Osteoporosis, vitamin C intake, and physical activity in Korean adults aged 50 years and over

Elucidating causal relationships of diet-derived circulating antioxidants and the risk of osteoporosis: A Mendelian randomization study

Background

Osteoporosis (OP) is typically diagnosed by evaluating bone mineral density (BMD), and it frequently results in fractures. Here, we investigated the causal relationships between diet-derived circulating antioxidants and the risk of OP using Mendelian randomization (MR).

Methods

Published studies were used to identify instrumental variables related to absolute levels of circulating antioxidants like lycopene, retinol, ascorbate, and β-carotene, as well as antioxidant metabolites such as ascorbate, retinol, α-tocopherol, and γ-tocopherol. Outcome variables included BMD (in femoral neck, lumbar spine, forearm, heel, total body, total body (age over 60), total body (age 45-60), total body (age 30-45), total body (age 15-30), and total body (age 0-15)), fractures (in arm, spine, leg, heel, and osteoporotic fractures), and OP. Inverse variance weighted or Wald ratio was chosen as the main method for MR analysis based on the number of single nucleotide polymorphisms (SNPs). Furthermore, we performed sensitivity analyses to confirm the reliability of the findings.

Results

We found a causal relationship between absolute retinol levels and heel BMD (p = 7.6E-05). The results of fixed effects IVW showed a protective effect of absolute retinol levels against heel BMD, with per 0.1 ln-transformed retinol being associated with a 28% increase in heel BMD (OR: 1.28, 95% CI: 1.13-1.44). In addition, a sex-specific effect of the absolute circulating retinol levels on the heel BMD has been observed in men. No other significant causal relationship was found.

Conclusion

There is a positive causal relationship between absolute retinol levels and heel BMD. The implications of our results should be taken into account in future studies and in the creation of public health policies and OP prevention tactics.

Innovative Application of Chicken Eggshell Calcium to Improve the Functional Value of Gingerbread

Food waste, such as eggshell, can be an environmental problem if it is not properly managed. One of the ways to solve this is by using the eggshell as the cheap calcium source in food products. Polish gingerbread fortified with chicken eggshell powder (ESP) calcium was developed to solve the eggshell waste problem and to reduce the risk of osteoporosis. This study focused on the effect of ESP addition on basic composition, sensory evaluation, and antioxidative activity of gingerbread. Two samples of gingerbread without and with 3% (w/w of wheat flour) ESP, with controlled green tea powder (4% w/w of white chocolate) were analyzed. Results of the research showed that the addition of 3% ESP significantly increased the ash and calcium content (p < 0.05) without changing the appearance, aroma, texture, taste profiles, and the hedonic score of gingerbread. The gingerbread samples were then stored for 2 months and were analyzed every month. The hedonic evaluation of the aroma of both gingerbread samples decreased significantly (p < 0.05) during storage. During 2 months of storage, the antioxidative activity of gingerbread fortified with 3% ESP was not significantly different compared to the control (p > 0.05), particularly in ABTS and ORACFL assay. The ABTS, DPPH, and ORACFL assays showed decreasing antioxidative activity during storage, which was also in accordance with decreasing total phenolic content of both gingerbread samples. In PCL assay, the lipid-soluble antioxidant activity in gingerbread with 3% ESP was significantly higher during 2 months of storage, compared to the control (p < 0.05). The developed product might be a potential alternative to improve the calcium (26% daily value (DV) recommendation per 100 g) and antioxidant intake in order to prevent calcium deficiency. Gingerbread enriched with an organic source of calcium may become an innovative product to reduce the risk of developing osteoporosis in the elderly population, having potential health and economic significance, given the incidence of osteoporosis and the costs of treating this disease.

Vitamin C in orthopedic practices: Current concepts, novel ideas, and future perspectives

Vitamin C (ascorbic acid), is an important antioxidant that has been applied broadly in the field of orthopaedics. Current research on vitamin C examines the molecule's role in bone and tendon physiology, as well as joint replacement and Postoperative pain. Most laboratory and human studies associate the use of vitamin C with improved bone health and tendon healing. Recent literature moderately supports the use of vitamin C to improve functional outcomes, decreased postoperative pain, and prevent complex regional pain syndrome following orthopaedic procedures. The perioperative use of vitamin C in patients undergoing joint replacement surgery and anterior cruciate ligament reconstruction is still under investigation. Overall, there is need for high-quality human trials to confirm whether vitamin C can potentiate the outcomes of orthopaedic procedures and to determine optimal dosage and means of administration to maximize its proposed benefits. The purpose of this review was to summarize the application of vitamin C in orthopaedic practices and to identify potential areas for future study.

Association of Dietary Total Antioxidant Capacity with Bone Mass and Osteoporosis Risk in Korean Women: Analysis of the Korea National Health and Nutrition Examination Survey 2008-2011

Antioxidant intake has been suggested to be associated with a reduced osteoporosis risk, but the effect of dietary total antioxidant capacity (TAC) on bone health and the risk of osteoporosis remains unclear. We aimed to assess the hypothesis that dietary TAC is positively associated with bone mass and negatively related to the risk of osteoporosis in Korean women. This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. Dietary TAC was estimated using task automation and an algorithm with 24-h recall data. In total, 8230 pre- and postmenopausal women were divided into four groups according to quartiles of dietary TAC. Dietary TAC was negatively associated with the risk of osteoporosis (odds ratio, 0.73; 95% confidence interval, 0.54-0.99; p-value = 0.045) in postmenopausal women, but not in premenopausal women. Dietary TAC was positively associated with bone mineral content (BMC) and bone mineral density of the femoral neck and lumbar spine in postmenopausal women and BMC of the total femur and lumbar spine in premenopausal women. Our study suggests that dietary TAC is inversely associated with the risk of osteoporosis in postmenopausal women and positively associated with bone mass in both pre- and postmenopausal women.

Evidence of a Positive Link between Consumption and Supplementation of Ascorbic Acid and Bone Mineral Density

In animal models it has been shown that ascorbic acid (AA) is an essential cofactor for the hydroxylation of proline in collagen synthesis. However, there are still no precise indications regarding the role of AA in maintaining bone health in humans, so the aim of this narrative review was to consider state of the art on correlation between bone mineral density (BMD), AA dietary intake and AA blood levels, and on the effectiveness of AA supplement in humans. This review included 25 eligible studies. Fifteen studies evaluated correlations between AA intake and BMD: eight studies demonstrated a positive correlation between AA dietary intake and BMD in 9664 menopausal women and one significant interaction between effects of AA intake and hormone therapy. These data were also confirmed starting from adolescence (14,566 subjects). Considering studies on AA blood concentration and BMD, there are four (337 patients) that confirm a positive correlation. Regarding studies on supplementation, there were six (2671 subjects), of which one was carried out with AA supplementation exclusively in 994 postmenopausal women with a daily average dose of 745 mg (average period: 12.4 years). BMD values were found to be approximately 3% higher in women who took supplements.

Functional Food for Elderly High in Antioxidant and Chicken Eggshell Calcium to Reduce the Risk of Osteoporosis-A Narrative Review

The elderly population is increasing globally and is predicted to reach 1.5 billion in 2050. The quality of life of the elderly must be concerned, for example, with developing functional food for the elderly. In this article, the development of functional food to reduce the risk of osteoporosis in the elderly is reviewed. Oxidative stress is one of the factors which accelerates osteoporosis. Various antioxidants, including vitamin C, vitamin E, polyphenols, or lycopene, have been proven by former studies to have antioxidant activity, therefore, could reduce the risk of osteoporosis. Additionally, the application of eggshell powder in various food products has been reported to improve calcium intake, and its usage is environmentally sustainable as this could contribute to reducing food waste. The application of both antioxidants and calcium could be a good combination, but the amount of some antioxidants must be concerned so it would not interfere with the bioavailability of calcium. Therefore, this review aims to explore the functional food for the elderly to reduce the risk of osteoporosis, particularly with antioxidants and calcium from chicken eggshells. The eating preference and dietary pattern of the elderly are also considered to determine the suitable form of functional food for the elderly. The results presented in the study may be the basis for the development of new calcium-enriched food products for the elderly.

MicroRNA expression profiling in an ovariectomized rat model of postmenopausal osteoporosis before and after estrogen treatment

Postmenopausal osteoporosis (PMOP) is a common disease that seriously threatens human health. Estrogen deficiency plays an essential role in the pathogenesis of PMOP. MicroRNAs (miRNAs) are involved in the development and progression of PMOP. Therefore, identification of miRNAs in PMOP due to estrogen deficiency may contribute to earlier diagnosis and better treatment of this disease. The rat model of PMOP was established by ovariectomy. After one month of treatment, the knee joints were evaluated by microcomputed tomography and histological analysis. The plasma estrogen levels were quantified by enzyme-linked immunosorbent assays (ELISAs). MiRNA levels were analyzed by high-throughput sequencing and validated using quantitative real-time PCR (qRT-PCR). Two months after ovariectomy, osteoporosis occurred in the subchondral bone of the rats in the PMOP group, while fewer symptoms of osteoporosis occurred in the subchondral bone of the rats with estrogen replacement therapy. Cartilage degeneration was detected in the PMOP group. MiR-29a-3p, miR-93-5p, and miR-486 expression decreased in the PMOP group compared to the control group. After estrogen treatment for one month, the plasma levels of miR-29a-3p, miR-93-5p, and miR-486 recovered to the normal levels. Estrogen eliminated the expression changes in miR-29a-3p, miR-93-5p, and miR-486. The identification of these differentially expressed miRNAs will help elucidate the crucial role of miRNAs in the pathogenesis of PMOP. Our data could lead to the potential utilization of miRNAs in the diagnosis of PMOP and provide a possible therapeutic target for treatment of this disease.

Role of Vitamin C in Osteoporosis Development and Treatment-A Literature Review

Osteoporosis and associated low energy fractures are a significant clinical problem, especially in the elderly population. The occurrence of a hip fracture is associated with significant mortality and a high risk of disability. For this, apart from the treatment of osteoporosis, effective prevention of both the development of the disease and related fractures is extremely important. One aspect of osteoporosis prevention is proper dietary calcium intake and normal vitamin D3 levels. However, there is some evidence for a potential role of vitamin C in osteoporosis and fracture prevention, too. This review aims to summarize the current knowledge about the role of vitamin C in osteoporosis development, prevention and treatment. The PubMed/Medline search on the role of vitamin C in bone metabolism database was performed for articles between 2000 and May 2020. Reports from in vitro and animal studies seem promising. Epidemiological studies also indicate the positive effect of high vitamin C content in the daily diet on bone mineral density. Despite promising observations, there are still few observational and intervention studies and their results do not allow for unequivocal determination of the benefits of high daily intake of vitamin C or its long-term supplementation.

Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases

The chronic character of inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.

The Paradoxical Role of Uric Acid in Osteoporosis

Because of its high prevalence worldwide, osteoporosis is considered a serious public health concern. Many known risk factors for developing osteoporosis have been identified and are crucial if planning health care needs. Recently, an association between uric acid (UA) and bone fractures had been explored. Extracellular UA exhibits antioxidant properties by effectively scavenging free radicals in human plasma, but this benefit might be disturbed by the hydrophobic lipid layer of the cell membrane. In contrast, intracellular free oxygen radicals are produced during UA degradation, and superoxide is further enhanced by interacting with NADPH oxidase. This intracellular oxidative stress, together with inflammatory cytokines induced by UA, stimulates osteoclast bone resorption and inhibits osteoblast bone formation. UA also inhibits vitamin D production and thereby results in hyper-parathyroidism, which causes less UA excretion in the intestines and renal proximal tubules by inhibiting the urate transporter ATP-binding cassette subfamily G member 2 (ABCG2). At normal or high levels, UA is associated with a reduction in bone mineral density and protects against bone fracture. However, in hyperuricemia or gout arthritis, UA increases bone fracture risk because oxidative stress and inflammatory cytokines can increase bone resorption and decrease bone formation. Vitamin D deficiency, and consequent secondary hyperparathyroidism, can further increase bone resorption and aggravated bone loss in UA-induced osteoporosis.

Vitamin C intake in relation to bone mineral density and risk of hip fracture and osteoporosis: a systematic review and meta-analysis of observational studies

We aimed to systematically review available data on the association between vitamin C intake and bone mineral density (BMD), as well as risk of fractures and osteoporosis, and to summarise this information through a meta-analysis. Previous studies on vitamin C intake in relation to BMD and risk of fracture and osteoporosis were selected through searching PubMed, Scopus, ISI Web of Science and Google Scholar databases before February 2017, using MeSH and text words. To pool data, either a fixed-effects model or a random-effects model was used, and for assessing heterogeneity, Cochran's Q and I 2 tests were used. Subgroup analysis was applied to define possible sources of heterogeneity. Greater dietary vitamin C intake was positively associated with BMD at femoral neck (pooled r 0·18; 0·06, 0·30) and lumbar spine (pooled r 0·14; 95 % CI 0·06, 0·22); however, significant between-study heterogeneity was found at femoral neck: I 2=87·6 %, P heterogeneity<0·001. In addition, we found a non-significant association between dietary vitamin C intake and the risk of hip fracture (overall relative risk=0·74; 95 % CI 0·51, 1·08). Significant between-study heterogeneity was found (I 2=79·1 %, P heterogeneity<0·001), and subgroup analysis indicated that study design, sex and age were the main sources of heterogeneity. Greater dietary vitamin C intake was associated with a 33 % lower risk of osteoporosis (overall relative risk=0·67; 95 % CI 0·47, 0·94). Greater dietary vitamin C intake was associated with a lower risk of hip fracture and osteoporosis, as well as higher BMD, at femoral neck and lumbar spine.

Bioinformatics Analysis Reveals the Altered Gene Expression of Patients with Postmenopausal Osteoporosis Using Liuweidihuang Pills Treatment

Postmenopausal osteoporosis (PMOP), as well as its associated increased risk for fragility fracture, is one of the most disabling consequences of aging in women. This present study aimed to identify candidate genes that involve pathogenesis of PMOP and the therapeutic mechanism of Liuweidihuang (LWDH) pills on PMOP. We integrated microarray datasets of PMOP derived from the Gene Expression Omnibus (GEO) to screen differentially expressed genes (DEGs) between PMOP and normal controls as well as patients with PMOP and patients after treatment of LWDH pills. GO and KEGG enrichment analysis for DEGs were performed. The shared DEGs, associated with both the pathogenesis of PMOP and the therapeutic mechanism of LWDH, were further analyzed by protein-protein interaction (PPI) network. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to verify the DEGs obtained by our integrated analysis. Compared with normal controls, 1732 DEGs in PMOP were obtained with p<0.05. According to the qRT-PCR results, expression of ATF2, FBXW7, RDX, and RBBP4 was consistent with that in our integrated analysis, generally. GO and KEGG enrichment analysis showed that those DEGs were significantly enriched in regulation of transcription, DNA-dependent, cytoplasm, protein binding, and MAPK signaling pathway. A total of 58 shared DEGs in PMOP versus normal control and in patients with PMOP versus patients after LWDH treatment were identified, which had opposite expression trend in these two comparisons. In the PPI network, CSNK2A1, ATF2, and FBXW7 were three hub proteins. Three genes including ATF2, FBXW7, and RDX were speculated to be therapeutic targets of LWDH for PMOP based on BATMAN-TCM database. We speculated that three genes of ATF2, FBXW7, and RDX may play crucial roles in both pathogenesis of PMOP and therapeutic mechanism of LWDH on PMOP. Our results may provide clues for the molecular pathogenesis of PMOP and offer new possibilities for treatment of PMOP.

Can Dietary Intake of Vitamin C-Oriented Foods Reduce the Risk of Osteoporosis, Fracture, and BMD Loss? Systematic Review With Meta-Analyses of Recent Studies

Background: Several epidemiological studies have been performed to evaluate the association of dietary intake of vitamin C-oriented foods (DIVCF) with risk of fracture and bone mineral density (BMD) loss, but the results remain controversial. Therefore, we conducted a systematic meta-analysis to assess this correlation. Methods: We searched EmBase, PubMed, Web of Science, and the Chinese database CNKI for relevant articles published up to August 2019. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using the random- or fixed-effects model. Discrepancies were resolved by consultation with a third expert. Results: A total of 13 eligible articles (including 17 studies) with 19,484 subjects were identified for the present meta-analysis. The pooled RR of hip fracture for the highest vs. lowest category was 0.66 (95% CI, 0.47-0.94) for DIVCF, i.e., people with a greater frequency of Vitamin C uptake had a 34% (95% CI, 6%-53%) lower prevalence of hip fracture. In subgroup analyses stratified by study design, gender, and age, the negative associations were statistically significant. Furthermore, the statistical analysis of the association between DIVCF and risk of osteoporosis (RR, 0.66; 95% CI, 0.48-0.92), BMD at the lumbar spine (pooled r, 0.15; 95% CI, 0.09-0.23), and BMD at the femoral neck (pooled r, 0.20; 95% CI, 0.11-0.34) showed beneficial effects of DIVCF. Conclusion: Our meta-analysis indicates that DIVCF is negatively associated with the risk of hip fracture, osteoporosis, and BMD loss, suggesting that DIVCF decreases the risk of hip fracture, osteoporosis, and BMD loss.

Association of ACTN3 polymorphisms with BMD, and physical fitness of elderly women

[Purpose] Association of ACTN3 polymorphism with bone mineral density and the physical fitness of elderly women is still unclear. Therefore, this study investigated the association between ACTN3 genotype and bone mineral density, and the physical fitness of elderly women. [Subjects and Methods] Sixty-eight elderly women (67.38 ± 3.68 years) were recruited at a Seongbuk-Gu (Seoul, Korea) Medical Service Public Health Center. Measurements of physical fitness included muscle strength, muscle endurance, flexibility, agility, balance and VO₂max. Bone mineral density (BMD), upper limb muscle mass, lower limb muscle mass, percent body fat and body fat mass for the entire body were measured by dual-energy X-ray absorptiometry and an analyzer. Genotyping for the ACTN3 R577X (rs1815739) polymorphism was performed using the TaqMan approach. [Results] ACTN3 gene distribution of subjects were in the Hardy-Weinberg equilibrium (p=0.694). The relative bone mineral density trunk, pelvis and spine differed significantly among the ACTN3 genotypes. There were no significant differences among bone mineral densities of the head, arms, legs, ribs and total, but the RR genotype tended to be higher than other genotypes. Physical fitness was not significantly different among the ACTN3 genotypes. [Conclusion] These results suggest that ACTN3 gene polymorphisms could be used as one of the genetic determinants of bone mass in elderly women, and in particular, they indicate that individuals with the RR genotype have higher BMD and bone mineral composition.

Relationship between bone mineral density and dietary intake of β-carotene, vitamin C, zinc and vegetables in postmenopausal Korean women: a cross-sectional study

Objective

To examine the relationship between nutritional intake and bone mineral density (BMD) in postmenopausal Korean women.

Methods

Dietary intake was recorded in postmenopausal Korean women using a semiquantitative questionnaire. The frequency of consumption of various food groups and nutrient intake were calculated. BMD T-scores were measured at the lumbar spine, femoral neck and total hip using dual-energy X-ray absorptiometry. Associations between T-scores and dietary intake were analysed using partial correlation coefficients and multiple linear regression analysis.

Results

A total of 189 postmenopausal women were included in the study. β-Carotene intake was positively correlated with the lumbar spine T-score. Sodium and vitamin C intake were positively associated and folate intake negatively associated with the femoral neck T-score. Sodium, zinc and vitamin C intake were positively correlated and potassium intake was negatively correlated with the total hip T-score. Vegetable intake showed a positive association with the femoral neck and total hip T-scores.

Conclusion

In postmenopausal Korean women, β-carotene, vitamin C, zinc and sodium intakes were positively associated with bone mass. Furthermore, frequency of vegetable consumption was positively associated with femoral neck and total hip T-scores.