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Effect of supplementation of calcium and Vitamin D on bone mineral density and bone mineral content in peri- and post-menopause women: A double-blind, randomized, controlled trial
Abstract
Osteoporosis is a serious global health problem for the future, that is why improving diagnostic methods and prevention of this disease could be helpful.
To assess the effects of calcium supplementations combined with Vitamin D on bone mineral density (BMD) and bone mineral content (BMC) in a representative sample of peri- and post-menopausal women in a double-blind, a randomized, controlled trial was untaken.
A total of 120 women aged over 45 were included in a randomised placebo-controlled, double-blind trial on the effect of a daily dietary supplementation of calcium and Vitamin D on bone mineral density and bone mineral content; over a 30-month period.
Dietary intake assessment; dual-energy X-ray absorptiometry to measure total body and segmental bone mineral density and bone mineral content at beginning of the study and every 15 months were undertaken.
There was no significant change in dietary calcium or Vitamin D intakes in either of the treatment groups during the 30-month intervention period. The change in total BMD in the calcium group was significantly different from that in the placebo group (P <0.005). The placebo group lost a total BMD at a rate of about 0.4% per year. There was an inverse correlation between BMD and age.
The effect of calcium and Vitamin D supplementation on bone mineral density of calcium has been demonstrated in this group of young adult women. Our results showed the positive effect of calcium and Vitamin D supplementation in women both peri- and post-menopausal status; for this reason a supplementation of calcium and Vitamin D should be recommended as a strategic option in helping to prevent early postmenopausal bone loss.
... Kidney stone risk was more elevated in the treatment group. Di Daniele et al. [26] 2004 120 30 months ...
... Various calcium and vitamin D dosages have been used to improve bone health markers [21][22][23][24][25][26][27] or reduce falls [28][29][30][31]. ...
... Another study evaluating calcium (1000 mg) and vitamin D (400 IU) in post-menopausal women demonstrated that the treatment group had a slightly higher hip BMD but no lower fracture risk [25]. Calcium and vitamin D supplementation (500 mg calcium and 200 IU vitamin D) indicated a protective effect of the supplement in peri-and postmenopausal women as those receiving the supplement showed no loss of total BMD, whereas the placebo group did lose BMD [26]. A study by Meier et al. [27] looked at the effect of calcium and vitamin D prescribed in winter months. ...
Bone health is an important issue in aging. Calcium and vitamin D currently have the most focus in published research on nutrition and bone health in aging, although evidence from published research is not conclusive. A systematic review was conducted to determine the impact of dietary and supplemental interventions focused on calcium and vitamin D over the past 10 years. Using key words to search, and search limits (aging population, English), 62 papers were found related to diet, nutrition, and bone; and 157 were found related to calcium and bone. Our review found a positive effect on bone health for supplements; food-based interventions; and educational strategies. Although there may be a publishing bias related to non-significant findings not being published, our results suggest the effectiveness of food based and educational interventions with less economic impact to the individual, as well as less risk of physiological side effects occurring.
... Genetic factors cannot be changed, but correcting some variables like lifestyle, physical activities, and suitable diets effectively stimulates increased bone density (3). Among the studied elements practical on the metabolism and skeletal strength, consuming calcium and vitamin D supplements is suggested as a strategic procedure to avoid premature bone loss in menopausal women (4). Some stud-ies have shown that calcium existing in the body cannot be consumed. ...
... It is noteworthy that half of the existing ALP in the blood is related to bones, and another half is related to the liver (23). It is worth mentioning that increasing bone density is a step 4 Zahedan J Res Med Sci. 2022; 24(3):e112795. ...
Background: Estrogen deficiency and increasing its reabsorption are determining factors in reducing bone density in postmenopausal women. Objectives: The purpose of this study was to investigate the response threshold of alkaline phosphatase (ALP) and parathyroid hormone (PTH) to resistance training along with Calcium and vitamin D intake in postmenopausal women. Methods: In the present study, 17 postmenopausal women (50 - 60 years old) in Zahedan were randomly selected and divided into two groups, exercise + supplement (n = 9) and control (n = 8). The exercise + supplement group received 1,500 mg of Calcium and 600 IU daily of vitamin D. Each of them performed resistance training movements in three sets with eight repetitions, with an intensity of 55% 1RM in the first week to 65% 1RM in the fourth week for three sessions/week during four weeks. Sampling was performed before the first training session and 24 hours after the last session from the first to fourth weeks. Data were analyzed with repeated-measures analysis of variance using SPSS software version 19 (P≤0.05). Results: The results showed that Calcium and vitamin D supplementation and resistance training significantly affected PTH (P = 0.004) and ALP (P = 0.02) levels. Also, it was shown that the ALP response started in the second week (P = 0.001), while the PTH response started in the third week (P = 0.001). Conclusions: According to the findings of the present study, it can be said that in postmenopausal women, the threshold for the response of ALP to resistance training and Calcium and vitamin D intake is the second week and the threshold for the response to PTH is the third week.
... Skeletal muscle is a voluntary controlled striated tissue responsible for locomotion, maintenance of posture, respiration and thermostasis and it represents an amino acid reservoir during starvation [1]. Indeed, it is a plastic tissue that can modify its mass, function, and metabolism in response to endogenous and exogenous stimuli; responding quickly to changes, such as intensified physical exercise, muscle wasting during advanced aging, neurodegenerative diseases, and immobilization [2][3][4][5]. ...
... Osteoporosis, a disorder of bone tissue, is correlated with an increased risk of fracture due to the reduction of bone strength [16]. It is one of the major public health problems today due to the fact that it affects hundreds of millions of people around the world [17,3]. ...
Skeletal muscles and bone tissue form the musculoskeletal apparatus, a complex system essential for the voluntary movement. The loss of muscle mass and muscle strength is often associated with a loss of bone mass, in a “hazardous duet” which implies the co-existence of sarcopenia-osteoporosis and exposes patients to a deterioration in quality of life and increased mortality. From the mechanostat theory to the recent definition of the osteosarcopenia syndrome, many aspects of muscle-bone interaction have been investigated in recent decades. The mechanical interaction is now accepted, considering the close anatomical relationship between the two tissues, however, much remains to be discovered regarding the biochemical muscle-bone interaction. Skeletal muscle has been defined as an endocrine organ capable of exerting an action on other tissues. Myokines, bioactive polypeptides released by the muscle, could represent the encrypted message in the communication between muscle and bone. These two tissues have a reciprocal influence on their metabolisms and respond in a similar way to the multiple external factors. The aim of this review is to stimulate the understanding of the encrypted language between muscle and bone, highlighting the role of catabolic pathways and oxidative stress in the musculoskeletal apparatus to elucidate the shared mechanisms and the similarity of response to the same stimuli by different tissues.
Our understanding of muscle-bone interactions it could be useful to identify and develop new strategies to treat musculoskeletal diseases, together with pharmacological, nutritional and exercise-based approaches, which are already in use for the treatment of these pathologies.
... They constitute the major source of calcium in diets of Europeans and provide from 60% to 80% of its total content [Kałuża et al., 2002; NIH, 2001; Szymelfejnik et al., 2006] . Investigations have shown that additional amounts of vitamins or minerals taken in the form of supplements or consumed with fortified foods are likely to improve diet quality and lower the risk of calcium deficiency [Bischoff-Ferrari et al., 2008; Di Daniele et al., 2004; Kałuża et al., 2004]. On the contrary, the use of vitamin supplements and/or minerals, especially in excessive quantities and without any control of a physician, may augment health risks and cause, among others, the shortening of lifespan Kałuża et al., 2004; Mulholland & Benford, 2007]. ...
... The results obtained in this study indicate that maintaining high bone mineral density by women requires a supply of calcium from dietary sources and supplements when no significant changes are made in eating habits. It confirms the significance of calcium supplementation for the bone mineral density [Bischoff-Ferrari et al., 2008; Di Daniele et al., 2004]. The results of a study by the research group of Di Daniele [2004] have formed the basis for recommending calcium (and vitamin D) supplementation as a strategy in the prevention of bone mass loss in women in the early post-menopausal period. ...
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.
... The role of calcium -the main component of the bone mass -in prevention and treatment of osteoporosis has been extensively studied [1][2][3][4][5][6][7][8]. The recommendations on advised calcium (Ca) intake are generally available, with the tendency of dose increasing in comparison to the previous decades with limitation of the upper cutoff value in order to prevent adverse events [3,4]. ...
... The results suggest positive effect of calcium supplementation on the skeletal growth and peak bone mass in prepubertal girls, particularly those with previously low calcium intake [5]. Calcium and vitamin D supplementations are significant in prevention of early postmenopausal bone mass loss [6]. ...
Treatment of osteoporosis, in addition to a specific antiresorptive or anabolic treatment, requires supplementation with calcium and vitamin D. Widespread cultivation of pearl shells has made pearls available for commercial use for a very reasonable price. The main chemical compound of pearls from shells Pinctada maxima is calcium-carbonate (CaCO3). Recently developed technologies applied in a micronisation process have provided increased gastrointestinal resorption of calcium, estimated at over 90% of calcium intake.
The paper is aimed at monitoring of efficacy and tolerance of six-month bio-calcium supplementation in postmenopausal women with reduced bone mineral density.
Group 1 (30 patients) received, three times a day, capsules of pearl powder from shells Pinctada maxima (it is equal to 260 mg of elementary calcium); group II (20 patients) received a daily dose of 500 mg inorganic CaCO3. Both groups received 666 IU of cholecalciferol per day. In all patients, bone mineral density (BMD) of the spine or hip, serum blood and urine levels of Ca, phosphates and alkaline phosphatase, were measured before and after six months of the treatment.
Group I/Group II: average age 61.7/61.7 years; beginning of menopause: 48.32 /48 years; menopause duration 13.4/13.7 years; average body mass index 27.2/27 kg/m2. These two groups did not different significantly before supplementation. Six-month supplementation with CaCO3 of the biological origin led to the increase of BMD from 0.901 g/cm2 to 0.948 g/cm2 (p = 0.067), while BMD remained the same in the group supplemented with inorganic CaCO3 Gastrointestinal tolerability of bio-calcium was excellent, without any adverse events.
These data could not strongly support the hypothesis of better efficacy of bio-calcium taking into account a small number of patients and a short follow-up period in this pilot study. Tolerance of CaCO3 of the biological origin was excellent and free of any adverse events. The results of laboratory values were within normal range.
... Diet and exercise are important modifiable risk factors for bone health and were viewed as important for overall heath by the majority of participants in the current study. Dietary calcium and vitamin D were mentioned as the primary nutrients important for bone health, which is not surprising given that much of the research on diet and bone has focused on these nutrients [28][29][30], although other nutrients and foods have also been shown to be important for bone health [31][32][33][34][35]. Many factors, such as cultural beliefs and traditions, acculturation, food availability, and socioeconomic status, influence dietary intake [36,37]. ...
Summary Few studies have examined knowledge and perceptions of osteoporosis among Caribbean Latino adults. Confusion regarding the term osteoporosis was noted. Doctors were viewed as trusted sources of health information, although descriptions of a paradoxical relationship emerged. This study can be used to inform culturally tailored interventions for osteoporosis prevention.
Purpose The overall goal of this study was to assess knowledge, attitudes, and beliefs of bone health and osteoporosis among Caribbean Latino adults aged > 50 years.
Methods This triangulated mixed methods study included completion of a quantitative questionnaire and participation in one of four focus groups to obtain information on (1) general health, (2) knowledge about bone health and osteoporosis, (3) sources of information about bone health, and (4) prevention knowledge and personal responsibility. Quantitative data were analyzed using SAS, and qualitative data were analyzed using descriptive and structural coding by two independent research members.
Results The majority of participants were female (73%), Dominican (84%), and low income (82% < $20,000) with a mean age of 68.4 (± 8.5) years. Most participants had heard of osteoporosis (90%); however, the majority were not able to accurately describe this chronic condition. Health care providers were viewed as most trusted sources of health information, despite feelings of being rushed during their visits, with limited communication about preventative care. Most participants felt that nutrition and exercise
were important for overall health.
Conclusions Caribbean Hispanic adults in this study reported knowledge of osteoporosis and nutritional factors associated with prevention of this chronic condition. However, qualitatively, there was confusion between osteoporosis and other bone and joint
conditions. Culturally specific interventions to promote prevention of osteoporosis are urgently needed for this underserved, high-risk population.
... [2][3][4] Adequate consumption of calcium, protein, and a sufficient vitamin D status contribute to accretion of peak bone mass, main-tenance of this bone mass, and its structural integrity throughout life, as well as positively affecting skeletal muscle mass and strength. 5,6 Among younger adult women, Picard et al. 7 showed that calcium intake in early adulthood influenced bone mass in premenopausal women, while Baran et al. 8 reported a reduction in vertebral bone loss in 20 premenopausal Caucasian women aged 30-to 42-yearold with addition of dairy products to their diets over 3 years, and Daniele et al. 9 showed that dietary calcium and vitamin D supplementation reduced total bone mineral density (BMD) loss in perimenopausal women (45 + years old) in Italy. In addition, a cross-sectional study of women from early childhood to young adulthood showed an association between levels of calcium/dairy intake and BMD. 10 There have been few studies on milk or calcium supplementation and bone health in premenopausal Asian women. ...
This study compared the effects of a high-calcium vitamin D fortified milk with added FOS-Inulin versus regular milk on serum parathyroid hormone (PTH), vitamin D status, grip strength (GS), as well as bone density in Chinese premenopausal women over 52 weeks. Premenopausal women (n = 133), mean age 41 (±5.1) years were randomized into control (n = 66; regular milk at 500 mg calcium per day) or intervention (Int; n = 67; fortified milk at 1200 mg calcium, 15 μg vitamin D, and 4 g FOS-Inulin per day) groups. Assessments were at baseline, weeks 12, 24, 36, and 52 for changes in vitamin D status, levels of PTH, and GS. Bone mineral densities (BMDs) of the lumbar spine (LS), femoral neck (FN), and whole body (WB) were assessed at baseline and week 52 using GE Lunar iDEXA (GE Healthcare, Madison, WI). At baseline, WB lean mass was positively associated with LS BMD (r = 0.30, p < 0.001) and FN BMD (r = 0.33, p = 0.003). Baseline 25(OH) vitamin D3 levels were 48.6 and 53.2 nmol/L (p = 0.57), respectively, and after the 12 months at 60.8 nmol/L (Int) versus 55.0 nmol/L (controls; p < 0.05 for change from baseline for both groups; no difference between groups at week 52). PTH levels decreased in both groups compared to baseline (p < 0.001), with no significant difference between groups. WB bone mineral content (BMC) and FN Z-score increased significantly in the Int group (p = 0.024 and p = 0.008). GS was positively associated with body weight, increasing in both groups over 52 weeks. Fortified milk improved vitamin D status, WB BMC, and Z-score of the FN, while regular milk maintained BMD. In addition, vitamin D status and GS improved.
... Diet and exercise are important modifiable risk factors for bone health and were viewed as important for overall heath by the majority of participants in the current study. Dietary calcium and vitamin D were mentioned as the primary nutrients important for bone health, which is not surprising given that much of the research on diet and bone has focused on these nutrients [28][29][30], although other nutrients and foods have also been shown to be important for bone health [31][32][33][34][35]. Many factors, such as cultural beliefs and traditions, acculturation, food availability, and socioeconomic status, influence dietary intake [36,37]. ...
Few studies have examined knowledge and perceptions of osteoporosis among Caribbean Latino adults. Confusion regarding the term osteoporosis was noted. Doctors were viewed as trusted sources of health information, although descriptions of a paradoxical relationship emerged. This study can be used to inform culturally tailored interventions for osteoporosis prevention.
Purpose
The overall goal of this study was to assess knowledge, attitudes, and beliefs of bone health and osteoporosis among Caribbean Latino adults aged > 50 years.
Methods
This triangulated mixed methods study included completion of a quantitative questionnaire and participation in one of four focus groups to obtain information on (1) general health, (2) knowledge about bone health and osteoporosis, (3) sources of information about bone health, and (4) prevention knowledge and personal responsibility. Quantitative data were analyzed using SAS, and qualitative data were analyzed using descriptive and structural coding by two independent research members.
Results
The majority of participants were female (73%), Dominican (84%), and low income (82% < $20,000) with a mean age of 68.4 (± 8.5) years. Most participants had heard of osteoporosis (90%); however, the majority were not able to accurately describe this chronic condition. Health care providers were viewed as most trusted sources of health information, despite feelings of being rushed during their visits, with limited communication about preventative care. Most participants felt that nutrition and exercise were important for overall health.
Conclusions
Caribbean Hispanic adults in this study reported knowledge of osteoporosis and nutritional factors associated with prevention of this chronic condition. However, qualitatively, there was confusion between osteoporosis and other bone and joint conditions. Culturally specific interventions to promote prevention of osteoporosis are urgently needed for this underserved, high-risk population.
... This was in accordance with Nicola et al who observed positive effect of calcium and vitamin D supplementation in both peri -and post-menopausal women. 18 Prince et al had also reported beneficial effect of calcium supplementation on forearm bone. 19 It is generally assumed that vitamin D deficiency or insufficiency should not occur in Indian living in India in view of ample exposure to sunlight. ...
Background: Osteoporosis is characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhanced bone fragility, thus increasing the susceptibility to fracture. This study was conducted with the objective of measuring forearm bone mineral density in postmenopausal Indian women and to establish a correlation with indices of calcium nutrition i.e. dietary calcium intake, calcium supplements, serum calcium, serum phosphorus, serum alkaline phosphatase and serum intact parathyroid hormone.Methods: Fifty healthy, ambulatory postmenopausal women were selected and a prospective observational study was conducted to correlate the BMD with indices of calcium nutrition. Patient’s laboratory investigations (serum calcium, serum phosphorous, serum alkaline phosphatase and serum intact parathyroid hormone were done and BMD was assessed with dual-energy X-ray absorptiometry at non-dominant forearm; T-scores and Z-score were derived. Correlation analysis was done to investigate the relationship between indices of calcium nutrition and BMD.Results: The proportion of osteoporosis in forearm was 22%in the deficient group, 60% in the insufficient group and 18% in the sufficient group. Among the study group 15 subjects were osteoporotic by T score mid forearm where as 7 were osteoporotic with T score ultra distal forearm and 11 subjects had osteoporosis with T score total forearm.Conclusions: Out of all the indices of calcium nutrition, the correlation between the serum alkaline phosphatase and T score forearm was statistically significant.
... Hipoestrogen circumstances in postmenopausal women at increased risk of osteoporosis with an increased osteoclast formation and increased bone turnover [2], [3], [4]. ...
... Randomised controlled trials of vitamin D supplementation during pregnancy will be needed in order to confidently link vitamin D and an increased risk of autism-related conditions. In light of the evidence linking prenatal vitamin D with general growth and bone health [68][69][70] such trials should be designed with several primary outcomes. In our data, we observe a more pronounced association for those who were deficient at two time points (that is, mid-gestation and at time of birth) compared with deficiency at only one time point. ...
There is intense interest in identifying modifiable risk factors associated with autism-spectrum disorders (ASD). Autism-related traits, which can be assessed in a continuous fashion, share risk factors with ASD, and thus can serve as informative phenotypes in population-based cohort studies. Based on the growing body of research linking gestational vitamin D deficiency with altered brain development, this common exposure is a candidate modifiable risk factor for ASD and autism-related traits. The association between gestational vitamin D deficiency and a continuous measure of autism-related traits at ~6 years (Social Responsiveness Scale; SRS) was determined in a large population-based cohort of mothers and their children (n=4229). 25-hydroxyvitamin D (25OHD) was assessed from maternal mid-gestation sera and from neonatal sera (collected from cord blood). Vitamin D deficiency was defined as 25OHD concentrations less than 25 nmol l−1. Compared with the 25OHD sufficient group (25OHD>50 nmol l−1), those who were 25OHD deficient had significantly higher (more abnormal) SRS scores (mid-gestation n=2866, β=0.06, P<0.001; cord blood n=1712, β=0.03, P=0.01). The findings persisted (a) when we restricted the models to offspring with European ancestry, (b) when we adjusted for sample structure using genetic data, (c) when 25OHD was entered as a continuous measure in the models and (d) when we corrected for the effect of season of blood sampling. Gestational vitamin D deficiency was associated with autism-related traits in a large population-based sample. Because gestational vitamin D deficiency is readily preventable with safe, cheap and accessible supplements, this candidate risk factor warrants closer scrutiny.
... Besides Ovx, a number of factors, such as high-calcium diet and age of animals, could modulate actions of prolactin (4,28,45). High-calcium diet has been a standard regimen to alleviate negative calcium balance after Ovx (16). Tudpor and colleagues (45) recently demonstrated that high-calcium diet (2.0% wt/wt Ca) significantly abolished the stimulatory effect of prolactin on the duodenal calcium transport in young ovariectomized rats, whereas, in adult rats, combination of prolactin and high-calcium diet further reduced the duodenal calcium transport below the control level. ...
... Typically, Vitamin E supplements provide only alpha-tocopherol, although "mixed" products contain other tocopherols and even tocotrienols. Most Vitamin E only supplements provide ≥100 IU of the nutrient, which are substantially higher than the RDA [11]. Explain RDA. ...
... Uluslararası geniş katılımlı bir çalışmada postmenopozal osteoporotik kadınların %71'inde D vitamini yetersizliği bulunmuştur (26). D vitamini ile birlikte kalsiyum alımının osteoporozu önlediği ve KMD değerlerini arttırdığı gösterilmiştir (27)(28). Osteoporoz riski altında veya osteoporozu olan kadınlara kalsiyumla birlikte D vitaminin önerilmesi ve 25-OHD seviyelerinin 30 ng/ml üzerinde tutulması Kutsal ...
Aim: Vitamin D deficiency is one of the most important public health problems as a result of osteomalacia, osteoporosis, muscle pain disease,
muscle weakness and increased risk of falls and fracture. Outfitting style effects the synthesis and blood levels of vitamin D. The aim of our study
is to investigate the effect of outfitting style on blood vitamin D and bone mineral density in postmenopausal osteoporotic women.
Materials and Methods: Fifty-five female patients who were diagnosed with osteoporosis were included in our study. These women were
divided into two groups according to their clothing habits as veiled and unveiled. Data of all patients about menopause, exposure to sun light,
dual energy x-ray absorptiometry results, blood calcium, phosphate, parathyroid hormone, 25-hydroxyvitamin D levels and osteoporosis treatment
were recorded.
Results: We found 25-hydroxyvitamin D level was significantly low in women with veiled dressing style (17,0±7,9 ng/ml in veiled and 33.9±22.0
ng/ml in unveiled patients, p
... The studies did not reveal any impact of non-dairy sources of calcium on bone mineral density. Our previous studies and some papers of other authors suggest a beneficial impact of taking calcium supplements and/or consumption of calcium-enriched food on bone health [29,47,48]. This paper did not focus on analyzing the impact on non-dairy calcium sources on the bones. ...
Abstract: The objective of the study was to analyze the consumption of dairy products and dietary calcium by women in the context of bone mineral density and to assess opportunities to prevent osteoporosis in a dietary manner. The study was carried out with 712 Polish women. In 170 women aged 32 to 59 bone mineral density (BMD) was measured. The data on the consumption of dairy products and dietary calcium and some other osteoporosis risk factors was collected from 712 women. The average calcium intake from a diet was 507 mg/day. Only 2% of the women met Polish calcium intake recommendations. During adulthood, dairy product consumption or dietary calcium intake did not differ significantly between women with low BMD (below −1 SD) and women with regular BMD (≥−1 SD) (47.4 vs. 44.3 servings/week and 459 vs. 510 mg/day, respectively, p > 0.05). The odds ratios adjusted for age, menstruation and BMI in women with upper BMD tercile in comparison to the reference group (bottom tercile) was 2.73 (95% CI: 1.14, 6.55; p < 0.05) for the daily consumption of dairy products during the pre-school period and 2.40 (95% CI: 1.01, 5.70; p < 0.05) for the daily consumption of dairy products during the school period. Two clusters of women were established. In the S1 cluster, low BMD (below −1 SD) was associated with older age (≥50 years), lack of menstrual cycle. In the S2 cluster, regular BMD (≥−1 SD) was related to younger aged women (<50 years), presence of menstrual cycle, consumption of higher level of dairy products (≥28 servings/week) during adulthood and daily intake of dairy products during childhood and adolescence. The results indicate that good bone health to the large extent depended upon the combined impact of dietary factors and some non-modifiable risk factors of osteoporosis such as age and the presence of menstruation. Consumption of dairy products in childhood and adolescence may improve bone mineral density and reduce the risk of osteoporosis in adult women.
... The maintenance of bone homeostasis depends on the balance of cellular activities during bone remodeling. Even though the exact pathophysiological mechanisms responsible for several aberrant bone remodeling states are still largely unclear, there is evidence that an unbalance in the bone remodeling process, favoring either OC or OB activity, may lead to a number of clinical diseases including osteopenia, osteoporosis or osteopetrosis [18][19][20][21][22][23]. ...
In the current study, we have investigate the effect of CB2 and TRPV1 receptor ligands on in vitro osteoblasts from bone marrow of human healthy donors. A pivotal role for the endocannabinoid/endovanilloid system in bone metabolism has been highlighted. We have demonstrated a functional cross-talk between CB2 and TRPV1 in human osteoclasts, suggesting these receptors as new pharmacological target for the treatment of bone resorption disease as osteoporosis. Moreover, we have shown the presence of these receptors on human mesenchimal stem cells, hMSCs. Osteoblasts are mononucleated cells originated from hMSCs by the essential transcription factor runt-related transcription factor 2 and involved in bone formation via the synthesis and release of macrophage colony-stimulating factor, receptor activator of nuclear factor kappa-B ligand and osteoprotegerin. For the first time, we show that CB2 and TRPV1 receptors are both expressed on human osteoblasts together with enzymes synthesizing and degrading endocannabinoids/endovanilloids, and oppositely modulate human osteoblast activity in culture in a way that the CB2 receptor stimulation improves the osteogenesis whereas TRPV1 receptor stimulation inhibits it.
Copyright © 2015. Published by Elsevier Ltd.
... Dietary intake assessment method was used to check the calcium and vitamin D intake while dual energy X-ray absorptiometry was used to calculate the whole body and segmental bone mineral density. It was observed that vitamin D and calcium supplements are needed to stop bone loss in women after menopause and delay the onset of osteoporosis (Daniele et al., 2004). Diet and physical activity play significant role in bone strength. ...
Osteoporosis is increasingly being recognized by the medical fraternity as a significant health problem. This research was designed to study the incidence of osteoporosis in post-menopausal women and its relation to body mass index, body muscles, body fat and mineral status (calcium and phosphorus). Thirty samples of post-menopausal women aging between 45-60 years were divided into 3 groups. Body weight and height seemed to be tested through the use of electronic weighing balance and Stadiometer. Body muscles and fat percentage were determined through Beurer GmBH BLACK Blr.64. Bone mineral density was calculated by bone densitometry. Serum concentration of calcium and phosphorus was determined by spectrophotometer. The data obtained was subjected to Analysis of Variance. Results showed the significant decrease in body muscle, bone mineral density and serum calcium with increasing age. It was concluded that body weight, body muscles, body fat, bone mineral density, serum calcium and phosphorus had significant association with age and osteoporosis. Body fat and serum phosphorus increases with age in post-menopausal women. Body mass index and height had non-significant association with age and osteoporosis.
... The studies did not reveal any impact of non-dairy sources of calcium on bone mineral density. Our previous studies and some papers of other authors suggest a beneficial impact of taking calcium supplements and/or consumption of calcium-enriched food on bone health [29,47,48]. This paper did not focus on analyzing the impact on non-dairy calcium sources on the bones. ...
Abstract: The objective of the study was to analyze the consumption of dairy products and dietary calcium by women in the context of bone mineral density and to assess opportunities to prevent osteoporosis in a dietary manner. The study was carried out with 712 Polish women. In 170 women aged 32 to 59 bone mineral density (BMD) was measured. The data on the consumption of dairy products and dietary calcium and some other osteoporosis risk factors was collected from 712 women. The average calcium intake from a diet was 507 mg/day. Only 2% of the women met Polish calcium intake recommendations. During adulthood, dairy product consumption or dietary calcium intake did not differ significantly between women with low BMD (below −1 SD) and women with regular BMD (≥−1 SD) (47.4 vs. 44.3 servings/week and 459 vs. 510 mg/day, respectively, p > 0.05). The odds ratios adjusted for age, menstruation and BMI in women with upper BMD tercile in comparison to the reference group (bottom tercile) was 2.73 (95% CI: 1.14, 6.55; p < 0.05) for the daily consumption of dairy products during the pre-school period and 2.40 (95% CI: 1.01, 5.70; p < 0.05) for the daily consumption of dairy products during the school period. Two clusters of women were established. In the S1 cluster, low BMD (below −1 SD) was associated with older age (≥50 years), lack of menstrual cycle. In the S2 cluster, regular BMD (≥−1 SD) was related to younger aged women (<50 years), presence of menstrual cycle, consumption of higher level of dairy products (≥28 servings/week) during adulthood and daily intake of dairy products during childhood and adolescence. The results indicate that good bone health to the large extent depended upon the combined impact of dietary factors and some non-modifiable risk factors of osteoporosis such as age and the presence of menstruation. Consumption of dairy products in childhood and adolescence may improve bone mineral density and reduce the risk of osteoporosis in adult women.
Keywords: BMD; dairy products; dietary calcium; osteoporosis; women
... Nevertheless, multivariate analysis confirmed that the medication exerted the strongest beneficial effect on BMD. This is consistent with earlier studies, which found improved BMD parameters in pre-and post-menopausal women [20], and in elderly patients who received calcium and vitamin D3 supplementation [21]. Our data are also in line with the report of the increased BMD in hypoparathyroid patients on suppressive L-T4 therapy for thyroid cancer who were receiving calcium and vitamin D3 supplements for a long time [22]. ...
Long-term management of patients with differentiated thyroid cancer (DTC) commonly includes TSH-suppressive therapy with L-T4 and, in case of postsurgical hypoparathyroidism, Calcium-D3 supplementation, both of which may affect skeletal health. Experience with female patients treated for DTC at a young age and who were then receiving long-term therapy with L-T4 and Calcium-D3 medication is very limited to date. This cross-sectional study set out to investigate effects of Calcium-D3 supplementation and TSH-suppressive therapy on bone mineral density (BMD) in 124 young female patients treated for DTC at a mean age of 14 years and followed-up for an average of 10 years. BMD was found to be significantly higher in patients receiving Calcium-D3 medication than in patients not taking supplements. The level of ionized calcium was the strongest factor determining lumbar spine BMD in patients not receiving Calcium-D3 supplementation. Pregnancy ending in childbirth and HDL-cholesterol were associated with a weak adverse effect on spine and femoral BMD. No evidence of adverse effects of L-T4 and of radioiodine therapies on BMD was found. We conclude that Calcium-D3 medication has a beneficial effect on BMD, and that TSH-suppressive therapy does not affect BMD in women treated for DTC at young age, at least after 10 years of follow-up.
... Nutrition has an important infl uence on bone metabolism; however, vitamin D and calcium intake seems to be the most extensive investigated. A study of Italian peri-and postmenopausal women treated with 500 mg calcium and 200 IU vitamin D revealed a signifi cant preventive eff ect of the supplementation on total BMD in all the women [34]. Another study of 136 Caucasian postmenopausal women showed an independent infl uence of calcium, energy and protein intake on several bones examined both separately and in multiple regression analysis. ...
Osteporosis aff ects a large percentage of postmenopausal women and leads to serious complications such as femur neck fracture. The standard of osteoporosis diagnosis is dual-energy X-ray absorptiometry (DXA) which evaluates bone mineral content and after dividing it by measurement area estimates bone mineral density. There are also biochemical indicators evaluated in human serum or urine such as calcium urine concentration, piridinoline, deoksypiridinoline (DPR), and collagene fragments, such as cross-linked N-telopeptide (NTX) and cross-linked C-telopeptide (CTX), which may be useful for determining the activity of bone formation and resorption processes. They are frequently used for scientifi c purposes, but not in general medical practice. Osteoporosis risk factors include: age over 70 years, low weight (below 40 kg) or body mass index (BMI) below 20, weight loss of more than 10% of total body mass, low physical activity, chronic treatment with glucocorticoids or anti-epileptic drugs, anorexia nervosa, type 1 diabetes mellitus, past gastrectomy, and hyperparathyroidismus. There are also some other conditions which may aff ect bone metabolism which include: female sex, smoking, cases of fractures in family, a history of ovariectomy, early menopause (before the age of 45), low calcium consumption, hyperthyroidismus, rheumatoid arthritis, chronic alcoholism, excessive vitamin A intake and cola drinks. Also, adequate intake of proteins and macro-and microelements may aff ect bone metabolism. Some epidemiological studies suggest that higher consumption of soy bean based foods in Asian populations compared to Western populations may be responsible for the low incidence of postmenopausal osteoporosis in Asian women. Soy beans are a rich source of isofl avones, mainly genistein and daidzein, which have both weak estrogenic and antiestrogenic eff ects. Isofl avones bind to estrogen receptors in body tissues such as uterine or bones, and some data suggest that they may stimulate osteoblastic activity and bone formation, and also inhibit osteoclastic bone resorption. In this way, they may prevent postmenopausal bone loss. The protective eff ects of other natural substances such as rhizome of Anemarrhena aspheloides or aqueus extract of black tea have also been investigated. This article presents a review of food contents and lifestyle factors which infl uence bone metabolism.
... Para determinar la eficiencia de la absorción del calcio se mide el efecto del calcio en la densidad ósea en el tiempo, es decir, se evalúa el proceso de remodelación ósea 113-116 . La medición de la densidad mineral ósea (DMO) permite identificar personas con mayor riesgo de osteoporosis 117,118 . En la actualidad, entre los métodos diagnósticos más utilizados para medir la DMO se encuentra la Absorciometría Dual de Rayos X (DEXA), de gran aceptación debido a su precisión, mínima radiación y rapidez del estudio; además, permite visualizar huesos y otros tejidos como músculo y grasa, y puede medir sitios relevantes de fractura por osteoporosis, pero es muy costoso. ...
Inadequate habits in the consumption of food that contains calcium causes dietary misbalances which drive to health problems, such as osteoporosis. Calcium is a vital element for the body, and its existence in it depends exclusively on its consumption in the diet. Consumer awareness about health problems has driven companies to develop food with calcium additions, aiming to make them a part of the feeding routine, innovating products or improving the quality of those that already exist with a higher added value. For these developments it is important to get familiar with some parameters mentioned in this article.
... [1,2] It is seen that a large population of the healthy adult population has low or borderline low serum 25(OH)D levels which further increases the risk of falls and fracture. [3][4][5][6][7] Vitamin D plays a critical role in bone health. [1,5,[8][9][10][11][12] Optimization of vitamin D status is therefore an essential component of preventing and managing osteoporosis especially in vulnerable groups like postmenopausal women. ...
To compare the effect of two different doses (500 and 1000 IU/day) of oral vitamin D3 (cholecalciferol) on serum 25-hydroxy vitamin D [25(OH)D] levels in apparently healthy postmenopausal Indian women.
Serum 25(OH)D, calcium with albumin, phosphorus, and alkaline phosphatase were measured in 92 apparently healthy postmenopausal women. The subjects were randomly assigned to one of the three groups and received supplementation for 3 months each. Each group received 1000 mg calcium carbonate daily while groups B and C received 500 and 1000 IU of cholecalciferol in addition, respectively. The tests were repeated after 3 months.
At baseline, 83.7% subjects had vitamin D deficiency (≤20 ng/mL). The difference in the percentage change in mean serum 25(OH)D levels from baseline in group A (-30.5 ± 5.3%), group B (+8.9 ± 19.7%), and in group C (+97.8 ± 53.3%) was statistically significant (P < 0.001) between the three groups. Serum 25(OH)D level >20 ng/mL was achieved in 4.7% (1/21), 16% (4/25), and 66.67% (12/18) subjects in groups A, B, and C, respectively. No significant change was found in serum calcium, phosphorus, and alkaline phosphatase levels at 3 months in either of the groups from baseline.
Standard dose of cholecalciferol available in "calcium tablets" (250 IU per 500 mg calcium carbonate) is not adequate for achieving optimum serum 25(OH)D levels in Indian postmenopausal women. Higher dose of vitamin D supplementation with 1000 IU/day (500 IU per 500 mg calcium carbonate) daily is superior to the standard dose therapy. For achievement of optimum serum 25(OH)D levels (>30 ng/mL) in Indian postmenopausal women, still higher doses of vitamin D are likely to be required.
... Calcium supplements appear to be effective in reducing bone loss in women, but there is a considerable uncertainty about the effectiveness of calcium supplementation in preventing bone loss at the early stage of the menopause [2][3][4]. Several adjunctive therapies with calcium supplementation were attempted earlier to prevent osteoporosis in early stage of menopause [5,6]. Of these different adjunctive therapies, HRT, SERMs, and vitamin D were mostly advised [7,8], but with controversial results [5,9,10]. ...
The present study was undertaken to find out the ability of black tea extract (BTE) as a suitable alternative of adjunct for calcium supplementation in treating an ovariectomized rat model of early osteoporosis. Female Wistar rats weighing 140-150 g were divided into four groups consisting of six animals in each group: (A) sham-operated control; (B) bilaterally ovariectomized; (C) bilaterally ovariectomized + BTE; (D) bilaterally ovariectomized + 17 β -estradiol. Results suggest that BTE could promote intestinal absorption of calcium significantly (P < 0.01 for duodenum and ileum; and P < 0.05 for jejunum). This was found associated with enhanced activities of two relevant intestinal mucosal enzymes alkaline phosphatase (P < 0.01 for duodenum, jejunum, and ileum) and Ca(2+) activated ATPase (P < 0.01 for duodenum, jejunum, and ileum). Such BTE-mediated promotion of calcium absorption was coupled with increase in serum estrogen titer (P < 0.01) and recovery of all urinary, bone, and serum osteoporotic marker parameters, including bone histological features. Serum parathyroid hormone level, however, was not altered in these animals (P > 0.05). A comparative study with 17 β -estradiol, a well-known adjunct for calcium supplementation, indicated that efficacy of BTE in maintaining skeletal health is close to that of 17 β -estradiol. This study suggests that simultaneous use of BTE is promising as a prospective candidate for adjunctive therapies for calcium supplementation in the early stage of menopausal bone changes.
... The use of calcium supplementation for the prevention of osteoporosis has been extensively studied. [10][11][12] The positive effects of calcium supplementation in women, particularly in the postmenopausal period, have been widely validated. Numerous clinical trials have found calcium supplementation to be effective for reducing bone loss and preventing fracture in this population. ...
The current literature on the effects of calcium supplementation on cardiovascular health is reviewed.
A comprehensive literature search identified reports on 13 observational studies and 9 clinical trials pertaining to calcium supplement use and the risk of adverse outcomes such as cardiovascular disease (CVD), myocardial infarction (MI), and stroke; cardiovascular events were not primary endpoints of any of the reviewed studies, most of which focused on the effects of calcium use on bone health. Several large cohort studies by researchers in Australia, France, Germany, Sweden, the United Kingdom, and elsewhere have found no significant associations between moderate calcium supplementation and adverse cardiovascular outcomes in otherwise healthy individuals; in some studies, calcium use appeared to confer preventive benefits. However, evidence from other studies suggests that increased calcium supplementation may be associated with an increased risk of MI, as well as a possible link between elevated serum calcium levels and carotid artery plaque buildup. In general, the studies of calcium use and cardiovascular health published to date have had important limitations (e.g., small samples, homogeneous study populations, reliance on self-reported data, lack of or inadequate controlling for established CVD risk factors), and the findings should be interpreted with caution.
The results of studies on the influence of calcium supplements on the cardiovascular system have been varied. Overall, the benefits of calcium supplementation, including the positive effects on bone health, appear to outweigh the theoretical risk of increased cardiovascular events.
... Entre los principales nutrientes de la dieta implicados en el mantenimiento de la salud ósea están el calcio (Di Daniele et al, 2004;Flynn, 2004), la vitamina D (Drin, 2004;Meier, 2004) y los AGs, aunque los estudios de su acción sobre la biología ósea son actualmente escasos (Watkins et al., 2001;Terano, 2001). En estudios en animales la ingesta de AGPIs omega-3 disminuye la osteoclastogénesis y la pérdida de masa ósea en ratones ovarioectomizados (Sun et al., 2003;Watkins et al., 2001). ...
Tesis Univ. Granada. Departamento de Bioquímica y Biología Molecular. Leída el 20 de marzo de 2006
... Thus, we cannot know if the lack of effect on fracture risk in the RECORD trial might be related to pretreatment levels of vitamin D and/or calcium. The hierarchy of evidence for the role of vitamin D in BMD [102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117] changes and fracture reduction is given in Table 2. ...
During the past decade, major advances have been made in vitamin D research that transcend the simple concept that vitamin D is Important for the prevention of rickets in children and has little physiologic relevance for adults. Inadequate vitamin D, in addition to causing rickets, prevents children from attaining their genetically programmed peak bone mass, contributes to and exacerbates osteoporosis in adults, and causes the often painful bone disease osteomalacia. Adequate vitamin D is also important for proper muscle functioning, and controversial evidence suggests it may help prevent type 1 diabetes mellitus, hypertension, and many common cancers. Vitamin D inadequacy has been reported in approximately 36% of otherwise healthy young adults and up to 57% of general medicine inpatients in the United States and in even higher percentages in Europe. Recent epidemiological data document the high prevalence of vitamin D inadequacy among elderly patients and especially among patients with osteoporosis. Factors such as low sunlight exposure, age-related decreases in cutaneous synthesis, and diets low in vitamin D contribute to the high prevalence of vitamin D inadequacy. Vitamin D production from cutaneous synthesis or intake from the few vitamin D-rich or enriched foods typically occurs only intermittently. Supplemental doses of vitamin D and sensible sun exposure could prevent deficiency in most of the general population. The purposes of this article are to examine the prevalence of vitamin D inadequacy and to review the potential implications for skeletal and extraskeletal health.
... Bone density is enhanced or diminished by other nutritional factors as well (e.g. vitamin D, phosphorous, respectively) [21,22]. Strength training and weight-bearing exercise-particularly high-impact activities involving jumping and sprinting-are recommended for osteoporosis prevention [23]. ...
To assess women's perceptions of risk for osteoporosis and to identify factors that shape those perceptions.
A community sample of 358 women (aged 40-86) rated their perceived risk of osteoporosis and provided detailed information about factors underlying their risk perceptions. Their open-ended responses were content analysed.
On average, participants believed they were less likely to develop osteoporosis than other women their age. In all, 63% perceived their risk as lower than other women their age; only 16% as higher. In explaining their risk, women mentioned more risk-decreasing factors than risk-increasing factors. Women who rated their risk as low attributed their risk primarily to their own preventive behaviors (e.g. taking calcium, exercising), whereas women who rated their risk as high attributed their risk primarily to their family history. Risk-increasing and risk-decreasing personal actions, hereditary factors, and physiological factors accounted for 53% of the variance in perceived risk for osteoporosis. Only one-half and one-third of all women, however, mentioned calcium consumption and exercise, respectively, as protective factors employed to reduce osteoporosis risk. Women also held misconceptions about osteoporosis risk and protective factors.
The current findings yield a detailed portrait of women's risk perceptions for osteoporosis. Increasing awareness of osteoporosis should be a priority for future osteoporosis prevention campaigns. Interventions should address misconceptions women may hold about their risk for the disease and promote specific behavioral strategies for osteoporosis prevention.
... Существуют несколько препаратов, которые предотвращают потерю костной массы и снижают риск переломов, возникающих вследствие хрупкости костей [9], однако важным является выбор наиболее подходящего лечения для каждого пациента с целью получения приемлемого соотношения «риск/преимущество». Два исследования, проведенные с участием молодых женщин в постменопаузе, леченных либо витамином Д и кальцием [10], либо алендроновой кислотой [11], показали значительное повышение костной массы по сравнению с группой плацебо, что подтверждает роль превентивного лечения у молодых женщин в постменопаузе. ...
The long-term effects of ossein-hydroxyapatite compound (OHC), a drug used for osteoporosis prevention, have not been previously reported. The aim of this study was to assess the long-term efficacy of OHC in postmenopausal women with bone mineral density (BMD) in the osteopenia range.
We performed a retrospective 4-year follow-up study in a primary-care setting to assess changes in BMD in a cohort of 112 postmenopausal women included in an osteoporosis programme that included health and dietary advice and who were treated with OHC 1660mg every 12 hours. BMD was measured annually in the distal part of the forearm, with T- and Z-score values being calculated for trabecular and total bone.
A progressive and statistically significant increase in BMD was observed in trabecular and total T- and Z-score mean values. At baseline, mean +/- SD trabecular T- and Z-scores were -1.27 +/- 0.7 and -1.03 +/- 0.7, respectively, and -0.86 +/- 0.7 and -0.62 +/- 0.7, respectively, at the end of the 4-year follow-up period (both p < 0.0001). Mild constipation was observed in 3.2% of patients during the follow-up period.
Ossein-hydroxyapatite compound could be an effective and safe agent for the prevention of bone loss in postmenopausal osteopenic women, with significant increases in BMD being observed in this group of patients.
... The medical necessity of calcium supplementation is undisputed-the results of several studies confirm this [10,19]. However other sources [11] indicate that actual levels of intake contradict these medical findings. It is particularly difficult to evaluate the degree of compliance with free combination of bisphosphonates and calcium. ...
The discussion of adequate compliance in health care often refers to a lack of information between patients and physicians. In our setting, we show that contract arrangements as well as the distribution of information are important for an adequate alignment of the interest of patients and physicians. The analysis emphasises the benefit of organised pharmaco-therapy enhancing the concomitant compliance. Therefore, the results can work as a proxy for the need of good economic-based approaches discussing compliance in chronic diseases.
Introduction:
Hip fractures have a huge impact in reducing the quality of life and increasing mortality. This review aims to assess the impact of daily oral supplementation of vitamin D3 plus calcium on the incidence of hip fracture in people over 65 years.
Methods:
PRISMA guidelines were followed and RCTs that evaluated the effectiveness of daily oral supplementation of vitamin D3 plus calcium in preventing hip fracture in adults over 65 years were included in the study. The databases such as Cochrane Library, Embase, Medline, PubMed, CINAHL, Web of Science and Scopus were searched from October 2019- January 2020.The Cochrane risk of bias tool was used to check the quality of the included studies. A meta-analysis with fixed effect model using Review Manager (Revman 5.3) was used to analyse the data.
Results:
The meta-analysis of seven RCTs on vitamin D3 plus calcium supplementation and hip fracture (n = 12,620) identified odds ratio (OR) of 0.75; 95% Confidence interval (CI): 0.64, 0.87; p = .0003. Daily oral supplementation of 800 IU of Vitamin D3 plus 1200 mg of calcium was found more effective (n = 5676 participants; OR = 0.69; 95% CI: 0.58, 0.82; p < .0001) than daily oral supplementation of 800 IU of Vitamin D3 plus 1000 mg of calcium (n = 6555,OR = 1.08; 95% CI: 0.74, 1.56; p = .70) in reducing hip fracture. A meta-analysis of the seven RCTs to identify the incidence of non-vertebral fracture gave the OR of 0.80; 95% CI: 0.72, 0.89; p < .0001. A meta-analysis of three RCTs on femoral neck bone mineral density (BMD) (n = 483) gave a mean difference of 1.21; 95% CI: -0.79, 3.20; p = .24.
Conclusion:
Daily oral supplementation 800 IU of vitamin D3 plus 1200 mg of calcium reduces hip fracture and non-vertebral fracture in older people. Administering vitamin D3 and calcium supplements had no effect in increasing the femoral neck BMD.
Implications for practice:
Even though it is evident from the review that optimal daily intake of vitamin D3 plus calcium supplementation help in the prevention of fracture, it is only one essential element in fracture prevention. Also, people who are on dietary supplements should be compliant with same for better result. Efforts to prevent bone loss and osteoporosis should begin from an early age. It includes maintaining a healthy lifestyle, optimal intake of calcium and vitamin D3, proper nutrition, adequate exposure to sunlight, exercise etc. Proper education on healthy lifestyle, avoiding risk factors like smoking, caffeine, alcohol and awareness of bone health should continue throughout life with emphasis during menopause when increased bone loss is expected.
Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.
Phenylalanine hydroxylase (PAH) deficiency is an inherited metabolic disorder requiring life-long restriction of dietary protein and phenylalanine-free medical food. Low bone mineral density (BMD) is reported, but factors associated with BMD Z-score (standard deviations from normal) are unknown. We examined associations between clinical and dietary parameters and total BMD Z-score in PAH deficiency patients, and developed models to predict Z-score. Data collected from patients >4 years of age (n = 88; mean age = 18.8 y; 61 % female) included demographic, clinical, laboratory, and dietary intakes. Adjusted Spearman's correlation coefficients were calculated between parameters and TBMD Z-score, measured by dual energy x-ray absorptiometry (DXA). Parameters approaching significance (p-value < 0.10) were candidate predictors for four linear regression models predicting TBMD Z-score. To validate, model-predicted Z-scores were compared to DXA Z-scores. Mean TBMD Z-score was -0.326; 18 (20.4 %) had Z-score < -1. Z-scores were positively correlated with dietary vitamin D, calcium, and medical food intake and compliance with prescription, and negatively with dietary carbohydrate, sugar, caffeine intake, glycemic load, and prescribed medical food (grams protein/day; p-value < 0.05). The best model included medical food compliance, medical food intake, caffeine intake, and bone-specific alkaline phosphatase (r-square = 0.364). This model predicted Z-score category [normal or low (<-1)] with sensitivity = 66.7 %, likelihood ratio = 14.7, and AUC = 0.83 compared to DXA Z-score. No subjects had low BMD for chronological age (Z-score ≤ -2). Compliance with medical food prescription was the strongest predictor of TBMD Z-score. One model, if validated in a separate sample of patients with more cases of low BMD, showed potential to estimate TBMD Z-score using routine clinical patient parameters.
Research in the field of nutrition allows considering the establishment of a real prevention of osteoporosis. The value of fruits is discussed. Indeed, red fruits are particularly interesting for their high content in anthocyans, endowed with antioxidant and anti-inflammatory properties.
Fifty-six postmenopausal women (less than 6 years) aged 50–65 years, without HRT, were included in a controlled, randomized, double-blind placebo, prospective study, after a medical examination and a blood test. Throughout the 3-month study period, they kept their eating habits, limiting however consumption of red fruits. They were randomized into two groups of 28 subjects receiving either 0 or 120 mg of anthocyans daily, from blueberry extract. Those polyphenols were provided at the dose of 0 or 60 mg of active molecule in 100 ml of fermented milk (two bottles of 100 ml/day covering 25 and 20 % RDA for calcium and vitamin D, respectively).
Consumption of the milk enriched in polyphenols significantly improved serum bALP activity (an osteoblastic marker), without significant modification of CTX, a marker for bone resorption. This favorable orientation of bone metabolism could be explained by the contribution of anthocyans, the only noticeable difference between the two test foods. This finding is independent of the initial calcium and vitamin D consumption.
In conclusion, consumption of fermented milk enriched with calcium and vitamin D, containing blueberry, for 3 months, has corrected the insufficiency of vitamin D of postmenopausal women and resulted in improved bone formation, as indicated by the rise of a biomarker of osteoblastic activity. This benefit is probably related to the presence of blueberries (rich in polyphenols and phenolic acids).
Objective:
This study was conducted to describe a 10-year trend of the supplement from 2000 to 2009 and to evaluate age, gender and racial disparities using a national level health data.
Design:
Cross-sectional observational study.
Setting and participants:
Data collected from patient visit records to stand-alone US ambulatory care clinics. Visits made by men and women who were 40 years of age and older were included (n=175,830).
Measurements:
Overall prevalence of recorded calcium and vitamin D use for osteoporosis prevention and treatment, and annual visit rates were estimated by age, gender, race, insurance types, physician specialties, geographical regions, and metropolitan status using chi square test. Multivariate logistic regression was conducted to determine potential predictive factors for calcium and vitamin D supplements.
Results:
An increase in yearly trend of calcium and vitamin D supplements was observed. The increase was proportional to patients' age (p<0.05) and female gender was a strong predictor of calcium and vitamin D supplement (p<0.0001).Visits made by blacks were significantly less likely to be associated with the supplement (<0.05). Visits associated with self-pay and Medicaid was less likely to be recorded with vitamin D (p<0.05) but not calcium supplements. Osteoporosis diagnosis was an independent predictor of calcium and vitamin D records (p<0.0001).
Conclusions:
In spite of the observed increases in the trend of visits associated with calcium and vitamin D supplements, variability in the access to the medications was observed. More focused strategies targeting elderly, men, or black population are needed to maintain and improve adequate calcium and vitamin D supplements.
The prevalence of risk factors for osteoporosis in persons with epilepsy, patients' awareness of their risk, and their engagement in osteoprotective behaviors were assessed in this study. Two hundred and sixty patients with epilepsy (F=51.5%, average age=42) completed a survey tool. Of 106 patients with a dual energy X-ray absorptiometry (DXA) result, 52% had low bone mineral density, and 11% had osteoporosis. The results suggest that the majority of patients with epilepsy do not engage in bone-protective behaviors. Those who have undergone a DXA scan may be more likely to take calcium and vitamin D supplementation compared with those who did not undergo a DXA scan, but they do not engage in other osteoprotective behaviors. Many patients did not accurately report their DXA results, indicating that better patient education is warranted.
Copyright © 2015 Elsevier Inc. All rights reserved.
In this randomized controlled trial, we examined the effects of a 3-month therapeutic lifestyle modification (TLM) intervention on knowledge, self-efficacy, and health behaviors related to bone health in postmenopausal women in rural Korea. Forty-one women ages 45 or older were randomly assigned to either the intervention (n = 21) or control (n = 20) group. The intervention group completed a 12-week, 24-session TLM program of individualized health monitoring, group health education, exercise, and calcium-vitamin D supplementation. Compared with the control group, the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks, providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis. © 2014 Wiley Periodicals, Inc.
Objectifs
Nous avons déjà démontré une diminution de la densité osseuse et une augmentation de l’incidence de la carence en 25-hydroxy vitamine D3 (25-OH D3) chez les adultes ayant une neurofibromatose 1 (NF1) comparés aux sujets témoins. La vitamine D3 est un complément bon marché, sûr et efficace dans la population générale mais son importance chez les NF1 n’a pas été démontrée. Cette étude étudie les effets thérapeutiques potentiels de la vitamine D3 sur la densité minérale osseuse (DMO) chez des patients ayant une NF1 avec carence en vitamine D3.
Méthodes
Nous avons mesuré la 25-OH D3, l’hormone parathyroïdienne, la calcémie, la phosphatase alcaline osseuse, la concentration urinaire de déoxypyridinoline et la DMO chez 35 adultes ayant une NF1. Dix-neuf patients reçurent une supplémentation en vitamine D3 pendant deux ans, six patients une supplémentation pendant un an et dix patients ne reçurent pas de supplémentation. La supplémentation fut administrée à la dose permettant de maintenir le taux de 25-OH D3 au-dessus de 30 μg/L. La DMO fut mesurée à un an et deux ans et l’évolution biochimique du métabolisme osseux fut mesurée au moins tous les six mois durant le traitement.
Résultats
Les sujets traités avaient, de façon significative, une réduction de leur perte de DMO mesurée par T score à la hanche (p = 0,011) et au rachis lombaire (p = 0,022). L’effet sur la DMO à la hanche fut apparent à un an, comparativement à l’inclusion (p = 0,002) et fut plus important à deux ans, comparativement à un an (p = 0,002).
Conclusions
La supplémentation en vitamine D améliore la DMO chez les patients ayant une NF1. Des études ultérieures sont nécessaires pour élucider le mécanisme responsable de la réduction de la DMO chez les patients porteurs d’une NF1.
Purpose of review: The use of dietary supplements or nutraceuticals in clinical endocrinology has been growing steadily despite controversy regarding the appropriateness of such therapies. This review provides an evidence-based survey of some popular dietary supplements or nutraceuticals targeting a variety of endocrine disorders.
Recent findings: The use of thyroid extracts or other natural remedies for thyroid disease is not evidence-based and is not superior to synthetic preparations. Insufficient data support the use of dehydroepiandrosterone or ginkgo biloba for hormonal disorders. Black cohosh and isoflavones may alleviate menopausal symptoms. Weak clinical data support the well tolerated use of several dietary supplements or nutraceuticals in diabetology, including a variety of botanicals and chromium. Carnitine and α-lipoic acid may alleviate diabetic neuropathy. Vitamin E is not a cardiovascular protectant. N-3 polyunsaturated fatty acids improve certain dyslipidemias. Data regarding conjugated linoleic acid and obesity are inconclusive. Isoflavones and vitamin K1 are promising but still unproven agents in osteoporosis, whereas the use of calcium and vitamin D alone has recently been challenged.
Summary: Patients and physicans must evaluate dietary supplements or nutraceuticals in terms of the - qualitatively variable - supporting clinical evidence and relative risk-benefit profiles. Otherwise, the use of unproven therapies can be dangerous.
Objectives:
We have previously demonstrated reduced bone density and an increased incidence of 25-hydroxy vitamin D3 (25-OH D3) deficiency in adults with neurofibromatosis 1 (NF1) compared to healthy controls. Vitamin D3 is a cheap, safe, and effective supplement in the general population, but its value in NF1 patients has not been demonstrated. This study investigates the therapeutic potential of oral vitamin D3 on bone mineral density (BMD) in NF1 patients with vitamin D3 deficiency.
Methods:
We measured serum 25-OH D3, parathyroid hormone, calcium, and bone alkaline phosphatase concentrations, urinary deoxypyridinoline concentrations, and BMD in 35 adults with NF1. Nineteen patients received vitamin D3 supplementation for 2 years, six patients received supplementation for 1 year and 10 patients received no supplementation. Supplementation was administered in a dose that maintained the serum 25-OH D3 level above 30 μg/l. BMD was measured again at 1 and 2 years, and biochemical assessments of bone metabolism were measured at least every half year during therapy.
Results:
Treated subjects had significantly reduced loss of BMD, as measured by T score at the hip (p=0.011) and lumbar spine (p=0.022). The effect on hip BMD was apparent at 1 year in comparison to baseline (p=0.02) and was greater at 2 years in comparison to measurements at 1 year (p=0.02).
Conclusions:
Vitamin D3 supplementation improves BMD in adult NF1 patients. Further studies are needed to elucidate the mechanisms responsible for reduced BMD in NF1 patients.
Low bone mass is a major health concern among young women nowadays due to sedentary lifestyle and lack of calcium rich food intake. Therefore there is an increase in the incidence of LBM among young university women so our main purpose of study was to compare effects of exercise program and calcium supplements on bone mass in young women.
This single blinded, cross sectional study included data collection in the form of SOS T-scores at distal radius for 104 young university women of mean age 22.3 years using Sunlight Omnisense Bone Sonometer 7000S. Of these, 62 women with low bone mass were included in a 3 month study but 60 subjects completed the study. They were randomly divided into 3 groups: exercise group (n=21), calcium supplementation group (n=21) and control group (n=20). All participants were evaluated pre and post protocol for T-score distal radius and midshaft tibia.
After measuring SOS T-score of 104 subjects; we found that 60.57% had low bone mass and remaining 39.43% had normal bone mass. After 3 months, the exercise group showed significant improvement in distal radius SOS T-score (t=5.10, P<0.001), at midshaft tibia (t=3.71, P<0.001) followed by improvement in calcium group at distal radius (t=6.28, P<0.001), midshaft tibia (t=2.33, P<0.05) as compared to control group which showed a marginal increase.
Exercise group showed more improvement in T-scores than calcium and control group. Exercise is important modifiable factor to improve bone accretion at this age and reduce risk of developing osteoporosis related debilitating conditions later in life.
Osteoporotic fracture is a major health burden. Early diagnosis and management would improve the quality of life and reduce costs to the society.
We aimed to identify risk factors associated with osteoporosis followed by development and validation of a screening tool in the hope of providing an appropriate regime to detect low bone density (BMD) in Malaysia.
Between November 1999 and November 2002, 514 healthy women aged ≥ 45 with intact uterus, non-HRT users were recruited. Following BMD testing, a screening tool was developed. For validation, 72 women were recruited from June 2003 to December 2003.
Age and a longer duration postmenopause were negatively linked to BMD. Higher family income, BMI, waist and hip circumference were positively correlated. A score of ≥ 4, the screening tool had a sensitivity of 73.2%, a specificity of 61.6% for identifying women with low BMD (T score ≤ -2) plus a sensitivity of 80.2% in selecting women with osteoporosis. The tool enabled a 45.9% reduction in unnecessary DEXA testing. Validation of the screening tool showed a negative predictive value of 97.8%, sensitivity and specificity of 87.5% and 70.3%, respectively.
The Malaysian Osteoporosis Screening Tool (MOST) is relatively simple. Its usage may reduce unnecessary DEXA test.
Body composition (BC) assessment is indispensable to evaluate nutritional status and thus health, both at the population and individual level, and to assess the efficacy of primary and secondary preventive nutritional strategies. Changes in BC, including the regional distribution of body fat, largely occur during pubertal transition, with marked differences between genders. They may, however, also occur in the elderly, who experience significant changes in the ratio between body fat and muscle with aging. The development and implementation of more sophisticated techniques (e.g. BC assessment at the molecular and atomic levels) could provide a major contribution to determining BC at different levels. This review discusses the application of dual-energy X-ray absorptiometry (DXA) on BC determination, given that DXA has the potential to provide overall and regional assessment of BC in terms of fat, lean mass and bone. DXA is widely used in many clinical settings primarily diagnosis osteoporosis. This article describes the use of whole-body DXA in assessing BC in patients with chronic diseases (e.g. metabolic syndrome) as well as in different sport activities to evaluate the effects of exercise.
The aim of this study was to identify risk factors associated with osteoporosis in urban midlife Malaysian women and to assess the effectiveness of lifestyle intervention in bone loss prevention with hormone replacement therapy (HRT) as a positive control. A total of 514 disease-free, uterus-intact, non-HRT-using women aged 45 years and older were recruited into the study. After initial bone mineral density (BMD) assessments, they were randomized into three groups: GI (control), G2 (lifestyle intervention), and G3 (lifestyle intervention with HRT). The study group was composed of 67.5% Chinese, 27.8% Malay, and 4.2% Indians with a mean age of 51.07+/-5.28 years. Two-fifths were postmenopausal, and the prevalence of osteoporosis was 24.1%, seen predominantly at the hip. Postmenopausal women had significantly lower mean BMD and a higher incidence of osteoporosis compared with the premenopausal women, 42.1% vs. 11.1% (p<0.0005). A lower incidence of osteoporosis was found in women who took calcium supplementation regularly as opposed to those who do not, 18.7% vs. 29.3% (p=0.036). Age and a greater postmenopausal duration showed a significant negative association with BMD, whereas higher family income, weight, body mass index, and waist and hip circumference were positively correlated. After 18-20 months, the effect of intervention was assessed based on BMD values of 279 women at baseline and after intervention. Lifestyle intervention alone was effective in premenopausal women, preventing over 90% of spinal bone loss compared with the controls, who lost 11.6% (0.046 g/cm2) bone mass with similar losses of hip bone, 2.0% (0.026 g/cm2) vs. 1.5% (0.020 g/cm2). Premenopausal women on HRT also showed a substantial decrease in spine and hip BMD, 18.6% (0.081 g/cm2) and 9.0% (0.122 g/cm2), respectively. The lifestyle intervention program retarded postmenopausal bone loss by 21% and 37% compared with controls, who lost 9.6% (0.141 g/cm2) and 6.0% (0.138 g/cm2) bone mass at the spine and hip. In comparison, lifestyle intervention with HRT increased postmenopausal BMD by 12.7% (0.216 g/cm2) at the spine and 1.9% (0.042 g/cm2) at the hip. The changes in hip BMD were influenced by current age, ethnicity, and income, while intervention had the strongest effect on spine BMD changes. In conclusion, lifestyle intervention prevented spinal bone loss in premenopausal women and retarded postmenopausal spine and hip bone loss compared with controls. The benefits of physical activity on spine and hip BMD highlight its potential as a safe and cost-effective alternative to HRT, which is not advocated because of its potential adverse effects.
Systemic and topical application of antioxidant substances for the medical treatment and prophylaxis of many diseases as well as additional protection of the skin against the destructive action of free radicals and other reactive species has become very popular during the past years. Stimulated by the positive results of a fruit and vegetable diet in supporting medical treatment and in cosmetics, artificial and extracted antioxidant substances have been broadly applied. Surprisingly, not only positive but also strong negative results have been obtained by different authors. According to study reports artificial and extracted antioxidant substances support different kinds of medical therapies, if they are applied in mixtures of different compounds at low concentration levels. In the case of the application of high concentration of some single compounds, side effects were often observed. Regarding skin treatment by systemically applied antioxidant substances for cosmetic purposes, positive cosmetic effects as well as no effects, but almost no side effects, apart from a number of allergic reactions, were reported. One reason for this seems to be the lower concentration of systemically applied antioxidant substances in comparison with a medical application. Topical application of antioxidant substances is closely related to cosmetic treatment for skin protection and anti-aging. Positive results were also obtained in this case. The present review is an attempt to classify and summarize the published literature concerning the efficiency of action of systemic and topical applications of antioxidant substances, such as carotenoids and vitamins, on human organism and especially on the skin. The available literature on this topic is very extensive and the results are often contradictory. Nevertheless, there are some clear tendencies concerning systemic and topical application of antioxidant substances in medicine and cosmetics, and we summarize them in the present paper.
To summarize current knowledge about premature ovarian failure (POF) with an emphasis on recent developments regarding its management.
The incidence of POF is increasing largely due to improved survival rates of cancer patients treated with radiation and chemotherapy. Delayed diagnosis and management of POF leads to suboptimal outcomes. Anticipation and early detection of this condition in high-risk women by means of ovarian function testing, followed by early institution of appropriate management could improve outcomes. Choice of strategies should vary depending on the age of onset, associated symptoms and fertility aspirations of the individual, and should change with the patient's advancing age.
Early assessment of the individual's risk of developing POF, development of a strategic management plan, and timely commencement of infertility and hormone deficiency treatment, together with counselling in an integrated management plan should improve both the short and long-term health of those with POF.
High physiological prolactin induced positive calcium balance by stimulating intestinal calcium absorption, reducing renal calcium excretion, and increasing bone calcium deposition in female rats. Although prolactin-induced increase in trabecular bone calcium deposition was absent after ovariectomy, its effects on cortical bones were still controversial. The present investigation, therefore, aimed to study the effect of in vivo long-term high physiological prolactin induced by either anterior pituitary (AP) transplantation or 2.5 mg/kg prolactin injection on cortical bones in ovariectomized rats. Since the presence of prolactin receptors (PRLR) in different bones of normal adult rats has not been reported, we first determined mRNA expression of both short- and long-form PRLRs at the cortical sites (tibia and femur) and trabecular sites (calvaria and vertebrae) by using the RT-PCR. Our results showed the mRNA expression of both PRLR isoforms with predominant long form at all sites. However, high prolactin levels induced by AP transplantation in normal rats did not have any effect on the femoral bone mineral density or bone mineral content. By using (45)Ca kinetic study, 2.5 mg/kg prolactin did not alter bone formation, bone resorption, calcium deposition, and total calcium content in tibia and femur of adult ovariectomized rats. AP transplantation also had no effect on the cortical total calcium content in adult ovariectomized rats. Because previous work showed that the effects of prolactin were age dependent and could be modulated by high-calcium diet, interactions between prolactin and these two parameters were investigated. The results demonstrated that 2.0% wt/wt high-calcium diet significantly increased the tibial total calcium content in 9-wk-old young AP-grafted ovariectomized rats but decreased the tibial total calcium content in 22-wk-old adult rats. As for the vertebrae, the total calcium contents in both young and adult rats were not changed by high-calcium diet. The present results thus indicated that the adult cortical bones were potentially direct targets of prolactin. Moreover, the effects of high physiological prolactin on cortical bones were age dependent and were observed only under the modulation of high-calcium diet condition.
Objective: To summarize controlled trials examining the effect of calcium on bone density and fractures in postmenopausal women. Data Source: We searched MEDLINE and EMBASE up to 1998 and the Cochrane Controlled Register up to 2000, and we examined citations of relevant articles and proceedings of international meetings. We contacted osteoporosis investigators to identify additional studies, and primary authors for unpublished data. Study Selection: We included 15 trials (1806 patients) that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm, or recorded the number of fractures, and followed patients for at least 1 yr. Data Extraction: For each trial, three independent reviewers assessed the methodological quality and extracted data. Data Synthesis: We found calcium to be more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% [95% confidence interval (CI) 0.24-3.86] for total body bone density, 1.66% (95% CI 0.92-2.39) for the lumbar spine, 1.64% (95% CI 0.70-2.57) for the hip, and 1.91% (95% Cl 0.33-3.50) for the distal radius. The relative risk (RR) of fractures of the vertebrae was 0.77, with a wide CI (95% CI 0.54-1.09); the RR for nonvertebral fractures was 0.86 (95% CI 0.43-1.72). Conclusions: Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but do not meaningfully address the possible effect of calcium on reducing the incidence of nonvertebral fractures.
Dietary supplements that prevent bone loss at the hip and that can be applied safely in the elderly are likely to reduce hip fractures. A daily dietary supplement of 750 mg calcium or 15 microg 25OH vitamin D3 on bone loss at the hip and other sites, bone turnover and calcium-regulating hormones were studied over 4 yr in elderly volunteers using a randomized, double-blind, placebo-controlled trial. Bone mineral density (BMD) was measured by dual x-ray absorptiometry and bone structure by radiographs. Calcium biochemistry and bone turnover markers were measured in blood and urine. The 316 women entering the trial had a mean age of 73.7 yr and the 122 men of 75.9 yr. Baseline median calcium intake was 546 mg/day, and median serum 25OH vitamin D3 was 59 nmol/L. On placebo, loss of BMD at total hip was 2% and femoral medulla expansion was 3% over 4 yr. Calcium reduced bone loss, secondary hyperparathyroidism, and bone turnover. 25OH vitamin D3 was intermediate between placebo and calcium. Fracture rates and drop-out rates were similar among groups, and there were no serious adverse events with either supplement. A calcium supplement of 750 mg/day prevents loss of BMD, reduces femoral medullary expansion, secondary hyperparathyroidism, and high bone turnover. A supplement of 15 microg/day 25OH vitamin D3 is less effective, and because its effects are seen only at low calcium intakes, suggests that its beneficial effect is to reverse calcium insufficiency.
Bone turnover is increased during weight loss in postmenopausal women and can be suppressed with calcium supplementation. In this study, we assessed the influence of energy restriction with and without calcium supplementation (1 g/day) in premenopausal women. Thirty-eight obese premenopausal women (body mass index [BMI] of 35.0 ± 3.9 kg/m2) completed a 6-month study of either moderate weight loss or weight maintenance. During weight loss, women were randomly assigned to either a calcium supplementation (n = 14) or placebo group (n = 14) and lost 7.5 ± 2.5% of their body weight. The control group of women (n = 10) maintained their body weight. Total body and lumbar bone mineral density (LBMD) and content were measured by dual-energy X-ray absorptiometry (DXA) at baseline and after weight loss. Throughout the study, blood and urine samples were collected to measure bone turnover markers and hormones. During moderate energy restriction, dietary calcium intake decreased (p < 0.05) and the bone resorption marker deoxypyridinoline (DPD) increased slightly (p ≤ 0.05) without evidence of bone loss. Calcium supplementation during weight loss tended to increase lumbar BMD by 1.7% (p = 0.05) compared with the placebo or weight maintenance groups. In contrast to our previous findings in postmenopausal women, premenopausal obese women who consume a low calcium diet do not lose bone over a 6-month period, whether their weight is stable or decreasing moderately.
The reproducibility of dual-energy X-ray absorptiometry (DXA) measurements for total body composition and for segmental body composition was investigated in 22 healthy male subjects who underwent six consecutive measurements in 90 min. Body weight (mean +/- SD) and body height were 72.3 +/- 8.8 kg and 1.75 +/- 0.04 m respectively, and body mass index was 23.5 +/- 2.5 kg m(-2). Bone mineral content (BMC) was 3.30 +/- 0.36 kg, lean mass and fat mass as measured by DXA were 57.1 +/- 6.1 kg and 11.8 +/- 6.5 kg respectively. For BMC, the reproducibility, expressed as the coefficient of variation, was 12%, 1.5%, 2.5%, 4.1% and 3.1% for total body, legs, arms, trunk and abdominal respectively. For lean tissue and for fat tissue, these values were 1.5% and 50%; 1.8% and 2.1%, 8.3% and 11.7%, 26% and 10.0%, 3.9% and 10.7% respectively. It is concluded that the reproducibility for BMC is excellent, but that for lean tissue and for fat tissue the variability is relatively high, especially in body segments.
An improved semiquantitative self-administered food frequency questionnaire has been designed in order to investigate possible associations between diet and health, to plan nutrition education programmes, and to examine dietary compliance. The questionnaire consists of 16 printed forms and 16 pages with coloured photos of the most common foods and courses from the Italian diet. Instructions and other questions are included. The questionnaire uses optical reading from a scanner connected to a personal computer. The questionnaire was validated by comparing it with the seven-day weighed record method using 46 healthy adult volunteers. Significant correlations were found for all nutrients tested (Spearman rank correlation procedure), r ranging from 0.33 for ascorbic acid to 0.84 for alcohol. The two methods gave comparable results (Wilcoxon matched-pairs signed rank test) for all nutrients except riboflavin and alcohol. Similarity of the two methods in classifying relative intakes was examined by determining the frequency of similar classification into tertiles. Half of the subjects were correctly classified for most nutrients and for frequency of consumption of 18 food groups.
To determine the long-term effects of calcium supplements or placebo on bone density in healthy women at least 3 years postmenopause.
Eighty-six women from our previously reported 2-year study agreed to continue on their double-blind treatment allocation (1 g elemental calcium or placebo) for a further 2 years, with 78 women (40 on placebo) reaching the 4-year end point. Median (interquartile range) dietary calcium intakes for the whole group were 700 mg (range 540 to 910) per day at baseline, 670 mg (range 480 to 890) per day at 2 years, and 640 mg (range 460 to 880) per day at 4 years. The bone mineral density (BMD) of the total body, lumbar spine, and proximal femur was measured every 6 months by dual-energy, x-ray absorptiometry.
There was a sustained reduction in the rate of loss of total body BMD in the calcium group throughout the 4-year study period (P = 0.002), and bone loss was significantly less in the calcium-treated subjects in years 2 through 4 also (difference between groups 0.25% +/- 0.11% per year, P = 0.02). In the lumbar spine, bone loss was reduced in the calcium group in year 1 (P = 0.004), but not subsequently. There was, however, a significant treatment effect at this site over the whole 4-year period (P = 0.03). In the proximal femur, the benefit from calcium treatment also tended to be greater in the first year and was significant over the 4-year study period in the femoral neck (P = 0.03) and the trochanter (P = 0.01). Nine symptomatic fractures occurred in 7 subjects in the placebo group and 2 fractures in 2 subjects receiving calcium (P = 0.037).
Calcium supplementation produces a sustained reduction in the rate of loss of total body BMD in healthy postmenopausal women.
The efficacy of calcium (Ca) in reducing bone loss is debated. In a randomized placebo-controlled double-masked study, we investigated the effects of oral Ca supplements on femoral shaft (FS), femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD), and on the incidence of vertebral fracture in vitamin-D-replete elderly. Ninety-three healthy subjects (72.1 +/- 0.6 years) were randomly allocated to three groups receiving 800 mg/day Ca in two different forms or a placebo for 18 months. Sixty-three patients (78.4 +/- 1.0 years) with a recent hip fracture were allocated to two groups receiving the two forms of Ca without placebo. FS BMD changes in Ca-supplemented non-fractured women were significantly different from those in the placebo group (+0.6 +/- 0.5% v -1.2 +/- 0.7%, p < 0.05). There was no difference in effect between the two forms of Ca. The changes of +0.7 +/- 0.8% v -1.7 +/- 1.6% in FN BMD of Ca-supplemented women and the placebo group did not reach statistical significance. In fractured patients, FS, FN and LS BMD changes were -1.3 +/- 0.8, +0.3 +/- 1.6 and +3.1 +/- 1.2% (p < 0.05 for the last). The rate of new vertebral fractures was 74.3 and 106.2 fractures per 1000 patient-years in Ca-supplemented non-fractured subjects and in the placebo group, respectively, and 144.0 in Ca-supplemented fractured patients. Thus, oral Ca supplements prevented a femoral BMD decrease and lowered vertebral fracture rate in the elderly.
When discussing the use of calcium and vitamin D in the prevention and the treatment of osteoporosis one can make a distinction between the use as dietary supplementation to correct or prevent deficiencies, and the pharmacologic use of higher doses, whether or not in association with other drugs. However, in practical terms it is not always possible to clearly make this distinction. Available evidence suggests that increasing the calcium intake can favourably affect the build-up of bone mass in adolescence. In this population, the daily consumption of calcium in the diet should, optimally, be at least 1200 mg/day. In view of the lack of data pertaining to the effect on the final peak bone mass, there is at present time no basis for the systematic administration of calcium supplements to healthy children and adolescents. Calcium supplementation, aiming at a total calcium intake of at least 1500 mg/day, has a partial protective effect on postmenopausal bone loss, this effect being documented mainly in women more than 5 years after menopause. In the present state of our knowledge, there is no established role for vitamin D supplementation in the prevention of postmenopausal osteoporosis, except in elderly patients presenting with a higher risk for relative vitamin D deficiency and with low calcium intake. The results of a controlled trial suggest that in institutionalised elderly patients, systematic administration of calcium and vitamin D supplements can substantially reduce the risk of hip fracture. In the treatment of established postmenopausal osteoporosis, calcium supplementation has only a role as a general adjuvant therapeutic measure and as a specific complement to the treatment with other active compounds. There are indications that treatment alpha-calcidol or calcitriol has a positive effect on the evolution of bone mass, but awaiting further confirmation of a favourable effect on the incidence of osteoporotic fractures, treatment with these drugs remains experimental.
To determine the long-term effect of calcium supplementation on bone density, 84 elderly women (54-74 years) more than 10 years past the menopause were studied for 4 years as part of a follow-up study of a randomized, double-masked, placebo-controlled trial. The placebo group who did not take calcium supplements at all during the 4-year study (control group, n = 21) served as a comparison with the treated group who took calcium supplements for 4 years (calcium supplement group, n = 14). We also studied subjects who were treated for 2 years with calcium supplements and then ceased taking them (non-compliant group, n = 49). The changes in bone density at the lumbar spine, hip and ankle sites, current calcium intake and activity were monitored. Over the 4 years the calcium supplement group (mean calcium intake 1988 +/- 90 mg/day) did not lose bone at the hip and ankle site. The control group (mean calcium intake 952 +/- 109 mg/day) lost significantly more bone than the calcium supplement group at all sites of the hip and ankle. No overall bone loss was seen at the spine, in either group, over the 4 years of this study. Between years 2 and 4 the non-compliant group (mean calcium intake 981 +/- 75 mg/day) lost significantly more bone at all sites of the ankle than the calcium supplement group. Therefore, calcium supplementation produces a sustained reduction in the rate of loss of bone density at the ankle and hip sites in elderly postmenopausal women. Increasing dietary calcium intake in women should be the aim of a public health campaign.
Since its introduction nearly ten years ago, dual-energy x-ray absorptiometry (DXA) has become the single most widely used technique for performing bone densitometry studies. One reason for its popularity is the ability of DXA systems to measure bone mineral density (BMD) in the spine and proximal femur, the two most common sites for osteoporotic fractures. Other advantages of DXA include the exceptionally low radiation dose to patients, short scan times, high resolution images, good precision and inherent stability of calibration. For these reasons DXA scans are widely used to diagnose osteoporosis, assist making decisions in treatment, and as a follow-up response to therapy. Another important application has been the use of DXA in many clinical trials of new treatments for osteoporosis. Since the first generation pencil beam DXA systems became available, the most significant technical innovation has been the introduction of fan beam systems with shorter scan times, increased patient throughput, and improved image quality. New clinical applications include the measurement of lateral spine and total body BMD, body composition, and vertebral morphometry. Despite these advances, posteroanterior (PA) spine and proximal femur scans remain the most widely used application because of their utility in treatment decisions and monitoring response to therapy.
We report a 4-year randomized, double-blind, placebo-controlled clinical trial in 236 normal postmenopausal women (mean age +/- SE, 66.3+/-0.2 years) who were randomized to a calcium (1600 mg/day as the citrate) or placebo group. The women were seen every 6 months; 177 completed the trial. Net percentage changes in each group are given relative to baseline. The differences in net percentage changes (calcium group minus placebo group) in medians were: for lumbar spine bone density, 2.0% (p < 0.001) at year 1 and 0.3% (not significant) at year 4; for proximal femur bone density, 1.3% (p = 0.003) at year 1 and 1.3% (p = 0.015) at year 4; and for total body bone mineral, 0.4% (p = 0.002) at year 1 and 0.9% (p = 0.017) at year 4. Similar differences at year 4 were: -18.9% (p = 0.002) for parathyroid hormone (PTH), -11.9% (p = 0.026) for serum osteocalcin, and -32.2% (p = 0.003) for urine free pyridinoline. We conclude that long-term administration of calcium supplements to elderly women partially reverses age-related increases in serum PTH level and bone resorption and decreases bone loss. However, the effects on bone loss were weaker than those reported for estrogen, bisphosphonates, or calcitonin therapy, indicating that calcium supplements alone cannot substitute for these in treating established osteoporosis. Nonetheless, because of their safety, high tolerance, and low expense, calcium supplements may be a useful preventive measure for elderly postmenopausal women whose bone mineral density values are normal for their age.
We undertook a double-masked, randomized, placebo-controlled trial to evaluate the effect of a calcium and vitamin D supplement and a calcium supplement plus multivitamins on bone loss at the hip, spine and forearm. The study was performed in 240 healthy women, 58-67 years of age. Duration of treatment was 2 years. Bone mineral density (BMD) was measured at the lumbar spine, hip and forearm. A dietary questionnaire was administered twice during the study and revealed a fairly good calcium and vitamin D intake (919 mg calcium/day; 3.8 micrograms vitamin D/day). An increase in lumbar spine BMD of 1.6% was observed in the treatment group after 2 years (p < 0.002). In the placebo group no significant changes were observed during the 2 years. Lumbar spine BMD was significantly higher in the treatment group at both 1 (p < 0.01) and 2 years (p < 0.05) compared with the placebo group. Though not significant, the same trend was seen at the hip. No significant changes from baseline values were observed at the distal forearm in either the treatment or the placebo group. In conclusion, we found a significant increase in urinary calcium excretion in the treatment group compared with the placebo group. Together with significant changes in serum calcium and serum parathyroid hormone, this indicates that a long-term calcium and vitamin supplement of 1 g elementary calcium (calcium carbonate) and 14 micrograms vitamin D3 increases intestinal calcium absorption. A positive effect on BMD was demonstrated, even in a group of early postmenopausal age, with a fairly good initial calcium and vitamin D status.
Supplementation with calcium and vitamin D reduces bone loss and prevents fractures in elderly people, but it is not known whether any lasting benefit remains if the supplements are discontinued.
The objective was to determine whether gains in bone mineral density (BMD) induced by calcium and vitamin D supplementation persist after supplement withdrawal.
Two-hundred ninety-five healthy, elderly men and women (aged >/=68 y) who had completed a 3-y randomized, placebo-controlled trial of calcium and vitamin D supplementation were followed for an additional 2 y during which no study supplements were given. BMD was measured by dual-energy X-ray absorptiometry, and biochemical variables related to calcium metabolism and bone turnover were measured.
In the 128 men, supplement-induced increases in spinal and femoral neck BMD were lost within 2 y of supplement discontinuation, but small benefits in total-body BMD remained. In the 167 women, there were no lasting benefits in total-body BMD or at any bone site. Consistent with the observations on BMD, the bone turnover rates in both men and women (as measured by serum osteocalcin concentrations) returned to their original higher concentrations within the same 2-y period.
Discontinued calcium and vitamin D supplementation has limited cumulative effect on bone mass in men and women aged >/=68 y.
A significant relationship between body weight (BW) and bone mass (BM) has been established previously. A diet-induced weight loss is accompanied by a significant decrease in bone mineral density (BMD) and total body bone mineral (TBBM), but the underlying mechanisms are not clarified. Sixty-two obese women were included in the study. Dual-energy X-ray absorptiometry (DXA) and measurements of a series of calcium-regulating hormones and biochemical markers of bone turnover were performed at baseline and after 1 month and 3 months on a low calorie diet. Thirty of the women were randomized to a daily supplement of 1 g of calcium. After an additional 3 months without dietary prescriptions or calcium supplements, a subgroup of 48 subjects (24 from each group) were scanned again using DXA. There was a significant decrease in TBBM after 1 month and 3 months. A similar pattern was observed in the bone mineral content (BMC) of the lumbar spine in the patients who did not receive a calcium supplement, whereas no changes occurred in the supplemented group. The initial calcium supplementation seemed to protect against bone loss in the lumbar spine but not in the TBBM. In the nonsupplemented group, a statistically significant inverse correlation was found between the calcium/creatinine ratio in the morning urine and the changes in BMC of the lumbar spine. Such a relationship was not seen in the calcium-supplemented group. In the nonsupplemented group, no significant biochemical changes were observed, whereas a significant decrease in serum parathyroid hormone (PTH) was seen in the calcium-supplemented group. This might explain some of the protective effects of calcium supplementation on trabecular bone mass. We conclude that a diet-induced weight loss is accompanied by a generalized bone loss, which probably is explained mainly by a reduced mechanical strain on the skeleton. This loss can be partly inhibited by a high calcium intake. Therefore, a calcium supplementation should be recommended during weight loss, even if the diet contains the officially recommended amounts of calcium.
It is known that participating in sports can have a beneficial effect on bone mass. However, it is not well established which sport is more beneficial for increased bone mineral density (BMD) and appendicular muscle mass (AMM). This study investigated the effects of different high-intensity activities on BMD and AMM in highly trained athletes.
Sixty-two male subjects aged 18--25 yr participated in the study. The sample included judo (J; N = 21), karate (K; N = 14), and water polo (W; N = 24) athletes who all competed at national and international level. Twelve age-matched nonathletic individuals served as the control group (C). All athletes exercised regularly for at least 3 h x d(-1), 6 d x wk(-1). Segmental, total BMD, and AMM were measured with a dual-energy x-ray (DXA) absorptiometry (Lunar Corp., Madison, WI). DXA analysis also includes bone mineral content (BMC) and fat and lean masses.
Total BMD(C) was significantly lower (mean +/- SD: 1.27 +/- 0.06 g x cm(-2), P < 0.05) than either judo or karate athletes (total BMD(J) (1.4 +/- 0.06 g x cm(-2)) and total BMD(K) (1.36 +/- 0.08 g x cm(-2))) but not different from the W athletes (total BMD(W) (1.31 +/- 0.09 g x cm(-2))). AMM was significantly lower in the C group compared with the three athletic groups (P < 0.05). Fat mass was higher in the W versus J and K athletes but not different from the C group (P < 0.05).
This cross-sectional study has shown that athletes, especially those engaged in high-impact sports, have significantly higher total BMD and AMM than controls. These results suggest that the type of sport activity may be an important factor in achieving a high peak bone mass and reducing osteoporosis risk.
The aim of the study was to investigate the effects of regular aerobic exercise training on bone mineral density (BMD) in middle-aged men. A population based sample of 140 men (53-62 years) was randomly assigned into the exercise and reference groups. BMD and apparent volumetric BMD (BMDvol) of the proximal femur and lumbar spine (dual-energy X-ray absorptiometry, DXA) and anthropomorphic measurements were performed at the randomization and 2 and up to 4 years later. The participation rate was 97% and 94% at the second and third BMD measurements, respectively. As another indication of excellent adherence and compliance, the cardiorespiratory fitness (aerobic threshold) increased by 13% in the exercise group. The 2% decrease in the reference group is regarded as an age-related change in cardiorespiratory fitness. Regardless of the group, there was no association between the increase in aerobic threshold and change in BMD. In the entire group, age-related bone loss was seen in the femoral neck BMD and BMDvol (p < 0.01). BMD and BMDvol values increased with age in L2-L4 (p < 0.004). An increased rate of bone loss at the femoral neck was observed in men with a low energy-adjusted calcium intake (p = 0.003). Men who increased their alcohol intake during the intervention showed a decrease in the rate of bone loss at the femoral neck (p = 0.040). A decrease in body height associated with decreased total femoral BMD (r = 0.19, p = 0.04) and the change in body height was a predictor of bone loss in the femoral neck (beta = 0.201). Long-term regular aerobic physical activity in middle-aged men had no effect on the age-related loss of femoral BMD. On the other hand, possible structural alterations, which are also essential for the mechanical strength of bone, can not be detected by the DXA measurements used in this study. The increase seen in lumbar BMD reflects age-related changes in the spine, thus making it an unreliable site for BMD follow-up in men.
Osteoporosis is a significant public health problem associated with increased mortality and morbidity. Our aim in this cross-sectional study was to investigate the relationship between lifetime physical activity and calcium intake and bone mineral density (BMD) and BMC (bone mineral content) in 42 regularly menstruating Caucasian women (age 21.26+/-1.91 years, BMI 23.83+/-5.85).
BMD and BMC at the lumbar spine (L2-L4), hip (femoral neck, trochanter, total), and total body were assessed by dual energy x-ray absorptiometry (DXA). Lifetime history of physical activity and calcium intake was obtained by a structured interview using valid and reliable instruments.
Measures of both lifetime physical activity and calcium intake were highly correlated. In stepwise multiple regression analyses, lean mass was the most important and consistent factor for predicting BMD and BMC at all skeletal sites (attributable r2 = 28.8%-78.7%). Lifetime physical activity contributed to 3.0% of the variation in total body BMD, and life-time weight-bearing physical activity explained 15.1% of variance in lumbar spine BMC. Current calcium intake predicted 6% of the variance in BMD at the femoral neck and trochanter.
We found lean mass to be a powerful predictor of BMD and BMC in young women. Because lean mass can be modified to some extent by physical activity, public health efforts must be directed at increasing physical activity throughout the lifespan. Furthermore, our results suggest that adequate calcium intake may help to enhance bone mass, thus decreasing the risk of osteoporotic fracture later in life.
To summarize controlled trials examining the effect of calcium on bone density and fractures in postmenopausal women.
We searched MEDLINE and EMBASE up to 1998 and the Cochrane Controlled Register up to 2000, and we examined citations of relevant articles and proceedings of international meetings. We contacted osteoporosis investigators to identify additional studies, and primary authors for unpublished data.
We included 15 trials (1806 patients) that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm, or recorded the number of fractures, and followed patients for at least 1 yr.
For each trial, three independent reviewers assessed the methodological quality and extracted data.
We found calcium to be more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% [95% confidence interval (CI) 0.24-3.86] for total body bone density, 1.66% (95% CI 0.92-2.39) for the lumbar spine, 1.64% (95% CI 0.70-2.57) for the hip, and 1.91% (95% CI 0.33-3.50) for the distal radius. The relative risk (RR) of fractures of the vertebrae was 0.77, with a wide CI (95% CI 0.54-1.09); the RR for nonvertebral fractures was 0.86 (95% CI 0.43-1.72).
Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but do not meaningfully address the possible effect of calcium on reducing the incidence of nonvertebral fractures.
Osteoporosis, a disease of increased skeletal fragility, is becoming increasingly common as the U.S. population ages. Adequate vitamin D and calcium intake is the cornerstone of osteoporosis prevention and treatment. Age-related changes in vitamin D and calcium metabolism increase the risk of vitamin D insufficiency and secondary hyperparathyroidism. Although longitudinal data have suggested a role of vitamin D intake in modulating bone loss in perimenopausal women, studies of vitamin D and calcium supplementation have failed to support a significant effect of vitamin D and calcium during early menopause. There is a clearer benefit in vitamin D and calcium supplementation in older postmenopausal women. Vitamin D intake between 500 and 800 IU daily, with or without calcium supplementation, has been shown to increase bone mineral density (BMD) in women with a mean age of approximately 63 years. In women older than 65, there is even more benefit with vitamin D intakes of between 800 and 900 IU daily and 1200-1300 mg of calcium daily, with increased bone density, decreased bone turnover, and decreased nonvertebral fractures. The decreases in nonvertebral fractures may also be influenced by vitamin D-mediated decreases in body sway and fall risk. There are insufficient available data supporting a benefit from vitamin D supplementation alone, without calcium, to prevent osteoporotic fracture in postmenopausal women.
Data suggest that a diet deficient in calcium is associated with higher body weight and that augmenting calcium intake may reduce weight and fat gain or enhance loss. Our aim was to determine whether calcium supplementation during a weight loss intervention affects body fat or weight loss. Data were combined from three separate 25-wk randomized, double blind, placebo-controlled trials of 1000 mg/d calcium supplementation in 100 premenopausal and postmenopausal women. The primary outcome measures were change in body weight and fat mass adjusted for baseline values.
There were no significant differences in body weight or fat mass change between the placebo and the calcium-supplemented groups in the pooled analysis (adjusted mean ± se; body weight, placebo −6.2 ± 0.7 vs. Ca −7.0 ± 0.7 kg; fat mass, placebo −4.5 ± 0.6 vs. Ca −5.5 ± 0.6 kg), and no significant interactions of calcium supplementation with menopausal/diet status. Analysis as separate trials also found no significant differences between the placebo and the calcium groups. Calcium supplementation did not significantly affect amount of weight or fat lost by women counseled to follow a moderately restricted diet for 25 wk. Nevertheless, the magnitude and direction of the differences for group means are consistent with a hypothesized small effect.
Role of calcium and Vitamin D in the prevention and the treatment of postmenopausal osteoporosis: an overview Technical principles of dual energy X-ray absorptiometry
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