings underscore that the benefits of dairy intake on the skeleton may be dependent on vitamin D intake.
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Affiliation(s)
- Shivani Sahni
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA; .,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and
| | - Kelsey M Mangano
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA;,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA;,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, MA
| | - Marian T Hannan
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA;,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and
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19
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20
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Whiting SJ, Kohrt WM, Warren MP, Kraenzlin MI, Bonjour JP. Food fortification for bone health in adulthood: a scoping review. Eur J Clin Nutr 2016; 70:1099-1105. [PMID: 27026430 PMCID: PMC5056988 DOI: 10.1038/ejcn.2016.42] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/14/2016] [Accepted: 02/18/2016] [Indexed: 12/20/2022]
Abstract
Food fortification can deliver essential micronutrients to large population segments without modifications in consumption pattern, suggesting that fortified foods may be formulated for populations at risk for fragility fractures. This scoping review determined the extent to which randomized controlled studies have been carried out to test the impact of fortified foods on bone outcomes, searching PubMed for all studies using the terms 'fortified AND bone', and 'fortification AND bone'. Studies were restricted to English language, published between 1996 and June 2015. From 360 articles, 24 studies met the following criteria: human study in adults ⩾18 years (excluding pregnancy or lactation); original study of a fortified food over time, with specific bone outcomes measured pre- and post intervention. Six studies involved adults <50 years; 18 involved adults ⩾50 years. Singly or in combination, 17 studies included calcium and 16 included vitamin D. There were 1 or 2 studies involving either vitamin K, magnesium, iron, zinc, B-vitamins, inulin or isoflavones. For adults <50 years, the four studies involving calcium or vitamin D showed a beneficial effect on bone remodeling. For adults ⩾50 years, n=14 provided calcium and/or vitamin D, and there was a significant bone turnover reduction. No consistent effects were reported in studies in which addition of vitamin K, folic acid or isoflavone was assessed. Results from this scoping review indicate that up to now most studies of fortification with bone health have evaluated calcium and/or vitamin D and that these nutrients show beneficial effects on bone remodeling.
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Affiliation(s)
- S J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - W M Kohrt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado, Denver, CO, USA
| | - M P Warren
- Department of Obstetrics and Gynecology and Medicine, Columbia University Medical Center, New York, NY, USA
| | - M I Kraenzlin
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Bale, Switzerland
| | - J-P Bonjour
- Department of Internal Medicine Specialties, Division of Bone Disease, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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21
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Effect of increasing dietary calcium through supplements and dairy food on body weight and body composition: a meta-analysis of randomised controlled trials. Br J Nutr 2015; 114:1013-25. [PMID: 26234296 DOI: 10.1017/s0007114515001518] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This meta-analysis of randomised controlled trials assessed the effect of Ca on body weight and body composition through supplementation or increasing dairy food intake. Forty-one studies met the inclusion criteria (including fifty-one trial arms; thirty-one with dairy foods (n 2091), twenty with Ca supplements (n 2711). Ca intake was approximately 900 mg/d higher in the supplement groups compared with control. In the dairy group, Ca intake was approximately 1300 mg/d. Ca supplementation did not significantly affect body weight (mean change ( - 0·17, 95% CI - 0·70, 0·37) kg) or body fat (mean change ( - 0·19, 95% CI - 0·51, 0·13) kg) compared to control. Similarly, increased dairy food intake did not affect body weight ( - 0·06, 95% CI - 0·54, 0·43) kg or body fat change ( - 0·36, 95% CI - 0·80, 0·09) kg compared to control. Sub-analyses revealed that dairy supplementation resulted in no change in body weight (nineteen studies, n 1010) ( - 0·32, 95% CI - 0·93, 0·30 kg, P= 0·31), but a greater reduction in body fat (thirteen studies, n 564) ( - 0·96, 95% CI - 1·46, - 0·46 kg, P < 0·001) in the presence of energy restriction over a mean of 4 months compared to control. Increasing dietary Ca intake by 900 mg/d as supplements or increasing dairy intake to approximately 3 servings daily (approximately 1300 mg of Ca/d) is not an effective weight reduction strategy in adults. There is, however, an indication that approximately 3 servings of dairy may facilitate fat loss on weight reduction diets in the short term.
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22
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Chandler PD, Wang L, Zhang X, Sesso HD, Moorthy MV, Obi O, Lewis J, Prince RL, Danik JS, Manson JE, LeBoff MS, Song Y. Effect of vitamin D supplementation alone or with calcium on adiposity measures: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2015; 73:577-93. [PMID: 26180255 DOI: 10.1093/nutrit/nuv012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
CONTEXT The independent or interactive effects of vitamin D and calcium on adiposity remain inconclusive. OBJECTIVE The objective of this systematic review and meta-analysis was to assess whether vitamin D and calcium supplements cause changes in adiposity. DATA SOURCES MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for literature published from 1966 to March 2014. STUDY SELECTION A systematic search was conducted for randomized clinical trials with ≥ 50 participants aged ≥ 18 years at baseline who had received at least 12 weeks of treatment. Among the inclusion criteria were supplementation with vitamin D with or without calcium and measurement of adiposity (weight, body mass index [BMI], and/or fat mass). DATA EXTRACTION The primary endpoints assessed were changes in weight, BMI, or fat mass. DATA SYNTHESIS Of 953 trials identified, 26 randomized clinical trials (n = 12, vitamin D alone; n = 10, vitamin D plus calcium versus calcium control; n = 4, vitamin D plus calcium versus placebo) with a total of 42,430 participants (median duration, 12 months) met the inclusion criteria. When compared with placebo, vitamin D supplementation had no significant effect on BMI (weighted mean difference [WMD], -0.06 kg/m(2); 95% confidence interval [95%CI], -0.14 to 0.03), weight (WMD, -0.05 kg; 95%CI, -0.32 to 0.23), or fat mass (WMD, -0.43 kg; 95%CI, -1.69 to 0.84). Likewise, no significant reduction in BMI (WMD, 0.02 kg/m(2); 95%CI, -0.11 to 0.14), weight (WMD, 0.12 kg; 95%CI, -0.24 to 0.49), or fat mass (WMD, 0.12 kg; 95%CI, -0.22 to 0.45) was observed in participants who received vitamin D plus calcium compared with those who received calcium control. CONCLUSIONS Supplementation with vitamin D showed no effect on adiposity measures in adults.
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Affiliation(s)
- Paulette D Chandler
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Lu Wang
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xi Zhang
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard D Sesso
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manickavasagar V Moorthy
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Obiageli Obi
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Lewis
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard L Prince
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacqueline S Danik
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - JoAnn E Manson
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meryl S LeBoff
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yiqing Song
- P.D. Chandler, L. Wang, H.D. Sesso, M.V. Moorthy, J.S. Danik, J.E. Manson, and Y. Song are with the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. X. Zhang and Y. Song are with the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA. H.D. Sesso and J.E. Manson are with the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. O. Obi is with the Boston University School of Public Health, Boston, Massachusetts, USA. J. Lewis and R.L. Prince are with the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. J. Lewis and R.L. Prince are with the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. R.L. Prince is with the School of Public Health, Curtin University, Perth, Western Australia, Australia. J.S. Danik is with the Cardiovascular Division, Mount Sinai St. Luke's Hospital, New York, New York, USA. M.S. LeBoff is with the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust 2015; 199:S1-S46. [PMID: 25370432 DOI: 10.5694/j.1326-5377.2013.tb04225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/02/2012] [Indexed: 12/14/2022]
Abstract
Osteoporosis imposes a tremendous burden on Australia: 1.2 million Australians have osteoporosis and 6.3 million have osteopenia. In the 2007–08 financial year, 82 000 Australians suffered fragility fractures, of which > 17 000 were hip fractures. In the 2000–01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions — to ensure people have adequate calcium intake, vitamin D levels and appropriate physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, muscle strengthening exercises and challenging balance/mobility activities should be conducted in a safe environment.
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Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC, Australia.
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Sahni S, Mangano KM, Tucker KL, Kiel DP, Casey VA, Hannan MT. Protective association of milk intake on the risk of hip fracture: results from the Framingham Original Cohort. J Bone Miner Res 2014; 29:1756-62. [PMID: 24760749 PMCID: PMC4381539 DOI: 10.1002/jbmr.2219] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/13/2014] [Accepted: 02/24/2014] [Indexed: 02/03/2023]
Abstract
Dairy foods are rich in bone-beneficial nutrients, yet the role of dairy foods in hip fracture prevention remains controversial. Our objective was to evaluate the association of milk, yogurt, cheese, cream, and milk + yogurt intakes with incident hip fracture in the Framingham Original Cohort. A total of 830 men and women from the Framingham Original Cohort, a prospective cohort study, completed a food-frequency questionnaire (1988 to 1989) and were followed for hip fracture until 2008. In this population-based study, Cox-proportional hazards regression was used to estimate hazard ratios (HR) by categories of energy-adjusted dairy intake (servings/wk), adjusting for standard confounders and covariates. The exposure was energy-adjusted intakes of milk, yogurt, cheese, cream, and milk + yogurt (servings/wk). Risk of hip fracture over the follow-up was the primary outcome; the hypothesis being tested was formulated after data collection. The mean age at baseline was 77 years (SD 4.9, range 68 to 96). Ninety-seven hip fractures occurred over the mean follow-up time of 11.6 years (range 0.04 to 21.9 years). The mean ± SD (servings/wk) of dairy intakes at baseline were: milk = 6.0 ± 6.4; yogurt = 0.4 ± 1.3; cheese = 2.6 ± 3.1; and cream = 3.4 ± 5.5. Participants with medium (>1 and <7 servings/wk) or higher (≥7 servings/wk) milk intake tended to have lower hip fracture risk than those with low (≤1 serving/wk) intake (high versus low intake HR 0.58, 95% confidence interval [CI] 0.31-1.06, p = 0.078; medium versus low intake HR 0.61, 95% CI 0.36-1.08, p = 0.071; p trend = 0.178]. There appeared to be a threshold for milk, with 40% lower risk of hip fracture among those with medium/high milk intake compared with those with low intake (p = 0.061). A similar threshold was observed for milk + yogurt intake (p = 0.104). These associations were further attenuated after adjustment for femoral neck bone mineral density. No significant associations were seen for other dairy foods (p range = 0.117 to 0.746). These results suggest that greater intakes of milk and milk + yogurt may lower risk for hip fracture in older adults through mechanisms that are partially, but not entirely, attributable to effects on bone mineral density.
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Affiliation(s)
- Shivani Sahni
- Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Avenell A, Mak JCS, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 2014; 2014:CD000227. [PMID: 24729336 PMCID: PMC7032685 DOI: 10.1002/14651858.cd000227.pub4] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D and related compounds have been used to prevent osteoporotic fractures in older people. This is the third update of a Cochrane review first published in 1996. OBJECTIVES To determine the effects of vitamin D or related compounds, with or without calcium, for preventing fractures in post-menopausal women and older men. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to December 2012), the Cochrane Central Register of Controlled Trials (2012, Issue 12), MEDLINE (1966 to November Week 3 2012), EMBASE (1980 to 2012 Week 50), CINAHL (1982 to December 2012), BIOSIS (1985 to 3 January 2013), Current Controlled Trials (December 2012) and reference lists of articles. SELECTION CRITERIA Randomised or quasi-randomised trials that compared vitamin D or related compounds, alone or with calcium, against placebo, no intervention or calcium alone, and that reported fracture outcomes in older people. The primary outcome was hip fracture. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial risk of selection bias and aspects of methodological quality, and extracted data. Data were pooled, where possible, using the fixed-effect model, or the random-effects model when heterogeneity between studies appeared substantial. MAIN RESULTS We included 53 trials with a total of 91,791 participants. Thirty-one trials, with sample sizes ranging from 70 to 36,282 participants, examined vitamin D (including 25-hydroxy vitamin D) with or without calcium in the prevention of fractures in community, nursing home or hospital inpatient populations. Twelve of these 31 trials had participants with a mean or median age of 80 years or over.Another group of 22 smaller trials examined calcitriol or alfacalcidol (1-alphahydroxyvitamin D3), mostly with participants who had established osteoporosis. These trials were carried out in the setting of institutional referral clinics or hospitals.In the assessment of risk of bias for random sequence generation, 21 trials (40%) were deemed to be at low risk, 28 trials (53%) at unclear risk and four trials at high risk (8%). For allocation concealment, 22 trials were at low risk (42%), 29 trials were at unclear risk (55%) and two trials were at high risk (4%).There is high quality evidence that vitamin D alone, in the formats and doses tested, is unlikely to be effective in preventing hip fracture (11 trials, 27,693 participants; risk ratio (RR) 1.12, 95% confidence intervals (CI) 0.98 to 1.29) or any new fracture (15 trials, 28,271 participants; RR 1.03, 95% CI 0.96 to 1.11).There is high quality evidence that vitamin D plus calcium results in a small reduction in hip fracture risk (nine trials, 49,853 participants; RR 0.84, 95% confidence interval (CI) 0.74 to 0.96; P value 0.01). In low-risk populations (residents in the community: with an estimated eight hip fractures per 1000 per year), this equates to one fewer hip fracture per 1000 older adults per year (95% CI 0 to 2). In high risk populations (residents in institutions: with an estimated 54 hip fractures per 1000 per year), this equates to nine fewer hip fractures per 1000 older adults per year (95% CI 2 to 14). There is high quality evidence that vitamin D plus calcium is associated with a statistically significant reduction in incidence of new non-vertebral fractures. However, there is only moderate quality evidence of an absence of a statistically significant preventive effect on clinical vertebral fractures. There is high quality evidence that vitamin D plus calcium reduces the risk of any type of fracture (10 trials, 49,976 participants; RR 0.95, 95% CI 0.90 to 0.99).In terms of the results for adverse effects: mortality was not adversely affected by either vitamin D or vitamin D plus calcium supplementation (29 trials, 71,032 participants, RR 0.97, 95% CI 0.93 to 1.01). Hypercalcaemia, which was usually mild (2.6 to 2.8 mmol/L), was more common in people receiving vitamin D or an analogue, with or without calcium (21 trials, 17,124 participants, RR 2.28, 95% CI 1.57 to 3.31), especially for calcitriol (four trials, 988 participants, RR 4.41, 95% CI 2.14 to 9.09), than in people receiving placebo or control. There was also a small increased risk of gastrointestinal symptoms (15 trials, 47,761 participants, RR 1.04, 95% CI 1.00 to 1.08), especially for calcium plus vitamin D (four trials, 40,524 participants, RR 1.05, 95% CI 1.01 to 1.09), and a significant increase in renal disease (11 trials, 46,548 participants, RR 1.16, 95% CI 1.02 to 1.33). Other systematic reviews have found an increased association of myocardial infarction with supplemental calcium; and evidence of increased myocardial infarction and stroke, but decreased cancer, with supplemental calcium plus vitamin D, without an overall effect on mortality. AUTHORS' CONCLUSIONS Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. Supplements of vitamin D and calcium may prevent hip or any type of fracture. There was a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D and calcium. This review found that there was no increased risk of death from taking calcium and vitamin D.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, UK, AB25 2ZD
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Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014:CD007470. [PMID: 24414552 DOI: 10.1002/14651858.cd007470.pub3] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Available evidence on the effects of vitamin D on mortality has been inconclusive. In a recent systematic review, we found evidence that vitamin D3 may decrease mortality in mostly elderly women. The present systematic review updates and reassesses the benefits and harms of vitamin D supplementation used in primary and secondary prophylaxis of mortality. OBJECTIVES To assess the beneficial and harmful effects of vitamin D supplementation for prevention of mortality in healthy adults and adults in a stable phase of disease. SEARCH METHODS We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index-Expanded and Conference Proceedings Citation Index-Science (all up to February 2012). We checked references of included trials and pharmaceutical companies for unidentified relevant trials. SELECTION CRITERIA Randomised trials that compared any type of vitamin D in any dose with any duration and route of administration versus placebo or no intervention in adult participants. Participants could have been recruited from the general population or from patients diagnosed with a disease in a stable phase. Vitamin D could have been administered as supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)) or as an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)). DATA COLLECTION AND ANALYSIS Six review authors extracted data independently. Random-effects and fixed-effect meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RRs). To account for trials with zero events, we performed meta-analyses of dichotomous data using risk differences (RDs) and empirical continuity corrections. We used published data and data obtained by contacting trial authors.To minimise the risk of systematic error, we assessed the risk of bias of the included trials. Trial sequential analyses controlled the risk of random errors possibly caused by cumulative meta-analyses. MAIN RESULTS We identified 159 randomised clinical trials. Ninety-four trials reported no mortality, and nine trials reported mortality but did not report in which intervention group the mortality occurred. Accordingly, 56 randomised trials with 95,286 participants provided usable data on mortality. The age of participants ranged from 18 to 107 years. Most trials included women older than 70 years. The mean proportion of women was 77%. Forty-eight of the trials randomly assigned 94,491 healthy participants. Of these, four trials included healthy volunteers, nine trials included postmenopausal women and 35 trials included older people living on their own or in institutional care. The remaining eight trials randomly assigned 795 participants with neurological, cardiovascular, respiratory or rheumatoid diseases. Vitamin D was administered for a weighted mean of 4.4 years. More than half of the trials had a low risk of bias. All trials were conducted in high-income countries. Forty-five trials (80%) reported the baseline vitamin D status of participants based on serum 25-hydroxyvitamin D levels. Participants in 19 trials had vitamin D adequacy (at or above 20 ng/mL). Participants in the remaining 26 trials had vitamin D insufficiency (less than 20 ng/mL).Vitamin D decreased mortality in all 56 trials analysed together (5,920/47,472 (12.5%) vs 6,077/47,814 (12.7%); RR 0.97 (95% confidence interval (CI) 0.94 to 0.99); P = 0.02; I(2) = 0%). More than 8% of participants dropped out. 'Worst-best case' and 'best-worst case' scenario analyses demonstrated that vitamin D could be associated with a dramatic increase or decrease in mortality. When different forms of vitamin D were assessed in separate analyses, only vitamin D3 decreased mortality (4,153/37,817 (11.0%) vs 4,340/38,110 (11.4%); RR 0.94 (95% CI 0.91 to 0.98); P = 0.002; I(2) = 0%; 75,927 participants; 38 trials). Vitamin D2, alfacalcidol and calcitriol did not significantly affect mortality. A subgroup analysis of trials at high risk of bias suggested that vitamin D2 may even increase mortality, but this finding could be due to random errors. Trial sequential analysis supported our finding regarding vitamin D3, with the cumulative Z-score breaking the trial sequential monitoring boundary for benefit, corresponding to 150 people treated over five years to prevent one additional death. We did not observe any statistically significant differences in the effect of vitamin D on mortality in subgroup analyses of trials at low risk of bias compared with trials at high risk of bias; of trials using placebo compared with trials using no intervention in the control group; of trials with no risk of industry bias compared with trials with risk of industry bias; of trials assessing primary prevention compared with trials assessing secondary prevention; of trials including participants with vitamin D level below 20 ng/mL at entry compared with trials including participants with vitamin D levels equal to or greater than 20 ng/mL at entry; of trials including ambulatory participants compared with trials including institutionalised participants; of trials using concomitant calcium supplementation compared with trials without calcium; of trials using a dose below 800 IU per day compared with trials using doses above 800 IU per day; and of trials including only women compared with trials including both sexes or only men. Vitamin D3 statistically significantly decreased cancer mortality (RR 0.88 (95% CI 0.78 to 0.98); P = 0.02; I(2) = 0%; 44,492 participants; 4 trials). Vitamin D3 combined with calcium increased the risk of nephrolithiasis (RR 1.17 (95% CI 1.02 to 1.34); P = 0.02; I(2) = 0%; 42,876 participants; 4 trials). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18 (95% CI 1.17 to 8.68); P = 0.02; I(2) = 17%; 710 participants; 3 trials). AUTHORS' CONCLUSIONS Vitamin D3 seemed to decrease mortality in elderly people living independently or in institutional care. Vitamin D2, alfacalcidol and calcitriol had no statistically significant beneficial effects on mortality. Vitamin D3 combined with calcium increased nephrolithiasis. Both alfacalcidol and calcitriol increased hypercalcaemia. Because of risks of attrition bias originating from substantial dropout of participants and of outcome reporting bias due to a number of trials not reporting on mortality, as well as a number of other weaknesses in our evidence, further placebo-controlled randomised trials seem warranted.
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Affiliation(s)
- Goran Bjelakovic
- Department of Internal Medicine, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000
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Takeda E, Yamamoto H, Yamanaka-Okumura H, Taketani Y. Increasing dietary phosphorus intake from food additives: potential for negative impact on bone health. Adv Nutr 2014; 5:92-7. [PMID: 24425727 PMCID: PMC3884105 DOI: 10.3945/an.113.004002] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
It is important to consider whether habitual high phosphorus intake adversely affects bone health, because phosphorus intake has been increasing, whereas calcium intake has been decreasing in dietary patterns. A higher total habitual dietary phosphorus intake has been associated with higher serum parathyroid hormone (PTH) and lower serum calcium concentrations in healthy individuals. Higher serum PTH concentrations have been shown in those who consume foods with phosphorus additives. These findings suggest that long-term dietary phosphorus loads and long-term hyperphosphatemia may have important negative effects on bone health. In contrast, PTH concentrations did not increase as a result of high dietary phosphorus intake when phosphorus was provided with adequate amounts of calcium. Intake of foods with a ratio of calcium to phosphorus close to that found in dairy products led to positive effects on bone health. Several randomized controlled trials have shown positive relations between dairy intake and bone mineral density. In our loading test with a low-calcium, high-phosphorus lunch provided to healthy young men, serum PTH concentrations showed peaks at 1 and 6 h, and serum fibroblast growth factor 23 (FGF23) concentrations increased significantly at 8 h after the meal. In contrast, the high-calcium, high-phosphorus meal suppressed the second PTH and FGF23 elevations until 8 h after the meal. This implies that adequate dietary calcium intake is needed to overcome the interfering effects of high phosphorus intake on PTH and FGF23 secretion. FGF23 acts on the parathyroid gland to decrease PTH mRNA and PTH secretion in rats with normal kidney function. However, increased serum FGF23 is an early alteration of mineral metabolism in chronic kidney disease, causing secondary hyperthyroidism, and implying resistance of the parathyroid gland to the action of FGF23 in chronic kidney disease. These findings suggest that long-term high-phosphorus diets may impair bone health mediated by FGF23 resistance both in chronic kidney disease patients and in the healthy population.
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Affiliation(s)
- Eiji Takeda
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima City, Tokushima, Japan; and,To whom correspondence should be addressed. E-mail:
| | - Hironori Yamamoto
- Department of Health and Nutrition, Faculty of Human Life, Jin-ai University, Echizen City, Fukui, Japan
| | - Hisami Yamanaka-Okumura
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima City, Tokushima, Japan; and
| | - Yutaka Taketani
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima City, Tokushima, Japan; and
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Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study. Arch Osteoporos 2013; 8:119. [PMID: 23371478 PMCID: PMC3641848 DOI: 10.1007/s11657-013-0119-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 01/07/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED Dairy foods are a complex source of essential nutrients. In this study, fluid dairy intake, specifically milk, and yogurt intakes were associated with hip but not spine bone mineral density (BMD), while cream may adversely influence BMD, suggesting that not all dairy products are equally beneficial for the skeleton. PURPOSE This study seeks to examine associations of milk, yogurt, cheese, cream, most dairy (total dairy without cream), and fluid dairy (milk + yogurt) with BMD at femoral neck (FN), trochanter (TR), and spine, and with incident hip fracture over 12-year follow-up in the Framingham Offspring Study. METHODS Three thousand two hundred twelve participants completed a food frequency questionnaire (1991–1995 or 1995–1998) and were followed for hip fracture until 2007 [corrected]. Two thousand five hundred and six participants had DXA BMD (1996-2001). Linear regression was used to estimate adjusted mean BMD while Cox-proportional hazards regression was used to estimate adjusted hazard ratios (HR) for hip fracture risk. Final models simultaneously included dairy foods adjusting for each other. RESULTS Mean baseline age was 55 (±1.6) years, range 26-85. Most dairy intake was positively associated with hip and spine BMD. Intake of fluid dairy and milk was related with hip but not spine BMD. Yogurt intake was associated with TR-BMD alone. Cheese and cream intakes were not associated with BMD. In final models, yogurt intake remained positively associated with TR-BMD, while cream tended to be negatively associated with FN-BMD. Yogurt intake showed a weak protective trend for hip fracture [HR(95%CI), ≤4 serv/week, 0.46 (0.21-1.03) vs. >4 serv/week, 0.43 (0.06-3.27)]. No other dairy groups showed a significant association (HRs range, 0.53-1.47) with limited power (n, fractures = 43). CONCLUSION Milk and yogurt intakes were associated with hip but not spine BMD, while cream may adversely influence BMD. Thus, not all dairy products are equally beneficial for the skeleton. Suggestive fracture results for milk and yogurt intakes need further confirmation.
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence‐informed strategy to prevent osteoporosis in Australia. Med J Aust 2013. [DOI: 10.5694/mjao12.11363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD
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Das JK, Salam RA, Kumar R, Bhutta ZA. Micronutrient fortification of food and its impact on woman and child health: a systematic review. Syst Rev 2013; 2:67. [PMID: 23971426 PMCID: PMC3765883 DOI: 10.1186/2046-4053-2-67] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/05/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies. METHODS A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1. RESULTS Our systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children. CONCLUSION Fortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality.
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Affiliation(s)
- Jai K Das
- Centre of Excellence in Women & Child Health, Aga Khan University, Karachi 74800, Pakistan.
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Gui JC, Brašić JR, Liu XD, Gong GY, Zhang GM, Liu CJ, Gao GQ. Bone mineral density in postmenopausal Chinese women treated with calcium fortification in soymilk and cow's milk. Osteoporos Int 2012; 23:1563-70. [PMID: 22282300 DOI: 10.1007/s00198-012-1895-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 05/16/2011] [Indexed: 10/14/2022]
Abstract
UNLABELLED Eighteen months of daily consumption of milk containing 250 mg calcium prevented bone mineral density (BMD) loss at the hip and the femoral neck in postmenopausal Chinese women aged 45 to 65. INTRODUCTION Estrogen-related bone loss in postmenopausal women can be prevented by the consumption of milk with high doses of calcium and soymilk with high doses of isoflavones. However, high doses of calcium and isoflavones may not be necessary to attain a beneficial effect of milk and soymilk on BMD. We hypothesized that BMD will increase in postmenopausal Chinese women who consume daily 250 mg calcium in milk or soymilk. Milk prevented bone loss at the hip and the femoral neck in postmenopausal Chinese women. METHODS A total of 141 eligible Chinese women without osteoporosis, aged 45-65, and postmenopausal for more than 2 years were randomized into groups receiving for 18 months (A) milk with 250 mg calcium daily, (B) soymilk with 250 mg calcium daily, or (C) neither milk nor soymilk. Dual-energy X-ray absorptiometry measured the BMD of the spine and hip at 0, 6, 12, and 18 months. RESULTS The BMD in the hip (2.52%) and the femoral neck (2.82%) of the women consuming milk was significantly higher (hip, P = 0.01; femoral neck, P < 0.0000001). The women in the control group experienced a reduction in BMD at all sites; the reduction in BMD was only significant at the hip during 12 months (P = 0.008) and at the femoral neck during 18 months (P = 0.005). CONCLUSIONS Daily consumption of milk containing 250 mg calcium over 18 months prevents BMD loss at the hip and the femoral neck in postmenopausal Chinese women.
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Affiliation(s)
- J-C Gui
- Department of Nuclear Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai 200040, People's Republic of China
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Caroli A, Poli A, Ricotta D, Banfi G, Cocchi D. Invited review: Dairy intake and bone health: A viewpoint from the state of the art. J Dairy Sci 2011; 94:5249-62. [DOI: 10.3168/jds.2011-4578] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/04/2011] [Indexed: 12/23/2022]
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Jia D, Gaddy D, Suva LJ, Corry PM. Rapid loss of bone mass and strength in mice after abdominal irradiation. Radiat Res 2011; 176:624-35. [PMID: 21859327 DOI: 10.1667/rr2505.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Localized irradiation is a common treatment modality for malignancies in the pelvic-abdominal cavity. We report here on the changes in bone mass and strength in mice 7-14 days after abdominal irradiation. Male C57BL/6 mice of 10-12 weeks of age were given a single-dose (0, 5, 10, 15 or 20 Gy) or fractionated (3 Gy × 2 per day × 7.5 days) X rays to the abdomen and monitored daily for up to 14 days. A decrease in the serum bone formation marker and ex vivo osteoblast differentiation was detected 7 days after a single dose of radiation, with little change in the serum bone resorption marker and ex vivo osteoclast formation. A single dose of radiation elicited a loss of bone mineral density (BMD) within 14 days of irradiation. The BMD loss was up to 4.1% in the whole skeleton, 7.3% in tibia, and 7.7% in the femur. Fractionated abdominal irradiation induced similar extents of BMD loss 10 days after the last fraction: 6.2% in the whole skeleton, 5.1% in tibia, and 13.8% in the femur. The loss of BMD was dependent on radiation dose and was more profound in the trabecula-rich regions of the long bones. Moreover, BMD loss in the total skeleton and the femurs progressed with time. Peak load and stiffness in the mid-shaft tibia from irradiated mice were 11.2-14.2% and 11.5-25.0% lower, respectively, than sham controls tested 7 days after a single-dose abdominal irradiation. Our data demonstrate that abdominal irradiation induces a rapid loss of BMD in the mouse skeleton. These effects are bone type- and region-specific but are independent of radiation fractionation. The radiation-induced abscopal damage to the skeleton is manifested by the deterioration of biomechanical properties of the affected bone.
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Affiliation(s)
- Dan Jia
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2011:CD007470. [PMID: 21735411 DOI: 10.1002/14651858.cd007470.pub2] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The available evidence on vitamin D and mortality is inconclusive. OBJECTIVES To assess the beneficial and harmful effects of vitamin D for prevention of mortality in adults. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science (to January 2011). We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials. SELECTION CRITERIA We included randomised trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention. Vitamin D could have been administered as supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)). DATA COLLECTION AND ANALYSIS Six authors extracted data independently. Random-effects and fixed-effect model meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RR). To account for trials with zero events, meta-analyses of dichotomous data were repeated using risk differences (RD) and empirical continuity corrections. Risk of bias was considered in order to minimise risk of systematic errors. Trial sequential analyses were conducted to minimise the risk of random errors. MAIN RESULTS Fifty randomised trials with 94,148 participants provided data for the mortality analyses. Most trials included elderly women (older than 70 years). Vitamin D was administered for a median of two years. More than one half of the trials had a low risk of bias. Overall, vitamin D decreased mortality (RR 0.97, 95% confidence interval (CI) 0.94 to 1.00, I(2) = 0%). When the different forms of vitamin D were assessed separately, only vitamin D(3) decreased mortality significantly (RR 0.94, 95% CI 0.91 to 0.98, I(2) = 0%; 74,789 participants, 32 trials) whereas vitamin D(2), alfacalcidol, or calcitriol did not. Trial sequential analysis supported our finding regarding vitamin D(3), corresponding to 161 individuals treated to prevent one additional death. Vitamin D(3) combined with calcium increased the risk of nephrolithiasis (RR 1.17, 95% CI 1.02 to 1.34, I(2) = 0%). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18, 95% CI 1.17 to 8.68, I(2) = 17%). Data on health-related quality of life and health economics were inconclusive. AUTHORS' CONCLUSIONS Vitamin D in the form of vitamin D(3) seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care. Vitamin D(2), alfacalcidol, and calcitriol had no statistically significant effect on mortality. Vitamin D(3) combined with calcium significantly increased nephrolithiasis. Both alfacalcidol and calcitriol significantly increased hypercalcaemia.
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Affiliation(s)
- Goran Bjelakovic
- Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000
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Moschonis G, Kanellakis S, Papaioannou N, Schaafsma A, Manios Y. Possible site-specific effect of an intervention combining nutrition and lifestyle counselling with consumption of fortified dairy products on bone mass: the Postmenopausal Health Study II. J Bone Miner Metab 2011; 29:501-6. [PMID: 21455716 DOI: 10.1007/s00774-010-0256-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 12/23/2010] [Indexed: 02/04/2023]
Abstract
The aim of the present study was to examine whether a holistic approach combining nutrition and lifestyle counselling with the consumption of milk and yoghurt enriched with calcium, vitamin D(3) and phylloquinone (vitamin K(1)) or menaquinone (vitamin K(2)) would have any additional benefit on bone mineral density (BMD) indices measured at various skeletal sites using two different techniques, dual energy X-ray absorptiometry and quantitative ultrasonography (QUS). A sample of 115 postmenopausal women were randomized to three intervention groups, receiving daily via fortified milk and yoghurt and for 12 months, 800 mg calcium and 10 μg vitamin D(3) (CaD group, n = 26); 800 mg calcium, 10 μg vitamin D(3) and 100 μg vitamin K(1) (CaDK1 group, n = 26); 800 mg calcium, 10 μg vitamin D(3) and 100 μg vitamin K(2) (CaDK2 group, n = 24); and a control group (CO group, n = 39) following their usual diet. All three intervention groups attended biweekly nutrition and lifestyle counselling sessions. Total BMD significantly increased in all three intervention groups and these changes were significantly higher compared to the CO (P < 0.001). Furthermore, the significant increases observed for L2-L4 BMD in the CaDK1 and CaDK2 groups were found to be significantly higher compared to the decrease observed in the CO (P = 0.001). No significant differences were observed for QUS parameters. The combined approach used in the current study led to favourable changes for all three intervention groups in total body BMD, while an additional benefit was observed for L2-L4 BMD in CaDK1 and CaDK2 groups. No significant differences were observed among groups in any of the QUS parameters.
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Affiliation(s)
- George Moschonis
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Ave, Kallithea, 176 71 Athens, Greece.
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Vitamin D in health and disease: an insight into traditional functions and new roles for the 'sunshine vitamin'. Nutr Res Rev 2010; 22:118-36. [PMID: 19900346 DOI: 10.1017/s0954422409990102] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vitamin D is unique among the vitamins in that man can synthesise it via the action of UV radiation upon the skin. This combined with its ability to act on specific target tissues via vitamin D receptors (VDR) make its classification as a steroid hormone more appropriate. While vitamin D deficiency is a recognised problem in some northern latitude countries, recent studies have shown that even in sunny countries, such as Australia, vitamin D deficiency may be more prevalent than first thought. Vitamin D is most well known for its role in bone health; however, the discovery of VDR on a wide variety of tissue types has also opened up roles for vitamin D far beyond traditional bone health. These include possible associations with autoimmune diseases such as multiple sclerosis and inflammatory bowel diseases, cancer, CVD and muscle strength. First, this paper presents an overview of the two sources of vitamin D: exposure to UVB radiation and food sources of vitamin D, with particular focus on both Australian and international studies on dietary vitamin D intake and national fortification strategies. Second, the paper reviews recent epidemiological and experimental evidence linking vitamin D and its role in health and disease for the major conditions linked to suboptimal vitamin D, while identifying significant gaps in the research and possible future directions for research.
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Trimpou P, Bosaeus I, Bengtsson BÅ, Landin-Wilhelmsen K. High correlation between quantitative ultrasound and DXA during 7 years of follow-up. Eur J Radiol 2010; 73:360-4. [DOI: 10.1016/j.ejrad.2008.11.024] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/14/2008] [Accepted: 11/26/2008] [Indexed: 11/28/2022]
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Abstract
Bone health is the resultant of bone mass, bone architecture, and body mechanics. Nutrition supports all three components, with the principal nutrients concerned being calcium, protein, and vitamin D. Potassium, magnesium, zinc, and several vitamins are also involved to varying extents. Given modern food sources, it is difficult to devise a diet that is "bone healthy" without including three servings of dairy per day, not just because of dairy calcium, but dairy protein and potassium as well.
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Affiliation(s)
- Robert P Heaney
- Creighton University, 2500 California St, Omaha, NE 68178, USA.
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Association between serum 25-hydroxyvitamin D levels and body composition in postmenopausal women. Menopause 2009; 16:701-7. [DOI: 10.1097/gme.0b013e318199d5d5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Avenell A, Gillespie WJ, Gillespie LD, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009:CD000227. [PMID: 19370554 DOI: 10.1002/14651858.cd000227.pub3] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D and related compounds have been used to prevent osteoporotic fractures in older people. OBJECTIVES To determine the effects of vitamin D or related compounds, with or without calcium, for preventing fractures in older people. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, CINAHL, and reference lists of articles. Most recent search: October 2007. SELECTION CRITERIA Randomised or quasi-randomised trials comparing vitamin D or related compounds, alone or with calcium, against placebo, no intervention, or calcium alone, reporting fracture outcomes in older people. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality, and extracted data. Data were pooled, where admissible, using the fixed-effect model, or random-effects model if heterogeneity between studies appeared high. MAIN RESULTS Forty-five trials were included. Vitamin D alone appears unlikely to be effective in preventing hip fracture (nine trials, 24,749 participants, RR 1.15, 95% CI 0.99 to 1.33), vertebral fracture (five trials, 9138 participants, RR 0.90, 95% CI 0.42 to 1.92) or any new fracture (10 trials, 25,016 participants, RR 1.01, 95% CI 0.93 to 1.09).Vitamin D with calcium reduces hip fractures (eight trials, 46,658 participants, RR 0.84, 95% CI 0.73 to 0.96). Although subgroup analysis by residential status showed a significant reduction in hip fractures in people in institutional care, the difference between this and the community-dwelling subgroup was not significant (P = 0.15).Overall hypercalcaemia is significantly more common in people receiving vitamin D or an analogue, with or without calcium (18 trials, 11,346 participants, RR 2.35, 95% CI 1.59 to 3.47); this is especially true of calcitriol (four trials, 988 participants, RR 4.41, 95% CI 2.14 to 9.09). There is a modest increase in gastrointestinal symptoms (11 trials, 47,042 participants, RR 1.04, 95% CI 1.00 to 1.08, P = 0.04) and a small but significant increase in renal disease (11 trials, 46,537 participants, RR 1.16, 95% CI 1.02 to 1.33). AUTHORS' CONCLUSIONS Frail older people confined to institutions may sustain fewer hip fractures if given vitamin D with calcium. Vitamin D alone is unlikely to prevent fracture. Overall there is a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D or its analogues. Calcitriol is associated with an increased incidence of hypercalcaemia.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK, AB25 2ZD.
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Manios Y, Moschonis G, Panagiotakos DB, Farajian P, Trovas G, Lyritis GP. Changes in biochemical indices of bone metabolism in post-menopausal women following a dietary intervention with fortified dairy products. J Hum Nutr Diet 2009; 22:156-65. [DOI: 10.1111/j.1365-277x.2008.00934.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Changes in body composition following a dietary and lifestyle intervention trial: The postmenopausal health study. Maturitas 2009; 62:58-65. [DOI: 10.1016/j.maturitas.2008.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 11/04/2008] [Accepted: 11/14/2008] [Indexed: 11/19/2022]
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Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 2008; 11:163-87. [PMID: 18442758 DOI: 10.1016/j.jocd.2007.12.011] [Citation(s) in RCA: 248] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/05/2007] [Indexed: 12/19/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is commonly used in the care of patients for diagnostic classification of osteoporosis, low bone mass (osteopenia), or normal bone density; assessment of fracture risk; and monitoring changes in bone density over time. The development of other technologies for the evaluation of skeletal health has been associated with uncertainties regarding their applications in clinical practice. Quantitative ultrasound (QUS), a technology for measuring properties of bone at peripheral skeletal sites, is more portable and less expensive than DXA, without the use of ionizing radiation. The proliferation of QUS devices that are technologically diverse, measuring and reporting variable bone parameters in different ways, examining different skeletal sites, and having differing levels of validating data for association with DXA-measured bone density and fracture risk, has created many challenges in applying QUS for use in clinical practice. The International Society for Clinical Densitometry (ISCD) 2007 Position Development Conference (PDC) addressed clinical applications of QUS for fracture risk assessment, diagnosis of osteoporosis, treatment initiation, monitoring of treatment, and quality assurance/quality control. The ISCD Official Positions on QUS resulting from this PDC, the rationale for their establishment, and recommendations for further study are presented here.
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Hans D, Krieg MA. The clinical use of quantitative ultrasound (QUS) in the detection and management of osteoporosis. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2008; 55:1529-38. [PMID: 18986943 DOI: 10.1109/tuffc.2008.829] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
For the detection and management of osteoporosis and osteoporosis-related fractures, quantitative ultrasound (QUS) is emerging as a relatively low-cost and readily accessible alternative to dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) in certain circumstances. The following is a brief, but thorough review of the existing literature with respect to the use of QUS in 6 settings: 1) assessing fragility fracture risk; 2) diagnosing osteoporosis; 3) initiating osteoporosis treatment; 4) monitoring osteoporosis treatment; 5) osteoporosis case finding; and 6) quality assurance and control. Many QUS devices exist that are quite different with respect to the parameters they measure and the strength of empirical evidence supporting their use. In general, heel QUS appears to be most tested and most effective. Overall, some, but not all, heel QUS devices are effective assessing fracture risk in some, but not all, populations, the evidence being strongest for Caucasian females over 55 years old. Otherwise, the evidence is fair with respect to certain devices allowing for the accurate diagnosis of likelihood of osteoporosis, and generally fair to poor in terms of QUS use when initiating or monitoring osteoporosis treatment. A reasonable protocol is proposed herein for case-finding purposes, which relies on a combined assessment of clinical risk factors (CR.F) and heel QUS. Finally, several recommendations are made for quality assurance and control.
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Affiliation(s)
- D Hans
- Dept. of Bone & Joint, Lausanne Univ. Hosp., Lausanne, Switzerland.
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Song Y, Paik HY, Joung H. Soybean and soy isoflavone intake indicate a positive change in bone mineral density for 2 years in young Korean women. Nutr Res 2008; 28:25-30. [PMID: 19083384 DOI: 10.1016/j.nutres.2007.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 09/27/2007] [Accepted: 11/09/2007] [Indexed: 11/25/2022]
Abstract
Many studies have shown that soybean and isoflavones have a favorable effect on bone mass for postmenopausal women, but few data are available on young Asian women. To investigate the effect of soybean and isoflavone intake on bone mineral density (BMD) and its change among young Korean women over 2 years, we conducted a longitudinal study for 34 women. The BMD was measured 3 times with 1-year intervals by dual x-ray absorptiometry at the lumbar spine and femur (neck, Ward's triangle [WT], and trochanter). Dietary intake was assessed up to 8 times by 24-hour recall with average 4-month interval. During the study period, BMD increased significantly for lumber spine and WT (2.5% and 5.2%). The average daily intake of soybeans and isoflavones was 39 g and 8 mg, respectively. Soybean intake and total isoflavone intake had positive correlation on femoral neck (FN) and WT. By longitudinal mixed-model regression analysis, BMD increased 0.26% per 1 mg of isoflavone intake per year in the FN and 0.31% for WT (P = .05 and .008). In conclusion, soybean and isoflavone intake have a positive effect on the change of BMD on the FN and WT among young Korean women. Because soybean and isoflavone intakes could be confounded by other nutrients, the positive effects of isoflavones on bone should be further investigated.
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Affiliation(s)
- YoonJu Song
- Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea
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Thorpe M, Mojtahedi MC, Chapman-Novakofski K, McAuley E, Evans EM. A positive association of lumbar spine bone mineral density with dietary protein is suppressed by a negative association with protein sulfur. J Nutr 2008; 138:80-5. [PMID: 18156408 PMCID: PMC2852881 DOI: 10.1093/jn/138.1.80] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary protein is theorized to hold both anabolic effects on bone and demineralizing effects mediated by the diet acid load of sulfate derived from methionine and cysteine. The relative importance of these effects is unknown but relevant to osteoporosis prevention. Postmenopausal women (n = 161, 67.9 +/- 6.0 y) were assessed for areal bone mineral density (aBMD) of lumbar spine (LS) and total hip (TH) using dual X-ray absorptiometry, and dietary intakes of protein, sulfur-containing amino acids, and minerals using a USDA multiple-pass 24-h recall. The acidifying influence of the diet was estimated using the ratio of protein:potassium intake, the potential renal acid load (PRAL), and intake of sulfate equivalents from protein. aBMD was regressed onto protein intake then protein was controlled for estimated dietary acid load. A step-down procedure assessed potential confounding influences (weight, age, physical activity, and calcium and vitamin D intakes). Protein alone did not predict LS aBMD (P = 0.81); however, after accounting for a negative effect of sulfate (beta = -0.28; P < 0.01), the direct effect of protein intake was positive (beta = 0.22; P = 0.04). At the TH, protein intake predicted aBMD (beta = 0.18; P = 0.03), but R2 did not improve with adjustment for sulfate (P = 0.83). PRAL and the protein:potassium ratio were not significant predictors of aBMD. Results suggest that protein intake is positively associated with aBMD, but benefit at the LS is offset by a negative impact of the protein sulfur acid load. If validated experimentally, these findings harmonize conflicting theories on the role of dietary protein in bone health.
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Affiliation(s)
- Matthew Thorpe
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana IL
| | - Mina C. Mojtahedi
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana IL
| | | | - Edward McAuley
- Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana IL
| | - Ellen M. Evans
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana IL,Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana IL
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Avenell A, Gillespie WJ, Gillespie LD, O'Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2005:CD000227. [PMID: 16034849 DOI: 10.1002/14651858.cd000227.pub2] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D and related compounds have been used to prevent fractures. OBJECTIVES To determine the effects of vitamin D or analogues, with or without calcium, in the prevention of fractures in older people. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group trials register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE, EMBASE, CINAHL, and reference lists of articles. Most recent search: March 2005. SELECTION CRITERIA Randomised or quasi-randomised trials comparing vitamin D or an analogue, alone or with calcium, against placebo, no intervention, or calcium, reporting fracture outcomes, in older people. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality, and extracted data. Data were pooled, where admissible, using the fixed-effect model, or random-effects model if the relative risks were heterogeneous. MAIN RESULTS Vitamin D alone showed no statistically significant effect on hip fracture (seven trials, 18,668 participants, RR 1.17, 95% CI 0.98 to 1.41), vertebral fracture (four trials, 5698 participants, RR (random effects) 1.13, 95% CI 0.50 to 2.55) or any new fracture (eight trials, 18,903 participants, RR 0.99, 95% CI 0.91 to 1.09). Vitamin D with calcium marginally reduced hip fractures (seven trials, 10,376 participants, RR 0.81, 95% CI 0.68 to 0.96), non-vertebral fractures (seven trials, 10,376 participants, RR 0.87, 95% CI 0.78 to 0.97), but there was no evidence of effect of vitamin D with calcium on vertebral fractures. The effect appeared to be restricted to those living in institutional care. Hypercalcaemia was more common when vitamin D or its analogues was given compared with placebo or calcium (14 trials, 8035 participants, RR 2.38, 95% CI 1.52 to 3.71). The risk was particularly high with calcitriol (three trials, 742 participants, RR 14.94, 95% CI 2.95 to 75.61). There was no evidence that vitamin D increased gastro-intestinal symptoms (seven trials, 10,188 participants, RR (random effects) 1.03, 95% CI 0.79 to 1.36) or renal disease (nine trials, 10,107 participants, RR 0.80, 95% CI 0.34 to 1.87). AUTHORS' CONCLUSIONS Frail older people confined to institutions may sustain fewer hip and other non-vertebral fractures if given vitamin D with calcium supplements. Effectiveness of vitamin D alone in fracture prevention is unclear. There is no evidence of advantage of analogues of vitamin D compared with vitamin D. Calcitriol may be associated with an increased incidence of adverse effects. Dose, frequency, and route of administration of vitamin D in older people require further investigation.
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Affiliation(s)
- A Avenell
- Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD.
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