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Calcium intake and osteoporosis: The influence of calcium intake from dairy products on hip bone mineral density and fracture incidence - A population-based study in women over 55 years of age

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Objective: The incidence of osteoporosis increases with age and is most frequently observed in postmenopausal women. The objective of the present population-based cohort study was to assess the influence of Ca intake from dairy sources on hip bone mineral density and hip fracture incidence in a group of Polish women over 55 years of age. Design: The main outcome measures included: bone mineral density, the number of previous fractures and the reported Ca intake from dairy sources, assessed by a diet questionnaire. Setting: The RAC-OST-POL Study was conducted in the District of Raciborz in the south of Poland. Subjects: The study was carried out in a group of 625 women, randomly recruited from the general population of women aged >55 years. Results: Median Ca intake from dairy products was lower in the group of women with femoral neck T-score ≤-2·5 than in the group with T-score >-2·5 (275 v. 383 mg/d; P = 0·0019). For total hip score, the difference was close to borderline significance (P = 0·0698). Median Ca intake from dairy products was lower in the group of women with previous fractures than in those without fracture history (336 v. 395 mg/d; P = 0·0254). The main dairy source of Ca in the analysed group included milk drinks, rennet cheese and milk. Conclusions: Higher dairy Ca intake is recommended, since a number of the women analysed were unable to satisfy their Ca requirement exclusively from their diet.
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Public Health Nutrition: 17(2), 383–389 doi:10.1017/S1368980012005307
Calcium intake and osteoporosis: the influence of calcium
intake from dairy products on hip bone mineral density and
fracture incidence – a population-based study in women over
55 years of age
Dariusz W"odarek
1,
*, Dominika G"a˛bska
1
, Aleksandra Ko"ota
2
, Piotr Adamczyk
3
,
Aleksandra Czekaj"o
4
,W"adys"aw Grzeszczak
5
, Bogna Drozdzowska
6
and
Wojciech Pluskiewicz
7
1
Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life
Sciences–SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland:
2
Chair of Nutritional Physiology,
Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life
Sciences, Warsaw, Poland:
3
Department and Clinic of Pediatrics, Medical University of Silesia, Katowice,
Poland:
4
Department of Nephrology, Regional Hospital in Racibo
´rz, Racibo
´rz, Poland:
5
Department and Clinic
of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland:
6
Department of Pathomorphology, Medical University of Silesia, Katowice, Poland:
7
Metabolic Bone
Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical
University of Silesia, Katowice, Poland
Submitted 19 June 2012: Final revision received 30 October 2012: Accepted 12 November 2012: First published online 10 December 2012
Abstract
Objective: The incidence of osteoporosis increases with age and is most frequently
observed in postmenopausal women. The objective of the present population-
based cohort study was to assess the influence of Ca intake from dairy sources on
hip bone mineral density and hip fracture incidence in a group of Polish women
over 55 years of age.
Design: The main outcome measures included: bone mineral density, the number
of previous fractures and the reported Ca intake from dairy sources, assessed by a
diet questionnaire.
Setting: The RAC-OST-POL Study was conducted in the District of Raciborz in the
south of Poland.
Subjects: The study was carried out in a group of 625 women, randomly recruited
from the general population of women aged .55 years.
Results: Median Ca intake from dairy products was lower in the group of women
with femoral neck T-score #–2?5thaninthegroupwithT-score.–2?5(275v.
383 mg/d; P50?0019). For total hip score, the difference was close to borderline
significance (P50?0698). Median Ca intake from dairy products was lower in
the group of women with previous fractures than in those without fracture history
(336 v. 395 mg/d; P50?0254). The main dairy source of Ca in the analysed group
included milk drinks, rennet cheese and milk.
Conclusions: Higher dairy Ca intake is recommended, since a number of the
women analysed were unable to satisfy their Ca requirement exclusively from
their diet.
Keywords
Osteoporosis
Women
Calcium
Dairy products
Osteoporosis is a skeletal disease associated with low
bone mass, microarchitectural deterioration of bone
tissue and, as a consequence, increased bone fragility and
susceptibility to fracture
(1)
. The incidence of osteoporosis
increases with age and is most frequently observed in
postmenopausal women, as bone tissue loss and remo-
delling are accelerated by decreased ovarian oestrogen
levels associated with menopause
(2)
. Osteoporotic bone
fractures may be particularly devastating in the case of
elderly women. Fracture prevention is one of the key
goals of osteoporosis therapy in postmenopausal women,
with targets to inhibit bone loss processes, maintain
proper bone strength, and minimise or eliminate the
factors contributing to slips or falls
(3)
.
The relationship between Ca intake and bone mineral
density (BMD) is a widely analysed issue; higher Ca intake
is associated with increased bone density in children
(4)
,as
well as higher bone mass
(5)
, reduced risk of osteoporosis
(6)
*Corresponding author: Email dariusz_wlodarek@sggw.pl rThe Authors 2012
and lower fracture risks
(7)
in adults and the elderly.
The above-mentioned association is very complex and
some authors emphasise the role of other factors, such as
environmental factors for example, while doubting any
strong correlation with Ca
(8,9)
. Simultaneously, besides
gender and age, body mass is the third important element
which influences the risk of osteoporosis
(10)
, while being
also associated with Ca intake
(11,12)
.
The most important sources of Ca are dairy products,
providing over 60 % of daily Ca intake in women’s
diets
(13,14)
and even 74 % in some Polish studies
(15)
.Simul-
taneously, they are at least as efficacious as Ca supplements
in osteoporosis prevention
(16)
.
It was hypothesised that Ca intake from dairy sources
will be associated with BMD in women over 55 years of
age. The objective of the present population-based cohort
study was to assess the influence of Ca intake from dairy
sources on hip BMD and hip fracture incidence in a group
of Polish women aged .55 years.
Methods
The RAC-OST-POL study was carried out in a group of
Polish women aged .55 years, randomly recruited from
the general population of women over 55 years of age in
the District of Raciborz in the south of Poland. The total
number of eligible women inhabiting the region at the
time of enrolment was 17 500, from whom 1750 were
randomly selected and invited by regular mail to partici-
pate in the study. A blind list of women, selected for the
study, was provided by the local government and each
woman was assigned a number without showing her
name. A group of 625 women responded positively to
the invitation and declared their intention to take part in
the study, which was performed in May 2010. Among
these women, six were still menstruating. All 625 partici-
pants were submitted to the study protocol, including
BMD measurements and an FFQ to assess Ca intake.
Body weight and height were measured with a standard
medical balance and used to calculate BMI (kg/m
2
).
The study complied with the guidelines of the Declara-
tion of Helsinki and all procedures involving human
subjects were approved by the Ethics Committee of the
Medical University of Silesia, Katowice, Poland. A written
informed consent was obtained from all participants.
The study group was described in a previous paper
(17)
.
Osteoporosis has been operationally defined on the
basis of BMD assessment. According to the WHO criteria,
osteoporosis is defined as a BMD level that lies 2?5SD or
more below the average value for young healthy women
(T-score of #–2?5)
(18)
. The skeletal status was assessed
by a Lunar DPX bone densitometer (GE Healthcare,
Waukesha, WI, USA), assessing femoral neck and total
hip bone density. Densitometric variables are presented
as BMD (g/cm
2
) and T-score. All measurements were
performed by one operator. The CV for measurements
(calculated on the basis of fifty measurements – two
for each participant with reposition) was 1?6 % for
femoral neck and 0?82 % for total hip. Participants were
queried about previous fractures of non-traumatic origin,
e.g. caused by a fall from standing height or less; since no
radiograms were obtained, some spine fractures might
have been missed.
Participants were asked questions from the applied
FFQ to assess their Ca intake from dairy products;
they were asked by a dietitian about the frequency of
consumption of forty-nine dairy products most common
in Poland (e.g. milk, yoghurt, other milk beverages,
rennet cheese, cottage cheese) and of meals containing
dairy products, as well as typical portion sizes. Ca intake
from a particular product was estimated by the following
formula: Ca intake (mg) 5typical portion size (g) 3Ca
content (mg/g). The FFQ results were analysed using the
Dietetyk 2 software package (the Polish dietetic software)
and the Polish database of nutritional values of food
products
(19)
. The use of an FFQ to assess Ca intake is a
commonly accepted and widely applied method, taking
into account specified sources of Ca in the diet, mainly
dairy products
(13,20–23)
. The standard error of the Ca
estimate for the FFQ administered (calculated on the basis
of two measurements for fifty participants with repetition
during the period of 6 weeks) was 180 mg, while the
median difference for the two estimations of daily Ca
intake was 12 %. A similar questionnaire, taking into
account similar groups of products and applied to assess
Ca intake in the Polish population, was also characterised
by high sensitivity
(24)
.
Data are presented as means and standard deviations,
along with minimum, maximum and median values. The
distribution of the analysed factors was verified using
the Shapiro–Wilk test, while the Spearman correlation
coefficient was used to characterise relationships among
the analysed factors and the Mann–Whitney Utest was
used to analyse differences between groups.
An additional statistical analysis was performed in order
to confirm that the analysed population might be treated as
a representative sub-sample. It was verified whether the
mean age in the analysed sub-population matched the
mean age in the general population. The two-sided level of
significance P#0?05 was accepted to define the signifi-
cance of correlations. Statistical analysis was carried out
using the Statistica software version 8?0.
Results
Table 1 presents the characteristic features of the partici-
pants: age, body weight, body height and BMI. According
to the 2010 Statistical Yearbook, the general population
of women over 55 years of age in Poland comprises the
following age subgroups: 29?8 % aged 55–59 years, 14?3%
384 DW"odarek et al.
aged 60–64 years and 55?9 % aged 65 years and older
(25)
.
These age subgroups accounted for respectively 27?0%,
19?8 % and 53?2 % of the women in the present study.
The x
2
test performed for the subgroup aged 60–64 years
revealed a significant difference between typical and
observed numerical strength in the analysed group.
A significant correlation was found between age and BMI
values (P50?0017; r50?12).
Dairy Ca intakes of the women, grouped according to
femoral neck and total hip T-scores .–2?5or#–2?5, are
presented in Table 2. Ca intake from dairy products
was lower in the group of women with femoral neck
T-scores #–2?5 than in the group with T-scores .–2?5
(P50?0019). For the total hip scores, the difference was
borderline significant (P50?0698).
Table 3 presents the associations between dairy Ca
intake and fractures. Ca intake from dairy products was
lower in the group of women with previous fractures than
in those without fracture history (P50?0254).
Ca intake from various dairy sources is presented in
Table 4. The median Ca intake from total dairy products
was 373?2 mg/d in the analysed group; however with a
considerable variability among particular individuals,
ranging from 3?6 mg/d to 1922?9 mg/d. Other milk drinks
(i.e. drinks other than milk, such as yoghurt, kefir,
buttermilk) were the main dairy source of Ca, providing a
Table 1 Characteristic features of the participants: Polish women (n625) aged .55 years, RAC-OST-POL Study,
May 2010
Mean SD Median Minimum Maximum
Age (years) 66?47?865?7* 55?092?2
Body height (cm) 155?46?0 156?0* 136?0 175?0
Body weight (kg) 75?514?275?0* 39?0 125?0
BMI (kg/m
2
)31?25?530?8* 15?453?1
*Variable was not normally distributed (verified by the Shapiro–Wilk test; P#0?05).
Table 3 Dairy calcium intake (mg/d) according to fracture status: Polish women (n625) aged .55 years, RAC-OST-
POL Study, May 2010
Dairy Ca intake (mg/d)
Fracture status nMean SD Median Minimum Maximum Pvalue*
Fractures 176 390?5 256?5 336?4-3?6 1922?90?0254
No fractures 450 438?1 273?6 395?4-15?5 1915?1
*Differences assessed by the Mann–Whitney Utest.
-Variable was not normally distributed (verified by the Shapiro–Wilk test; P#0?05).
Table 2 Dairy calcium intake (mg/d) according to femoral neck and total hip bone mineral density T-scores: Polish
women (n625) aged .55 years, RAC-OST-POL Study, May 2010
Dairy Ca intake (mg/d)
T-score nMean SD Median Minimum Maximum Pvalue*
Femoral neck #22?5 59 360?4 226?1 274?9-3?6 1915?10?0019
.22?5 559 431?1 263?1 383?0-15?5 1922?9
Total hip #22?5 23 311?1 202?2 239?2-99?0 770?30?0698
.22?5 595 428?0 271?8 374?0-3?6 1922?9
*Differences assessed by the Mann–Whitney Utest.
-Variable was not normally distributed (verified by the Shapiro–Wilk test; P#0?05).
Table 4 Calcium intake (mg/d) from dairy sources: Polish women (n625) aged .55 years, RAC-OST-POL Study, May
2010
Ca intake (mg/d)
Mean SD Median Minimum Maximum
Total dairy products 424?7 269?6 373?2* 3?6 1922?9
Milk 95?7 138?170?8* 0?0 1300?0
Other milk drinks 134?3 138?999?1* 0?0 1377?4
Rennet cheese 117?5 139?772?6* 0?0 1091?1
Cottage cheese 34?134?525?5* 0?0 274?6
Dairy dishes 31?135?620?5* 0?0 252?2
*Variable was not normally distributed (verified by the Shapiro–Wilk test; P#0?05).
Calcium intake and osteoporosis 385
median of 99?1 mg Ca/d. Important sources of Ca
included rennet cheese (median 72?6 mg/d) and milk
(median 70?8 mg/d). The other analysed sources of Ca
included cottage cheese, dairy dishes and other products.
The correlations of age and BMI with Ca intake from
various dairy sources are presented in Table 5. In the case
of older individuals, a lower intake of Ca was observed,
both from total dairy products and particular dairy products
groups (including milk, other milk drinks, cottage and
rennet cheese), while a higher intake of Ca from dairy
dishes was confirmed. BMI values were inversely cor-
related with Ca intake levels from cottage cheese only.
Table 6 presents correlations between Ca intake from
various dairy sources and measured BMD values. Positive
correlations between femoral neck and total hip BMD
were observed for total dairy Ca intake as well as Ca
intake from milk and other milk drinks, while a negative
correlation was found between total hip BMD values and
Ca intake from dairy dishes.
Discussion
The present data were obtained from research carried out
in a group of Polish women aged .55 years, analysing
their dietary Ca intake from dairy products and its
association with osteoporosis. The correlation between
dietary Ca intake and osteoporosis development arouses
a great deal of controversy, as Ca intake is not the only
factor affecting BMD
(9)
, but remains a vital issue that is
evaluated intensively in various countries
(26–30)
.
The group of women analysed in the present study was
characterised by excessive body mass, with a median BMI
of 30?84 kg/m
2
. The high BMI values in these women
are congruent with BMI levels observed in osteoporosis
studies conducted in Europe
(26,27)
. Increased BMI may
be associated with bone mineral loss
(31)
and during
weight reduction overweight postmenopausal women are
also more susceptible to bone loss, even if they are
characterised by daily Ca intake of 1000 mg
(32)
.
Femoral neck T-score is the main indicator of osteo-
porosis in BMD assessment
(18)
, with fractures being the
most adverse effect of the disease
(33)
. In the present study,
womenwitheitherlowerfemoralneckT-scoresor
previous fractures were characterised by lower dairy Ca
intake. Other reports indicate that postmenopausal women
with higher intakes of dairy products are also characterised
by higher lumbar BMD values
(10)
. Some researchers have
emphasised a strong negative correlation between Ca
intake and hip fracture incidence among women
(34)
,as
well as a correlation between Ca intake and broadband
ultrasound attenuation Z-score in elderly women
(35)
.
However, other studies of Ca intake and osteoporosis
indicated associations between Ca intake and BMD to be
rather contradictory. Some researchers claim that, even if a
certain influence of Ca intake on bone mass improvement
is observed, neither Ca nor vitamin D supplementation
demonstrates any short-term effect on fracture risk
(6)
; thus
coming to the conclusion that no correlation exists between
Ca intake and fracture incidence
(28)
.
Dairy Ca intake may be perceived as a strong predictor
of total Ca intake, as Ca intake from products other than
dairy products is fairly constant. The results of other
authors indicate that dairy products provide over 60 % of
daily Ca intake in women’s diets; in a group characterised
by Ca intake of about 800 mg/d the contribution from dairy
products was about 62 %, while in group characterised by
Ca intake of about 900 mg/d the contribution amounted to
about 84 %
(13)
. As the daily Ca intake from non-dairy
products remains at a fairly stable level, a higher total daily
Ca intake suggests a higher contribution of Ca from dairy
products in the diet. The total Ca intake of the women in
the present study may be estimated as the sum of Ca
intakes from all products in the FFQ and about 250mg
Ca from products other than dairy products. Thus, in
the present group of Polish women, Ca intake can be
estimated at the level of about 675 mg/d. In other research
conducted in postmenopausal women in Poland, the
total Ca intake was similar over 600 mg daily
(36)
.
The latter study, performed in nine European countries,
indicated that Polish women are characterised by low Ca
intake compared with women in the other countries
evaluated
(36)
. Ca intake in non-European populations
was lower than in Poland below 600 mg/d
(37–39)
.The
recommended daily Ca intake for postmenopausal women
Table 6 Correlations between calcium intake from dairy sources
and femoral neck and total hip bone mineral density (BMD): Polish
women (n625) aged .55 years, RAC-OST-POL Study, May 2010
BMD – femoral neck BMD – total hip
Pvalue rPvalue r
Total dairy products 0?0048* 0?11 0?0198* 0?09
Milk 0?0039* 0?12 0?0361* 0?08
Other milk drinks 0?0001* 0?15 0?0001* 0?15
Rennet cheese 0?2799 0?04 0?2870 0?04
Cottage cheese 0?1203 0?06 0?5519 0?02
Dairy dishes 0?1470 20?06 0?0057* 20?11
*Significant correlations (assessed by the Spearman correlation coefficient;
P#0?05).
Table 5 Correlations of age and BMI with calcium intake from dairy
sources: Polish women (n625) aged .55 years, RAC-OST-POL
Study, May 2010
Age BMI
Pvalue rPvalue r
Total dairy products 0?0000* 20?19 0?4192 20?03
Milk 0?1980 20?05 0?2066 0?05
Other milk drinks 0?0002* 20?15 0?5740 0?02
Rennet cheese 0?0001* 20?16 0?7871 20?01
Cottage cheese 0?0000* 20?19 0?0115* 20?10
Dairy dishes 0?0008* 0?13 0?3257 0?04
*Significant correlations (assessed by the Spearman correlation coefficient;
P#0?05).
386 DW"odarek et al.
is 1000–1500 mg, depending on age and recommending
institution
(40)
. As a result, a number of women in the
present study were unable to satisfy their Ca requirement
exclusively from their diet.
The present women had lower intakes of Ca from milk
and milk drinks, as well as from cheeses and other products,
as compared with the results of other studies
(13)
. The pro-
portion of dairy products as sources of Ca was also different.
In the study by Poliquin et al.
(14)
the proportion of Ca from
milk to Ca from other dairy products was about 3?2:4 and in
the study by Fardellone et al.
(26)
it was about 1?8:4, whereas
the proportion was 0?7:4 in the present study. Simulta-
neously, Gonelli et al.
(13)
found the proportion of Ca from
milkandmilkdrinkstoCafromcheesesandotherdairy
products to be about 3:4, while this proportion was 5?5:4
in our study. Therefore it may be concluded that while
milk consumption was low in the present study group,
the consumption of other milk drinks was fairly high in
comparison with the results from other research.
ThestrongeffectofageonCaintakeweobservedisalso
reported by other researchers
(26,37,39)
.Accordingtoother
authors, the daily Ca intake of postmenopausal women is
significantly lower than that of premenopausal women
(39)
and the proportion of women with low Ca intake rises with
age
(26,37)
. However, the character of the relationship is not
obvious, as other authors report lower Ca inadequacy in
women above 75 years of age
(36)
, probably associated with
higher intake of Ca supplements
(14)
.
In the present study it can be concluded that the lower
Ca intake observed in the case of older women
can be attributed to lower consumption of dairy products,
probably as a result of changing nutritional habits.
Simultaneously, milk consumption remains stable, inde-
pendently of age, while the consumption of dairy dishes
is higher, without any major impact on the total dairy Ca
intake. With age, everyday activities such as preparing
meals become more difficult
(41)
and chewing ability also
decreases
(42)
. So, the above-mentioned higher consump-
tion of dairy dishes may probably result from the fact that
dairy dishes are easy to prepare and eat.
In the research of Zhong et al.
(28)
, a close to significant
association was observed between Ca intake and BMI:
postmenopausal women with higher BMI values reported
lower Ca intake. No such correlation was observed in our
study group. The only correlation we observed, that
between cottage cheese consumption and BMI, could have
been attributed to the general observation that individuals
with lower BMI consume more cottage cheese, also con-
firmed by other researchers
(43)
.
In the present group of females, correlations were
observed between Ca intake from various dairy sources
and BMD that corresponded to the results of other
authors, claiming similar correlations between Ca intake
and BMD
(39,44,45)
.
In contrast, the observed negative correlation between
Ca intake from dairy dishes and total hip BMD score is
rather difficult to explain. Only the fact indicated
previously, that dairy dishes are generally easier to pre-
pare and to eat and may be more often chosen by elderly
people, may provide an explanation. The positive corre-
lation between dairy Ca intake and BMD in the case of Ca
from milk and other milk drinks, but not for Ca from
rennet cheese and cottage cheese, may be associated with
lactose. Lactose is contained in milk and other milk
drinks, being a factor promoting Ca absorption
(46)
.
The content of lactose in milk and other milk drinks
is significantly higher than in either rennet cheese or
cottage cheese; according to the Polish food composition
database, the lactose content is 4?6–4?9 g/100 g and
4?1–5?0 g/100 g for cow’s milk and other milk drinks, as
opposed to 0?1–1?0 g/100 g and 1?0–3?3 g/100 g for rennet
cheese and cottage cheese, respectively
(19)
. So, it may be
concluded that BMD is correlated not only with Ca from
dairy products but with Ca intake from lactose-containing
dairy products, where lactose improves Ca absorption.
One of the factors that influences Ca metabolism in the
human body, and as a consequence reduces the risk of
osteoporosis, is vitamin D
3
. In the present study, neither
vitamin D intake nor its serum level was assessed.
This may be a limitation of the study, but nevertheless the
proper intake of Ca is the main dietary factor influencing
bone density, and in the research of other authors a
similar attitude is chosen
(10,47)
. Other potential limitations
of our study may be associated with the fact that only
36 % of invited women participated and that BMD was
measured at the hip only and spine radiograms were not
available, thus some spine fractures might not have been
taken into account.
Conclusions
In the present group of Polish women above 55 years of
age, it may be concluded that lower BMD (femoral neck
T-score #–2?5) and previous fractures were associated
with lower reported dairy Ca intake. Due to the insuffi-
cient consumption of dairy products, a number of women
were unable to satisfy their Ca requirement exclusively
from their diet. The main dairy sources of Ca in the
analysed group included milk, other milk drinks and
rennet cheese. It is therefore important to recommend
the consumption of dairy products with lactose, a Ca-
absorption improving factor, such as milk and milk
drinks, to improve BMD and reduce fracture risks in the
population of postmenopausal women with osteoporosis.
Acknowledgements
Sources of funding: This research received no specific grant
from any funding agency in the public, commercial or non-
for-profit sectors. Conflicts of interest: The authors have no
conflicts of interest to declare. Authors’ contributions: D.W.
and W.P. designed study; D.W., D.G., A.K., P.A., A.C., W.G.,
Calcium intake and osteoporosis 387
B.D. and W.P. conducted the research; D.W., D.G. and A.K.
analysed the data and performed the statistical analysis;
D.W. and D.G. wrote the paper; D.W. had primary
responsibility for final content.
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... Dairy products have been found to be associated with a lower risk of fracture, diabetes, and mortality in previous studies [8,9]. However, inconsistent health effects of dairy products were reported in recent research [10][11][12][13][14]. Several systematic reviews and metaanalyses concluded that dairy product intake was not related to fracture [12,13,15,16]. ...
... However, inconsistent health effects of dairy products were reported in recent research [10][11][12][13][14]. Several systematic reviews and metaanalyses concluded that dairy product intake was not related to fracture [12,13,15,16]. The conclusions of cohort studies are also contradictory [10,13,14,[17][18][19], apart from no relations observed in some research, some cohort studies provided evidence that higher dairy product intake increased the risk of fracture in western countries [10,18]. The association between dairy products and the fracture was inferred to be mediated by height by some research, that is, dairy products contributed to growing tall, while higher height further increased the risk of fracture [20,21]. ...
... The health effects of dairy products/milk have been debated for years, but epidemiological literature on dairy product intake and the risk of fracture is still limited, especially among Chinese adults [10,13,14,[17][18][19][32][33][34][35][36][37]. Our results support the conclusions of several cohort studies that dairy product intake was associated with a decreased risk of fracture among adults [14,17,34,37]. ...
Article
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Background: The current literature reports inconsistent associations between dairy product intake and fracture. This study assessed the association between dairy product intake and the risk of fracture among Chinese adults and examined the mediation effects of height and body mass index (BMI) on the association. Methods: Data in 1997-2015 from the China Health and Nutrition Survey were used. Dietary data were collected by a 24-hour dietary recall, and occurrences of fracture were obtained by self-report of participants. Cumulative average intake of daily dairy products was calculated by the sum of the dairy product intake and divided by the total waves of participating in the surveys before fracture. Cox proportion hazard regressions were performed to explore the associations between dairy product intake and the risk of fracture. Mediation analysis models were established to examine the mediation effects of height and BMI on the associations. Results: A total of 14,711 participants were included. Dairy product intake of 0.1-100 g/day was associated with a decreased risk of fracture, while no association was observed among participants with dairy product intake of >100 g/day. The indirect effects of dairy product intake on the fracture mediated by height and BMI were much smaller than the direct effects. Conclusions: Dairy product intake with 0.1-100 g/day is associated with a lower risk of fracture, and the association is mainly a direct result of nutrients in dairy products and much less a result of the mediation effects of height or BMI. Dairy product intake of 0.1-100 g/day might be a cost-effective measure for Chinese adults to decrease fracture incidence.
... The long-term influence of lactose intolerance behaviors may contribute to a later risk of osteoporosis. Conversely, some studies reported that older adults enjoyed many benefits from dairy product intake, such as decreased mortality and chronic disease risk (such as stroke, hypertension, hip fracture, Alzheimer's disease, sarcopenia, and cardiovascular disease mortality risk) [4][5][6][7][8][9][10][11][12][13]. Other studies have reported that enough dairy product intake might reduce colorectal cancer by 10%, metabolic syndrome by 13%, obesity by 16%, and osteoporosis risk by 39% [10,11,[14][15][16]. ...
... Conversely, some studies reported that older adults enjoyed many benefits from dairy product intake, such as decreased mortality and chronic disease risk (such as stroke, hypertension, hip fracture, Alzheimer's disease, sarcopenia, and cardiovascular disease mortality risk) [4][5][6][7][8][9][10][11][12][13]. Other studies have reported that enough dairy product intake might reduce colorectal cancer by 10%, metabolic syndrome by 13%, obesity by 16%, and osteoporosis risk by 39% [10,11,[14][15][16]. Overall, the benefits of the benefits of dairy product intake outweigh its harm to human health. ...
... In the preparation stage, IC had a positive correlation with dietary intake behaviors. Older adults might be scared that their health will become worse, so that the increase of the IC score led to more frequency of dairy intake behaviors [2][3][4][5][6][7][8][9][10][11][12][13]. Furthermore, IP made an impact on dairy product intake merely in the preparation stage (Table 5). ...
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Adequate dairy product intake can reduce the risk of chronic disease, mortality, low quality of life, and healthcare expenditure. However, the insufficient consumption of dairy products is a serious issue in Eastern societies. To the authors’ knowledge, few studies have explored dairy intake among Taiwanese older adults, especially using the transtheoretical model. The study aims were to address the following unknowns: (i) the distribution of dairy product intake behavior on stages of change (SOC); (ii) differences in variables (intake knowledge (IK), intake cons (IC), intake pros (IP), and intake self-efficacy (ISE)) among SOCs; (iii) discriminative abilities of variables on SOCs; and (iv) predictive ability of variables (IK, IC, IP, and ISE) for dairy product intake behavior on SOC for older adults. An explorative cross-sectional study was conducted to collect data from northern Taiwan using a questionnaire. A total of 342 older adults were recruited. Data were analyzed using multivariate analysis of variance, discriminant analysis, and multiple linear regression. There was a significant difference between the variables and SOCs. There was a better discriminant among the five SOCs. Dairy product intake behaviors were significantly associated with knowledge and self-efficacy in the pre-action stage, and with cons, pros, and self-efficacy in the post-action stage. In conclusion, appropriate nutritional empowerment could benefit older adults by improving dairy intake among the different SOCs.
... The relationship between calcium intake and bone density is a factor that has been widely discussed in academia; higher calcium intake is associated with increased bone density in children as well as higher bone mass, reduced risk of osteoporosis, and lower risk of fractures in adults and the elderly (Ko et al., 2012). The relationship is very complex, and some studies emphasize the role of other factors, such as environmental factors. ...
... The relationship is very complex, and some studies emphasize the role of other factors, such as environmental factors. At the same time, apart from gender and age, body mass is an important element influencing the risk of osteoporosis associated with calcium intake (Ko et al., 2012). ...
Article
As the correlation between overweight and obesity on bone density in adolescence has not been fully understood, this study aimed to identify the correlation between calcium intake, bone density, and overweight/obesity status in adolescents. Conducted in two urban areas, Gorontalo City and Manado City, this research employed a cross-sectional study design. The research sample was obtained by using the minimum sample size formula for a crosssectional study. The total sample encompassed 90 samples (45 adolescents in Gorontalo City and 45 adolescents in Manado City). The collected data comprised anthropometric data, bodyweight classification, bone density data, and calcium intake data. The data analysis was carried out by univariate analysis and Pearson correlation analysis. The results of the Pearson correlation test show that body weight is significantly correlated with bone density and calcium intake, each with p-values of 0.000 and 0.001, respectively. Thus, it was concluded that body weight correlates with bone density and calcium intake.
... All postmenopausal women can benefit from nonpharmacological interventions to reduce the risk of fracture, including a balanced diet with adequate intake of calcium and vitamin D, regular exercise, measures to prevent falls or minimize their impact, smoking cessation, and moderation of alcohol intake. 6) Among the many factors affecting bone density, the role of some nutrients, such as calcium and vitamin D, 7) in bone health is obvious, but the effects of other nutrients are less well known. Some studies have reported that certain dietary factors, such as sodium, may modulate calcium metabolism. ...
Article
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Background: Dietary Na+ or Na+/K+ ratio has been reported to be associated with bone mineral density (BMD). However, this remains unclear, and only a few studies have been reported on the Korean population. Therefore, this study aimed to determine the association between dietary Na+, K+, and Na+/K+ ratios and BMD in middle-aged Korean women. Methods: This study used data from the Korea National Health and Nutrition Examination Survey 2008-2011. A total of 3,690 women aged >50 years were included. Study participants were classified into quartiles (lowest quartile Q1-highest quartile Q4) according to dietary Na+, K+, and Na+/K+ ratio, and we examined the association of these parameters with BMD. Total femur and lumbar spine BMD were measured using dual-energy X-ray absorptiometry. Multiple linear regression analyses were performed using IBM SPSS ver. 19.0. Results: The mean age was 62 years, and a significant negative trend in the β-coefficient regarding dietary Na+ was only observed in the total femur BMD. However, the total femur and lumbar spine BMD decreased from Q1 to Q4 regarding the dietary Na+/K+ ratio (P-value for trend: 0.044 for total femur BMD and 0.002 for lumbar spine BMD). Conclusion: A significant negative trend in the β-coefficient for both total femur and lumbar spine BMD was observed regarding the Na+/K+ ratio. Therefore, based on the results of this study, a higher dietary Na+/K+ ratio may be associated with a lower BMD.
... This cohort was then studied in regard to various aspects of bone health. [2][3][4][5][6][7][8][9][10][11][12] More recently, we presented data from a large group of female patients enrolled when attending a single outpatient osteoporosis clinic; this research was published in consecutive papers and identified with the acronym GO Study. [13][14][15] In recent years, methods for fracture risk assessment were developed, 12,[16][17][18] and fracture risk assessment became an important part of the examination of patients. ...
Article
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Background: The method of recruiting the study subjects is an important element of the study design. It can have a strong influence on the results. Different recruitment schedules can give a different picture of the studied phenomenon. Objectives: The aim of the study was to compare bone health in a group of female patients treated for osteoporosis with a population-based sample. Material and methods: A cohort of women from GO Study from 1 outpatient osteoporotic clinic (n = 1442, mean age 65.8 ±6.7 years) and population-based female sample of RAC-OST-POL Study (n = 963, mean age 65.8 ±7.5 years) were studied. Mean age did not differ between groups. Mean weight, height and body mass index (BMI) in subjects from GO Study and RAC-OST-POL Study were 69.5 ±13.1 kg, 157.8 ±6.1 cm and 27.9 ±5.1 kg/m2, and 74.2 ±13.7 kg, 156.0 ±6.0 cm and 30.5 ±5.4 kg/m2, respectively, and differed significantly (p < 0.0001 for each variable). Data on clinical risk factors for osteoporosis and fractures were collected. Bone densitometry at hip was performed using a Prodigy or Lunar DPX device (GE Healthcare, Waukesha, USA). Fracture risk was established using FRAX, Garvan and POL-RISK. Results: Mean values of T-score for femoral neck in subjects from GO Study and RAC-OST-POL Study were -1.67 ±0.91 and -1.27 ±0.91 and differed significantly (p < 0.0001). In GO Study and RAC-OST-POL Study, there were 518 (35.9%) and 280 (29.1%) subjects with fractures, respectively. The fracture frequency was significantly higher in the GO Study group (p < 0.001). Among clinical risk factors, only rheumatoid arthritis (p < 0.0001) secondary osteoporosis (p < 0.0001) and falls (p < 0.0001) were more frequent in RAC-OST-POL Study. Fracture risk established using FRAX, Garvan and POL-RISK calculators was significantly greater in patients enrolled in the GO Study than in subjects from the RAC-OST-POL population-based sample (p < 0.0001 for each variable). Conclusions: Differences noted between female patients treated for osteoporosis and population-based sample, especially in regard to fracture risk, reveal a strong influence of recruitment criteria on study results in the field of bone health and osteoporosis.
... In that study, an epidemiological, population-representative sample was recruited, involving postmenopausal women, aged over 55 years. The cohort was studied in regard to various aspects of bone health [2][3][4][5][6][7][8][9][10][11][12]. At baseline, health status data were collected in the patients, identifying factors with a potential influence of bone metabolism and bone status (more than 200 variables were recorded). ...
Article
Full-text available
Introduction: The therapeutic regimens for osteoporosis are the key elements in the management of osteoporotic patients. Objective: The aim of the study was to present the data on changes in the therapy for osteoporosis in females during a 10-year follow-up. Patients and methods: A population-based sample of the RAC-OST-POL Study provided the material for analysis. At baseline, the cohort included 978 women, out of whom, 541 women remained at the follow-up observation, their mean age being 74.7 (SD 6.6) years. Results: The number of women without therapy and of those on alendronate decreased, while the number of patients, receiving other forms of the antiresorptive therapy or calcium/vitamin D supplementation increased. The percentage of untreated women in the rural areas and the urban areas was 85% and 74.1%, respectively at baseline and 74.3% and 63.3%, respectively. at the end of the follow-up period. The percentage of untreated women decreased significantly, both in rural and urban cohorts. It was accompanied by a significant increase of calcium/vitamin D supplementation in both subgroups. Regarding the antiresorptive therapy, there was a significant increase in the frequency of its use only in the rural cohort. The frequency of therapy strategies was determined by the level of education. The frequency of calcium and/or vitamin D supplementation increased significantly in all education categories during follow-up. Conclusion: Changes in the therapy of postmenopausal women with osteoporosis, observed in a 10-year follow-up of postmenopausal women, indicated that the level of care of the postmenopausal women with osteoporosis did not improve.
... Among the impacts resulting from hypoestrogenism, there is a predisposition to osteoporosis, one of the most common diseases in this population. In this sense, it is observed that resorption slowly exceeds bone formation, and the risk of osteopenia and osteoporosis increases in perimenopause and menopause [4,5]. Considering the commitment to the decade of healthy aging, the investigation of new disease preventive measures in this population is of great importance [6,7], with perimenopause being a period of opportunity for promoting health [8]. ...
Article
Aims This study verified the action of oxytocin (OT) as a preventive measure to control bone damage during aging in female rats. Main methods Wistar rats received saline (0.15 mol/L/IP; Vehicle Group), Atosiban/AT (300 μg/Kg/IP; At Group), OT (134 μg/Kg/IP; Ot Group), or AT+OT (OT injections 5 min after AT; At+Ot Group), at 19 and 20 months of age. A functional test was performed immediately before and 30 days after the injections to analyze the animals' gait. Key findings Animals in the At group had higher alkaline phosphatase (ALP) activity, lower cortical and trabecular thickness, fewer trabeculae, higher expression of tartrate-resistant acid phosphatase (TRAP) and lower osteocalcin (OCN), higher cortical porosity, and lower moment of inertia and bone strength at the femoral neck. OT administration increased lipidic peroxidation and plasma superoxide dismutase (SOD), and provided, in the femoral neck, lower expression of TRAP and higher OCN, greater cortical and trabecular thickness, a greater number of trabeculae, bone mineral density (BMD), higher inertia bone strength, and lower cortical porosity. At + Ot group showed great similarity with the vehicle group, higher SOD, and BMD. An increase in stride length and no increase in base width of 21-month-old animals were observed after OT, unlike animal's vehicle or AT. Significance Endogenous OT plays an important role in the regulation of bone remodeling during periestropause, and exogenous OT stands out as a potential preventive intervention in this period to improve bone quality with functional repercussions, possibly providing better gait activity.
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The side effects of soft drinks are still an important challenge especially for the expressed genes of foetuses that regulate ossification. For that purpose, we investigate the expression of R-spending2 (RSPO2), Hydroxyacid Oxidase 1 (HAO1), and runt related transcription factor 2 (RUNX2) genes and the foetuses skeletal malformation due to maternal Pepsi consumption. Pregnant rats were divided into control group that was administrated orally with distilled water, group1 from day 1 to day 7 was orally administrated with 2.5 ml/day of Pepsi, group2 from day 1 to day 7 was administrated orally with 5ml/day of Pepsi, group 3 from day 8 to day 20 was orally administrated with 2.5 ml/day of Pepsi, and group 4 from day 8 to day 20 was orally administrated with 5 ml/day of Pepsi. Gene expression analysis revealed that the RSPO2 gene is significantly decreased with increasing the dosage of soft drinks during the 1st stage of pregnancy. Conversely, there is a significant increase in the HAO1 gene in 1st stage group relative to the control group. RUNX2 gene is significantly decreased in group1 and group 2 while it was significantly increased in groups 3 and 4 regarding the control group. Pepsi administration caused retarded body length and weight, ossification and lengths of some bones, and shortness of others. Different bones are seriously affected by Pepsi. Therefore, our findings reveal the effect of soft drink consumption on skeletal malformation and the RSPO2, HAO1, and RUNX2 genes that can be used as biomarkers for skeletal modulation.
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Calcium is an essential and critical component of human health. However, most people do not cover daily calcium recommendations. Therefore, a calcium-based drink, called BEVERAGE, is developed in order to offer an alternative source of this mineral to the population. A combination of kefir, eggshell, citric fruits, and tap water were investigated. Orange was selected because it provides the highest amount of carbohydrates for fermentation, and it is accessible to the population. The proportion of components that produce the highest concentration of calcium in the BEVERAGE was with 10 g of kefir, 6 g of eggshell, 200 ml of orange juice, and 800 ml of tap water, 20 ºC, and 72 h of incubation. With these conditions, the BEVERAGE was fortified with 600 mg calcium/liter. In addition, the intestinal absorption of calcium was evaluated through an ex vivo model of the everted small intestinal sacs, proving to be higher than the control solutions (water+CaCl2, juice+CaCl2). This study provides a methodology to prepare at home a beverage that could contribute to increase daily calcium intake.
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Analyses were conducted for calcium intake from dairy products linked with the consumption of calcium supplements and consumption of calcium-fortified food in respect to bone mineral density (BMD) of women (n=39) aged 34-56 years. A relationship was demonstrated between bone mineral density (BMD) of the women and calcium intake from dairy products, calcium-fortified food products and calcium supplements. Low BMD of the women resulted from a very low intake of calcium from dairy products and restricted use of calcium supplements and/or consumption of calcium-fortified foods. Appropriate calcium intake from dairy products was insufficient to reach high BMD values. The high BMD values of the women were determined by calcium intake from calcium-fortified foods and the consumption of calcium supplements, and-to a lesser extent-by calcium intake from dairy products with an average calcium intake. © Copyright by Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences.
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The aim of the study was to prepare a tool for quantitive evaluation of calcium intake and its calibration. The ADOS-Ca test calibration was carried out by the 24-hour recall method repeated seven times. The study included 90 people (aged 22.6±0.1) who gave complete information, i.e. 630 nutrition interviews and 90 ADOS-Ca tests. Calcium intake from dairy products estimated by the test was stated in mg/person/day and was estimated on the basis of the consumed products amount, intake frequency indices and calcium content in 100 g of a product. Calibration includ-ed comparing the mean calcium intake (dependant-sample t-test, correlation coefficient) and compatibility of population distribution (chi 2 test) in calcium intake classes (<66.7% of the Polish RDI at the safe level = calcium deficiency risk; 66.6–90% of RDI = no calcium deficiency risk; >90% of RDI = no calcium deficiency risk). Moreover sensitivity, specificity and accuracy indices were calculated for the prepared test. No differences between mean calcium intake from dairy products estimated by the ADOS-Ca test and the 24-hour recall method repeated seven times (men: 619 mg vs. 661 mg; p=0.263; women: 434 mg vs. 442 mg; p=0.645) were revealed, but calcium intake correlation was noted. No differentiation in the population distribution in three calcium intake classes was noted, and the percentage of people classified accurately into the same class by the ADOS-Ca test and the 24-hour recall method repeated seven times was high (71% of the population). The noted high sensitiv-ity index value (88%), shows high ability of the test to classify people properly to a group under calcium deficiency risk. The prepared ADOS-Ca diagnostic test was proved to be a good tool for quantitive evaluation of calcium intake from dairy products and enabled accurate classification of people with different calcium intake with regards to risk of its deficiencies.
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Bone density of the elderly in Taiwan was assessed by quantitative ultrasound bone densitometry of the heel in the Elderly Nutrition and Health Survey in Taiwan (1999-2000). Broadband ultrasound attenuation (BUA) was measured, and the corresponding Z-score was calculated. Physical examination data of 1123 males and 1034 females were included in the current analysis, and data of 752 males and 721 females who also had complete questionnaire information were used for analysis of relationships between several risk factors and BUA status. The results show that in elderly Taiwanese males, higher BMI and intake of dietary calcium is positively associated with a higher BUA Z-score. Advancing age and living in the second stratum in the southern areas appeared to be negatively associated with BUA Z-score in elderly females. BMI, height, years of education, and intake of dietary calcium were positive predictors of BUA Z-score. Further analysis was performed by grouping subjects according to the gender-specific medians of intake levels of dietary calcium, protein, and sodium. The results revealed that for both genders, those in the "high calcium/high protein" group had a higher mean BUA Z-score. The results of the current analysis show that in Taiwan, BMI and dietary calcium intake are positive predictors of BUA Z-score in elderly males, whereas BMI, height, years of education, and dietary calcium intake are positively associated with BUA Z-score in elderly females. The effects of dietary calcium intake may be influenced by the intake of other nutrients such as sodium and protein.
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Objective: To update the evidence-based consensus opinion published by The North American Menopause Society (NAMS) in 2001 on the role of calcium in peri- and postmenopausal women. Design: NAMS followed the general principles established for evidence-based guidelines to create this document. A panel of clinicians and researchers acknowledged to be experts in the field of calcium and women's health was enlisted to review the previous position statement and data published since then, compile supporting statements, and make recommendations. Their advice was used to assist the NAMS Board of Trustees in publishing this position statement. Results: Adequate calcium intake (in the presence of adequate vitamin D status) has been shown to reduce bone loss in peri- and postmenopausal women and reduce fractures in postmenopausal women older than age 60 with low calcium intakes. Adequate calcium is considered a key component of any bone-protective therapeutic regimen. Calcium has also been associated with beneficial effects in several nonskeletal disorders, primarily hypertension, colorectal cancer, obesity, and nephrolithiasis, although the extent of those effects has not been fully elucidated. The calcium requirement rises at menopause. The target calcium intake for most postmenopausal women is 1,200 mg/day. Adequate vitamin D status, defined as 30 ng/mL or more of serum 25-hydroxyvitamin D (usually achieved with a daily oral intake of at least 400 to 600 IU), is required to achieve the nutritional benefits of calcium. The best source of calcium is food, and the best food source is dairy products. High-quality calcium supplements (taken in divided doses) are alternative sources for women unable to consume enough dietary calcium. There are no reported cases of calcium intoxication from food sources, and cases associated with supplements are rare (high intake levels of 2,150 mg/day have resulted in a 17% increase in renal calculi in one recent study, but not others). Because no accurate test to determine calcium deficiency exists, clinicians should focus instead on encouraging women to consume enough calcium to meet the recommended levels. Conclusions: The most definitive role for calcium in peri- and postmenopausal women is in bone health, but, like most nutrients, calcium has beneficial effects in many body systems. Based on the available evidence, there is strong support for the importance of ensuring adequate calcium intake in all women, particularly those in peri- or postmenopause.
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In a randomized cohort of postmenopausal women representative for Bialystok Region BOS-1 we found 14.8% of osteoporosis, 43% of normal results and 42.2% of osteopenia, while 30% of them reported low trauma fractures. 50% of Fx occurred in osteopenic BMD, 24.5% in normal and 25.5% in osteoporotic one. Mean Hip T-score of all Fx was -1.6. In a non-selected cohort of 1608 women in BOS-2, all clinical, independent, risk of fracture (FxRF) were included to evaluate population ten-year probability of major osteoporotic Fx - (hip, clinical spine, forearm or proximal humerus) (m.o.Fx.) as well as hip Fx (h.Fx.) with and without BMD measurement using FRAX™BMI and FRAX™BMD, a WHO Algorithm on the basis of epidemiology in women of the U.K. Results: 10 year probability of m.o.Fx. increased with age from 5.2% with BMD and 4.8% without BMD in the 5th decade to 23.9% and 29.5% respectively in the 9th decade, mean 11.8% with and 11.0% without BMD, and h.Fx from 0.4% and 0.5% to 11.4% and 15.4% mean 3.1% with and 2.8% without BMD respectively. 71% of women with Fx have BMD above hip T-score -2.5 and 18% of those without Fx have BMD below hip T-score -2.5. The results of BOS-1 and BOS-2 studies of epidemiology of osteoporotic fractures indicated that 10-year risk of fracture but not "densitometric osteoporosis" should be diagnostic and therapeutic tool for decision making health care subjects.
Article
Objective: The North American Menopause Society (NAMS) established a goal to review the published medical data and develop an evidence-based consensus opinion regarding the role of calcium in peri- and postmenopausal women. Design: In building this consensus opinion, NAMS followed the general principles established for evidence-based guidelines. As part of that process, NAMS appointed a panel of clinicians and researchers acknowledged to be experts in the field of calcium. Their advice was used to assist the NAMS Board of Trustees in developing this consensus opinion. Results: Adequate calcium intake (in the presence of adequate vitamin D intake) has been shown to prevent bone loss and reduce fracture risk in peri- and postmenopausal women. Although calcium is not as effective as antiresorptive agents (e.g., estrogen, selective estrogen-receptor modulators, or bisphosphonates), it is an essential component of antiresorptive agent therapy for osteoporosis. Calcium has also been associated with beneficial effects in several nonskeletal disorders, primarily hypertension, colorectal cancer, obesity, and nephrolithiasis, although the extent of those effects and mechanisms involved have not been fully explored. Estimates of adequate intakes of calcium for peri- and postmenopausal women are based on evidence relating to osteoporosis prevention. At least 1,200 mg/day of calcium is required for most women; levels greater than 2,500 mg/day are not recommended. To ensure adequate calcium absorption, a daily intake of 400-600 IU of vitamin D is recommended, either through sun exposure or through diet or supplementation. Since no accurate test to determine calcium deficiency exists, clinicians should focus instead on ensuring that a woman consumes enough calcium to meet the recommended levels. Conclusion: Although the most definitive role for calcium in peri- and postmenopausal women is in bone health, it is clear that adequate calcium intake has implications that encompass a woman's overall health. Based on the available evidence, a strong statement can be made regarding the importance of ensuring adequate calcium intake in all women, particularly those in peri- or postmenopause.
Article
Objective: The North American Menopause Society (NAMS) established a goal to create an evidence-based position statement regarding the management of postmenopausal osteoporosis. Design: NAMS followed the general principles established for evidence-based guidelines to create this document. A MEDLINE search was conducted. Clinicians and researchers acknowledged to be experts in the field of osteoporosis were enlisted to review the evidence. The NAMS Board of Trustees reviewed and approved the final document. Results: Osteoporosis, which has its highest rate of occurrence in postmenopausal women, increases the risk for fractures, including hip and spine fractures. These injuries are often associated with particularly high morbidity and mortality. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures by slowing or preventing bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to falls. The evaluation of postmenopausal women for osteoporosis risk requires the recording of a medical history, a physical examination, and diagnostic tests. Major risk factors for osteoporosis are age, genetics, lifestyle (especially nutrition), and menopausal status. Management focuses first on nonpharmacologic measures, such as a balanced diet including adequate calcium and vitamin D intakes, appropriate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, FDA-approved options are estrogens (prevention only), bisphosphonates and selective estrogen-receptor modulators (prevention and treatment), and calcitonin (treatment only). Conclusions: Management of postmenopausal osteoporosis involves identifying the potential risk for osteoporosis and osteoporotic fracture, followed by measures that focus on reducing modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy.
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IntroductionOverview of Methods for Cost-Effectiveness AnalysisCost-Effectiveness of Osteoporosis TreatmentSummaryAcknowledgments
Article
In the RAC-OST-POL study, epidemiological data were presented concerning osteoporosis in 625 women older than 55 yr coming from the District of Raciborz in Poland. The mean age was 66.4 ± 7.8 yr. All the women fulfilled a questionnaire, gathering data on clinical risk factors of osteoporosis. Femoral neck (FN) and total hip (TH) were measured. The mean value of bone mineral density for FN was 0.862 ± 0.129 g/cm(2), T-score -1.25 ± 0.92, and Z-score 0.039 ± 0.78, whereas the respective values for TH were 0.945 ± 0.149 g/cm(2), -0.47 ± 1.19, and 0.52 ± 0.98. T-score for FN below -2.5 was noted in 59 women (9.5%) and for TH in 23 women (3.7%). One hundred seventy six women reported prior osteoporotic fracture(s) (28.2%). Falls were the most common clinical risk factor. The number of clinical risk factors was significantly higher in subjects with fracture history than in those without fracture records. The only first-line antiresorptive medications, used in the therapy for osteoporosis, included alendronate-42 subjects (6.7%). Estrogen therapy was prescribed in 135 women and 7 were treated with calcitonin. Calcium was administered in 94 patients and vitamin D in 84 women. In all the women on therapy, Z-score values were significantly lower than in untreated women. Concluding, the results of our epidemiological study demonstrate low treatment rate in women with history of low trauma fracture. Effective strategies are needed for prevention, especially in regard to falls, and management of this disease, in particular for improvement of the treatment rates in affected women with prior fracture, in general.