Calcium intake and bone mineral density: systematic review and meta-analysis

Between a Rock and a Short Place-The Impact of Nephrolithiasis on Skeletal Growth and Development Across the Lifespan

PURPOSE OF REVIEW

The impact of nephrolithiasis on skeletal growth and bone health across the life span of kidney stone formers is reviewed.

MAIN FINDINGS

Bone disease is an early event among kidney stone formers (SF), with distinct phenotypes according to each age, sex, menopausal status, dietary, hormonal and genetic factors. Nephrolithiasis-associated bone disorder is characterized by reduced bone mineral density (BMD) and histologically discloses low bone formation, high bone resorption and abnormal mineralization. Although hypercalciuria has been presumed to be pathogenic for bone loss in SF, the association of BMD with urinary calcium is not uniform in all studies. Hypocitraturia, metabolic disturbances, cytokines and receptors, growth factors and acid-base status may all influence skeletal outcomes. The potential link of bone disease with vascular calcification and cardiovascular disease among SF is discussed. The unique vulnerability of the younger skeleton to the effects of nephrolithiasis on attainment of peak bone mass and strength is highlighted and the association of bone loss with kidney stone formation early in life indicate the opportunity for intervention to reduce the risk of future bone fractures.

Dairy and Exercise for Bone Health: Evidence from Randomized Controlled Trials and Recommendations for Future Research

PURPOSE OF REVIEW

To examine evidence from randomized controlled trials (RCTs) on how modifiable factors such as exercise and nutrition, with a focus on dairy products, play a role in improving bone health across the lifespan.

RECENT FINDINGS

Meta-analyses of RCTs demonstrate the advantages of consuming dairy products to improve bone mineral density/content (BMD/BMC) and markers of bone metabolism and turnover (BTMs). Eighteen RCTs were conducted investigating the combined effects of dairy and exercise, with most indicating a benefit in youth and adult populations. Results were less conclusive in older adults, perhaps due to altered requirements for dairy/nutrients and exercise with increased age.   RCTs demonstrate that dairy product consumption alone benefits bone health and can enhance the effects of exercise on bone. This may help improve skeletal growth and development in adolescence and prevent osteoporosis with increased age. Future RCTs should account for habitual nutrient intakes, and dairy dosage, timing, and matrix effects.

Contribution of direct-drinking water to calcium and magnesium and the influence on the height in school-age children

Objective

To estimate the contribution of direct-drinking water provided in school to dietary intake (DI) and recommended nutrient intake (RNI) of calcium and magnesium, and to explore its influence on the height in school-age children.

Methods

Tap water and direct-drinking water samples were collected from schools in Taicang City to test the contents of calcium and magnesium, and compared by one-way ANOVA and post-hoc test. Contribution rates of direct-drinking water to DI and RNI were calculated by using the contents of calcium and magnesium and data from the Nutrition and Health Status Survey 2021. A retrospective cohort was conducted among 4,850 first-grade children consuming direct-drinking water in Taicang City from 24 primary schools in 2019. Group 1 (1,070 boys and 946 girls) consumed UF-process water with normal calcium and magnesium contents and Group 2 (1,548 boys and 1,286 girls) consumed NF/RO-process water with very low calcium and magnesium contents. During 2019-2023, the height and height growth were analyzed with the Student's t-test.

Results

The highest calcium content was examined in tap water samples, followed by direct-drinking water samples supplied through a UF, NF, and RO system (F = 1,227.725, p < 0.001). The highest magnesium content was examined in water supplied through a UF system, followed by that through a tap, NF and RO system (F = 146.504, p < 0.001). Calcium and magnesium contents in direct-drinking water supplied through a UF system changed little compared with those in tap water, which were significantly reduced in direct-drinking water supplied through a NF and RO system. The contribution rates of direct-drinking water to DI of calcium and magnesium were 8.95 and 2.78%, respectively, and those to RNI of calcium and magnesium were 2.63 and 1.96%, respectively. There were no significant differences in the height and height growth of first-grade children drinking water supplied through the UF system vs. NF/RO system (p > 0.05).

Conclusion

Direct-drinking water processed through a NF or RO system should be cautiously adopted in primary and secondary schools. A UF system is preferred in schools where no health concerns are associated with water quality.

British Gynaecological Cancer Society and British Menopause Society guidelines: Management of menopausal symptoms following treatment of gynaecological cancer

These guidelines have been developed jointly by the British Gynaecological Cancer Society and British Menopause Society to provide information for all healthcare professionals managing women treated for gynaecological cancer. Menopausal symptoms can have a significant impact on quality of life for women. Cancer therapies, including surgery, pelvic radiotherapy, chemotherapy and endocrine therapy, can all affect ovarian function. The benefits and risks of using hormone replacement therapy are considered by cancer type with guidance on the type of HRT and optimal time of commencement after cancer treatment. Vaginal estrogens can be very effective for improving urogenital symptoms and are safe for the majority of women, including those for whom systemic HRT is contraindicated with rare exceptions. Alternative options to HRT are reviewed including pharmacological and non-pharmacological approaches.

Prediction model for low bone mass mineral density in type 2 diabetes: an observational cross-sectional study

PURPOSE

Considering the prevalence of type 2 diabetes (T2D), osteoporosis should be considered a serious complication. However, an effective tool for the assessment of low bone mass mineral density (BMD) in T2D patients is not currently available. Therefore, the aim of our study was to establish a simple-to-use risk assessment tool by exploring risk factors for low BMD in T2D patients.

METHODS

This study included 436 patients with a low BMD and 381 patients with a normal BMD. Multiple logistic regression analysis was performed to evaluate risk factors for low BMD in T2D patients. A nomogram was then developed from these results. A receiver operating characteristic (ROC) curve, calibration plot, and goodness-of-fit test were used to validate the nomogram. The clinical utility of the nomogram was also assessed.

RESULTS

Multivariate logistic regression indicated that age, sex, education, body mass index (BMI), fasting C-peptide, high-density cholesterol (HDL), alkaline phosphatase (ALP), estimated glomerular filtration rate (eGFR), and type I collagen carboxy terminal peptide (S-CTX) were independent predictors for low BMD in T2D patients. The nomogram was developed from these variables using both the unadjusted area under the curve (AUC) and the bootstrap-corrected AUC (0.828). Calibration plots and the goodness-of-fit test demonstrated that the nomogram was well calibrated.

CONCLUSIONS

The nomogram-illustrated model can be used by clinicians to easily predict the risk of low BMD in T2D patients. Our study also revealed that common factors are independent predictors of low BMD risk. Our results provide a new strategy for the prediction, investigation, and facilitation of low BMD in T2D patients.

Lactobacilli and Their Fermented Foods as a Promising Strategy for Enhancing Bone Mineral Density: A Review

Lactobacilli fermentation possesses special nutritional and health values to food, especially in improving diseases related to the gut microbiota such as osteoporosis risk. Previous research indicates that lactobacilli-fermented foods have the potential to enhance the bone mineral density (BMD), as suggested by some clinical studies. Nonetheless, there is currently a lack of comprehensive summaries of the effects and potential mechanisms of lactobacilli-fermented foods on BMD. This review summarizes findings from preclinical and clinical studies, revealing that lactobacilli possess the potential to mitigate age-related and secondary factor-induced bone loss. Furthermore, these findings imply that lactobacilli are likely mediated through the modulation of bone remodeling via gut inflammation-related pathways. Additionally, lactobacilli fermentation may augment calcium accessibility through directly promoting calcium absorption or modifying food constituents. Considering the escalating global health challenge of bone-related issues among the elderly population, this review may offer a valuable reference for the development of food strategies aimed at preventing osteoporosis.

Effects of Endocrine-Disrupting Chemicals on Bone Health

This comprehensive review critically examines the detrimental impacts of endocrine-disrupting chemicals (EDCs) on bone health, with a specific focus on substances such as bisphenol A (BPA), per- and polyfluoroalkyl substances (PFASs), phthalates, and dioxins. These EDCs, by interfering with the endocrine system's normal functioning, pose a significant risk to bone metabolism, potentially leading to a heightened susceptibility to bone-related disorders and diseases. Notably, BPA has been shown to inhibit the differentiation of osteoblasts and promote the apoptosis of osteoblasts, which results in altered bone turnover status. PFASs, known for their environmental persistence and ability to bioaccumulate in the human body, have been linked to an increased osteoporosis risk. Similarly, phthalates, which are widely used in the production of plastics, have been associated with adverse bone health outcomes, showing an inverse relationship between phthalate exposure and bone mineral density. Dioxins present a more complex picture, with research findings suggesting both potential benefits and adverse effects on bone structure and density, depending on factors such as the timing and level of exposure. This review underscores the urgent need for further research to better understand the specific pathways through which EDCs affect bone health and to develop targeted strategies for mitigating their potentially harmful impacts.

The Importance of Vitamin K and the Combination of Vitamins K and D for Calcium Metabolism and Bone Health: A Review

The aim of the present review is to discuss the roles of vitamin K (phylloquinone or menaquinones) and vitamin K-dependent proteins, and the combined action of the vitamins K and D, for the maintenance of bone health. The most relevant vitamin K-dependent proteins in this respect are osteocalcin and matrix Gla-protein (MGP). When carboxylated, these proteins appear to have the ability to chelate and import calcium from the blood to the bone, thereby reducing the risk of osteoporosis. Carboxylated osteocalcin appears to contribute directly to bone quality and strength. An adequate vitamin K status is required for the carboxylation of MGP and osteocalcin. In addition, vitamin K acts on bone metabolism by other mechanisms, such as menaquinone 4 acting as a ligand for the nuclear steroid and xenobiotic receptor (SXR). In this narrative review, we examine the evidence for increased bone mineralization through the dietary adequacy of vitamin K. Summarizing the evidence for a synergistic effect of vitamin K and vitamin D3, we find that an adequate supply of vitamin K, on top of an optimal vitamin D status, seems to add to the benefit of maintaining bone health. More research related to synergism and the possible mechanisms of vitamins D3 and K interaction in bone health is needed.

Determination of the Combined Effects of Asian Herbal Medicine with Calcium and/or Vitamin D Supplements on Bone Mineral Density in Primary Osteoporosis: A Systematic Review and Meta-Analysis

Our review of 52 RCTs from 5 databases suggests a tendency for notable improvement in BMD when combining herbal medicine with supplements (calcium and vitamin D variants) compared to supplement monotherapy in primary osteoporosis. However, caution is needed in interpreting results due to substantial heterogeneity among included studies.

PURPOSE

To conduct a systematic review and meta-analysis to determine whether herbal medicine (HM) plus supplements such as calcium (Ca) or vitamin D (Vit.D) improves bone mineral density (BMD) compared to supplements alone in primary osteoporosis (OP) patients.

METHODS

We searched 5 databases for randomized controlled trials (RCTs) using HMs with supplements (Ca or Vit.D variants) as interventions for primary OP patients published until August 31, 2022. Meta-analysis using BMD score as the primary outcome was performed using RevMan 5.4 version. Risk of bias in the included studies was assessed useing RoB 2.0 tool.

RESULTS

In total, 52 RCTs involving 4,889 participants (1,408 men, 3,481 women) were included, with average BMD scores of 0.690 ± 0.095 g/cm2 (lumbar) and 0.625 ± 0.090 g/cm2 (femoral neck). As a result of performing meta-analysis using BMD scores for all 52 RCTs included in this review, combination of HMs with Ca and Vit.D variants improved the BMD score by 0.08 g/cm2 (lumbar, 38 RCTs, 95% CI: 0.06-0.10, p < 0.001, I2 = 97%) and 0.06 g/cm2 (femoral neck, 19 RCTs, 95% CI: 0.04-0.08, p < 0.001, I2 = 92%)compared to controls. However, statistical significance of the lumbar BMD improvement disappeared after adjusting for potential publication bias.

CONCLUSION

Our data suggest that combining of HM and supplements tends to be more effective in improving BMD in primary OP than supplements alone. However, caution is needed in interpretation due to the reporting bias and high heterogeneity among studies, and well-designed RCTs are required in the future.

Bone mineral density and body composition in Australians following plant-based diets vs. regular meat diets

Background and aims

Bone mineral density (BMD) and body composition play an important role in maintaining metabolic health and physical functioning. Plant-based diets (PBDs) are known to be lower in protein and calcium, which can impact BMD and body composition. This study aimed to investigate the relationship between various PBDs compared to regular meat diet and whole-body BMD, body composition, and weight status.

Methods

A cross-sectional study was conducted with adults (n = 240) aged 30-75 years, who habitually followed dietary patterns: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat eater (48 per group). Parameters were measured using dual-energy x-ray absorptiometry (DXA), and multivariable regression analyses were used to adjust for lifestyle confounders, socioeconomic factors, and BMI.

Results

After adjustments, whole-body BMD and body composition were not significantly different between those following PBDs and regular meat diets, except for lacto-ovo vegetarians, who had significantly lower lean mass by -1.46 kg (CI: -2.78, -0.13). Moreover, lacto-ovo vegetarians had a significantly lower T-score by -0.41 SD (CI: -0.81, -0.01) compared to regular meat eaters. Waist circumference was significantly lower in individuals adhering to a PBD compared to a regular meat diet: vegans by -4.67 cm (CI: -8.10, -1.24), lacto-ovo vegetarians by -3.92 cm (CI: -6.60, -1.23), pesco-vegetarians by -3.24 cm (CI: -6.09, -0.39), and semi-vegetarians by -5.18 cm (CI: -7.79, -2.57). There were no significant differences in lean mass (%), fat mass (% and total), android/gynoid measures, body weight, or BMI across dietary patterns. All dietary patterns met the recommended dietary intake for calcium and protein, and 25-hydroxy-vitamin D status was comparable across groups.

Conclusions

This cross-sectional study found that adhering to a PBD characterized by varying degrees of dairy and meat restriction is not associated with meaningful changes in BMD or body composition, provided that the dietary patterns are planned appropriately with adequate levels of calcium and protein.

Limosilactobacillus reuteri 6475 and Prevention of Early Postmenopausal Bone Loss: A Randomized Clinical Trial

Importance

Daily supplementation with the probiotic Limosilactobacillus reuteri ATCC PTA 6475 (L reuteri) vs placebo has previously been demonstrated to reduce bone loss in an estrogen deficiency mice model and older women, although the magnitude of the effect was small. We hypothesized that long-term treatment with L reuteri could result in clinically relevant skeletal benefits in postmenopausal osteoporosis.

Objective

To evaluate whether daily supplementation with L reuteri vs placebo could reduce early postmenopausal bone loss and whether the effects remained or increased over time during 2 years of treatment.

Design, Setting, and Participants

A double-blind, randomized, placebo-controlled clinical trial was conducted between December 4, 2019, and October 6, 2022, at a single center in Gothenburg, southwestern Sweden. Participants were recruited by online advertisements, and letters were sent to 10 062 women aged 50 to 60 years. Responding women (n = 752) underwent telephone screening, resulting in 292 women being invited to a screening visit. Of those who were screened, 239 women met all inclusion criteria and had no exclusion criteria.

Interventions

Capsules with L reuteri in 2 doses, 5 × 108 (low dose) or 5 × 109 (high dose) colony-forming units, taken twice daily or placebo were administered. All capsules also included cholecalciferol, 200 IU.

Main Outcomes and Measures

The primary outcome was the relative change in tibia total volumetric bone mineral density (vBMD) over 2 years. Secondary outcomes included relative change in areal BMD of the lumbar spine and total hip, bone turnover markers C-terminal telopeptide cross-links of collagen type I and type I procollagen intact N-terminal propeptide, as well as tibia trabecular bone volume fraction and cortical vBMD. Both intention-to-treat and per-protocol analyses were conducted.

Results

A total of 239 postmenopausal women (median age, 55 [IQR, 53-56] years) were included. Tibia vBMD (primary outcome), hip and spine vBMD, and tibia cortical area and BMD decreased significantly in all groups, with no group-to-group differences (percent change tibia vBMD high dose vs placebo least-squares means, -0.08 [95 CI, -0.85 to 0.69] and low dose vs placebo least-squares means, -0.22 [95% CI, -0.99 to 0.55]). There were no significant treatment effects on any other predefined outcomes. A prespecified sensitivity analysis found a significant interaction between body mass index (BMI) and treatment effect at 2 years. No significant adverse effects were observed.

Conclusions and Relevance

In this randomized clinical trial of 239 early postmenopausal women, supplementation with L reuteri had no effect on bone loss or bone turnover over 2 years. The observed interaction between BMI and treatment effect warrants further investigation.

Trial Registration

ClinicalTrials.gov Identifier: NCT04169789.

Risk of Bone Fracture on Vegetarian and Vegan Diets

PURPOSE OF REVIEW

Bone fractures can have a devastating effect on health, especially in the elderly, undermining their independence for daily activities, and increasing the risk of comorbidities and mortality. Nutrition is a key factor in maintaining an optimal bone health across the lifespan. The number of people that choose to avoid meat or even all animal products is increasing globally, for a diversity of reasons. Properly planned vegetarian and vegan diets are widely recognized as a healthy dietary pattern, but the long-term impact of these diets on bone health and more specifically risk of bone fractures is less clear. Classic studies have observed a slightly lower bone mineral density in vegetarians but have many limitations, including inadequate adjusting for relevant confounding factors, and cross-sectional design. The aim of this review is to summarize and put into context the current evidence on the effect of vegetarian and vegan diets on bone health, with a focus on fracture risk.

RECENT FINDINGS

In recent years, results from many large prospective studies have emerged, which allowed us to assess the risk of incident bone fractures in vegetarians. In these studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. In many recent prospective cohort studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. At least part of this risk could be due to a lower body mass index and a lower intake of nutrients such as calcium, vitamin D, and protein. Some evidence suggests that combined vitamin D and calcium supplementation and other factors such as consumption of protein-rich foods may attenuate this risk. The eventual deleterious effect of vegetarian diets on bone health should be contextualized and balanced with its benefits, such as lower risk of cardiovascular disease and cancer.

Three-Year Mortality of Older Hospitalized Patients with Osteosarcopenia: Data from the OsteoSys Study

Osteosarcopenia, the concurrent presence of sarcopenia and osteopenia/osteoporosis, poses a significant health risk to older adults, yet its impact on clinical outcomes is not fully understood. The aim of this prospective, longitudinal multicentre study was to examine the impact of osteosarcopenia on 3-year mortality and unplanned hospitalizations among 572 older hospitalized patients (mean age 75.1 ± 10.8 years, 78% female). Sarcopenia and low bone mineral density (BMD) were evaluated using Dual Energy X-ray Absorptiometry and the European Working Group on Sarcopenia in Older People (EWGSOP2) and WHO criteria, respectively. Among participants, 76% had low BMD, 9% were sarcopenic, and 8% had osteosarcopenia. Individuals with osteosarcopenia experienced a significantly higher rate of mortality (46%, p < 001) and unplanned hospitalization (86%, p < 001) compared to those without this condition. Moreover, "healthy" subjects-those without sarcopenia or low BMD-showed markedly lower 3-year mortality (9%, p < 001) and less unplanned hospitalization (53%, p < 001). The presence of osteosarcopenia (p = 0.009) increased the 3-year mortality risk by 30% over sarcopenia alone and by 8% over low BMD alone, underscoring the severe health implications of concurrent muscle and bone deterioration. This study highlights the substantial impact of osteosarcopenia on mortality among older adults, emphasizing the need for targeted diagnostic and therapeutic strategies.

Nutrition-Based Support for Osteoporosis in Postmenopausal Women: A Review of Recent Evidence

Postmenopausal osteoporosis stands as the predominant bone disorder in the developed world, posing a significant public health challenge. Nutritional factors play a crucial role in bone health and may contribute to its prevention or treatment. Calcium and vitamin D, extensively studied with robust scientific evidence, are integral components of the non-pharmacological treatment for this disorder. Nevertheless, other less-explored nutritional elements appear to influence bone metabolism. This review provides a comprehensive summary of the latest evidence concerning the relationship between various nutrients, such as phosphorus, magnesium, vitamins, phytate, and phytoestrogens; specific foods like dairy or soy, and dietary patterns such as the Mediterranean diet with bone health and osteoporosis.

The role of carotenoids in bone health-A narrative review

Osteoporosis constitutes a serious challenge for public health. Dietary patterns belong to important, modifiable risk factors of this disease. Therefore, what and in what quantities we consume on a daily basis are extremely relevant. It is commonly known that bone health is positively affected by vitamins (e.g., vitamin D and vitamin K) as well as mineral components (e.g., calcium and magnesium). However, the human diet consists of many other groups of compounds that exhibit a potential antiosteoporotic and supporting bone-building effect. These dietary components include carotenoids. This paper presents a broad review of studies on the influence of particular carotenoids (β-carotene, lutein, zeaxanthin, β-cryptoxanthin, and lycopene) on bones. The paper discusses up-to-date in vitro experiments and research on animal models and presents how the results translate into clinical effect in humans.

Metabolic bone disorders and the promise of marine osteoactive compounds

Metabolic bone disorders and associated fragility fractures are major causes of disability and mortality worldwide and place an important financial burden on the global health systems. These disorders result from an unbalance between bone anabolic and resorptive processes and are characterized by different pathophysiological mechanisms. Drugs are available to treat bone metabolic pathologies, but they are either poorly effective or associated with undesired side effects that limit their use. The molecular mechanism underlying the most common metabolic bone disorders, and the availability, efficacy, and limitations of therapeutic options currently available are discussed here. A source for the unmet need of novel drugs to treat metabolic bone disorders is marine organisms, which produce natural osteoactive compounds of high pharmaceutical potential. In this review, we have inventoried the marine osteoactive compounds (MOCs) currently identified and spotted the groups of marine organisms with potential for MOC production. Finally, we briefly examine the availability of in vivo screening and validation tools for the study of MOCs.

Calcium - a scoping review for Nordic Nutrition Recommendations 2023

The aim of this scoping review was to conduct evidence-based documentations between calcium (Ca) intake and health outcomes for updating dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the sixth edition of Nordic Nutrient Recommendations (NNR2023). The systematic literature search was limited to reviews on human data published between 2011 and June 2021. Systematic reviews (SRs) and original publications of relevance for this scoping review were included. A common practice of designing studies on health outcomes related to Ca supplement intake is to examine combined Ca and vitamin D, and therefore, a combination of Ca with vitamin D (CaD) was included in this review. In total, 27 studies addressing the association between dietary or supplemental Ca on bone health, bone mineral density (BMD), pregnancy-related outcomes, cardiovascular diseases (CVD), cancers, obesity, and mortality were reviewed. SRs showed that both dietary and supplemental Ca intakes were positively associated with BMD, but evidence did not support the benefit in fracture prevention. Current evidence did not support that Ca or CaD supplementation increases risk of coronary heart disease or all-cause mortality in older adults, but that Ca may be beneficial for hypertension, especially in young people. Increasing Ca intake may be beneficial during pregnancy, especially for those at high risk of pre-eclampsia due to ethnicity, age, high BMI, and those with low baseline Ca intake. The associations between high Ca intake and cancers were varied, with strong evidence that high consumption of dairy products is protective against colorectal cancer and limited-suggestive evidence that dairy products and diets high in Ca might also be protective against breast cancer. Moreover, there is limited-suggestive evidence that dairy products and diets high in Ca increase the risk of prostate cancer. Based on current evidence, Ca intake is beneficial or neutral in relation to most of the outcomes evaluated in this review. Data from the Nordic countries show that average Ca intake is around the same as previously recommended by NNR. However, the average Ca intake in the Baltic countries is below the recommendations.

Considerations for the Consumption of Vitamin and Mineral Supplements in Athlete Populations

Vitamins and minerals are of fundamental importance to numerous human functions that are essential to optimise athlete performance. Athletes incur a high turnover of key vitamins and minerals and are therefore dependent on sufficient energy intake to replenish nutrient stores. However, many athletes are poor at servicing their energy replenishment needs, especially female athletes, and although a 'food first approach' to meeting nutrient requirements is the primary goal, it may be important for some athletes to consider a vitamin and/or mineral supplement to meet their daily needs. When working to determine if an athlete requires vitamin or mineral supplements, practitioners should use a robust framework to assess the overall energy requirements, current dietary practices and the biological and clinical status of their athletes. Of note, any supplementation plan should account for the various factors that may impact the efficacy of the approach (e.g. athlete sex, the nutrient recommended dietary intake, supplement dose/timing, co-consumption of other foods and any food-drug interactions). Importantly, there are numerous vitamins and minerals of key importance to athletes, each having specific relevance to certain situations (e.g. iron and B vitamins are significant contributors to haematological adaptation, calcium and vitamin D are important to bone health and folate is important in the female athlete); therefore, the appropriate supplement for a given situation should be carefully considered and consumed with the goal to augment an athlete's diet.

Identification of heel bone mineral density as a risk factor of Alzheimer's disease by analyzing large-scale genome-wide association studies datasets

Introduction: Both low bone mineral density (BMD) and Alzheimer's disease (AD) commonly co_occur in the older adult. Until now, the association between AD and BMD has been widely reported by observational studies. However, Mendelian randomization (MR) studies did not support the causal association between BMD and AD. We think that the lack of significant causal association between AD and BMD identified by recent MR studies may be caused by small number of potential instrumental variables. Methods: We conduct a MR study to evaluate the causal effect of heel BMD on the risk of AD using 1,362 genome-wide significant and independent (p < 5.00E-08) heel BMD genetic variants as the potential instrumental variables, which are identified by a large-scale genome wide association study (GWAS) of heel BMD in 394,929 UK Biobank individuals. Using these 1,362 genome-wide significant and independent heel BMD genetic variants, we extracted their corresponding AD GWAS summary results in IGAP AD GWAS dataset (n = 63,926) and FinnGen AD GWAS dataset (n = 377,277). Five methods including inverse-variance weighted meta-analysis (IVW), weighted median, MR-Egger, MR-PRESSO, and MRlap were selected to perform the MR analysis. 951 of these 1,362 genetic variants are available in AD GWAS dataset. Results: We observed statistically significant causal effect of heel BMD on the risk of AD using IVW in IGAP AD GWAS dataset (OR = 1.048, 95%CI: 1.002-1.095, p = 0.04) and FinnGen AD GWAS dataset (OR = 1.053, 95% CI:1.011-1.098, p = 0.011). Importantly, meta-analysis of IVW estimates from IGAP and FinnGen further supported the causal effect of heel BMD on the risk of AD (OR = 1.051, 95% CI: 1.02-1.083, p = 0.0013). Discussion: Collectively, our current MR study supports heel BMD to be a risk factor of AD by analyzing the large-scale heel BMD and AD GWAS datasets. The potential mechanisms underlying the association between heel BMD and AD should be further evaluated in future.

Adherence to the dietary approaches to stop hypertension and bone health in the Chinese elderly

INTRODUCTION

Many studies have demonstrated the relationship between diet and bone health, but research on the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and bone health across populations is rare. The purpose of this study was to examine associations between the DASH dietary pattern and bone health outcomes in Chinese elders, to verify whether higher adherence to the DASH was associated with better bone health in elderly populations.

MATERIALS AND METHODS

A total of 839 Chinese adults aged 50 years and above participated in this cross-sectional study. Bone mineral density (BMD) at calcaneus was measured via ultrasonic bone densitometer. A semiquantitative food frequency questionnaire (FFQ) was used to assess the usual dietary intake in the past 12 months. The DASH score was calculated based on energy-adjusted intakes of nine dietary components, including whole grains, beans, vegetables, fruits, dairy, red meat, total fat, sodium, and sugar-sweetened beverages.

RESULTS

In postmenopausal women, DASH score was significantly and positively correlated with BMD T-score after controlling potential covariates (β: 0.027 ± 0.012, P = 0.031) in multivariable linear regression models. In binary logistic regression analysis, male participants in the highest tertile of DASH score had lower risk of osteoporosis than those in the lowest tertile (odds ratio = 0.499; 95% confidence interval, 0.262-0.951; P = 0.035) after adjusting potential covariates.

CONCLUSION

Adherence to the DASH dietary pattern was associated with better bone health in Chinese elderly adults.

Water quality, WASH, and gender: differential impacts on health and well-being in Abeokuta City, Nigeria

It is often assumed that humans experience the effect of poor water quality like multiple health and socioeconomic impacts in the same way. But these impacts are not gender neutral due to inequalities caused by physiological composition, age marginalization, and socioeconomic conditions, among others. A mixed method, comprising water quality assessment, a survey of 456 individuals, and medical record collection, was applied to examine the differential impacts of water quality and WASH practices in Abeokuta City, Nigeria. The assessment shows that without point-of-use water treatment, the water sources in the area are not safe for potable purposes, as the waters are hard in the sequence of borehole > surface water > hand-dug well > sachet water, with elevated levels of calcium (> 75 mg/L) and not free from microbial contamination. Among the area population segments, men and boys (relative to women and girls) may be more susceptible (55%) to the compounding health effects associated with the hardness and high calcium concentration in water. Girls are the most affected by the associated impacts of water collection. Men and boys are more vulnerable to the consequences of poor hygiene, while women are more susceptible to the health effects of toilet cleaning and the sharing of sanitation facilities, among others. We conclude that there are differential impacts of unsafe water, WASH services, and practices on human health. Gendered statistics through sex-disaggregated data is crucial to unmasking the differential impacts, which are neither gender neutral nor evenly distributed between women and men, and boys and girls.

Soft drinks, tea and coffee consumption in relation to risk of fracture: evidence from china health and nutrition survey

INTRODUCTION

To investigate the association between soft drinks, tea and coffee consumption, and risk of fracture in the China Health and Nutrition Survey.

MATERIALS AND METHODS

A cross-sectional study with multi-stage random cluster sampling was conducted in nine Chinese provinces in 2004, 2006, 2009 and 2011. A total of 36,740 participants were included the data analyses. Self-administered questionnaires and physical examinations provided data on beverages consumption, fracture history, and other potential risk factors. Binary logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potentially confounding variables.

RESULTS

The prevalence of fracture increased over the 7-year period of the surveys, with 1833 (5.3%) participants reporting a fracture history. Soft drink consumption increased over this time period, and tea consumption was relatively stable, whereas coffee consumption tended to increase sharply. Consumers of soft drinks ≥ 3 times/week (versus never) had a higher risk of fracture (OR = 1.86, 95% CI = 1.43-2.32, p < 0.001, p for trend = 0.039). Consumers of tea ≥ 5 cups/day (versus never) also had a higher risk of fracture (OR = 1.21, 95% CI = 1.09-1.45, p = 0.028, p for trend < 0.001). Similarly, consumers of coffee ≥ 2 cups/day (versus never) had a higher risk of fracture (OR = 1.84, 95% CI = 1.01-3.34, p = 0.045, p for trend = 0.002). Subgroup analyses by gender suggested that coffee consumption increased risk of fracture in females (OR = 1.84, 95% CI = 1.32-2.63, p = 0.001).

CONCLUSION

Our findings suggest that high consumption of soft drinks, tea and coffee is associated with an increased risk of fracture in the Chinese population. Which has important public health implications given the widespread consumption of these beverages.

Association between a Calcium-to-Magnesium Ratio and Osteoporosis among Puerto Rican Adults

BACKGROUND

The ratio of calcium-to-magnesium intake (Ca:Mg) may be important for bone due to their competitive absorption. The Ca:Mg ratio has been related to health outcomes, but few studies have related it to bone.

OBJECTIVES

The purpose of this analysis was to examine associations between the Ca:Mg intake with bone mineral density (BMD) and osteoporosis among Puerto Rican adults.

METHODS

Adults, aged 47-79 y, from the Boston Puerto Rican Osteoporosis Study, with complete BMD and dietary data (n = 955) were included. BMD was assessed with dual-energy X-ray absorptiometry and diet by a food frequency questionnaire. Calcium and magnesium intakes from food were energy adjusted, and the Ca:Mg was calculated. Adjusted linear and logistic regression models were utilized for testing associations between Ca:Mg and bone outcomes.

RESULTS

Calcium intake was greater in the highest compared with lowest tertile, whereas magnesium intake was similar across tertiles. Mean BMD at hip sites was higher in the middle, compared with the lowest, tertile. Higher odds of osteoporosis were observed for the highest and lowest tertiles, compared with the middle tertile, after adjustment (T3 compared with T2 OR: 2.79; 95% CI: 1.47, 5.3; T1 compared with T2 OR: 2.01; 95% CI: 1.03, 3.92). Repeated analyses without supplement users (n = 432) led to stronger differences and ORs, but lost significance for some comparisons.

CONCLUSIONS

Dietary calcium and magnesium are important for bone, perhaps not independently. The Ca:Mg intake ratio appeared most protective within a range of 2.2-3.2, suggesting that a balance of these nutrients may be considered in recommendations for osteoporosis..

Burden of falls attributable to low bone mineral density among people aged 60 years and over in China from 1990 to 2019

Objective

Falls in older people have become a major public health, economic and societal problem. Osteoporosis predisposes older adults to high risk of falls, which were the most common outcome attributable to low bone mineral density (LBMD). In this study, we analyze the long-term trends in falls burden attributable to LBMD among people aged 60 years and over from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019).

Methods

Data from GBD 2019 were used to assess the long-term trends in mortality and disability-adjusted life-year (DALY) rates by Joinpoint regression. The age-period-cohort (APC) model was used to evaluate the effects of age, period and cohort on mortality rate of falls attributable to LBMD.

Results

The mortality and DALYs rates of falls attributable to LBMD among people aged 60 years and over increased from 1990 to 2019, with average annual percentage changes (AAPCs) of 1.74% (95% CI: -1.47 to 2.01%) and 0.99% (95% CI: 0.80-1.19%), respectively. APC analysis revealed that the mortality rate due to LBMD significantly increased among the older people over the age of 75 years. The risk of falls mortality due to LBMD during the period of 1990-2019 initially declined but later elevated. An overall increasing risk for falls death attributable to LBMD was presented across birth cohorts, but in cohorts born after 1930, the upward trend has slowed down. The overall net drift per year attributable to LBMD was above 0. The corresponding results showed that the negative impact of period and cohort effects among males was more pronounced than those among females.

Conclusions

Falls attributable to LBMD remain an ongoing health burden in the older people in China, and the mortality has been on the rise from 1990 to 2019, especially among the older people aged 80+ years group. The prevention and treatment of LBMD should be emphasized, especially among males and oldest-old people. Furthermore, there is an urgent need to strengthen the implementation of system-wide, integrated and effective public health policies and other health interventions in China.

The Role of Trace Elements and Minerals in Osteoporosis: A Review of Epidemiological and Laboratory Findings

The objective of the present study was to review recent epidemiological and clinical data on the association between selected minerals and trace elements and osteoporosis, as well as to discuss the molecular mechanisms underlying these associations. We have performed a search in the PubMed-Medline and Google Scholar databases using the MeSH terms "osteoporosis", "osteogenesis", "osteoblast", "osteoclast", and "osteocyte" in association with the names of particular trace elements and minerals through 21 March 2023. The data demonstrate that physiological and nutritional levels of trace elements and minerals promote osteogenic differentiation through the up-regulation of BMP-2 and Wnt/β-catenin signaling, as well as other pathways. miRNA and epigenetic effects were also involved in the regulation of the osteogenic effects of trace minerals. The antiresorptive effect of trace elements and minerals was associated with the inhibition of osteoclastogenesis. At the same time, the effect of trace elements and minerals on bone health appeared to be dose-dependent with low doses promoting an osteogenic effect, whereas high doses exerted opposite effects which promoted bone resorption and impaired bone formation. Concomitant with the results of the laboratory studies, several clinical trials and epidemiological studies demonstrated that supplementation with Zn, Mg, F, and Sr may improve bone quality, thus inducing antiosteoporotic effects.

New Insights into Nutrients for Bone Health and Disease

Bone health includes the health of bone minerals, mass, geometry, and microstructure [...].

The association of dietary acid load (DAL) with estimated skeletal muscle mass and bone mineral content: a cross-sectional study

BACKGROUND & AIMS

Dietary patterns that promote mild metabolic acidosis may have a negative effect on bone and muscle, and a high dietary acid load (DAL) may be detrimental to skeletal muscle mass and bone mineral content. However, the association between skeletal muscle mass and bone mineral content with dietary acid load has not been consistently reported in previous studies. The objective of the study was to evaluate the association of potential renal net acid load (PRAL) and net endogenous acid production (NEAP) with bone mineral content and skeletal muscle mass in pre-menopause women with overweight or obesity in Iran.

METHOD

Three hundred and ninety women with a body mass index (BMI) of 25 were included in this cross-sectional study. We used a validated 147-item semi-quantitative food frequency questionnaire (FFQ) for evaluating the dietary intake. Based on the dietary data, potential renal net acid load (PRAL) and net endogenous acid production (NEAP) were calculated. Muscle mass and bone mineral content were estimated by a bioelectrical impedance analyzer (BIA).

RESULTS

After controlling for potential confounders, we discovered a significant linear relationship between PRAL (β = -0.027, 95%CI = -0.049 to -0.004, P = 0.02) and NEAP (β = -0.05, 95%CI = -0.097 to -0.003, P = 0.03) and skeletal muscle mass index. However, there was no significant difference between SMM and BMC across PRAL and NEAP tertiles.

CONCLUSION

PRAL and NEAP were found to be inversely related to skeletal muscle mass index among overweight/obese women. Further research is required to establish whether this relationship is important for musculoskeletal health in these populations.

Gender-specific effects of capsiate supplementation on body weight and bone mineral density: a randomized, double-blind, placebo-controlled study in slightly overweight women

INTRODUCTION

Overweight and obesity are highly prevalent conditions associated with premature morbidity and mortality worldwide. Capsiate, a nonpungent analogue of capsaicin, binds to TRP vanilloid 1 (TRPV1) receptor, which is involved in adipogenesis, and could be effective as a weight-lowering agent.

METHODS

Eighteen slightly overweight women were enrolled in this randomized, double-blind, placebo-controlled study. Nine patients were included in the capsiate intervention group and received 9 mg/day of capsinoids and 9 patients received placebo for 8 weeks. All patients underwent weight and waist circumference assessment before and after treatment. Body composition and bone mineral density (BMD) were also detected by dual-energy X-ray absorptiometry (DXA).

RESULTS

Fourteen patients completed the study. The treatment with capsiate or placebo for 8 weeks was not associated with significant changes in weight or waist circumference. After treatment, there was a significant improvement in BMD values measured at the spine in the capsiate group (1.158 vs 1.106 g/cm², + 4.7%; p = 0.04), but not in the group treated with placebo. Similarly, the capsiate group showed a 9.1% increase (p = 0.05) in the adipose tissue and an 8.5% decrease in lean mass measured at the supraclavicular level, whereas these changes were not statistically significant in the placebo group.

CONCLUSIONS

Treatment with capsiate for 8 weeks led to negligible changes in body weight in a small sample of slightly overweight women, but our findings suggest a potential effect of capsaicin on bone metabolism in humans.

Role of calcium &/or vitamin D supplementation in preventing osteoporotic fracture in the elderly: A systematic review & meta-analysis

Background & objectives

Calcium and vitamin D, separately or in combination are usually prescribed to prevent fragility fractures in elderly population. However, there are conflicting results regarding the ideal dosage and overall efficacy obtained from randomized controlled trials (RCTs) conducted in the past. The objective of this study was to assess the fracture risk with the administration of calcium or vitamin D alone or in combination in elderly population (>60 yr).

Methods

PubMed, Cochrane and Embase databases were searched to identify the studies from inception to February 2021 with keywords, 'vitamin D', 'calcium' and 'fracture' to identify RCTs. The trials with comparing vitamin D, calcium or combination with either no medication or placebo were included for final analyses. The data were extracted and the study quality was assessed by two reviewers. The principal outcome measure was fractures around hip joint and secondary outcomes assessed were vertebral and any other fracture.

Results

Eighteen RCTs were considered for the final analysis. Neither calcium nor vitamin D supplementation was associated with risk of fractures around hip joint [risk ratio (RR) 1.56; 95% confidence interval (CI), 0.91 to 2.69, I[2]=28%; P=0.11]. In addition, the combined administration of calcium and vitamin D was also not associated with fractures around the hip joint in comparison to either no treatment or placebo. The incidence of vertebral (RR 0.95; 95% CI, 0.82 to 1.10, I[2]=0%; P=0.49) or any other fracture (RR 0.83; 95% CI 0.65 to 1.06, I[2]=0%; P=0.14) was not significantly associated with the administration of calcium and vitamin D either individually or in combination. Further subgroup analysis of the results did not vary with the dosage of calcium or vitamin D, dietary calcium intake sex, or serum 25-hydroxyvitamin D levels.

Interpretation & conclusions

The present meta-analysis of RCTs on calcium, vitamin D or a combination of the two in comparison to no treatment or placebo did not support the routine administration protocol of calcium and vitamin D either alone or in combination to lower the risk of fractures in elderly population.

Bone fragility during the COVID-19 pandemic: the role of macro- and micronutrients

Bone fragility is the susceptibility to fracture due to poor bone strength. This condition is usually associated with aging, comorbidities, disability, poor quality of life, and increased mortality. International guidelines for the management of patients with bone fragility include a nutritional approach, mainly aiming at optimal protein, calcium, and vitamin D intakes. Several biomechanical features of the skeleton, such as bone mineral density (BMD), trabecular and cortical microarchitecture, seem to be positively influenced by micro- and macronutrient intake. Patients with major fragility fractures are usually poor consumers of dairy products, fruit, and vegetables as well as of nutrients modulating gut microbiota. The COVID-19 pandemic has further aggravated the health status of patients with skeletal fragility, also in terms of unhealthy dietary patterns that might adversely affect bone health. In this narrative review, we discuss the role of macro- and micronutrients in patients with bone fragility during the COVID-19 pandemic.

Risk of major osteoporotic fractures among ultra-orthodox Jews

The Ultra-Orthodox Jewish population has behaviors that can influence the risk for osteoporotic fractures. We investigated whether this population is more prone to osteoporotic fractures than non-Orthodox Jewish. We did not find a significant difference in osteoporotic fracture rates between the two populations despite major differences in exposure to potential risk factors.

INTRODUCTION

The Ultra-Orthodox Jewish population is a conservative population with unique cultural behaviors such as modest clothing and specific dietary restrictions, which can influence bone density and risk for osteoporotic fractures. The aim of this study is to investigate whether the Ultra-Orthodox Jewish population is more prone to osteoporotic fractures than the non-Orthodox Jewish population.

METHODS

This retrospective cohort study utilized computerized records from Maccabi Health Service. Study population included patients 65 years and older without a history of osteoporotic fracture, who reside in regions of Ultra-Orthodox and non-Orthodox Jews. The primary outcome was the adjusted risk to osteoporotic fracture during 9 years of follow-up. Cox regression included patient characteristics and risk factors for osteoporosis.

RESULTS

A total of 115,134 patients were included in this study: 5397 patients residing in Ultra-Orthodox regions (51.0% female) and 109,737 patients residing in non-Orthodox regions (52.6% female). A total of 16,352 (14.2%) patients had an osteoporotic fracture during the study period. There was no significant difference in fracture rate between Ultra-Orthodox and non-Orthodox (14.3% vs. 14.2%, p = 0.827). Among Ultra-Orthodox and non-Orthodox females and males, there were no significant differences in fracture rates (19.1% vs. 19.1% p = 0.982 and 9.3% vs. 8.8% p = 0.311, respectively). The adjusted hazard risk for the Ultra-Orthodox Jews was 1.026, 95% CI: 0.95-1.11, p = 0.512.

CONCLUSION

We did not find a significant difference in the rate of osteoporotic fractures between Ultra-Orthodox and non-Orthodox populations despite major differences in exposure to potential risk factors. Results suggest that the perception of risk factors relevant for the religious communities should be re-evaluated.

Role of metabolic equivalent between calcium intake and vertebral fractures: a cross-sectional study of NHANES 2013-2014

BACKGROUND

This study was to analyze the association of calcium intake and metabolic equivalent (MET) with vertebral fractures, and to explore the role of MET between calcium intake and vertebral fractures.

METHOD

This cross-sectional study used data from the National Health and Nutrition Examination Surveys (NHANES) 2013-2014. The study involved individuals aged ≥ 50 years old with complete information on vertebral fracture, calcium intake, and physical activity. Vertebral fracture assessment is obtained using dual-energy x-ray absorptiometry to perform a lateral scan of the thoracolumbar spine. Calcium intake included total nutrient intake and total dietary supplements. The total MET is the sum of the METs for each activity (Vigorous/ moderate work-related activities, walking or bicycling for transportation and vigorous/ moderate recreational activities). Univariate and multivariate logistic regression analyses were utilized to investigate the effect of calcium intake, MET, and their combined effect on vertebral fracture.

RESULTS

A total of 766 participants were included in the analysis, and 54 participants had vertebral fractures. The median calcium intake and MET were 8.43 mcg and 280.00, respectively. Multivariate results showed that neither calcium intake nor MET as continuous or categorical variables was significantly associated with vertebral fractures. MET < 160 and calcium intake ≥ 670 mg group was associated with the decreased risks of vertebral fracture [odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.26-0.83, P = 0.032] after adjusting for age, race, energy, total femur bone mineral density (BMD), and femoral neck BMD. In the group of MET < 160, increased calcium intake was associated with a reduced risk of vertebral fracture, with a decreased OR value. In the group of MET ≥ 160, increased calcium intake was associated with an increased risk of vertebral fracture, with an increased OR value.

CONCLUSION

The combination of MET < 160 and calcium intake ≥ 670 mg was associated with decreased risks of vertebral fractures. There may be an interaction between calcium intake and MET on vertebral fracture risk.

Bone Strength of the Calcaneus Is Associated with Dietary Calcium Intake in Older Japanese Men, but Not Women

The relationship between calcium intake and bone strength in older Asian individuals, including Japanese, is controversial; therefore, we herein investigated this relationship in older Japanese populations. We performed a cross-sectional analysis of 314 participants older than 65 years who voluntarily participated in a medical examination and responded to questionnaires. The osteo-sono assessment index (OSI) measured at the right calcaneus using a quantitative ultrasonic device was used as an indicator of bone strength. The daily dietary intake of calcium was assessed using a brief-type self-administered diet history questionnaire. A two-way analysis of covariance revealed a significant interaction between sex and calcium intake on the OSI (p < 0.01). A multiple regression analysis showed a positive correlation between calcium intake and the OSI in males (p < 0.01), but not females (p = 0.27). In females, grip strength divided by body weight positively correlated with the OSI (p = 0.04). The present results suggest that a higher calcium intake contributes to bone strength in older Japanese males. Although a higher grip strength may contribute to bone strength in females, the potential of estrogen as a confounding factor needs to be considered.

Calcium complexes of oxicams: new dimensions in rheumatoid arthritis treatment

Various metals have been complexed with drugs to improve their cellular impact. Inflammatory diseases like rheumatoid arthritis (RA) are characterized by unbalanced production of proinflammatory cytokines (PICs) and prostaglandins with decreased levels of vitamin D and calcium. The inflammation can be suppressed through targeting the formation of PICs or related enzymes by various treatment strategies that involve the use of corticosteroids, disease-modifying antirheumatic drugs and NSAIDs. We present a detailed review on the impact of calcium complexes of oxicams as an advanced treatment strategy for RA. The calcium complexes demonstrate promising capabilities to cure the disease, improve the strength of bones and suppress PICs in RA.

Changes in bone turnover markers in adolescents with gastroesophageal reflux disease treated with lansoprazole

Background

Proton pump inhibitors (PPIs) have been suggested to lead to bone resorption, while the effects of PPIs on the bone mineral metabolism in children has received only limited attention in literature to date. The present study investigates whether lansoprazole alters bone turnover markers in adolescents with gastroesophageal reflux disease (GERD).

Patients and methods

Included in the study were adolescents aged 16-18 with GERD and a healthy volunteers group. The GERD patient group was treated with lansoprazole 30 mg once daily for eight weeks. The serum calcium, phosphorus, magnesium, alkaline phosphatase (ALP), parathormone (PTH), 25 (OH) vitamin D, osteocalcin and urinary calcium, creatinine, deoxypyridinoline (DPD), collagen type-1 crosslinked C-telopeptide (CTX) and collagen type-1 crosslinked N-telopeptide (NTX) of both groups were studied before and after the end of the treatment.

Results

A comparison of the 30 patients with GERD and the 30 volunteers revealed no significant difference in the serum calcium, phosphorus, magnesium, ALP, urinary calcium/creatinine ratio, 25 (OH) vitamin D and PTH levels measured before and after the lansoprazole treatment, while the osteocalcin, DPD, CTX and NTX values were found to be higher after treatment when compared to those at pre- treatment.

Conclusions

The results of this study reveal that eight weeks of treatment with 30 mg lansoprazole daily increased the bone turnover markers of CTX, NTX, DPD and osteocalcin in adolescents aged 16-18.

The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials

Background:

The effect of calcium supplementation on bone mineral accretion in people under 35 years old is inconclusive. To comprehensively summarize the evidence for the effect of calcium supplementation on bone mineral accretion in young populations (≤35 years).

Methods:

This is a systematic review and meta-analysis. The Pubmed, Embase, ProQuest, CENTRAL, WHO Global Index Medicus, Clinical Trials.gov, WHO ICTRP, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases were systematically searched from database inception to April 25, 2021. Randomized clinical trials assessing the effects of calcium supplementation on bone mineral density (BMD) or bone mineral content (BMC) in people under 35 years old.

Results:

This systematic review and meta-analysis identified 43 studies involving 7,382 subjects. Moderate certainty of evidence showed that calcium supplementation was associated with the accretion of BMD and BMC, especially on femoral neck (standardized mean difference [SMD] 0.627, 95% confidence interval [CI] 0.338–0.915; SMD 0.364, 95% CI 0.134–0.595; respectively) and total body (SMD 0.330, 95% CI 0.163–0.496; SMD 0.149, 95% CI 0.006–0.291), also with a slight improvement effect on lumbar spine BMC (SMD 0.163, 95% CI 0.008–0.317), no effects on total hip BMD and BMC and lumbar spine BMD were observed. Very interestingly, subgroup analyses suggested that the improvement of bone at femoral neck was more pronounced in the peripeak bone mass (PBM) population (20–35 years) than the pre-PBM population (<20 years).

Conclusions:

Our findings provided novel insights and evidence in calcium supplementation, which showed that calcium supplementation significantly improves bone mass, implying that preventive calcium supplementation before or around achieving PBM may be a shift in the window of intervention for osteoporosis.

Funding:

This work was supported by Wenzhou Medical University grant [89219029].

Osteoporosis and bone fractures are common problems among older people, particularly older women. These conditions cause disability and reduce quality of life. Progressive loss of bone mineral density is usually the culprit. So far, strategies to prevent bone weakening with age have produced disappointing results. For example, taking calcium supplements in later life only slightly reduces the risk of osteoporosis or fracture. New approaches are needed.

Bone mass increases gradually early in life and peaks and plateaus around 20-35 years of age. After that period, bone mass slowly declines. Some scientists suspect that increasing calcium intake during this period of peak bone mass may reduce osteoporosis or fracture risk later in life.

A meta-analysis by Liu, Le et al. shows that boosting calcium intake in young adulthood strengthens bones. The researchers analyzed data from 43 randomized controlled trials that enrolled 7,382 participants. About half the studies looked at the effects of taking calcium supplements and the other half analyzed the effects of a high calcium diet. Boosting calcium intake in people younger than age 35 improved bone mineral density throughout the body. It also increased bone mineral density at the femoral neck, where most hip fractures occur. Calcium supplementation produced larger effects in individuals between the ages of 20 and 35 than in people younger than 20.

Both high calcium diets and calcium supplements with doses less than 1000 mg/d boosted bone strength. Higher dose calcium supplements did not provide any extra benefits. The analysis suggests people should pay more attention to bone health during early adulthood. Large randomized clinical trials are needed to confirm the long-term benefits of boosting calcium intake during early adulthood. But if the results are validated, taking calcium supplements, or eating more calcium-rich foods between the ages of 20 and 35 may help individuals build healthier bones and prevent fractures and osteoporosis later in life.

Cardiovascular risks associated with calcium supplementation in patients with osteoporosis: a nationwide cohort study

AIMS

This study aimed to evaluate the real effects of calcium supplementation on cardiovascular outcomes within a population-based cohort.

METHODS AND RESULTS

From a nationwide health screening database in South Korea, a total of 11 297 patients with osteoporosis who had taken calcium supplementation with or without vitamin D for at least 90 days [total calcium group; calcium supplementation only (CaO), n = 567; calcium supplementation in combination with vitamin D (CaD), n = 10 730] were matched at a 1:1 ratio to patients who had not taken calcium supplements (control group) by using propensity scores. The overall mean age was 59.9 ± 8.8 years and the percentage of women was 87.9% in our study population. Over a median follow-up of 54 months, the incidence rate of composite cardiovascular diseases (CVDs) per 1000 person-years was not different between the groups: 9.73 in the total calcium group and 8.97 in the control group [adjusted hazard ratio (HR): 1.12; 95% confidence interval (CI): 0.99-1.28; P = 0.08]. However, calcium supplementation without vitamin D was associated with an increased risk of composite CVD (HR: 1.54; 95% CI: 1.17-2.04; P < 0.01), especially non-fatal myocardial infarction (HR: 1.89; 95% CI: 1.23-2.91; P < 0.01), compared with no calcium supplementation.

CONCLUSION

Our population-based study supported that taking calcium supplementation combined with vitamin D did not appear to be harmful to cardiovascular health, but reminded that calcium supplementation without vitamin D should be used carefully even in populations with low dietary calcium intake.

Effect of 24-Week, Late-Evening Ingestion of a Calcium-Fortified, Milk-Based Protein Matrix on Biomarkers of Bone Metabolism and Site-Specific Bone Mineral Density in Postmenopausal Women with Osteopenia

Dietary calcium intake is a modifiable, lifestyle factor that can affect bone health and the risk of fracture. The diurnal rhythm of bone remodelling suggests nocturnal dietary intervention to be most effective. This study investigated the effect of daily, bed-time ingestion of a calcium-fortified, milk-derived protein matrix (MBPM) or control (CON), for 24 weeks, on serum biomarkers of bone resorption (C-terminal telopeptide of type I collagen, CTX) and formation (serum pro-collagen type 1 N-terminal propeptide, P1NP), and site-specific aerial bone mineral density (BMD), trabecular bone score (TBS), in postmenopausal women with osteopenia. The MBPM supplement increased mean daily energy, protein, and calcium intake, by 11, 30, and 107%, respectively. 24-week supplementation with MBPM decreased CTX by 23%, from 0.547 (0.107) to 0.416 (0.087) ng/mL (p < 0.001) and P1NP by 17%, from 60.6 (9.1) to 49.7 (7.2) μg/L (p < 0.001). Compared to CON, MBPM induced a significantly greater reduction in serum CTX (mean (CI95%); −9 (8.6) vs. −23 (8.5)%, p = 0.025 but not P1NP −19 (8.8) vs. −17 (5.2)%, p = 0.802). No significant change in TBS, AP spine or dual femur aerial BMD was observed for CON or MBPM. This study demonstrates the potential benefit of bed-time ingestion of a calcium-fortified, milk-based protein matrix on homeostatic bone remodelling but no resultant treatment effect on site-specific BMD in postmenopausal women with osteopenia.

The effect of maltobionic acid on bone metabolism markers in healthy Japanese postmenopausal women: A randomized double-blind placebo-controlled crossover study

Osteoporosis is characterized by compromised bone strengthpredisposing to an increased risk of fracture and is a disease with a high incidence in postmenopausal women. Frequent estrogen deficiency, particularly in postmenopausal women, induces osteoclast activation and is a major contributor to reduced bone mineral density. Maltobionic acid (MB) reportedly promotes mineral resorption and maintains bone mineral density in human clinical trials, although no studies have confirmed that MB improves bone metabolism in humans. Therefore, this study aimed to investigate the effects of MB administration on bone-resorption markers in healthy Japanese postmenopausal women. This was a randomized, double-blind, placebo-controlled, crossover trial. Twenty-six healthy adult Japanese women who realized that they had passed through more than 1 year of natural menopause and were aged 40-69 years were categorized into three groups. The experimental groups were allowed to consume maltobionic acid syrup 4 g (MB syrup 4 g group), maltobionic acid syrup 2 g plus maltose syrup 2 g (MB syrup 2 g group), and maltose syrup 4 g (placebo group) for 4 weeks. All 26 participants completed the intervention. Continuous ingestion of MB syrup 2 g or 4 g for 4 weeks significantly reduced the levels of bone-resorption markers deoxypyridinoline (DPD) and urinary N-telopeptide (u-NTx), and significantly increased the bone formation marker osteocalcin (OC) compared with the placebo group. Maltobionic acid (MB) intake may improve bone metabolism and reduce bone health problems, including osteoporosis, in postmenopausal, adult Japanese women. (UMIN-CTR ID: UMIN000038627).

Molecular Pathogenesis and New Therapeutic Dimensions for Spinal Muscular Atrophy

The condition known as 5q spinal muscular atrophy (SMA) is a devastating autosomal recessive neuromuscular disease caused by a deficiency of the ubiquitous protein survival of motor neuron (SMN), which is encoded by the SMN1 and SMN2 genes. It is one of the most common pediatric recessive genetic diseases, and it represents the most common cause of hereditary infant mortality. After decades of intensive basic and clinical research efforts, and improvements in the standard of care, successful therapeutic milestones have been developed, delaying the progression of 5q SMA and increasing patient survival. At the same time, promising data from early-stage clinical trials have indicated that additional therapeutic options are likely to emerge in the near future. Here, we provide updated information on the molecular underpinnings of SMA; we also provide an overview of the rapidly evolving therapeutic landscape for SMA, including SMN-targeted therapies, SMN-independent therapies, and combinational therapies that are likely to be key for the development of treatments that are effective across a patient’s lifespan.

Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes

Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low- and middle-income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high-income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health-related behaviors, or the risk of calcium-related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population-level interventions to safely improve calcium intake and status where necessary.

Changing trends in hip fracture epidemiology in the Republic of Ireland: a follow-up study

A national, population-based study of hip fracture epidemiology is reported following a previously published study for the same population to ascertain the accuracy of projected incidence rates. Results suggest a decline in age-specific incidence rates in females but not males, and an over-estimation of same in the previously reported projections.

PURPOSE

Accurate estimates of hip fracture numbers and incidence rates are necessary for health service resource planning. A study in 2009 estimated projected figures for 2016 and 2026, for the Republic of Ireland. The purpose of the current study was to scrutinize these projections, based upon actual population and fracture statistics for the year 2016.

METHODS

Population data was obtained from the Central Statistics Office, and hip fracture data was obtained from the National HIPE Database for the year 2016, using similar search criteria to the previously published study. Hip fracture numbers and incidence rates were calculated. The calculated figures were compared to projected figures from the previous report.

RESULTS

Population projection models used in the 2009 paper accurately reflected the 2016 Irish population. For younger age groups, projected number of fractures closely estimated actual numbers, however, for those over 70 years of age, hip fracture projections overestimated the actual fracture numbers observed. There was a significant difference in the age-specific hip fracture rates in the over 70 s sub-groups compared to the published results of the 2009 study.

CONCLUSIONS

Hip fracture numbers continue to increase, though the age-specific incidence rates in the Republic of Ireland are reducing in the older age groups. The previously published study over-estimated hip fracture projections for the year 2016 (and potentially 2026) due to a false assumption of a stable age-specific incidence rate in the Republic of Ireland, which is in fact reducing.

Calcium selective channel TRPV6: Structure, function, and implications in health and disease

Calcium-selective channel TRPV6 (Transient Receptor Potential channel family, Vanilloid subfamily member 6) belongs to the TRP family of cation channels and plays critical roles in transcellular calcium (Ca2+) transport, reuptake of Ca2+ into cells, and maintaining a local low Ca2+ environment for certain biological processes. Recent crystal and cryo-electron microscopy-based structures of TRPV6 have revealed mechanistic insights on how the protein achieves Ca2+ selectivity, permeation, and inactivation by calmodulin. The TRPV6 protein is expressed in a range of epithelial tissues such as the intestine, kidney, placenta, epididymis, and exocrine glands such as the pancreas, prostate and salivary, sweat, and mammary glands. The TRPV6 gene is a direct transcriptional target of the active form of vitamin D and is efficiently regulated to meet the body's need for Ca2+ demand. In addition, TRPV6 is also regulated by the level of dietary Ca2+ and under physiological conditions such as pregnancy and lactation. Genetic models of loss of function in TRPV6 display hypercalciuria, decreased bone marrow density, deficient weight gain, reduced fertility, and in some cases alopecia. The models also reveal that the channel plays an indispensable role in maintaining maternal-fetal Ca2+ transport and low Ca2+ environment in the epididymal lumen that is critical for male fertility. Most recently, loss of function mutations in TRPV6 gene is linked to transient neonatal hyperparathyroidism and early onset chronic pancreatitis. TRPV6 is overexpressed in a wide range of human malignancies and its upregulation is strongly correlated to tumor aggressiveness, metastasis, and poor survival in selected cancers. This review summarizes the current state of knowledge on the expression, structure, biophysical properties, function, polymorphisms, and regulation of TRPV6. The aberrant expression, polymorphisms, and dysfunction of this protein linked to human diseases are also discussed.

A preliminary study on the effects of an osteoporosis prevention program based on an Information-Motivation-Behavioral skill model in older adult women: A cluster randomized controlled trial

We aimed to evaluate the feasibility and effects of an osteoporosis prevention program using the Information-Motivation-Behavioral skill (IMB) model in older adult women in this preliminary study. Korean women ≥65 years were randomly assigned to control (N=21) and intervention (N=23) groups. The intervention group participated in an IMB model-based, 12-week osteoporosis prevention program. The primary outcome was osteoporosis prevention behavior over time in both groups directly before, immediately after (post-test 1), and 4 weeks after (post-test 2) the intervention. Participants had a higher retention and attendance rate for the intervention, and the osteoporosis prevention behavior of the intervention group at post-test 1 and post-test 2 had significantly improved. The program based on the IMB model may be a feasible and effective intervention for osteoporosis prevention behavior in older adult women.

Examining subjective well-being among older adults using pain medications

PURPOSE

To examine the relationship between social participation and subjective well-being (SWB) among older adults using pain medications and evaluate the impact of sex on this relationship.

METHODS

A cross-sectional analysis was conducted using the 2019 National Health and Aging Trends Study data, a nationally-representative sample of Medicare beneficiaries 65 years and older. Individuals were included if they reported taking pain medications for five days or more per week over the last month. Social participation was operationalized using the sum score of four items: visiting family and friends, going out for enjoyment, attending religious services, and participation in other organized activities. SWB was operationalized as a latent variable using four items reflecting positive and negative emotions, and three items reflecting self-evaluation. Structural equation modeling was used to test the relationship between key study constructs, as well as the moderating effect of sex on the relationship between social participation and SWB.

RESULTS

A total of 964 (weighted N = 7,660,599) participants were included in the study. Most participants were female (61.3%), White (81.0%), community-dwelling (94.9%) older adults. Confirmatory factor analysis showed appropriate fit for SWB. Social participation had a statistically significant association with SWB (unstandardized regression coefficient = 0.133; 95% CI 0.071, 0.196; p < 0.001) after adjusting for covariates. However, this relationship was not moderated by sex (p = 0.836).

CONCLUSION

Social participation is positively and significantly associated with SWB among older adults using pain medications. Interventions aimed at improving SWB should consider incorporating a social activities component.

Dairy intake and incident functional disability among older Japanese adults: the Ohsaki Cohort 2006 Study

PURPOSE

Previous studies have investigated the association between dairy intake and functional disability, but their results were inconsistent. Our study aimed to investigate whether dairy intake may protect against incident functional disability among Japanese older adults.

METHODS

We conducted a longitudinal analysis of dairy intake with incident functional disability in a prospective cohort study of 11,911 Japanese individuals aged ≥ 65 years who were followed up for 8.2 years on average. Data on milk, yogurt, and cheese intake were collected using a validated food frequency questionnaire. Total dairy intake was the sum of the daily intake of milk, yogurt, and cheese, which was sex-specifically categorized in quintiles. Data on functional disability were retrieved from the public Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CIs) for incident functional disability.

RESULTS

During 97,234 person-years of follow-up, 4874 persons (40.9%) were ascertained as having functional disability. Our study suggested a null association between total dairy intake and incident risk of functional disability; compared to Q1 (the lowest quintile) group, the multivariable-adjusted HRs (95%CIs) were 0.96 (0.88-1.05) for Q2, 0.93 (0.85-1.02) for Q3, 0.93 (0.85-1.02) for Q4, and 1.01 (0.92-1.10) for Q5 (p-trend = 0.840). We did not find any associations between milk, yogurt, or cheese intake and incident risk of functional disability.

CONCLUSION

We found no evidence showing that dairy intake was associated with functional disability among Japanese older adults.

Predictors of lower limb fractures in general Japanese: NIPPON DATA90

Objective

This study aimed to investigate the incidence rates and predictors of lower limb fractures in a general Japanese population.

Methods

NIPPON DATA is a nationwide, long-term, prospective cohort study of individuals who participated in the National Cardiovascular Survey Japan and the National Nutrition Survey in 1990. Overall, 3,134 individuals (1,827 women, 1,307 men) who participated in follow-up assessments in 1995, 2000, and/or 2006 were included in the present analysis. The outcomes of this study were lower limb fractures (including proximal femur fractures).

Results

The mean age at baseline was 63.8 years in women and 63.1 years in men. The average body mass index (BMI) was 23.3 kg/m² in women and 22.9 kg/m² in men. During a mean follow-up of 12.1 years, 271 total lower limb fractures were observed. In women, older age, lower BMI, and less intake of vegetables were associated with increased risks of proximal femur fractures. With regard to the outcome of total lower limb fractures, less intake of vegetables and regular exercise were significant predictors in women. Calcium intake was not significantly associated with proximal femur or total lower limb fractures. There were no significant predictors of proximal femur or total lower limb fractures in men, except for age.

Conclusions

Aging was a significant risk factor for proximal femur and total lower limb fractures in both men and women. With regard to modifiable risk factors, low BMI and low intake of vegetables were associated with increased risks of proximal femur and/or total lower limb fractures in the general population of Japanese women.

Obesity history, physical exam, laboratory, body composition, and energy expenditure: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is intended to provide clinicians an overview of the clinical and diagnostic evaluation of patients with pre-obesity/obesity.

Methods

The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS outlines important components of medical, dietary, and physical activity history as well as physical exams, with a focus on specific aspects unique to managing patients with pre-obesity or obesity. Patients with pre-obesity/obesity benefit from the same preventive care and general laboratory testing as those without an increase in body fat. In addition, patients with pre-obesity/obesity may benefit from adiposity-specific diagnostic testing - both generally and individually - according to patient presentation and clinical judgment. Body composition testing, such as dual energy x-ray absorptiometry, bioelectrical impedance, and other measures, each have their own advantages and disadvantages. Some patients in clinical research, and perhaps even clinical practice, may benefit from an assessment of energy expenditure. This can be achieved by several methods including direct calorimetry, indirect calorimetry, doubly labeled water, or estimated by equations. Finally, a unifying theme regarding the etiology of pre-obesity/obesity and effectiveness of treatments of obesity centers on the role of biologic and behavior efficiencies and inefficiencies, with efficiencies more often associated with increases in fat mass and inefficiencies more often associated with decreases in fat mass.

Conclusion

The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity.

Sex- and Age-Related Dynamic Changes of the Macroelements Content in the Femoral Bone with Hip Osteoarthritis

Simple Summary

The study assessed the content of macroelements Ca, Mg, P, and Na in the proximal femoral bone tissue in patients with hip osteoarthritis, and it correlated with age, sex, and BMI. The high reduction of macroelements in the femoral bone of patients with hip osteoarthritis is more pronounced in the cortical bone and occurs in women under 60 years of age. In men, it begins in the seventh and increases in the eighth decade of life.

Abstract

Background: The content of macroelements in bones varies with age and depends on sex. The aim of the study was to evaluate the content of macroelements and its correlation with age and sex in the femoral bone obtained during total hip arthroplasty. Methods: In the 86 patients, the content of macroelements (Ca, P, Mg, and Na) in the femoral head and neck (cancellous and cortical bone) was assessed by means of the inductively coupled plasma optical emission spectrometry analytical technique (ICP-OES). Results: There was a decrease in the content of macroelements in the cortical bone with age in the women in the 51–60 years (statistically significant: −0.59 for Ca, −0.65 for P) and over 70 years age groups (correlation not statistically significant: −0.29 for Ca, −0.38 for P). A significant decrease in the content of macroelements in the cortical bone was found in men over 70 years of age. Conclusions: Patterns of increased loss of macronutrients (Ca, P, and Mg) in the femoral neck (cortical bone) were demonstrated in the following patients with osteoarthritis: women aged 51–60 years and patients of both sexes over 70 years of age.