Comparison of bone tissue trace-element concentrations and mineral density in osteoporotic femoral neck fractures and osteoarthritis

Iron, Zinc, Copper, Cadmium, Mercury, and Bone Tissue

The paper presents the current understanding on the effects of five metals on bone tissue, namely iron, zinc, copper, cadmium, and mercury. Iron, zinc, and copper contribute significantly to human and animal metabolism when present in sufficient amounts, but their excess or shortage increases the risk of developing bone disorders. In contrast, cadmium and mercury serve no physiological purpose and their long-term accumulation damages the osteoarticular system. We discuss the methods of action and interactions between the discussed elements as well as the concentrations of each element in distinct bone structures.

The Mutual Incorporation of Mg2+ and CO32- into Hydroxyapatite: A DFT Study

Hydroxyapatite (HA) with a stoichiometry composition of Ca₁₀(PO₄)₆(OH)₂ is widely applied for various biomedical issues, first of all for bone defect substitution, as a catalyst, and as an adsorbent for soil and water purification. The incorporation of foreign ions changes the acid-base relation, microstructure, porosity, and other properties of the HA materials. Here, we report the results of calculations of the density functional theory and analyze the possibility of two foreign ions, CO₃^2- and Mg²⁺, to be co-localized in the HA structure. The Na⁺ was taken into account for charge balance preservation. The analysis revealed the favorable incorporation of CO₃^2- and Mg²⁺ as a complex when they interact with each other. The energy gain over the sole ion incorporation was pronounced when CO₃^2- occupied the A position and Mg²⁺ was in the Ca(2) position and amounted to -0.31 eV. In the most energy-favorable complex, the distance between Mg²⁺ and the O atom of carbonate ion decreased compared to Mg…O distances to the surrounding phosphate or hydroxide ions, and amounted to 1.98 Å. The theoretical calculations agree well with the experimental data reported earlier. Understating the structure-properties relationship in HA materials varying in terms of composition, stoichiometry, and morphology paves the way to rational designs of efficient bio-based catalytic systems.

The Abundance of Trace Elements in Human Bone Relative to Bone Type and Bone Pathology

As the global population ages and the proportion of individuals afflicted with musculoskeletal disease spirals upward, there is an increasing interest in understanding and preventing bone-related diseases. Bone diseases, such as osteoporosis and osteoarthritis, are known to be influenced by a variety of factors including age, gender, nutrition, and genetics, but are also inherently linked to the human body's ability to produce biominerals of suitable quality. Because the crystal lattice structure and mineralogy of bone hydroxyapatite is surprisingly analogous to geological hydroxyapatite, trace element levels and exposure have long been proposed to influence the structure of biominerals as they do geological minerals (e.g., strontium substitution changes the crystal lattice of bone minerals, while toxic lead disrupt bone cellular processes leading to bone disease). Here, we explore the distribution of trace elements in human bones to evaluate the distribution of these elements with respect to bone type (cortical vs. trabecular) and bone disease (osteoarthritis vs. osteoporosis). We find higher concentrations of many metabolically active transition metals, as well as lead, in cortical bone compared to trabecular bone. When compared to patients who have osteoarthritis, and thus presumably normal bone minerals, osteoporosis patients have higher concentrations of scandium and chromium (Cr) in trabecular bone, and Cr and lead in cortical bone. Lower concentrations of barium and titanium are associated with osteoporotic trabecular bone. This survey is an exploratory cross-sectional geochemical examination of several trace element concentrations previously understudied in human bone minerals.

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.

Role of Dietary Supplements and Probiotics in Modulating Microbiota and Bone Health: The Gut-Bone Axis

Osteoporosis is characterized by an alteration of bone microstructure with a decreased bone mineral density, leading to the incidence of fragility fractures. Around 200 million people are affected by osteoporosis, representing a major health burden worldwide. Several factors are involved in the pathogenesis of osteoporosis. Today, altered intestinal homeostasis is being investigated as a potential additional risk factor for reduced bone health and, therefore, as a novel potential therapeutic target. The intestinal microflora influences osteoclasts’ activity by regulating the serum levels of IGF-1, while also acting on the intestinal absorption of calcium. It is therefore not surprising that gut dysbiosis impacts bone health. Microbiota alterations affect the OPG/RANKL pathway in osteoclasts, and are correlated with reduced bone strength and quality. In this context, it has been hypothesized that dietary supplements, prebiotics, and probiotics contribute to the intestinal microecological balance that is important for bone health. The aim of the present comprehensive review is to describe the state of the art on the role of dietary supplements and probiotics as therapeutic agents for bone health regulation and osteoporosis, through gut microbiota modulation.

Magnesium Picolinate Improves Bone Formation by Regulation of RANK/RANKL/OPG and BMP-2/Runx2 Signaling Pathways in High-Fat Fed Rats

Magnesium (Mg) deficiency may affect bone metabolism by increasing osteoclasts, decreasing osteoblasts, promoting inflammation/oxidative stress, and result in subsequent bone loss. The objective of the present study was to identify the molecular mechanism underlying the bone protective effect of different forms of Mg (inorganic magnesium oxide (MgO) versus organic magnesium picolinate (MgPic) compound) in rats fed with a high-fat diet (HFD). Forty-two Wistar albino male rats were divided into six group (n = 7): (i) control, (ii) MgO, (iii) MgPic, (iv) HFD, (v) HFD + MgO, and (vi) HFD + MgPic. Bone mineral density (BMD) increased in the Mg supplemented groups, especially MgPic, as compared with the HFD group (p < 0.001). As compared with the HFD + MgO group, the HFD + MgPic group had higher bone P (p < 0.05) and Mg levels (p < 0.001). In addition, as compared to MgO, MgPic improved bone formation by increasing the levels of osteogenetic proteins (COL1A1 (p < 0.001), BMP2 (p < 0.001), Runx2 (p < 0.001), OPG (p < 0.05), and OCN (p < 0.001), IGF-1 (p < 0.001)), while prevented bone resorption by reducing the levels of RANK and RANKL (p < 0.001). In conclusion, the present data showed that the MgPic could increase osteogenic protein levels in bone more effectively than MgO, prevent bone loss, and contribute to bone formation in HFD rats.

The Effects of Calcium, Magnesium, Phosphorus, Fluoride, and Lead on Bone Tissue

Bones are metabolically active organs. Their reconstruction is crucial for the proper functioning of the skeletal system during bone growth and remodeling, fracture healing, and maintaining calcium-phosphorus homeostasis. The bone metabolism and tissue properties are influenced by trace elements that may act either indirectly through the regulation of macromineral metabolism, or directly by affecting osteoblast and osteoclast proliferation or activity, or through becoming part of the bone mineral matrix. This study analyzes the skeletal impact of macroelements (calcium, magnesium, phosphorus), microelements (fluorine), and heavy metals (lead), and discusses the concentration of each of these elements in the various bone tissues.

Do Only Calcium and Vitamin D Matter? Micronutrients in the Diet of Inflammatory Bowel Diseases Patients and the Risk of Osteoporosis

Osteoporosis is one of the most common extraintestinal complications among patients suffering from inflammatory bowel diseases. The role of vitamin D and calcium in the prevention of a decreased bone mineral density is well known, although other nutrients, including micronutrients, are also of extreme importance. Despite the fact that zinc, copper, selenium, iron, cadmium, silicon and fluorine have not been frequently discussed with regard to the prevention of osteoporosis, it is possible that a deficiency or excess of the abovementioned elements may affect bone mineralization. Additionally, the risk of malnutrition, which is common in patients with ulcerative colitis or Crohn's disease, as well as the composition of gut microbiota, may be associated with micronutrients status.

Is Zinc an Important Trace Element on Bone-Related Diseases and Complications? A Meta-analysis and Systematic Review from Serum Level, Dietary Intake, and Supplementation Aspects

Bone-related diseases are very common problems, especially in the elderly population. Zinc takes part in the growth and maintenance of healthy bones. This meta-analysis aims to evaluate the effects of zinc supplementation or dietary zinc intake on serum zinc levels and bone turnover markers. A systematical research was performed with 2899 articles in PubMed, WoS, and Scopus for relevant articles in English which have mean/standard deviation values of serum zinc levels, dietary zinc intake/zinc supplementation (mg/day), and bone turnover markers up to February 2020. In the overall analysis, serum zinc level was significantly lower in patients with osteoporosis compared with controls (p 0.0002). Dietary zinc intake decreased in the fracture group compared with controls according to subgroup analysis patients with fracture (p 0.02). Zinc supplementation was effective on the femoral neck (p < 0.0001) and lumbar spine (p 0.05) bone mineral density (BMD). In the correlation analysis of the data obtained from all of the included studies, serum osteocalcin (p 0.0106, r - 0.9148) correlated with serum zinc level. In conclusion, serum zinc level and dietary zinc intake could have an essential role in preventing osteoporosis. Zinc supplementation might improve bone turnover markers for bone formation such as serum osteocalcin and serum alkaline phosphatase and also, BMD at the site of the femoral neck.

Supplementation of nanofiltrated deep ocean water ameliorate the progression of osteoporosis in ovariectomized rat via regulating osteoblast differentiation

Magnesium was reported to be necessary for bone formation. Previous study indicated nanofiltrated deep ocean water (DOW) rich in magnesium. This study investigated the potential mechanisms of DOW in ameliorating osteoporosis. Briefly, female Sprague-Dawley rat was ovariectomized and fed with 0.35, 0.7, or 1.4 ml/kg of DOW daily for 8 weeks. In the results, DOW increased bone density, decreased trabecular bone loss, and decreased bone adiposity. DOW improved bone mass by examining structure in micro-computed tomography. About 0.35 and 0.7 ml/kg of DOW can increase protein expression of runt-related transcription factor 2 (RUNX2), an essential transcription factor for regulating osteoblast differentiation, by 9.4% or 12.9%. In human osteoblast, DOW increased the levels of osteocalcin, RUNX2, and alkaline phosphatase; all the proteins can regulate osteoblast differentiation. Considering the results of in vivo and in vitro study, DOW can ameliorate ovareictomy-caused osteoporosis via regulating the osteoblast differentiation, thereby, maintenance of bone structure. PRACTICAL APPLICATIONS: In addition to calcium, magnesium is essential to promoting the deposition of calcium in bones and regulating its transport; it may also slow the progression of osteoporosis. Nanofiltrated DOW contains abundant magnesium along with several microelements and peptides. In this study, a product was developed for decelerating osteoporosis by using an estrogen depletion model. DOW regulates osteoblast differentiation and thus prevents osteoporosis. This finding provides an alternative healthy source of bone supplements. In addition to tablets or capsules, aqueous supplements can be produced to achieve osteoporosis prevention. This finding is beneficial to the health-care industry for developing sustainable supplements.

The content of toxic and essential elements in trabecular and cortical femoral neck: a correlation with whole blood samples

Pollution caused by heavy metals affects all forms of life. The aim of the study was to determine the content of toxic (Sr, Ni, Pb, V, Cd, U, Rb, As) and essential (Na, K, Ca, Mg, Zn, Cu, Se, Mn, Cr, Mo, Co) metals in the bone and whole blood samples, in regard to clinical means of long- and short-term exposure, respectively. For this purpose, the cortical and trabecular parts of femoral neck, as well as the blood samples, were collected to quantify bone-important metals by inductively coupled plasma (ICP)-based techniques. According to principal component analysis (PCA), the most influential metal discriminating blood samples was Cu, while all other quantified elements were present in higher amounts in the bones. Additionally, trabecular bones (TBs) could be characterized by higher content of Mo, Cr, V, Mn, Co, As, and Ni compared to cortical bones (CBs). Linear discrimination analysis (LDA) was successfully applied to distinguish trabecular bone from the cortical bone. Significant correlation between essential Ca and toxic Sr with other elements was found and discussed. This study provides novel data on the effects of metal pollutants on bone health hazards. The results obtained for investigating metals may serve as a baseline for further clinical investigations in the orthopedic fields.

Effects of ultrasound therapy on the synovial fluid proteome in a rabbit surgery-induced model of knee osteoarthritis

Background

Ultrasound (US) therapy may improve osteoarthritis symptoms. We investigated the effects of US on the synovial fluid (SF) proteome in a rabbit knee osteoarthritis (KOA) model to explore its therapeutic mechanisms.

Methods

Sixteen healthy 6-month-old New Zealand white rabbits (eight male, eight female), weighing 2.5–3.0 kg, were randomly divided into groups A and B with eight rabbits per group. Both groups were subjected to right anterior cruciate ligament transaction. Six weeks after surgery, we treated the operated knee joint of group A rabbits with US and of group B rabbits with sham US for 2 weeks. The proteomes of knee joint SF from groups A and B rabbits were then analyzed using a label-free mass spectrometry (MS) quantification method.

Results

We identified 19 protein sequences annotated by 361 Gene Ontology (GO) items. According to the Kyoto Encyclopedia of Genes and Genomes (KEGG) database of rabbit protein sequences, we then annotated the KO numbers of homologous/similar proteins to 32 relevant KEGG pathways. We extracted 10 significantly differentially expressed proteins among the 32 relevant KEGG messages/metabolism pathways. The proteins whose levels were decreased were apolipoprotein A-I (AopA-1), transferrin (TF), carboxypeptidase B2 (CBP2), arylesterase/paraoxonase (PON), fibrinogen alpha chain, and alpha-2-macroglobulin (A2M). The proteins whose levels were increased were molecular chaperone HtpG/heat shock proteins (htpG, HSP90A), decorin (DCN), pyruvate kinase (PK, pyk), and fatty acid-binding protein 4/adipocyte (FABP4, aP2).

Conclusions

US therapy can alter protein levels in SF, which can decrease AopA-1, TF, CBP2, PON, fibrinogen alpha chain and A2M protein levels, and increase HtpG/HSP90A, DCN, PK/PKY, and FABP4/aP2 protein levels in SF of KOA, suggesting that the therapeutic mechanisms of US therapy on KOA may occur through changes in the SF proteome.

The change of synovial fluid proteome in rabbit surgery-induced model of knee osteoarthritis

The aims of this study were to explore the change of synovial fluid (SF) proteome in a knee osteoarthritis (KOA) rabbit model, and to provide a new target for the treatment of knee osteoarthritis at the proteomic level. Sixteen New Zealand rabbits were randomly and equally divided into two groups. Group A rabbits were subjected to right anterior cruciate ligament transection (ACLT), while group B rabbits were subjected to sham ACLT. Six weeks later, the proteomes of knee joint SF from group A and B rabbits were analyzed using a label-free quantitative proteomic analysis method. We extracted 944 relevant items from GO BlastGO2 for the 23 proteins differentially expressed between the two groups. The final annotation results were 23 protein sequences annotated by 462 GO items. According to the KEGG gene database of rabbit protein sequences, as well as annotation of the KO numbers of homologous/similar proteins to the relevant 64 KEGG pathways, we extracted the sequences of 16 significantly differently expressed proteins among the relevant 64 KEGG messages/metabolism pathways. These included adiponectin, pyruvate kinase, bisphosphoglycerate mutase, HtpG/heat shock proteins, hemoglobin subunit alpha-1 2, VCP (CDC48), 14-3-3 protein beta/theta/zeta, and ferritin heavy chain, whose levels were decreased in group A. The other proteins were fibrinogen alpha/beta/gamma chain, carboxylesterase 2, paraoxonase/arylesterase 1, apolipoprotein A-I, immunoglobulin heavy chain, and transferrin, whose levels were increased in group B. The identified differentially expressed proteins indicate the change of SF proteomic expression in KOA and may provide protein targets for treating this condition.

Changes of serum trace elements in early stage trauma and its correlation with injury severity score

BACKGROUND

Severe trauma can cause secondary multiple organ dysfunction syndrome and death. The absolute and relative concentrations of trace elements in both critical care and conventional treatment, which can lead to acute trace element deficiency, constitute an important mechanism of multiple organ dysfunction syndrome (MODS)/multiple organ failure (MOF).

METHODS

We investigated the changes in serum Cu, Zn, and Fe in early stage trauma of patients with the high injury severity score (ISS) and correlated the change in trace elements with ISS. Blood samples were collected within an hour of admittance and the patients were scored according to ISS. We collected clinical data records and ISS score values, and determined serum Fe, Zn, and Cu by inductively coupled plasma mass spectrometry.

RESULTS

Compared with the control group, the serum Zn and Fe values of trauma patients were decreased. There was no significant difference in serum Cu between the patients and the control group. In the trauma group, the serum Zn and Fe were lower than that of the minor injury group, and the difference of Cu concentration was not statistically significant.

CONCLUSIONS

Serum Zn and Fe levels in patients with multiple trauma fractures were significantly different than those in the normal group, suggesting that Zn and Fe need to be monitored in the early stage of trauma.

Perturbed bone composition and integrity with disorganized osteoblast function in zinc receptor/Gpr39-deficient mice

Changes in bone matrix composition are frequently found with bone diseases and may be associated with increased fracture risk. Bone is rich in the trace element zinc. Zinc was established to play a significant role in the growth, development, and maintenance of healthy bones; however, the mechanisms underlying zinc effects on the integrity of the skeleton are poorly understood. Here, we show that the zinc receptor (ZnR)/Gpr39 is required for normal bone matrix deposition by osteoblasts. Initial analysis showed that Gpr39-deficient ( Gpr39^-/-) mice had weaker bones as a result of altered bone composition. Fourier transform infrared spectroscopy analysis showed high mineral-to-matrix ratios in the bones of Gpr39^-/- mice. Histologic analysis showed abnormally high numbers of active osteoblasts but normal osteoclast numbers on the surfaces of bones from Gpr39^-/- mice. Furthermore, Gpr39^-/- osteoblasts had disorganized matrix deposition in vitro with cultures exhibiting abnormally low collagen and high mineral contents, findings that demonstrate a cell-intrinsic role for ZnR/Gpr39 in these cells. We show that both collagen synthesis and deposition by Gpr39^-/- osteoblasts are perturbed. Finally, the expression of the zinc transporter Zip13 and a disintegrin and metalloproteinase with thrombospondin motifs family of zinc-dependent metalloproteases that regulate collagen processing was downregulated in Gpr39^-/- osteoblasts. Altogether, our results suggest that zinc sensing by ZnR/Gpr39 affects the expression levels of zinc-dependent enzymes in osteoblasts and regulates collagen processing and deposition.-Jovanovic, M., Schmidt, F. N., Guterman-Ram, G., Khayyeri, H., Hiram-Bab, S., Orenbuch, A., Katchkovsky, S., Aflalo, A., Isaksson, H., Busse, B., Jähn, K., Levaot, N. Perturbed bone composition and integrity with disorganized osteoblast function in zinc receptor/Gpr39-deficient mice.

The Distribution of Elements in 48 Canine Compact Bone Types Using Handheld X-Ray Fluorescence

A major question when we talk about the elements in the bone is whether all bones contain the same elements. To answer this question, this study was designed for determination of the elemental levels in 48 various canine compact bones using handheld X-ray fluorescence technique. From a total of 26 elements that could be detected, only 13 elements were found in all 48 bones. The sternum and os penis were significantly different from the other bones in that they contained the highest number of elements. The ratio of Ca and P was significantly different when comparing certain bones: there was a higher Ca/P ratio in the patella (right), calcaneus (right and left), and sternum compared with a lower ratio in the radius (left), rib (left), phalanx (left forelimb), and carpus (left). These results are the first to demonstrate that different types of bones have different elemental profiles, even for major elements such as Ca and P. Moreover, the Ca/P ratio was also different between bone types. This data is important for the selection of bones appropriate to the element studied. In addition, the results proved that the elements were not equally distributed in every bone in the body.

Comparison of Bone Tissue Elements Between Normal and Osteoarthritic Pelvic Bones in Dogs

Physiochemical analysis of bones affected with osteoarthritis (OA) can be used to better understand the etiology of this disease. We investigated the percentage of chemical elements in canine pelvic bone affected with varying degrees of OA using a handheld X-ray fluorescence (XRF) analyzer that discriminates magnesium (Mg(12)) through bismuth (Bi(83)). A total of 45 pelvic bones, including both ilium and subchondral acetabular bone plates, were categorized as normal (n = 20), mild grade OA (n = 5), moderate grade OA (n = 15), and severe grade OA (n = 5). In normal pelvic, seven elements (P, Ca, Mn, Ag, Cd, Sn, and Sb) differed (p < 0.005) in percentage between ilium and acetabulum. Comparisons among the four OA groups found Mn and Fe to be highest in severe grades (p < 0.05) in both ilium and acetabulum. Three heavy metals (Ag, Sn, and Sb) were detected in high percentages (p < 0.05) in the severe OA group in the acetabulum, but in ilium only Sn was high (p < 0.05) in severe OA. In conclusion, the percentages of several elements differed between pelvic types in dogs, and also with increasing severity of OA. The finding of high Mn and Fe in severe grade OA bone suggests these two elements may be useful in future studies of the etiology and pathophysiology of OA.

Influence of Environmental Factors and Relationships between Vanadium, Chromium, and Calcium in Human Bone

The aim of this study was to investigate the impact of environmental factors on the concentrations of vanadium (V), chromium (Cr), and calcium (Ca) and to examine the synergistic or antagonistic relationships between these metals, in cartilage (C), cortical bone (CB), and spongy bone (SB) samples obtained following hip joint surgery on patients with osteoarthritis in NW Poland. We found significantly higher concentrations of V and Cr in spongy bone in patients who consumed game meat and also those with prosthetic implants. Chromium levels were significantly lower in patients with kidney diseases. The greatest positive correlations were found between spongy bone V and (i) the amount of consumed beer and (ii) seafood diet. Correlation analysis also showed a significant correlation between Cr levels and seafood diet. To a certain extent these results indicate that the concentrations of V, Cr, and Ca in the human hip joint tissues are connected with occupational exposure, kidney diseases, diet containing game meat, sea food, beer, and the presence of implants. Furthermore, we noted new types of interactions in specific parts of the femoral head. Vanadium may contribute to the lower bone Ca levels, especially in the external parts (cartilage and cortical bone).

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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