Protective effect of total and supplemental vitamin C intake on the risk of hip fracture - a 17-year follow-up from the Framingham Osteoporosis Study

Dietary Assessment and Epidemiology Research Program, Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) and Friedman School of Nutrition Science and Policy (FSNSP), Tufts University, Boston, MA, USA.
Osteoporosis International (Impact Factor: 4.17). 04/2009; 20(11):1853-61. DOI: 10.1007/s00198-009-0897-y
Source: PubMed


Vitamin C may play a role in bone health. In the Framingham Study, subjects with higher total or supplemental vitamin C intake had fewer hip fractures and non-vertebral fractures as compared to subjects with lower intakes. Therefore, vitamin C may have a protective effect on bone health in older adults.
Dietary antioxidants such as vitamin C may play a role in bone health. We evaluated associations of vitamin C intake (total, dietary, and supplemental) with incident hip fracture and non-vertebral osteoporotic fracture, over a 15- to 17-year follow-up, in the Framingham Osteoporosis Study.
Three hundred and sixty-six men and 592 women (mean age 75 +/- 5 years) completed a food frequency questionnaire (FFQ) in 1988-1989 and were followed for non-vertebral fracture until 2003 and hip fracture until 2005. Tertiles of vitamin C intake were created from estimates obtained using the Willett FFQ, after adjusting for total energy (residual method). Hazard ratios were estimated using Cox-proportional hazards regression, adjusting for covariates.
Over follow-up 100 hip fractures occurred. Subjects in the highest tertile of total vitamin C intake had significantly fewer hip fractures (P trend = 0.04) and non-vertebral fractures (P trend = 0.05) compared to subjects in the lowest tertile of intake. Subjects in the highest category of supplemental vitamin C intake had significantly fewer hip fractures (P trend = 0.02) and non-vertebral fractures (P trend = 0.07) compared to non-supplement users. Dietary vitamin C intake was not associated with fracture risk (all P > 0.22).
These results suggest a possible protective effect of vitamin C on bone health in older adults.

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Available from: Jeffrey B. Blumberg, Oct 01, 2015
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    • "Blood and tissue concentrations of vitamin C in humans depend on diet. The higher vitamin C intake was reported to reduce the risk of bone marrow lesions and development of osteoarthritis in middle-aged subjects [39] and hip fracture in osteoporosis [40]. Under oxidative stress conditions, Asc may support osteoblastogenesis [41], implicated in bone regeneration and healing process. "
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    ABSTRACT: In bacterial bone infections, excessively formed oxidants may result in local and systemic oxidative stress. Vitamin C is the major extracellular nonenzymatic antioxidant, also implicated in bone cells metabolism and viability. The physiological functions of vitamin C largely depend on its redox status. We sequentially assessed oxidative stress markers, hydroperoxides and malondialdehyde (MDA), total antioxidant activity (AOA), total vitamin C, ascorbic acid (Asc), and oxidized/reduced vitamin C ratio in 137 patients with acute osteomyelitis (OM). Compared to 52 healthy controls, in OM group baseline serum hydroperoxides, MDA and oxidized/reduced vitamin C ratio were higher whilst Asc and AOA were lower (P < 0.05, resp.). On the other side, total vitamin C levels in patients and controls were similar (P > 0.05), thereby suggesting a relative rather than absolute vitamin C deficiency in OM. During the follow-up, oxidative stress markers, AOA, and oxidizedreduced vitamin C ratio were gradually returned to normal, while there was no apparent change of total vitamin C concentrations. Persistently high values of oxidized/reduced vitamin C ratio and serum MDA were found in subacute OM. In conclusion, acute OM was associated with enhanced systemic oxidative stress and the shift of vitamin C redox status towards oxidized forms.
    Mediators of Inflammation 08/2014; 2014:975061. DOI:10.1155/2014/975061 · 3.24 Impact Factor
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    • "For example, low vitamin C intake is associated with low bone mass and a high fracture risk [3], [4]. More importantly, persuasive epidemiological evidence suggests that higher vitamin C intake is associated with higher bone mass [5], as well as reduced fracture risk over a 17-year follow-up [6]. Likewise, the Women's Health Initiative found a statistical relationship between total vitamin C intake and bone mineral density at both the hip and spine in women receiving hormone therapy [7]. "
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    ABSTRACT: Epidemiologic studies correlate low vitamin C intake with bone loss. The genetic deletion of enzymes involved in de novo vitamin C synthesis in mice, likewise, causes severe osteoporosis. However, very few studies have evaluated a protective role of this dietary supplement on the skeleton. Here, we show that the ingestion of vitamin C prevents the low-turnover bone loss following ovariectomy in mice. We show that this prevention in areal bone mineral density and micro-CT parameters results from the stimulation of bone formation, demonstrable in vivo by histomorphometry, bone marker measurements, and quantitative PCR. Notably, the reductions in the bone formation rate, plasma osteocalcin levels, and ex vivo osteoblast gene expression 8 weeks post-ovariectomy are all returned to levels of sham-operated controls. The study establishes vitamin C as a skeletal anabolic agent.
    PLoS ONE 10/2012; 7(10):e47058. DOI:10.1371/journal.pone.0047058 · 3.23 Impact Factor
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    • "In an earlier study we established that an inadequate dietary intake of antioxidants increases considerably the risk of hip fracture in current smokers, whereas current smokers with a more adequate intake of antioxidants appear to have a fracture risk similar to that observed among never smokers [43], supporting the theory that oxidative stress has important effects on bone in man. A low intake of antioxidants has also recently been associated with an increased hip fracture risk in women [44] [45]. It has as well been shown that osteoporotic women have lower serum antioxidant levels compared with controls [46], and that higher intake of antioxidants may suppress bone resorption [47] and retard bone loss in some [48] [49] [50] [51] but not all [52] observational studies. "
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    ABSTRACT: Oxidative stress has recently been identified as a pivotal pathogenetic factor of bone loss in mice, but its importance in humans is not clear. We aimed to investigate the association between urinary 8-iso-PGF(2 alpha) levels, a major F(2)-isoprostane and a reliable in vivo biomarker of oxidative stress, and bone mineral density (BMD), and to study whether vitamin E in the form of serum alpha-tocopherol, a scavenger of peroxyl radicals, modifies the association. In 405 men, urinary 8-iso-PGF(2 alpha) and serum alpha-tocopherol were measured at age 77 years and BMD at age 82 years. One SD increase in 8-iso-PGF(2 alpha) corresponded to an approximately 2-4% decrease in average adjusted BMD values of total body, lumbar spine, and proximal femur (all P<0.001). Serum alpha-tocopherol levels seemed to modify the association between urinary 8-iso-PGF(2 alpha) and BMD. Men with alpha-tocopherol levels below the median combined with high oxidative stress, i.e., 8-iso-PGF(2 alpha) above the median, had 7% (95% CI 3-11%) lower BMD at the lumbar spine and 5% (95% CI 2-9%) lower BMD at the proximal femur. In elderly men high oxidative stress is associated with reduced BMD, which is more pronounced in individuals with low serum levels of the antioxidant vitamin E.
    Free Radical Biology and Medicine 07/2009; 47(5):668-73. DOI:10.1016/j.freeradbiomed.2009.05.031 · 5.74 Impact Factor
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