Nutrition in bone health revisited: a story beyond calcium

Osteoporosis is a complex, multi-factorial condition characterized by reduced bone mass and impaired micro-architectural structure, leading to an increased susceptibility to fractures. Although most of the bone strength (including bone mass and quality) is genetically determined, many other factors (nutritional, environmental and life-style) also influence bone. Nutrition is important modifiable factor in the development and maintenance of bone mass and the prevention and treatment of osteoporosis. Approximately 80-90% of bone mineral content is comprised of calcium and phosphorus. Other dietary components, such as protein, magnesium, zinc, copper, iron, fluoride, vitamins D, A, C, and K are required for normal bone metabolism, while other ingested compounds not usually categorized as nutrients (e.g. caffeine, alcohol, phytoestrogens) may also impact bone health. Unraveling the interaction between different factors; nutritional, environmental, life style, and heredity help us to understand the complexity of the development of osteoporosis and subsequent fractures. This paper reviews the role of dietary components on bone health throughout different stages of life. Each nutrient is discussed separately, however the fact that many nutrients are co-dependent and simultaneously interact with genetic and environmental factors should not be neglected. The complexity of the interactions is probably the reason why there are controversial or inconsistent findings regarding the contribution of a single or a group of nutrients in bone health.     

低聚半乳糖与聚葡萄糖联用对生长期大鼠钙代谢和骨量的影响

目的 探究低聚半乳糖(galacto - oligosaccharides,GOS)与聚葡萄糖（polydextroses,PD）联用对生长期大鼠骨代谢和骨钙含量的影响。方法 60只刚断乳SD大鼠随机分为低钙组（饲料钙0.15%）、正常组（饲料钙0.5%）、强化组（饲料钙0.375% + 维生素D强化）、低比组（强化组饲料 + PD 2.5% + GOS 2.5%）和高比组（强化组饲料 + PD 4% + GOS 1%）5个组,分别饲喂含钙、维生素D3和益生元含量不同的饲料。观察大鼠一般情况,记录体重,于实验第83 d进行3 d的钙代谢实验,原子吸收法检测饲料、粪便和尿液中的钙含量,计算钙表观吸收率和储备率;喂饲93 d后处死,取心肝脾肾称重计算脏器系数,取血清测定血清钙、磷水平,取股骨测股骨干重,并采用原子吸收法测量股骨钙含量。结果 实验结束时,正常组、低比组和高比组体重均显著高于低钙组;各组的钙表观吸收率和钙储留率显著低于低钙组;与低钙组比较,各组的血清钙和骨钙含量都显著增加;低比组和高比组的股骨重和骨钙含量显著高于强化组,与正常组无显著差异。结论 充足的钙摄入对生长期大鼠的钙代谢及骨骼生长具有重要意义;聚葡萄糖和低聚半乳糖联用可增加生长期大鼠的骨钙含量。     

Pregnancy and lactation affect markers of calcium and bone metabolism differently in adolescent and adult women with low calcium intakes

Physiologic adaptation to the high calcium demand during pregnancy and lactation may be different in adolescents than in adults, particularly at low calcium intake. The aim of this cross-sectional study was to compare biochemical markers of calcium and bone metabolism between adolescent (14-19 y) and adult (21-35 y) women with calcium intake approximately 500 mg/d, in three different physiologic states, i.e., control (nonpregnant, nonlactating; NPNL), pregnant and lactating. Markers of calcium metabolism [serum Ca, P and intact parathyroid hormone (iPTH); urinary Ca and P] and of bone turnover [urinary deoxypyridinoline (D-Pyr) and plasma bone alkaline phosphatase (BAP)] were measured in NPNL (adolescents, n = 12 and adults, n = 25), pregnant (adolescents, n = 30 and adults, n = 36) and lactating (adolescents, n = 19 and adults, n = 26) women. In the NPNL women, iPTH, D-Pyr and BAP were higher (P < 0.001) and urinary Ca was lower (P < 0.001) in adolescents than in adults. Serum iPTH was higher (P < 0.001) and urinary Ca was lower (P < 0.01) in adolescents than in adults also in pregnancy and lactation. Compared with NPNL women, serum Ca decreased (P < 0.001) with pregnancy in adolescents but not in adults. The increase in D-Pyr with pregnancy and lactation was very pronounced in adults ( approximately 130%, P < 0.001) but less in adolescents (<25%, P < 0.01). BAP increased (P < 0.001) with pregnancy and lactation in adults ( approximately 60%) but decreased (P < 0.001) with pregnancy in adolescents ( approximately 13%). Pregnancy and lactation appear to affect bone turnover in adolescent and adult women with low calcium intake differently.     

Non-digestible oligosaccharides and calcium absorption in girls with adequate calcium intakes

Non-digestible oligosaccharides such as inulin and oligofructose have been shown to consistently increase calcium absorption in experimental animals, but data in humans are less clear-cut. The objective of this study was to assess the effect of 8 g/d of oligofructose or a mixture of inulin and oligofructose on calcium absorption in girls at or near menarche. A total of fifty-nine subjects were studied using a balanced, randomized, cross-over design. They received, in random order, 8 g/d placebo (sucrose), oligofructose or the mixture inulin+oligofructose for 3 weeks, separated by a 2-week washout period. Throughout the study, subjects consumed a total of approximately 1500 mg/d dietary calcium, by adding two glasses of calcium-fortified orange juice to their diet. Four grams of placebo, oligofructose or the mixture inulin+oligofructose was added to each glass of orange juice immediately before it was consumed. At the end of each 3-week adaptation period, calcium absorption was measured, using a dual stable isotope technique, from the cumulative fractional excretion of an oral and an intravenous tracer over 48 hours. Calcium absorption was significantly higher in the group receiving the inulin+oligofructose mixture than in the placebo group v. P=0.01), but no significant difference was seen between the oligofructose group and the placebo group v. P=NS). We conclude that modest intakes of an inulin+oligofructose mixture increases calcium absorption in girls at or near menarche.     

Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes

BACKGROUND: Adolescent mothers may be at increased risk of irreversible bone loss during pregnancy and lactation, particularly when calcium intake is low. OBJECTIVE: Longitudinal changes in bone mass from lactation to postweaning were evaluated in 10 adolescent mothers aged 15-18 y who habitually consumed <500 mg Ca/d. DESIGN: Total-body bone mineral content (TBBMC), total-body bone mineral density (TBBMD), and lumbar spine bone mineral density (LSBMD) were measured at lactation (6-24 wk postpartum) and after weaning (12-30 mo postpartum). Serum hormones (intact parathyroid hormone, estradiol, and prolactin), serum calcium, and markers of bone turnover [urinary N-telopeptide cross-linking region of type I collagen (NTx) and plasma activity of bone alkaline phosphatase] were measured at lactation. RESULTS: TBBMC, total calcium content, TBBMD, and LSBMD increased from lactation to postweaning (P < 0.01). TBBMD and LSBMD were, respectively, 3.6% and 9.7% lower than predicted at lactation and 0.3% and 4.8% lower than predicted in the postweaning period. The increase in age-matched TBBMD adequacy was correlated with the time after resumption of menses (r = 0.86, P < 0.01). Calcium accretion from lactation to postweaning correlated negatively with estradiol (r = -0.86) and prolactin (r = -0.69) and positively with intact parathyroid hormone (r = 0.72) and NTx (r = 0.84) measured at lactation (P < 0.05). CONCLUSIONS: It appears that adolescent mothers with habitually low calcium intakes recover from lactation-associated bone loss after weaning. The rate of bone accretion, however, may not be sufficient to attain peak bone mass at maturity. Hormones regulating bone turnover during lactation may influence bone recovery in adolescent mothers.     

Stimulatory effect of inulin on intestinal absorption of calcium and magnesium in rats is modulated by dietary calcium intakes

Summary Previous studies have shown that short–term intake of fermentable oligosaccharides (OS), including inulin, can increase mineral intestinal absorption in humans and animals. While the stimulatory effect of these substances on intestinal magnesium (Mg) absorption is generally high and consistent, their effect on calcium (Ca) seems to depend on experimental conditions, particularly the duration of fermentable OS intake. The aim of this study was to determine how the short– and long–term dietary Ca intake may modulate the effect of inulin on Ca absorption. Sixty male Wistar rats, weighing 275 g, were randomized into two groups to receive or not 10% of inulin in their diet. Each group was divided into three sub–groups to receive one of the following dietary Ca levels 0.25%, 0.50% and 0.75% in their food. The animals were fed fresh food and water ad libitum for 40 days. Apparent intestinal absorptions of Ca and Mg were determined at D13 and D36 of the experiment. As expected, inulin feeding increased Ca and Mg absorption in both periods at all dietary Ca levels. However, the effect of inulin on intestinal Ca absorption was dependent on dietary Ca levels and on experiment duration. In the short–term period, the inulin effect was prominent in the groups receiving high or low Ca levels, but in long–term period inulin improved intestinal Ca absorption much more in the group receiving the low Ca level. In addition, efficiency of intestinal absorption of Ca and Mg (%) was negatively affected by Ca intake levels. These results show that the beneficial effect of inulin on intestinal Ca absorption may be more marked in cases where the Ca intake is low or where the organism’s Ca requirement is high. Further studies are required to confirm these results in humans.     

Sodium and potassium intakes amongst free-living adult Nigerians

Sixteen adult male and female Nigerians, aged between 18 and 48 years, participated in a 7-d study designed to estimate mean daily intakes of sodium and potassium and to determine their food sources. Food logs were kept during the 7-d study period. Analysis of data showed a mean daily intake of 8.1 g table salt with a range of 3.8 to 18.1 g which provided a mean daily intake of 3.2 g sodium. Mean sodium intake from foods alone was 0.85 g +/- 0.08 while sodium nutrient density was 2.3 g/1000 kcal. Potassium intake was 2.86 g +/- 0.2 or 1.46 g/1000 kcal. Mean sodium/potassium ratio of the diets was 1.5. Discretionary use of salt was 82 per cent of total intake with table salt supplying 78 per cent. Cereals and products provided the highest proportion of natural sodium while starchy staples supplied over 40 per cent of the potassium in the diet.     

Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health

BACKGROUND: Information concerning the adequacy of bone mineralization in children who customarily avoid drinking cow milk is sparse. OBJECTIVE: The objective was to evaluate dietary calcium intakes, anthropometric measures, and bone health in prepubertal children with a history of long-term milk avoidance. DESIGN: We recruited 50 milk avoiders (30 girls, 20 boys) aged 3-10 y by advertisement. We measured current dietary calcium intakes with a food-frequency questionnaire and body composition and bone mineral density with dual-energy X-ray absorptiometry and compared the results with those of 200 milk-drinking control children. RESULTS: The reasons for milk avoidance were intolerance (40%), bad taste (42%), and lifestyle choice (18%). Dietary calcium intakes were low (443 +/- 230 mg Ca/d), and few children consumed substitute calcium-rich drinks or mineral supplements. Although 9 children (18%) were obese, the milk avoiders were shorter (P < 0.01), had smaller skeletons (P < 0.01), had a lower total-body bone mineral content (P < 0.01), and had lower z scores (P < 0.05) for areal bone mineral density at the femoral neck, hip trochanter, lumbar spine, ultradistal radius, and 33% radius than did control children of the same age and sex from the same community. The z scores for volumetric (size-adjusted) bone mineral density (g/cm(3)) were -0.72 +/- 1.17 for the lumbar spine and -0.72 +/- 1.35 for the 33% radius (P < 0.001). Twelve children (24%) had previously broken bones. CONCLUSIONS: In growing children, long-term avoidance of cow milk is associated with small stature and poor bone health. This is a major concern that warrants further study.     

酶解骨粉对大鼠钙吸收及骨密度的影响

目的 观察酶解牛骨粉、超微酶解牛骨粉、酶解鱼骨粉的补钙效果.方法 90只SPF级4周龄雌性SD大鼠随机分为9组:酶解牛骨粉、超微酶解牛骨粉、酶解鱼骨粉、碳酸钙低、高剂量组以及低钙对照组,喂养13周.于试验第3周末做代谢试验,测量钙吸收率和骨密度.结果 酶解骨粉钙表观吸收率34.0%～67.93%,均明显低于低钙对照组(...     

维生素D摄入水平对孕鼠骨代谢的影响

目的:研究大鼠孕期维生素D摄入水平对胎鼠的影响。方法:24只怀孕大鼠随机分为Ⅰ、Ⅱ、Ⅲ组,Ⅰ组为正常对照组(每公斤饲料含维生素D 1 500 IU),Ⅱ组为补充维生素D组(每公斤饲料含维生素D 5 000 IU),Ⅲ组为缺维生素D组(饲料中不添加维生素D)。用含有不同维生素D剂量的饲料喂养怀孕大鼠,观察孕鼠血清钙、磷水平的变化及尿钙和尿羟脯氨酸的变化,观察新生鼠的体重、身长、尾长。计算各组孕鼠平均产仔数。结果:与对照组比较,Ⅱ组孕鼠尿钙升高(P<0.05),尿羟脯氨酸无变化,Ⅲ组孕鼠尿钙和羟脯氨酸均升高(P<0.01);各组子鼠骨骼无畸形,发育指标无统计学差异;平均每只大鼠的产仔数目以补充维生素D组最多(平均每只孕鼠产仔11只),缺维生素D组最少(平均每只孕鼠产仔4只)。结论:孕期缺乏维生素D会使孕鼠骨吸收增强,产仔数减少,未发现维生素D缺乏对子代大鼠发育的影响。     

Fat mass gain is lower in calcium-supplemented than in unsupplemented preschool children with low dietary calcium intakes

BACKGROUND: Dietary calcium may play a role in the stimulation of lipolysis and the inhibition of lipogenesis, thereby reducing body fat. OBJECTIVE: The aim was to determine whether an association existed between change in percentage body fat (%BF) or fat mass and calcium intake in children aged 3-5 y. DESIGN: A secondary analysis of a 1-y randomized calcium and activity trial in 178 children was conducted. Three-day diet records and 48-h accelerometer readings were obtained at 0, 6, and 12 mo. Body composition was measured by dual-energy X-ray absorptiometry at 0 and 12 mo. RESULTS: The decrease in %BF was less in girls (-0.6 +/- 2.8%) than in boys (-1.5 +/- 2.6%; P = 0.03) and correlated with age (r = 0.19, P = 0.01) and maternal body mass index (r = 0.19, P = 0.02). Changes in fat mass were not significantly different by activity group or between children randomly assigned to receive calcium or placebo (0.5 +/- 0.9 and 0.6 +/- 0.8 kg, respectively; P = 0.32). Similar findings were observed for the change in %BF. No correlations between %BF and fat mass changes and dietary calcium (r = -0.01, P = 0.9 and r = -0.05, P = 0.5) or total (dietary + supplement) calcium intake (r = -0.02, P = 0.8 and r = -0.06, P = 0.4) were observed. Among children in the lowest tertile of dietary calcium (<821 mg/d), fat mass gain was lower in the calcium group (0.3 +/- 0.5 kg) than in the placebo group (0.8 +/- 1.1 kg) (P = 0.04) but was not correlated with mean total calcium intake (r = -0.20). CONCLUSION: These findings support a weak relation between changes in fat mass gain and calcium intake in preschool children, who typically consume below recommended amounts of dietary calcium.     

Dietary calcium supplementation suppresses bone formation in magnesium-deficient rats

The purpose of this study was to clarify the effects of dietary calcium (Ca) supplementation on bone metabolism of magnesium (Mg)-deficient rats. Male Wistar rats were randomized by weight into three groups, and fed a control diet (control group), a Mg-deficient diet (Mg- group) or a Mg-deficient diet having twice the control Ca concentrations (Mg-2Ca group) for 14 days. Trabecular bone volume was significantly lower in the Mg- and Mg-2Ca groups than in the control group. Trabecular number was also significantly lower in the Mg- and Mg-2Ca groups than in the control group. Mineralizing bone surface, mineral apposition rate (MAR), and surface referent bone formation rate (BFR/BS) were significantly lower in the Mg- and Mg-2Ca groups than in the control group. Furthermore, MAR and BFR/BS were significantly lower in the Mg-2Ca group than in the Mg- group. These results suggest that dietary Ca supplementation suppresses bone formation in Mg-deficient rats.     

Factors that influence peak bone mass formation: a study of calcium balance and the inheritance of bone mass in adolescent females

We suggested that calcium may be an important determinant of peak bone mass. For further elucidation, calcium balances in adolescent females with different calcium intakes (270-1637 mg/d), and a 2-y intervention study of calcium supplementation were performed. Hereditary influences on bone status were also evaluated by comparing subjects' and parents' bone mass. The main determinant of calcium balance was calcium intake; net calcium absorption increased with intake and urinary calcium did not change. Adolescent females retained 200-500 mg Ca/d, suggesting that inadequate calcium intake may translate into inadequate calcium retention and a reduction in peak bone mass. There was a more pronounced increase in bone mass over time in the calcium-supplemented group (1640 mg Ca/d) than in the control group (750 mg Ca/d), but the differences between bone mass measurements were not statistically significant, possibly because of a type II error. By the age of 16 y daughters had accumulated 90-97% of the bone mass of their premenopausal mothers.     

Sustained effect of short-term calcium supplementation on bone mass in adolescent girls with low calcium intake

BACKGROUND: The effect of short-term calcium supplementation on peak bone mass in adolescent girls is not completely defined. In our previous double-blind, placebo-controlled, calcium-supplementation study (1000 mg calcium carbonate/d), we showed that calcium supplementation of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition. OBJECTIVE: The objective of this follow-up study, conducted 3.5 y after the end of calcium supplementation, was to investigate the sustained effect of calcium supplementation on bone mineral mass. DESIGN: Anthropometric data, nutrient intakes, and bone variables were reassessed in 96 of the 100 adolescent girls whose data had been studied at the end of the supplementation period. Bone mineral content and bone mineral density (BMD) of the total body, lumbar spine, and femoral neck were determined by dual-energy X-ray absorptiometry. RESULTS: The calcium-supplemented group tended to have a greater accretion of total-body BMD (TBBMD) than did the control group 3.5 y after the end of supplementation. The finding was statistically significant in the active-treatment cohort (n = 17 in the calcium-supplemented group and 28 in the placebo group), who had a compliance rate of > or =75% during the intervention study. In a multivariate linear-regression analysis, TBBMD accretion from the beginning of the intervention study to the follow-up study in the active-treatment cohort was attributed to calcium supplementation and to the time since inclusion in the initial study. CONCLUSION: Calcium supplementation for 1 y in postmenarcheal girls with low calcium intakes may provide a sustained effect on the basis of TBBMD measurements in participants with compliance rates of > or =75%.     

维生素D受体基因与骨量的关系

近年来对维生素D受体(VDR)基因和骨量关系的研究颇有争议。有许多研究认为维生素D受体基因多态性与骨量有关联。但还有一部分研究未能证实VDR基因多态性与骨量的关联。本文就VDR基因与钙吸收、骨量、药物治疗的关系和VDR基因的协同作用以及与其它基因、环境因素的交互作用对骨量影响的研究进展进行了综述。