How do carbohydrate quality indices influence on bone mass density in postmenopausal women? A case-control study

Treatment of Osteoporosis and Osteoarthritis in the Oldest Old

Osteoporosis and osteoarthritis are key diseases of musculoskeletal ageing and are increasing in prevalence and burden with the progressively ageing population worldwide. These conditions are thus particularly common in 'the oldest old', and there are complexities of managing them within the context of extensive multimorbidity, physical and mental disability, and polypharmacy, the rates for all of which are high in this population. In this narrative review, we explore the epidemiology of osteoporosis and osteoarthritis in the oldest old before examining trials and real-world data relating to the pharmacological treatment of these diseases in older adults, including anti-resorptives and bone-forming agents in osteoporosis and symptomatic slow-acting drugs for osteoarthritis, paracetamol, and non-steroidal anti-inflammatory drugs in osteoarthritis, recognising that the oldest old are usually excluded from clinical trials. We then review the potential benefits of nutritional interventions and exercise therapy before highlighting the health economic benefits of interventions for osteoporosis and osteoarthritis. The high prevalence of risk factors for both disease and adverse events associated with treatment in the oldest old mean that careful attention must be paid to the potential benefits of intervention (including fracture risk reduction and improvements in osteoarthritis pain and function) versus the potential harms and adverse effects. Further direct evidence relating to such interventions is urgently needed from future research.

The Association of Phytochemical Index and oxidative balance score with bone Mineral density: a case-control study

BACKGROUND

Phytochemical index (PI) and oxidative balance score (OBS) have not been previously evaluated in women with osteoporosis. The present study aimed to investigate their relationship with bone mineral density (BMD) in postmenopausal women.

METHODS

The current case-control study included healthy postmenopausal women (n = 131) and postmenopausal women with abnormal BMD (osteopenia: T-score between - 1 and - 2.5; osteoporosis: T-score less than - 2.5) (n = 131). All participants were recruited from the Isfahan Bone Densitometry Center. Dual-energy X-ray absorptiometry (DXA) measured BMD at the lumbar vertebrae and femoral neck, expressed in grams per square centimeter. A validated semi-quantitative food frequency questionnaire was used to assessed PI and OBS. Binary logistic regression was performed to analyze the association between PI and OBS with BMD.

RESULTS

A positive association was observed between PI and both lumbar and femoral BMD (P < 0.001 for both of them). Similarly, a significant positive association was found between OBS and both lumbar and femoral BMD (P < 0.001 for both of them). Compared to the first tertile of PI, significantly higher odds of abnormal BMD were observed in the last tertile across all models (crude model: odds ratio (OR) = 0.25, 95% confidence interval (CI): 0.13-0.46, P < 0.001 - adjusted model 1: OR = 0.23, 95% CI: 0.12-0.44, P < 0.001 - adjusted model 2: OR = 0.28, 95% CI: 0.14-0.55, P < 0.001). Similarly, compared to the first tertile of OBS, higher odds of abnormal BMD were in the last tertile across all models (crude model: OR = 0.25, 95% CI: 0.13-0.47, P < 0.001 - adjusted model 1: OR = 0.24, 95% CI: 0.13-0.46, P < 0.001 - adjusted model 2: OR = 0.26, 95% CI: 0.13-0.52, P < 0.001).

CONCLUSIONS

Overall, the present study highlighted the important role of PI and OBS in abnormal BMD. The findings indicated that higher PI and OBS were inversely associated with the odds of abnormal BMD.

The role of dietary inflammation in the risk of osteoporosis in Iranian postmenopausal women: a case-control study

Chronic inflammation is known to play a critical role in the development of various diseases, such as osteoporosis. The inflammatory potential of a diet can be evaluated using a well-established scale known as the Dietary Inflammatory Index (DII). This study aimed to investigate the relationship between the DII score and the odds of osteoporosis in Iranian women. The study conducted was a case-control study involving 131 postmenopausal healthy women, as well as 131 women with osteoporosis and osteopenia aged 45-65. Osteoporosis was diagnosed through dual-energy X-ray absorptiometry, which measures bone mineral density (BMD) in the femoral neck bone and lumbar spine. To assess the DII score, a validated semi-quantitative food frequency questionnaire was applied. In comparison to the first tertile of DII score, higher and significant odds of osteoporosis/osteopenia were seen in the last tertile (fully adjusted model (body mass index, age, income, education, physical activity, calcium and vitamin D supplements): odds ratio (OR) = 2.43, 95% confidence interval (CI): 1.19-4.95, Ptrend = 0.023). Also, individuals in the highest DII tertile had higher odds of abnormalities in femoral neck and lumbar spine BMD (fully adjusted model: OR = 2.85, 95% CI: 1.37-5.89, Ptrend = 0.007 and OR = 2.59, 95% CI: 1.29-5.19, Ptrend = 0.009, respectively). Based on our findings, it appears that there may be a connection between following pro-inflammatory diets and the odds of osteoporosis in postmenopausal women.

Chrebp Deletion and Mild Protein Restriction Additively Decrease Muscle and Bone Mass and Function

Background/Objectives: Carbohydrate and protein restriction are associated with sarcopenia and osteopenia, but the underlying mechanisms remain unclear. We aimed to determine whether mild protein restriction affects muscle and bone function in wild-type (WT) and homozygous carbohydrate response element binding protein (Chrebp) knockout (KO) mice. Methods: Eighteen-week-old male wild-type and homozygous carbohydrate response element binding protein (Chrebp) knockout (KO) mice were fed a control diet (20% protein) or a low-protein diet (15% protein) for 12 weeks. We estimated the muscle weight and limb grip strength as well as the bone mineral density, bone structure, and bone morphometry. Results: Chrebp deletion and a low-protein diet additively decreased body weight (WT control-KO low-protein: mean difference with 95% CI, 8.7 [6.3, 11.0], p < 0.0001) and epidydimal fat weight (1.0 [0.7, 1.2], p < 0.0001). Chrebp deletion and a low-protein diet additively decreased tibialis anterior muscle weight (0.03 [0.01, 0.05], p = 0.002) and limb grip strength (63.9 [37.4, 90.5], p < 0.0001) due to a decrease in insulin/insulin-like growth factor 1 mRNA and an increase in myostatin mRNA. In contrast, Chrebp deletion increased bone mineral density (BMD) (WT control-KO control: -6.1 [-1.0, -2.3], p = 0.0009), stiffness (-21.4 [-38.8, -4.1], p = 0.011), cancellous bone BV/TV (-6.517 [-10.99, -2.040], p = 0.003), and the number of trabeculae (-1.1 [-1.8, -0.5], p = 0.0008). However, in KO mice, protein restriction additively decreased BMD (KO control-KO low-protein: 8.1 [4.3, 11.9], p < 0.0001), bone stiffness (38.0 [21.3, 54.7], p < 0.0001), cancellous bone BV/TV (7.7 [3.3, 12.2], p = 0.006), and the number of trabeculae (1.2 [0.6, 1.9], p = 0.0004). The effects of mild protein restriction on bone formation parameters (osteoid volume (WT control-WT low-protein: -1.7 [-2.7, -0.7], p = 0.001) and the osteoid surface (-11.2 [-20.8, -1.5], p = 0.02) were observed only in wild-type (WT) mice. The levels of bone resorption markers, such as the number of osteoclasts on the surface, the number of osteoclasts, and surface erosion, did not differ between the groups. Conclusions: Both Chrebp deletion and protein restriction led to a decrease in muscle and bone function; therefore, an adequate intake of carbohydrates and proteins is important for maintaining muscle and bone mass and function. Further studies will be needed to elucidate the mechanisms by which ChREBP deletion and a low-protein diet cause osteosarcopenia.

Dietary glycemic and insulin indices with the risk of osteoporosis: results from the Iranian teachers cohort study

Background

Osteoporosis is a chronic condition characterized by reduced bone strength and an elevated risk of fractures. The influence of diet and glucose metabolism on bone health and the development of osteoporosis has been an area of interest. This study aimed to investigate the potential association between dietary glycemic index (DGI), dietary glycemic load (DGL), dietary insulin index (DII), dietary insulin load (DIL), and the odds of osteoporosis among Iranian adults.

Methods

Data from 12,696 Iranian teachers (35-50 years) in a cross-sectional study on diet, nutrition, physical activity, and diseases were analyzed. The participants had no history of diabetes, cardiovascular diseases, stroke, thrombosis, or cancer and consumed between 800 and 4,200 kcal/day. We estimated DGI, DGL, DII, and DIL from a validated semi-quantitative food-frequency questionnaire (FFQ). We also diagnosed osteoporosis using dual-energy X-ray absorptiometry.

Results

In the fully adjusted model, higher DGI and DGL were significantly associated with increased odds of osteoporosis (OR = 1.78 and 1.46 for the highest vs. the lowest tertile; P trend < 0.05). Nonetheless, no significant association was found between DII or DIL and osteoporosis prevalence. Moreover, higher DIL and DGL were associated with a higher intake of calorie-dense/nutrient-poor foods and a lower intake of antioxidant-rich foods.

Conclusion

Although our study showed that high DGI/DGL increased osteoporosis risk in Iranian teachers, no association was found between DII/DIL and osteoporosis prevalence. More research is needed to confirm these results and understand the mechanisms involved.

Nutrition and Bone Marrow Adiposity in Relation to Bone Health

Bone remodeling is energetically demanding process. Energy coming from nutrients present in the diet contributes to function of different cell type including osteoblasts, osteocytes and osteoclasts in bone marrow participating in bone homeostasis. With aging, obesity and osteoporosis the function of key building blocks, bone marrow stromal cells (BMSCs), changes towards higher accumulation of bone marrow adipose tissue (BMAT) and decreased bone mass, which is affected by diet and sex dimorphism. Men and women have unique nutritional needs based on physiological and hormonal changes across the life span. However, the exact molecular mechanisms behind these pathophysiological conditions in bone are not well-known. In this review, we focus on bone and BMAT physiology in men and women and how this approach has been taken by animal studies. Furthermore, we discuss the different diet interventions and impact on bone and BMAT in respect to sex differences. We also discuss the future perspective on precision nutrition with a consideration of sex-based differences which could bring better understanding of the diet intervention in bone health and weight management.

Association between daily consumption of spicy food and bone mineral density in middle-aged and older adults: a cross-sectional study

Background: Many studies have reported the effects of spicy food on human health, but no studies have been conducted on the impact of long-term spicy food consumption on bone mineral density (BMD). This study aimed to investigate the impact of daily consumption of spicy food on BMD in the population aged 50 years and older. Methods: This cross-sectional study was conducted from 2020 to 2022 in Jiangxi Province, China. This study investigated the differences in BMD between non-consumers and daily spicy food consumers in adults aged 50-85 years. A multiple linear regression model was used to investigate the association between spicy food consumption and BMD of the total lumbar spine (LS), femoral neck (FN), and total hip, as well as biochemical markers of bone metabolism (BMBM) levels. Results: The results showed that daily consumption of spicy food was negatively associated with total LS BMD (β = -0.013, P = 0.015). Subgroup analyses showed this negative association was more pronounced among smokers and drinkers compared to non-smokers (β: -0.006 vs. -0.042; P for interaction <0.05) and non-drinkers (β: -0.004 vs. -0.037; P for interaction <0.05). In addition, according to the daily frequency of spicy food consumption, the daily spicy food consumers were categorized into one meal per day, two meals per day, and three meals per day groups. Further analysis revealed that the negative association between spicy food and total LS BMD was progressively stronger as the frequency of daily consumption of spicy food increased (P for trend <0.05). For BMBM, daily consumption of spicy food was positively associated with serum PINP levels and negatively associated with serum Ca and serum Mg levels. Conclusions: Our study suggested that daily consumption of spicy food was associated with lower LS BMD in middle-aged and older Chinese adults, and this association was more pronounced in the smoking and drinking populations. The adverse effects of spicy food on LS BMD become progressively stronger with increasing frequency of daily consumption of spicy food. In addition, daily consumption of spicy food was associated with higher PINP levels and lower serum Ca and Mg levels.

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 relation between dietary quality and healthy eating index with bone mineral density in osteoporosis: a case-control study

BACKGROUND

In this study, we aimed to illustrate the association between the Healthy Eating Index (HEI) and Dietary Quality Index (DQI) with bone mineral density (BMD) among postmenopausal Iranian women with osteoporosis compared to the healthy control.

METHODS

In the current case-control study, 131 postmenopausal women with osteoporosis and 131 healthy postmenopausal women participated. Dual-energy X-ray absorptiometry was used to assess the lumbar vertebrae and femoral neck BMD. The subjects completed a validated food frequency questionnaire (FFQ), and then HEI and DQI were calculated based on the FFQ data. Crude and adjusted multivariable logistic regression was used to assess the relation between HEI and DQI with the odds of the femoral and lumbar BMD.

RESULTS

According to the results, participants in the last tertile of HEI were more likely to have higher femoral and lumbar BMD in the crude model (odds ratio (OR) = 0.38; 95% confidence interval (CI): 0.20-0.71 and OR = 0.20; 95% CI: 0.10-0.40, respectively) and also in the adjusted model (OR = 0.40; 95% CI: 0.20-0.78 and OR = 0.20; 95% CI: 0.10-0.41, respectively). Also, in terms of DQI-I, participants in the last tertile were more likely to have higher femoral and lumbar BMD in the crude model (OR = 0.23; 95% CI: 0.12-0.45 and OR = 0.29; 95% CI: 0.15-0.55, respectively) and also in the adjusted model (OR = 0.29; 95% CI: 0.14-0.58 and OR = 0.34; 95% CI: 0.17-0.67, respectively).

CONCLUSIONS

The results of the current study supported the hypothesis that high-quality diets with healthy patterns can be clinically effective in maintaining bone health. Thus, recommendations regarding the consumption of nutrient-rich food groups in a healthy diet can serve as a practical non-pharmacological strategy against osteoporosis.

Dietary Calcium Intake and Osteoporosis Risk in Arab Adults

Osteoporosis is a major public health concern in Saudi Arabia's aging population. There is particularly limited information on how diet affects bone loss in this ethnic group. The purpose of this study was to examine the association between dietary calcium (Ca) intake and osteoporosis risk in Saudi adults. A total of 1950 patients (416 males and 1534 females) with known risk factors for osteoporosis participated in this cross-sectional study. A short questionnaire (CaQ) was used to assess dietary Ca intakes in patients attending tertiary hospitals in Riyadh City. The prevalence of osteoporosis was 21.3% and was more common in females (93.5%). Patients with osteoporosis were older (p < 0.001) and had lower BMI (p < 0.001). Results showed that the overall mean Ca intake was only 445.1 mg/day (recommended dietary intake of 1300 mg/day). Tea intake (OR = 0.8 95%CI: 0.7-1.0; p = 0.02) and consumption of fish and eggs (OR = 0.9 95%CI: 0.8-1.0; p = 0.01) were significantly associated with a lower risk of osteoporosis. Furthermore, consumption of biscuits, cake and bread slices were significantly associated with higher incidence of osteoporosis (OR = 1.3 95%CI: 1.0-1.5; p = 0.02). In conclusion, extremely low dietary Ca intake was observed among Saudi adults already at risk of osteoporosis. A balanced diet including high amount of Ca, vitamin D and omega-3 fatty acids accompanied by limiting consumption of foods high in saturated fats and glycemic index may be helpful in reducing osteoporosis risk in the Saudi adult population.

Associations between Macronutrients Intake and Bone Mineral Density: A Longitudinal Analysis of the Health Workers Cohort Study Participants

OBJECTIVE

This study aimed to evaluate the association between macronutrient intake and bone mineral density (BMD) using non-substitution and substitution statistical approaches.

DESIGN

Longitudinal analysis.

SETTINGS AND PARTICIPANTS

1,317 adults in the Health Worker Cohort Study in Mexico.

MEASUREMENTS

These participants were assessed at baseline (2004-2006) and follow-up (2010-2012). Dietary intakes were assessed using validated food frequency questionnaires. BMD at the different sites was performed by dual-energy X-ray absorptiometry (DXA). Hybrid-mixed effects regression models were performed to evaluate the associations of interest.

RESULTS

Cross-sectional associations were found between fiber intake and higher total hip and femoral neck BMD in women and longitudinal associations with loss of femoral neck BMD in men. An increase in 5% energy intake from carbohydrate was associated with a BMD loss at several site in women and total hip and femoral neck in men. In both sexes, an increase in 5% energy intake of animal protein or fat was associated with a site-specific BMD gain after six years. Substitution analysis showed that the energy intake replacement from fat or carbohydrate by protein had an increase in BMD at different sites in women; while in men, it was only significant when replacing carbohydrate. Substitution of protein or fat by carbohydrates was associated with lower BMD in women, and only protein replacement by carbohydrates in men.

CONCLUSION

Our findings suggest that carbohydrate intake was associated with loss of BMD, while animal protein and fat intake was associated with gain of BMD among the Mexican population. Macronutrient substitutions resulted in significant associations; however, additional studies are needed to confirm these findings.