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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    • "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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    • "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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