Minerals and vitamins in bone health: the potential value of dietary enhancement

United States Grown and Imported Rice on Sale in Las Vegas: Metal(loid)s Composition and Geographic Origin Discrimination

Concentrations of metal(loid)s, Ag, Al, As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Se, Sr, V and Zn, were determined in rice on sale in Las Vegas. The rice samples were grown in five different countries, the USA, Thailand, India, Pakistan, and Bangladesh. The elemental concentrations in rice grain were determined using inductively coupled plasma mass spectrometry (ICP-MS) following hot block-assisted digestion. The accuracy of the laboratory procedure was verified by the analysis of rice flour standard reference material (NIST SRM 1568b). The mean metal(loid) contents in rice of various geographic origins were 3.18-5.91 mg kg-1 for Al, 0.05-0.12 mg kg-1 for As, 3.64-41 μg kg-1 for Cd, 5.11-12 μg kg-1 for Co, 0.12-0.14 mg kg-1 for Cr, 1.5-1.91 mg kg-1 for Cu, 3.04-4.98 mg kg-1 for Fe, 4.2-10.4 mg kg-1 for Mn, 0.21-0.41 mg kg-1 for Ni, 0.02-0.07 mg kg-1 for Se, 0.68-0.88 mg kg-1 for Sr, 3.64-5.26 μg kg-1 for V, and 16.6-19.9 mg kg-1 for Zn. respectively. The mean concentration of As in US rice was significantly higher than in Indian, Pakistani, and Bangladeshi rice. On the other hand, it was found a significantly low mean level of Cd in US-grown rice. It was also found that the concentrations of metal(loid)s in black and brown rice on sale in Las Vegas were statistically similar, except for Mn and Se. The geographic origin traceability of rice grain involved the use of ICP-MS analysis coupled with chemometrics that allowed their differentiation based on the rice metal(loid) profile, thus confirming their origins. Data were processed by linear discriminant analysis, and US and Thai rice samples were cross-validated with higher accuracy (100%). This authentication quickly discriminates US rice from the other regions and adds verifiable food safety measures for consumers.

Nutritional, Phytochemical, and In Vitro Antioxidant Activity Analysis of Different States of Soy Products

Consumer demand for food nutritional content and quality is driving the design of plant-based foods that are enhanced with proteins. In this study, we aimed to reveal the nutrient compositional differences of various states of soy flours. We compared soy protein concentrate (SPC) with full fat (FF), raw soy flour (RSF), and defatted (DF) soy flour for investigating nutritional content, phytochemicals, and in vitro antioxidant activity. The results showed that the SPC contained significantly (p < 0.001) higher protein content (65.14%) and low-fat content (0.54%) than RSF, FF, and DF. Furthermore, the findings revealed that all products contain a significant (ANOVA, p < 0.001) amount of essential minerals. The RSF contains significantly higher (p < 0.001) potassium (1178.6 mg), calcium (216.77 mg), and magnesium (247 mg) per 100 g than FF, DF, and SPC. SPC contains essential amino acids, but we were unable to detect phenylalanine and tryptophan due to a limitation in the method. Furthermore, using methanolic and aqueous extracts of RSF, FF, DF, and SPC, the flavonoid, phenolics, and antioxidant capacity were also evaluated. According to the findings, soy products in methanolic extract had higher phenolic (about 12-34 mg/g) and flavonoid (about 63-150 mg/g) levels than aqueous extract. Results also demonstrated that FF had higher phenolic content, and SPC had higher flavonoid content than the other products. In vitro models such as phosphomolybdenum blue, FRAP, DPPH, and ABTS assays were used to study the total antioxidant and free radical scavenging potential of soy products, and results found that soy products contained a significant (p < 0.001) amount of antioxidant equivalent to gallic acid and vitamin C standard. In the DPPH and ABTS assays, the results also showed that soy products can reduce free radicals in different in vitro models. Altogether, these findings suggest that soy flours, particularly DF and SPC, could be a beneficial food ingredient in the formulation of functional foods.

Modifiable risk factors for bone health & fragility fractures

Osteoporosis is an ageing disorder characterised by poor microstructural architecture of the bone and an increase in the risk of fragility fractures, which often leads to hospitalisation and eventually a loss of mobility and independence. By 2050, it is estimated that more than 30 million people in Europe will be affected by bone diseases, and European hospitalisation alone can approximately cost up to 3.5 billion euros each year [1]. Although inherited variation in bone mineral density (BMD) is pre-determined by up to 85% [2], there is a window of opportunity to optimise BMD and reduce fracture risk through key modifiable lifestyle factors during the life course. An optimal diet rich in micronutrients, such as calcium, vitamin D, and potassium, has long been considered an important modifiable component of bone health, which is attributed to their direct roles within bone metabolism. Recently, there has been emerging evidence to suggest that protein and even an adequate intake of fruit and vegetables may also play an important role in improving BMD [3,4]. Maintaining a physically active lifestyle is not only protective from non-communicable diseases such as cardiovascular disease but it also has been shown to lessen the risk of fractures later in life, thereby making it an imperative modifiable factor for bone health, particularly as it also supports peak bone mass attainment during childhood/adolescence and can facilitate the maintenance of bone mass throughout adulthood [5]. Other key lifestyle factors that could be potentially modified to reduce the risk of osteoporosis or osteoporotic fractures later in life include smoking status, alcohol intake, and body composition [6]. Therefore, the principle aim of this review is to highlight the recent evidence pertaining to modifiable lifestyle factors that contribute to optimal bone health and the prevention of fragility fractures in later life.

The Role of Macronutrients, Micronutrients and Flavonoid Polyphenols in the Prevention and Treatment of Osteoporosis

Osteoporosis is considered an age-related disorder of the skeletal system, characterized primarily by decreased bone mineral density (BMD), microstructural quality and an elevated risk of fragility fractures. This silent disease is increasingly becoming a global epidemic due to an aging population and longer life expectancy. It is known that nutrition and physical activity play an important role in skeletal health, both in achieving the highest BMD and in maintaining bone health. In this review, the role of macronutrients (proteins, lipids, carbohydrates), micronutrients (minerals—calcium, phosphorus, magnesium, as well as vitamins—D, C, K) and flavonoid polyphenols (quercetin, rutin, luteolin, kaempferol, naringin) which appear to be essential for the prevention and treatment of osteoporosis, are characterized. Moreover, the importance of various naturally available nutrients, whether in the diet or in food supplements, is emphasized. In addition to pharmacotherapy, the basis of osteoporosis prevention is a healthy diet rich mainly in fruits, vegetables, seafood and fish oil supplements, specific dairy products, containing a sufficient amount of all aforementioned nutritional substances along with regular physical activity. The effect of diet alone in this context may depend on an individual’s genotype, gene-diet interactions or the composition and function of the gut microbiota.

Ultrasound-Assisted Extraction of Micro- and Macroelements in Fruit Peel Powder Mineral Supplement for Osteoporosis Patients and Their Determination by Flame Atomic Absorption Spectrometry

Osteoporosis is a worldwide disease depicted by the reduced bone mass, an adequate supply of minerals is needed to support bone remodeling, and their deficiency causes bone-related diseases, osteoporosis in particular, and has osteoprotective effects. The aim of this recent research was to quantify the micro- (Mn, Fe, Cu, and Zn) and macroelements (Mg, K, and Ca) in the peel powder of some common fruits (pomegranate, orange, lemon, mango, and grapefruit) by flame atomic absorption spectrometer (FAAS). The extraction of micro- and macroelements in peel powder was done by using dilute acids in an ultrasonic bath. Apple leaves were used as standard reference material (SRM, NIST 1515) to optimize the ultrasound-assisted extraction (UAE) method at varied operating parameters. Maximum response was obtained for extracting of minerals in 500 mg SRM at 60°C temperature, setting a vortexing time of 5 min while using 5.0 mL extracting agent HNO3 (0.5 M)-H2O2 (10%) at 90% sonication amplitude of ultrasound bath for 6 min. While analyzing the SRM, the percentage recovery was obtained in a range between 96.8 and 102.7% to assure the accuracy whereas repeatability (n = 10) study in terms of % RSD yielding ≤2.29 supports well the precision of the proposed method, and limits of quantitation (μg/g) were 0.034, 0.061, 0.065, 0.057, 0.017, 0.175, and 0.053 for Mn, Fe, Cu, Zn, Mg, K, and Ca, respectively. The proposed UAE method was reliable, efficient, and advantageous over the conventionally employed acid digestion method with regard to less consumption of reagents and short analysis time for the determination of micro- and macroelements in fruit peel powder.

3D porous PCL-PEG-PCL / strontium, magnesium and boron multi-doped hydroxyapatite composite scaffolds for bone tissue engineering

Bioceramic/polymer composite systems have gained importance in treating hard tissue damages using bone tissue engineering (BTE). In this context, it was aimed to develop 3D porous composite PCL-PEG-PCL scaffolds containing different amounts of B, Sr and Mg multi-doped HA that can provide bone regeneration in the bone defect area and to investigate the effect of both the amount of inorganic phase and the porosity on the mechanical and the biological properties. B-Sr-Mg multi-doped HA and PCL-PEG-PCL copolymer were successfully synthesized. PCL-PEG-PCL composite scaffolds containing different amounts of hydroxyapatite (HA) (10% and 20 wt%) were produced with the desired porosity (50% and 60%) by compression-molding and particulate leaching method. The porosity of the scaffolds was determined between 47% and 59%. HA/PCL-PEG-PCL composite scaffolds were subjected to a 3-week degradation test and showed negligible (0.2-0.5%) degradation. The water uptake percentage of the composite scaffolds with 60% porosity was the highest among all groups. Presence of HA in the scaffolds improved the water adsorption and the mechanical properties. Compressive strength of the scaffolds was between 9.32 and 24.27 MPa and 20% 2Sr0.5BHA scaffolds were found to have the maximum compressive strength. Compressive strength of 50% porous samples was higher than that of 60% porous samples. In the relative cell viability (%) test, the highest viability was observed on the scaffolds with HA and 2Sr0.5BHA. The specific ALP activity level of the cells on the scaffolds containing 2Sr0.5BHA was significantly higher (2.6 times) than that of the control group. The amount of porosity did not make a significant difference in cellular response. It was concluded that PCL-PEG-PCL composite scaffolds with 2Sr0.5BHA have the potential to be used in BTE.

The association between serum vitamin D and body composition in South African HIV-infected women

BACKGROUND

HIV and antiretroviral therapy (ART) alter vitamin D metabolism, and may be associated with bone loss.

OBJECTIVES

The aim of this study was to determine the association between serum 25-hydroxyvitamin D (25(OH)D) and body composition in postmenopausal South African women living with HIV and on ART.

METHOD

In this 2-year longitudinal study on 120 women conducted in the North West province of South Africa, serum 25(OH)D concentration, bone mineral density (BMD) at three sites, lean mass and percentage of body fat (%BF) were measured by dual-energy X-ray absorptiometry (DXA). Multivariable linear mixed models were used to assess the association between serum 25(OH)D and body composition over 2 years. Linear mixed models were also used to determine the longitudinal association between lean mass, %BF and BMD.

RESULTS

Vitamin D deficiency and insufficiency increased from baseline (10.2% and 19.5%) to 11.5% and 37.5%, respectively, after 2 years. Serum 25(OH)D decreased significantly, however, with a small effect size of 0.39 (P = 0.001), whilst total BMD (effect size 0.03, P = 0.02) and left hip femoral neck (FN) BMD (effect size 0.06, P = 0.0001) had significant small increases, whereas total spine BMD did not change over the 2 years. Serum 25(OH)D had no association with any BMD outcomes. Lean mass had a stronger positive association with total spine and left FN BMD than %BF.

CONCLUSION

Serum 25(OH)D was not associated with any BMD outcomes. Maintenance of lean mass could be important in preventing bone loss in this vulnerable group; however, longer follow-up may be necessary to confirm the association.

Biofortification of Sodium Selenate Improves Dietary Mineral Contents and Antioxidant Capacity of Culinary Herb Microgreens

Selenium biofortification of plants has been suggested as a method of enhancing dietary selenium intake to prevent deficiency and chronic disease in humans, while avoiding toxic levels of intake. Popular herbs such as basil (Ocimum basilicum L.), cilantro (Coriandrum sativum L.), and scallions (Allium fistulosum L.) present an opportunity for biofortification as these plants are used for added flavors to meals and are available as microgreens, young plants with increasing popularity in the consumer marketplace. In this study, basil, cilantro, and scallion microgreens were biofortified with sodium selenate under hydroponic conditions at various selenium concentrations to investigate the effects on yield, selenium content, other mineral contents (i.e., sodium, potassium, calcium, magnesium, phosphorus, copper, zinc, iron, manganese, sulfur, and boron), total phenol content, and antioxidant capacity [oxygen radical absorbance capacity (ORAC)]. The results showed that the selenium content increased significantly at all concentrations, with scallions demonstrating the largest increase. The effects on other minerals varied among herb species. Antioxidant capacity and total phenol content increased in all herbs at the highest selenium treatments, but basil and scallions demonstrated a decreased crop yield. Overall, these biofortified culinary herb microgreens are an ideal functional food for enhancing selenium, other dietary minerals, and antioxidants to benefit human health.

The combination effect of vitamin K and vitamin D on human bone quality: a meta-analysis of randomized controlled trials

BACKGROUND

Previous studies did not draw a consistent conclusion about the effects of vitamin K combined with vitamin D on human skeletal quality.

METHOD AND FINDINGS

A comprehensive search on Web of Science, PubMed, Embase and the Cochrane Library (from 1950 to February 2020) and bibliographies of relevant articles was undertaken, with the meta-analysis of eight randomized controlled trials (RCTs) including a total of 971 subjects. Vitamin K combined with vitamin D significantly increased the total bone mineral density (BMD): the pooled effect size was 0.316 [95% CI (confidence interval), 0.031 to 0.601]. A significant decrease in undercarboxylated osteocalcin (-0.945, -1.113 to -0.778) can be observed with the combination of vitamin K and D. Simultaneously, subgroup analysis showed that K2 or vitamin K (not specified) supplement was less than 500 μg d-1, which when combined with vitamin D can significantly increase the total BMD compared with the control group fed a normal diet or the group with no treatment (0.479, 0.101 to 0.858 and 0.570, 0.196 to 0.945).

CONCLUSIONS

The combination of vitamin K and D can significantly increase the total BMD and significantly decrease undercarboxylated osteocalcin, and a more favorable effect is expected when vitamin K2 is used.

Mineral Composition and Antioxidant Potential in the Common Poppy (Papaver rhoeas L.) Petal Infusions

The flowers of the common poppy are used for medicinal purposes, both internally and externally. They are reported to have antispasmodic and antitussive properties, to alleviate inflammatory conditions and soothe anxiety-related digestive problems. The aim of the study was to determine the antioxidant potential and the content of vitamin C, polyphenols, and minerals in infusions made from the petals of the common poppy at different temperatures. The infusions were made at various temperatures (25 °C, 70 °C, 80 °C, and 90 °C). The antioxidant potential and the content of polyphenols and vitamin C were determined by spectrophotometric methods. The mineral content was determined using the ICP-OES method. The total polyphenol content ranged from 135.2 to 137.24 ppm and that of vitamin C-from 15.47 to 15.78 mg/100 mL. The temperature of the water used to make the infusions did not appear to have a significant effect on these parameters. The temperature did, however, significantly affect the antioxidant potential of the infusions-the highest antioxidant activity (71.21% DPPH inhibition) was observed in the infusion prepared using water at 80 °C. The infusions included in the study contained a number of minerals. No significant effect of temperature was found for the content of K, Zn, Cu, Fe, and Ni in the infusions. On the other hand, the content of Ca in the infusions was significantly correlated with the increasing temperature of the water. It was concluded that poppy petal infusions may serve as a valuable dietary supplement, providing antioxidants and minerals required by the human body to function properly.

Content of Mineral Elements in the Traditional Oštiepok Cheese

Oštiepok is traditional half-fat semi-hard cheese manufactured in Slovak Republic. In this research, we have analyzed the content of macro-elements (calcium, potassium, magnesium, and sodium) and micro-elements (chromium, copper, iron, manganese, molybdenum, selenium, and zinc) in Oštiepok cheese samples collected from various parts of Slovak Republic. The analysis of Oštiepok cheese samples (n = 19) was carried out by using inductively coupled plasma optical emission spectroscopy (ICP-OES). The macro-element concentrations in the investigated samples varied quite significantly with the highest values recorded for sodium with its average concentration of 8083 mg kg^-1. The second highest macro-element concentration was observed for calcium with the average concentration of 6850 mg kg^-1. Average concentration of zinc was 23.2 mg kg^-1; iron, 14.1 mg kg^-1; and copper, 10.0 mg kg^-1. The concentration of macro- and micro-elements varied from sample to sample, but we can conclude that the traditional Oštiepok cheese is a suitable source of some minerals important for human health. Based on the RDA, the exposure amounts of analyzed samples are low, and no element can be referred to as significant since none reaches 15% of the nutrient reference values, according to EC Regulation 1169/2011.

Magnesium Intake Predicts Bone Turnover in Postmenopausal Black South African Women

This prospective study investigated the association between nutrient intake, dietary patterns, and changes in bone turnover and bone mineral density (BMD) in postmenopausal urban black South African women over two years. These women (n = 144) underwent BMD measurements at the distal radius, lumbar spine, femoral neck (FN), as well as a biochemical analysis which included the parathyroid hormone (PTH), 25-hydroxyvitamin D, C-Telopeptide of type I collagen (CTX-1) in 2010 and 2012. Their dietary intake was assessed in 2010 using a food frequency questionnaire, and sociodemographic and health information was collected. Four dietary patterns explained 54.4% of the variance of dietary intake, namely staple foods and processed meats, home cooking, snacking, and high sugar. Dietary magnesium negatively correlated with CTx-1 in 2012 (r = −0.21, p = 0.02), calcium correlated with distal radius BMD in 2010 (r = 0.22, p = 0.01) and 2012 (r = 0.24, p = 0.005), and the snacking dietary pattern score correlated with FN BMD in 2010 (r = 0.18, p = 0.03) and 2012 (r = 0.21, p = 0.02). The baseline CTx-1 and dietary magnesium intake predicted 22% of the variance in percentage change of CTx-1 over two years (p < 0.001).The magnesium intake predicted short-term bone resorption over two years.

Effects of Nutritional Deficiency of Boron on the Bones of the Appendicular Skeleton of Mice

Scientific evidence has shown the nutritional importance of boron (B) in the remodeling and repair of cancellous bone tissue. However, the effects of the nutritional deficiency of B on the cortical bone tissue of the appendicular skeleton have not yet been described. Thus, a study was performed to histomorphometrically evaluate the density of osteocyte lacunae of cortical bone of mouse femora under conditions of nutritional deficiency of B and to analyze the effects of the deficiency on the biomechanical properties of mouse tibiae. Weaning, 21-day-old male Swiss mice were assigned to the following two groups: controls (B+; n = 10) and experimental (B-; n = 10). Control mice were fed a basal diet containing 3 mg B/kg, whereas experimental mice were fed a B-deficient diet containing 0.07 mg B/kg for 9 weeks. The histological and histomorphometric evaluations of the mice fed a B-deficient diet showed a decrease in the density of osteocyte lacunae in the femoral cortical bone tissue and the evaluation of biomechanical properties showed lower bone rigidity in the tibia.

Dietary fat, saturated fatty acid, and monounsaturated fatty acid intakes and risk of bone fracture: a systematic review and meta-analysis of observational studies

Total dietary fat intake might influence the risk of fracture; however, conflicting findings have been reported to date. Moreover, the type of fatty acids is also of vital importance. We aimed to conduct a comprehensive review of the literature on the association between dietary fat intake, saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and the risk of fracture. PubMed and Scopus were used to conduct a comprehensive search for articles published up to 7 January 2018. To pool effect sizes, random effects models (the DerSimonian-Laird method) were applied. The Cochrane Q test was used to trace the source of between-study heterogeneity. Six studies met inclusion criteria for meta-analysis. We found no significant association between total dietary fat intake and risk of fracture (pooled effect size 1.31, 95% confidence interval (95% CI) 0.95-1.79, P = 0.09). A significant positive association was observed between SFA intake and the risk of hip fracture (pooled effect size 1.79, 95% CI 1.05-3.03, P = 0.03). There was also a significant positive association between MUFAs derived from animal sources and the risk of fracture (pooled effect size 2.29, 95% CI 1.50-3.50, P < 0.0001). Our findings showed a strong positive association between SFAs intake and risk of hip fracture. Moreover, there was a significant positive association between MUFAs derived from animal sources and the risk of fracture.

What nutritional factors influence bone mineral density in Crohn's disease patients?

Background/Aims

Bone mineral density (BMD) is often low in patients with Crohn's disease (CD). This study aimed to evaluate the association between nutritional factors and BMD in a group of CD patients.

Methods

CD patients 18 years of age or older were included. The body mass index (BMI), waist circumference (WC) and dietary intake were evaluated during two 24-hour recalls. Bone densitometry was performed by dual-energy X-ray absorptiometry of the full body to assess body composition and of the lumbar vertebrae and femoral neck to assess BMD.

Results

In the 60 patients evaluated, there was no association between BMD and disease activity or between BMD and disease duration. We observed moderate correlations between BMD in at least one of the evaluated sites and BMI, lean mass, WC, and protein, calcium, phosphorus and magnesium dietary intakes (P<0.05). In the linear regression analysis for spinal BMD, only BMI and calcium dietary intake remained associated (P<0.05). In the linear regression analysis for femoral BMD, WC and phosphorus intake continued to be significant in the final model, although they had low explanatory power for BMD (P<0.05).

Conclusions

The prevalence of low BMD was high in CD patients. BMI, WC, calcium and phosphorus dietary intake were positively correlated with BMD.

Phenotypic analysis of milk coagulation properties and mineral content of Pinzgauer cattle breed

Abstract. This study aimed to characterize milk coagulation properties (rennet coagulation time, curd-firming time and curd firmness 30 min after rennet addition to milk) and major mineral contents (Ca, Mg, P, K and Na) in Pinzgauer dual-purpose cattle breed. The edited dataset consisted of 7763 milk observations from 851 cows reared in 60 herds in the Alpine area of Bolzano province (Italy). Data were analysed through a linear mixed model which included stage of lactation, parity and their interaction as fixed effects, and cow and herd test date as random effects. Rennet coagulation time, curd-firming time and curd firmness 30 min after rennet addition to milk averaged 22.66 min, 5.53 min and 16.79 mm, respectively. The most abundant minerals were P (1495 mg kg−1) and Ca (1344 mg kg−1), and the least abundant Mg (141 mg kg−1). Compared to their older contemporaries, early-lactating younger animals yielded milk that was more favourable for cheese production (i.e. with shorter coagulation time and stronger curd firmness). Mineral contents were lower in milk of primiparous than multiparous cows, except for Na. Moreover, Ca, Mg, P and Na contents decreased from parturition to peak of lactation and increased thereafter, except for K, which exhibited an opposite trend. Our results showed that Pinzgauer breed produced milk with better coagulation properties and mineral content, from a technological point of view, in first than later parities and in early than late lactation. The characterization of milk coagulation properties and mineral content in autochthonous breeds is important to increase their value and marketability of their products.

Nutrition and growth: assessing the impact of regional nutritional intake on childhood development and metacarpal parameters

Measuring skeletal development throughout juvenile growth can provide a greater understanding into the health, hormonal function and genetics of children. The metacarpals have been of interest for their potential to provide insights into healthy juvenile skeletal development. This study investigated the growth patterns of developing females from isolated communities who had varied diets. Anthropometrical measurements and hand-wrist X-rays were taken of 353 juvenile females from three populations: Pari Coastal Village and Bundi Highlands Village, Papua New Guinea (PNG); and Brisbane, Australia between 1968 to 1983. Radiographs were digitized, and the length and width of the second and third metacarpals compared to each subject's height and weight. As subject heights increased, metacarpal length and width increased. However, stature and second metacarpal length indicated the strongest correlation (P<0.01), compared to third metacarpal length (P<0.01) or width. From 11 to 13 years of age, Brisbane subjects were significantly heavier and taller in comparison to subjects from PNG, and coastal females were heavier and taller than the highland females. A prominent difference between the two PNG populations was the regional intake of protein in their diets. The second metacarpal presents particularly accurate measurements when determining the height or development of a child. Nutritional intake appears to have a major influence normal childhood growth, with a potential for protein deficiency to strongly inhibit growth. Any delayed growth is particularly evident in the child's stature, as well as in the development of the metacarpal long bones of the hand.

Effect of mineral status and glucocorticoid use on bone mineral density in patients with Crohn's disease

OBJECTIVES

Crohn's disease (CD) is a condition that is characterized by chronic inflammation. The presence of multifactorial pathogenesis that results from inflammation is associated with low micronutrient consumption and glucocorticoid use, which may be related to bone health. This study aimed to evaluate the relationship between dietary mineral intake and glucocorticoid use in bone mineral density (BMD) in patients with CD.

METHODS

A cross-sectional study of 62 patients with CD ages 20 y to 40 y measured their macro- and micronutrient intake with a 3-d food record. The lumbar spine and femoral neck BMDs were determined using a bone densitometry technique. The C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) values were also noted.

RESULTS

Dietary intake of calcium, zinc, and magnesium was below the reference values but the phosphorus intake level was within the normal value range. Patients with osteopenia and osteoporosis accounted for 17.7% and 14.5%, respectively, of the total number of participants. Significant bone loss was found in 22.6% of patients taking glucocorticoid medications. BMD was significantly reduced and also observed in patients in the active phase of their disease. Zinc and calcium intakes were found to be correlated with reduced femoral neck BMD. The mean CRP and ESR values were above the normal ranges. Significant differences in age and ESR were observed between patients with normal and reduced BMD (P <0.05).

CONCLUSIONS

Low calcium and zinc intake, glucocorticoid use, and active disease phase are favorable conditions for bone loss in patients with Crohn's disease.

Bioaccessibility of four calcium sources in different whey-based dairy matrices assessed by in vitro digestion

Numerous calcium sources are available to enrich food, but their behavior during digestion is still unknown. This study focused on the influence of the gastro-intestinal pH, the food structure and the calcium source on the bioaccessibility of the nutrient. Four calcium sources were studied: calcium carbonate, calcium citrate malate, calcium phosphate and calcium bisglycinate. These were added to dairy matrices, containing cream and whey proteins, of different forms (liquid or gel). The kinetics of solubility and ionic calcium concentration during in vitro digestion were studied, as function of gastro-intestinal pH. All calcium sources were almost fully soluble in the gastric compartment, and then became insoluble in the intestinal phase. The level of calcium insolubilisation in the intestinal phase was not significantly influenced by the matrix structure (liquid or gel), but was more dependent on the calcium source, this effect leading to different final calcium bioaccessibility from 36% to 20%.

High dietary sodium intake is associated with low bone mass in postmenopausal women: Korea National Health and Nutrition Examination Survey, 2008-2011

The present cross-sectional study performed using data from the Korea National Health and Nutrition Examination Survey in 9526 women older than 18 years of age demonstrates that high sodium intake is associated with lower bone mineral density and sodium intake ≥2000 mg/day is a risk factor for osteoporosis in postmenopausal women.

INTRODUCTION

Several studies have reported that large amount of dietary sodium intake is highly associated with elevated urinary calcium. However, the direct effect of excessive dietary sodium intake on bone mass, as a risk factor for osteoporosis, is still a controversial issue. The aim of the present study was to assess the relationship between high intake of sodium and lower bone mass and risk of osteoporosis in adult women.

METHODS

This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. Participants (n = 9526 women older than 18 years) were divided into a premenopausal (n = 4793) and postmenopausal (n = 4733) group. Both groups were subdivided into five groups according to quintiles of energy-adjusted sodium intake. Multiple regression analysis was performed to assess relationships between sodium intake and lower bone mass.

RESULTS

Multivariate linear regression analysis showed that high sodium intake was negatively associated with bone mineral content (BMC) and bone mineral density (BMD) in postmenopausal women. After adjusting confounding factors, high sodium intake was negatively associated with BMC and BMD of the lumbar spine in postmenopausal women. Postmenopausal women, whose sodium intake was ≥2000 mg/day (odds ratio 1.284, 95% CI 1.029-1.603, P = 0.027), were at risk of developing osteoporosis after adjustment of confounding variables.

CONCLUSIONS

The present study suggested that high sodium intake could be a potential risk factor for low bone mass after adjusting for confounding factors in postmenopausal women.

Bone Mineral Density, Mechanical, Microstructural Properties and Mineral Content of the Femur in Growing Rats Fed with Cactus Opuntia ficus indica (L.) Mill. (Cactaceae) Cladodes as Calcium Source in Diet

Mechanical, microstructural properties, mineral content and bone mineral density (BMD) of the femur were evaluated in growing rats fed with Opuntia ficus indica (L.) Mill. (Cactaceae) cladodes at different maturity stages as calcium source. Male weanling rats were fed with cladodes at early maturity stage (25 and 60 days of age, belonging to groups N-60 and N-200, respectively) and cladodes at late maturity stage (100 and 135 days of age, belonging to groups N-400 and N-600, respectively) for 6 weeks. Additionally, a control group fed with calcium carbonate as calcium source was included for comparative purposes. All diets were fitted to the same calcium content (5 g/kg diet). The failure load of femurs was significantly lower (p ≤ 0.05) in groups N-60 and N-200 in comparison to N-400, N-600 and control groups. The cortical width (Ct.Wi) and trabecular thickness (Tb.Th) of the femurs in control and N-600 groups were significantly higher (p ≤ 0.05) than Ct.Wi and Tb.Th of femurs in groups N-60 and N-200. Trabecular separation of the femurs in N-60 and N-200 groups showed the highest values compared with all experimental groups. The highest calcium content in the femurs were observed in control, N-600 and N-400 groups; whereas the lowest phosphorus content in the bones were detected in N-200, N-600 and N-400 groups. Finally, the BMD in all experimental groups increased with age; nevertheless, the highest values were observed in N-600 and control groups during pubertal and adolescence stages. The results derived from this research demonstrate, for the first time, that the calcium found in Opuntia ficus indica cladodes is actually bioavailable and capable of improving mineral density and mechanical and microstructural properties of the bones. These findings suggest that the consumption of cladodes at late maturity stage within the diet might have a beneficial impact on bone health.

Food fortification for bone health in adulthood: a scoping review

Food fortification can deliver essential micronutrients to large population segments without modifications in consumption pattern, suggesting that fortified foods may be formulated for populations at risk for fragility fractures. This scoping review determined the extent to which randomized controlled studies have been carried out to test the impact of fortified foods on bone outcomes, searching PubMed for all studies using the terms 'fortified AND bone', and 'fortification AND bone'. Studies were restricted to English language, published between 1996 and June 2015. From 360 articles, 24 studies met the following criteria: human study in adults ⩾18 years (excluding pregnancy or lactation); original study of a fortified food over time, with specific bone outcomes measured pre- and post intervention. Six studies involved adults <50 years; 18 involved adults ⩾50 years. Singly or in combination, 17 studies included calcium and 16 included vitamin D. There were 1 or 2 studies involving either vitamin K, magnesium, iron, zinc, B-vitamins, inulin or isoflavones. For adults <50 years, the four studies involving calcium or vitamin D showed a beneficial effect on bone remodeling. For adults ⩾50 years, n=14 provided calcium and/or vitamin D, and there was a significant bone turnover reduction. No consistent effects were reported in studies in which addition of vitamin K, folic acid or isoflavone was assessed. Results from this scoping review indicate that up to now most studies of fortification with bone health have evaluated calcium and/or vitamin D and that these nutrients show beneficial effects on bone remodeling.

Adherence to the Mediterranean diet is associated with a higher BMD in middle-aged and elderly Chinese

Previous studies showed that better adherence to the Mediterranean diet (MD) is associated with lower risk of chronic diseases, but limited data are available on bone health. We investigated the association of the MD with bone mineral density (BMD) in Chinese adults. We included 2371 participants aged 40–75 years in this community-based cross-sectional study. Dietary information was assessed at baseline and a 3-year follow-up. Alternate Mediterranean diet (aMed) scores were calculated. BMD was determined at the second survey. After adjusting for potential covariates, higher aMed scores were positively and dose-dependently associated with BMD (all P-trends < 0.05). The BMD values were 1.94% (whole body), 3.01% (lumbar spine), 2.80% (total hip), 2.81% (femur neck), 2.62% (trochanter), and 2.85% (intertrochanter) higher in the quintile 5 (highest, vs. quintile 1) aMed scores for all of the subjects (all P-values < 0.05). Similar associations were found after stratifying by gender (P-interaction = 0.338–0.968). After excluding the five non-significant components of vegetables, legumes, fish, monounsaturated to saturated fat ratio, and alcohol intake from the aMed scores, the percentage mean differences were substantially increased by 69.1–150% between the extreme quintiles. In conclusion, increased adherence to the MD shows protective associations with BMD in Chinese adults.

Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study

BACKGROUND

The Norwegian population has among the highest hip fracture rates in the world. The incidence varies geographically, also within Norway. Calcium in drinking water has been found to be beneficially associated with bone health in some studies, but not in all. In most previous studies, other minerals in water have not been taken into account. Trace minerals, for which drinking water can be an important source and even fulfill the daily nutritional requirement, could act as effect-modifiers in the association between calcium and hip fracture risk. The aim of the present study was to investigate the association between calcium in drinking water and hip fracture, and whether other water minerals modified this association.

MATERIALS AND METHODS

A survey of trace metals in 429 waterworks, supplying 64% of the population in Norway, was linked geographically to the home addresses of patients with incident hip fractures (1994-2000). Drinking water mineral concentrations were divided into "low" (below and equal waterworks average) and "high" (above waterworks average). Poisson regression models were fitted, and all incidence rate ratios (IRRs) were adjusted for age, geographic region, urbanization degree, type of water source, and pH of the water. Effect modifications were examined by stratification, and interactions between calcium and magnesium, copper, zinc, iron and manganese were tested both on the multiplicative and the additive scale. Analyses were stratified on gender.

RESULTS

Among those supplied from the 429 waterworks (2,110,916 person-years in men and 2,397,217 person-years in women), 5433 men and 13,493 women aged 50-85 years suffered a hip fracture during 1994-2000. Compared to low calcium in drinking water, a high level was associated with a 15% lower hip fracture risk in men (IRR=0.85, 95% CI: 0.78, 0.91) but no significant difference was found in women (IRR=0.98, 95%CI: 0.93-1.02). There was interaction between calcium and copper on hip fracture risk in men (p=0.051); the association between calcium and hip fracture risk was stronger when the copper concentration in water was high (IRR=0.52, 95% CI: 0.35, 0.78) as opposed to when it was low (IRR=0.88, 95% CI: 0.81, 0.94). This pattern persisted also after including potential confounding factors and other minerals in the model. No similar variation in risk was found in women.

CONCLUSION

In this large, prospective population study covering two thirds of the Norwegian population and comprising 19,000 hip fractures, we found an inverse association between calcium in drinking water and hip fracture risk in men. The association was stronger when the copper concentration in the water was high.

The phenolic acids of Agen prunes (dried plums) or Agen prune juice concentrates do not account for the protective action on bone in a rat model of postmenopausal osteoporosis

Dietary supplementation with dried plum (DP) has been shown to protect against and reverse established osteopenia in ovariectomized rodents. Based on in vitro studies, we hypothesized that DP polyphenols may be responsible for that bone-sparing effect. This study was designed to (1) analyze whether the main phenolic acids of DP control preosteoblast proliferation and activity in vitro; (2) determine if the polyphenolic content of DP or DP juice concentrate is the main component improving bone health in vivo; and (3) analyze whether DP metabolites directly modulate preosteoblast physiology ex vivo. In vitro, we found that neochlorogenic, chlorogenic, and caffeic acids induce the proliferation and repress the alkaline phosphatase activity of primary preosteoblasts in a dose-dependent manner. In vivo, low-chlorogenic acid Agen prunes (AP) enriched with a high-fiber diet and low-chlorogenic acid AP juice concentrate prevented the decrease of total femoral bone mineral density induced by estrogen deficiency in 5-month-old female rats and positively restored the variations of the bone markers osteocalcin and deoxypyridinoline. Ex vivo, we demonstrated that serum from rats fed with low-chlorogenic acid AP enriched with a high-fiber diet showed repressed proliferation and stimulated alkaline phosphatase activity of primary preosteoblasts. Overall, the beneficial action of AP on bone health was not dependent on its polyphenolic content.

A review of the effect of diet on cardiovascular calcification

Cardiovascular (CV) calcification is known as sub-clinical atherosclerosis and is recognised as a predictor of CV events and mortality. As yet there is no treatment for CV calcification and conventional CV risk factors are not consistently correlated, leaving clinicians uncertain as to optimum management for these patients. For this reason, a review of studies investigating diet and serum levels of macro- and micronutrients was carried out. Although there were few human studies of macronutrients, nevertheless transfats and simple sugars should be avoided, while long chain ω-3 fats from oily fish may be protective. Among the micronutrients, an intake of 800 μg/day calcium was beneficial in those without renal disease or hyperparathyroidism, while inorganic phosphorus from food preservatives and colas may induce calcification. A high intake of magnesium (≥380 mg/day) and phylloquinone (500 μg/day) proved protective, as did a serum 25(OH)D concentration of ≥75 nmol/L. Although oxidative damage appears to be a cause of CV calcification, the antioxidant vitamins proved to be largely ineffective, while supplementation of α-tocopherol may induce calcification. Nevertheless other antioxidant compounds (epigallocatechin gallate from green tea and resveratrol from red wine) were protective. Finally, a homocysteine concentration >12 µmol/L was predictive of CV calcification, although a plasma folate concentration of >39.4 nmol/L could both lower homocysteine and protect against calcification. In terms of a dietary programme, these recommendations indicate avoiding sugar and the transfats and preservatives found in processed foods and drinks and adopting a diet high in oily fish and vegetables. The micronutrients magnesium and vitamin K may be worthy of further investigation as a treatment option for CV calcification.

Dietary patterns and bone mineral density in Brazilian postmenopausal women with osteoporosis: a cross-sectional study

BACKGROUND/OBJECTIVES

The aim of this study was to investigate the association between dietary patterns and bone mineral density (BMD) in postmenopausal women with osteoporosis.

SUBJECTS/METHODS

This cross-sectional study included 156 postmenopausal and osteoporotic Brazilian women aged over 45 years. BMD of lumbar spine, total femur (TF), femoral neck and of total body (TB), as well as body composition (fat and lean mass), was assessed by dual-energy X-ray absorptiometry. Body mass index and lifestyle information were also obtained. Dietary intake was assessed by using a 3-day food diary. Dietary patterns were obtained by principal component factor analysis. Adjusted multiple linear regression analysis was applied in order to evaluate the predictive effect of dietary patterns on BMD. Significance was set at P<0.05.

RESULTS

Five patterns were retained: 'healthy', 'red meat and refined cereals', 'low-fat dairy', 'sweet foods, coffee and tea' and 'Western'. The 'sweet foods, coffee and tea' pattern was inversely associated with TF BMD (β=-0.178; 95% CI: -0.039 to -0.000) and with TB BMD (β=-0.320; 95% CI: -0.059 to -0.017) even after adjusting for energy and calcium intake, lean mass, age and postmenopausal time.

CONCLUSIONS

A concomitant excessive consumption of sweet foods and caffeinated beverages appears to exert a negative effect on BMD even when the skeleton already presents some demineralization. Food and beverage intake is a modifiable factor that should not be neglected in the treatment of individuals with osteoporosis.

Element concentrations and element ratios in antler and pedicle bone of yearling red deer (Cervus elaphus) stags-a quantitative X-ray fluorescence study

The present study compared the concentrations of different elements (Ca, P, Mg, Sr, Ba, K, S, Zn, Mn) as well as Ca/P, Ca/Mg, Sr/Ca, and Ba/Ca ratios in hard antler and pedicle bone of yearling red deer stags (n = 11). Pedicles showed higher concentrations of calcium and phosphorus and a higher Ca/Mg ratio than antlers, while antlers exhibited higher concentrations of potassium, sulfur, and manganese as well as higher Ca/P, Sr/Ca, and Ba/Ca ratios. The findings indicate that antlers are less mineralized and show less maturation of their bone mineral than pedicles. Antlers also showed a higher intrasample variation of mineralization than pedicles, which can be related to the shorter life span of the (deciduous) antlers compared to the (permanent) pedicles. It is suggested that antler bone formation is stopped before the theoretically possible degree of mineralization and mineral maturation is reached, resulting in antler biomechanical properties (high bending strength and work to fracture) that are well suited for their role in intraspecific fighting. It is further suggested that the differences in Sr/Ca and Ba/Ca ratios of antlers and pedicles are related to the dietary shift from milk to vegetation in combination with an increasing intestinal discrimination against Sr and Ba with age, resulting in a less marked difference in these ratios than would be expected based on the dietary shift alone. The findings of our study underscore the suitability of antlers and pedicles as models of bone mineralization and the influence of different animal-related and/or external factors on this process.

Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: a case-control study

This case-control study compared the associations of four widely used diet-quality scoring systems with the risk of hip fractures and assessed their utility in elderly Chinese. We found that individuals avoiding a low-quality diet have a lower risk of hip fractures in elderly Chinese.

INTRODUCTION

Few studies examined the associations of diet-quality scores on bone health, and no studies were available in Asians and compared their validity and utility in a study. We assessed the associations and utility of four widely used diet-quality scoring systems with the risk of hip fractures.

METHODS

A case-control study of 726 patients with hip fractures (diagnosed within 2 weeks) aged 55-80 years and 726 age- (within 3 years) and gender-matched controls was conducted in Guangdong, China (2009-2013). Dietary intake was assessed using a 79-item food frequency questionnaire with face-to-face interviews, and the Healthy Eating Index-2005 (HEI-2005, 12 items), the alternate Healthy Eating Index (aHEI, 8 items), the Diet Quality Index-International (DQI-I, 17 items), and the alternate Mediterranean Diet Score (aMed, 9 items) (the simplest one) were calculated.

RESULTS

All greater values of the diet-quality scores were significantly associated with a similar decreased risk of hip fractures (all p trends <0.001). The multivariate-adjusted odds ratios (ORs) and 95% confidential intervals (95% CIs) comparing the extreme groups of diet-quality scores were 0.29 (0.18, 0.46) (HEI-2005), 0.20 (0.12, 0.33) (aHEI), 0.25 (0.16, 0.39) (DQI-I), and 0.28 (0.18, 0.43) (aMed) in total subjects; and the corresponding ORs ranged from 0.04 to 0.27 for men and from 0.26 to 0.44 for women (all p trends <0.05), respectively.

CONCLUSIONS

Avoiding a low-quality diet is associated with a lower risk of hip fractures, and the aMed score is the best scoring system due to its equivalent performance and simplicity for the user.

Dietary protein in relation to bone stiffness index and fat-free mass in a population consuming relatively low protein diets

Dietary protein has a mixed effect on skeletal health and the effect may differ by amount or source of protein. The purpose of this study was to investigate dietary protein in relation to bone density and fat-free mass in rural Korean residents consuming relatively low protein diets. Between 2008 and 2010, 3,330 participants were recruited for a baseline examination of a community-based study in Kangwha. Of those, 1,182 men and 1,393 postmenopausal women were eligible for the present study. Diet was assessed using a food-frequency questionnaire developed for Korean adults. Calcaneal bone density measured by ultrasound was expressed as the stiffness index (SI). Fat-free mass index (FFMI) was defined as fat-free mass in kilograms divided by the height in meters squared. The mean ages of men and women were 59.5 and 60.0 years, respectively. The median daily intakes of total and meat protein were 52.3 and 6.7 g in men and 45.0 and 3.0 g in women, respectively. After controlling for potential confounders, SI and FFMI showed an increasing trend with a higher meat protein intake in men (P for trend = 0.017 and 0.033, respectively), but not in women. No positive association was observed for other food sources of protein. In conclusion, our findings suggest that meat protein contributes to skeletal health in men consuming relatively low protein diets.

Validation of a food-frequency questionnaire for the assessment of calcium intake in schoolchildren aged 9-10 years

Bone mass increases steadily until age 20-30 years, when peak bone mass (PBM) is acquired. Nutrition plays a critical role in achievement of the optimal genetically programmed PBM, with reduction in the risk of osteoporosis later in life. Intake of nutrients can be estimated through the use of various tools; typically, food-frequency questionnaires (FFQs) are used in epidemiologic studies. The aim of this study was to validate a 21-item, semiquantitative FFQ to assess important nutrient intakes for bone health in Italian schoolchildren 9-10 years of age. Relative validation was accomplished through comparison of the 7-days weighed food record (7D records) with an FFQ developed ad hoc, completed by a group of 75 Italian schoolchildren (36 females, 39 males). Agreement between the two methods was evaluated by Spearman's correlation test and Bland-Altman analysis applied on the data on intake of energy, macronutrients, and micronutrients. Particular attention was devoted to nutrients relevant for bone health. Good correlations between the two methods (FFQ and 7D records) were observed for all nutrients. In particular, mean dietary calcium intakes were 725.6 mg/day (95 % CI 683.2-768.1) from 7D records and 892.4 mg/day (95 % CI 844.6-940.2) from the FFQ. These results indicate that our FFQ for schoolchildren aged 9-10 years is highly acceptable as it is an accurate method that can be used in large-scale or epidemiological studies for the evaluation of nutrient intakes important for the prevention of osteoporosis in a similar population.

Dietary fiber, organic acids and minerals in selected wild edible fruits of Mozambique

The harvesting, utilization and marketing of indigenous fruits and nuts have been central to the livelihoods of the majority of rural communities in African countries. In this study we report on the content of dietary fiber, minerals and selected organic acids in the pulps and kernels of the wild fruits most commonly consumed in southern Mozambique. The content of soluble fiber in the pulps ranged from 4.3 to 65.6 g/100 g and insoluble fiber from 2.6 to 45.8 g/100 g. In the kernels the content of soluble fiber ranged from 8.4 to 42.6 g/100 g and insoluble fiber from 14.7 to 20.9 g/100 g. Citric acid was found in all fruits up to 25.7 g/kg. The kernels of Adansonia digitata and Sclerocarya birrea were shown to be rich in calcium, iron, magnesium and zinc. The data may be useful in selecting wild fruit species appropriate for incorporation into diets.

Healthy diet to prevent cardiovascular diseases and osteoporosis: the experience of the 'ProSa' project

The ProSa (PROmozione e tutela della SAlute) Project ('Health Promotion Project') is a workplace programme geared to promote health among the Roman staff of the National Research Council of Italy. 789 employees of both genders (450 men, 339 women) have participated in the cardiovascular prevention programme (screening, computerized calculation of the risk level, dietary and pharmacological intervention) and 245 women have participated in the osteoporosis programme (calcaneal ultrasonometer test, dietary and pharmacological intervention). Menopause increases the risk of cardiovascular diseases and osteoporosis. In order to lower dietary fat content, dietary intake of calcium and vitamin D could be reduced. However, supplementation of both may not be necessary if we follow an integrated dietary approach. Therefore, for women in menopause with mixed hyperlipidaemia (hypercholesterolaemia and/or hypertriglyceridaemia) and/or overweight/obesity, dietary intervention was aimed at promoting the choice of foods low in fats and rich in calcium based on a list of recommended products distributed to all the participants. The dietary intervention was accompanied by a programme of regular physical activity with adequate exposure to sunlight. By following a balanced diet it is possible to improve the prognosis not only for hyperlipidaemic patients, but also for patients with signs of osteopaenia or osteoporosis.

European guidance for the diagnosis and management of osteoporosis in postmenopausal women

Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk of fractures due to osteoporosis.

INTRODUCTION

The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2008. This manuscript updates these in a European setting.

METHODS

Systematic literature reviews.

RESULTS

The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk, general and pharmacological management of osteoporosis, monitoring of treatment, assessment of fracture risk, case finding strategies, investigation of patients and health economics of treatment.

CONCLUSIONS

A platform is provided on which specific guidelines can be developed for national use.

No association between dietary vitamin K intake and fracture risk in chinese community-dwelling older men and women: a prospective study

Data on the association between dietary vitamin K intake and fracture risk are limited among Chinese. This study examined such an association in community-dwelling elderly in Hong Kong. We present data from 2,944 subjects (1,605 men, 1,339 women) who participated in a prospective cohort study. Baseline dietary intakes of energy, protein, calcium, vitamin D, and vitamin K were assessed using a food-frequency questionnaire. Data on incident hip fracture and nonvertebral fracture during a median of 6.9 follow-up years were collected from a hospital database. Cox regression analyses were performed with adjustments for age, education attainment, smoking status, alcohol use, body mass index, hip bone mineral density, physical activity, use of calcium supplement, and energy-adjusted nutrient intakes. There were 29 (1.8 %) men and 19 (1.4 %) women with incident hip fractures and 97 (6.0 %) men and 88 (6.6 %) women with nonvertebral fractures. The median (interquartile range) of dietary vitamin K intake was 241.8 (157.5-360.8) and 238.9 (162.4-343.6) μg/day in men and women, respectively. Similar dietary vitamin K intakes were observed between subjects with hip or nonvertebral fractures and subjects without hip or nonvertebral fractures. In both men and women, dietary vitamin K intake was not associated with fracture risks at all measured sites in either crude or adjusted models. In Chinese community-dwelling elderly, hip or nonvertebral fracture risk was not associated with dietary vitamin K intake. The high dietary vitamin K intake of the studied group may have limited the ability to detect the association between vitamin K intake and fracture risk.