Osteoporosis Blog

Many studies have reported that including fruits and vegetables as a significant part of the overall diet is beneficial to bone health. There may be many components of fruits and vegetables responsible for this. Researchers at the University of Toronto reported that lycopene, found mostly in tomato products, slows bone breakdown rates and likely helps to reduce the risk of osteoporosis.

They studied 33 postmenopausal women and found that those with the greatest intake of lycopene from their diet had the lowest blood levels of markers of bone loss. On average, those with the lowest rates of bone loss consumed daily the amount of lycopene present in about two tablespoons of tomato sauce or catsup.

Lycopene is absorbed by the body more efficiently from cooked tomato products than it is from fresh tomatoes. Also, the presence of some fat in the meal increases the intestinal absorption of lycopenes.

So, pizza looks rather good as a food for bones: cheese provides the calcium along with some fat to enhance the absorption of lycopene from the tomato sauce. As part of a diet with plenty of overall variety, you and your bones can feel good about enjoying pizza and other foods made with tomato sauces. Hold the mayo, extra catsup please!

Source
Rao, Leticia G. et al. “Lycopene Consumption Decreases Oxidative Stress and Bone Resorption Markers in Postmenopausal women.” Osteoporosis International 18 (2007): 109-15. (See article abstract)

Both pregnancy and nursing a child place big demands on a mother's body. Large amounts of nutrients, especially calcium, are transferred from a woman's body to both the growing fetus during pregnancy and to the young baby via breastfeeding. This creates a substantial calcium demand on a woman's body causing calcium to be drawn from the mother's bones. Does this affect her overall risk of developing osteoporosis? Read more.

Many people with osteoporosis go undiagnosed until serious problems become evident. By this time, significant bone loss has taken place and the window of opportunity for prevention is lost. However, screening everyone with expensive DEXA scans is not economically feasible.

Researchers in the School of Dentistry at the University of Manchester may have a solution to this dillema. A big part of routine dental work involves taking X-rays of the teeth and jawbones, so these researchers decided to develop an automated system for the X-rays taken by dentists to be used as a screening tool to identify people with low bone density. They developed and tested a computer software system that could automatically detect likely cases of osteoporosis by quantifying the thickness of a portion of the lower jaw.

By testing the system on over 600 women 65 years and older, they estimated that at least two out of five cases of osteoporosis would be automatically flagged by their computer software in the dentist’s office without any additional work by the dentist, other than referring the patient to get testing for osteoporosis. The system is not perfect, but it would catch many cases of osteoporosis that would otherwise go unnoticed until serious symptoms of osteoporosis became evident. Since this system could greatly reduce both patient suffering and medical costs, I hope it gets the fast track to implementation.

Source
Devlin, Hugh et al. “Automated Osteoporosis Risk Assessment by Dentists: A New Pathway to Diagnosis” Bone (In Press/Corrected Proof; available online 22 December 2006). (See article abstract)

In 1997, the Food and Nutrition Board of the Institute of Medicine (IOM) published the last official recommendations for daily vitamin D intake. Since then, there has been a great upsurge in research on vitamin D and many of the world’s top vitamin D researchers have been claiming that the Institute of Medicine’s recommendations for vitamin D are much too low. Some of the researchers making these claims were members of the Food and Nutrition Board panel that set the recommendations based on the science available at the time.

In the January 2007 issue of the American Journal of Clinical Nutrition, an article was published that reviewed the studies available on vitamin D to establish a “No Adverse Effect Level” for the vitamin. Their summary and analysis recommends an increase in the IOM “Tolerable Upper Intake Level” (UL) from current 2,000 IU / day to 10,000 IU / day. The UL is defined by the IOM as, “The maximum level of total chronic daily intake of a nutrient or food component that is unlikely to pose risks of adverse effects to the most sensitive members of the healthy population.”

Two of the authors of the report are from the Council for Responsible Nutrition, a Washington-based trade association representing ingredient suppliers and manufacturers in the dietary supplement industry. The other two authors are well-known vitamin D researchers from Mount Sinai Hospital in Toronto and Creighton University in Omaha.

Since 1980, recommended nutrient intake values have been revised about every ten years in the U.S., so if the IOM follows suit, we should see new official recommendations within the next few years. Stay tuned.

Read more on vitamin D and bone health.

Source
Hathcock, John N. et al. “Risk Assessment for Vitamin D.” American Journal of Clinical Nutrition 85 (2007): 6-18. (See article abstract)

Frequently, proponents of a raw food vegetarian diet claim that it is the ideal diet for human health. This is not the case for bone health according to the results of a study conducted by Dr. Luigi Fontana from the Instituto Superiore di Sanita in Rome in collaboration with researchers at the Washington University School of Medicine in St. Louis. Their study compared 18 people who had been eating raw food vegetarian diets for an average of 3.6 years to 18 individuals who consumed typical American diets. The raw food group had significantly lower bone mineral content and bone mineral density in comparison to those eating standard fare.

The average bone mineral density T scores for both female and male vegetarians were about –2.0 at the lumbar spine and approximately –1.8 for women and –1.5 for men when measured at the hip. These T scores are diagnostic of osteopenia (T scores from –1 to –2.5) and are reason for concern and taking serious measures for osteoporosis prevention.

Due to the small number of participants in this study and the fact that the researchers can’t be sure that the low bone mineral density did not exist in these people before they started eating a raw vegetarian diet, additional research is needed to confirm their results. However, the results make sense because the diets of these vegetarians were low in calcium, vitamin D, and protein. This would be expected to result in a loss of bone mass with any type of diet - raw, cooked, vegetarian, or otherwise. Read more about osteoporosis prevention.

Source
Fontana, Luigi, et al. “Low bone mass in subjects on a long-term raw vegetarian diet.” Archives of Internal Medicine 165 (2005): 684-9. (See article abstract)

Did a New Year’s resolution lead you embark on a low calorie diet for weight loss and improved health? For the sake of your bones, you may need to reconsider your strategy.

A study conducted by Dr. Dennis Villareal and colleagues in the Division of Geriatrics and Nutritional Sciences at the Washington University School of Medicine in St. Louis followed 38 men and women with an average age of 57 years while they lost weight over the period of one year by dieting or exercising. They reported that 19 men and women who lost an average of 8.2 kilograms (18 pounds) by restricting calorie intake also lost over two percent of their bone mineral density at the hip and spine.

A similar group of men and women who lost an average of 6.7 kilograms (15 pounds) by exercising regularly for the year had no significant changes in bone mineral density. A third group of 10 people who followed a healthy lifestyle and lost no weight over the year also had no measurable bone loss.

For the sake of your bones, if you need to lose weight, do it with exercise rather than by restricting calorie intake.

Read more on weight loss and bones.

Source
Villareal, Dennis et al. “Bone mineral density response to caloric restriction-induced weight loss or exercise-induced weight loss: A randomized controlled trial.” Archives of Internal Medicine 166 (2006): 2502-10. (See article abstract)

Heartburn, known medically as gastro esophageal reflux disease (GERD), is commonly treated with medications that decrease the production of stomach acid. Heartburn has nothing to do with the heart, but the pain is felt in the chest – thus the popular name. The pain is caused by the reflux of stomach acid up into the esophagus. This irritates the lower part of the esophagus just above the stomach and causes the painful symptoms of GERD. For more about GERD see Heartburn / GERD on About.com.

An article in the December 27, 2006 issue of the Journal of the American Medical Association found that people who had used GERD medications called proton pump inhibitors (PPIs) for more than one year had an increased risk of hip fracture. The risk was 2.6 times greater among long-term users of higher doses. Overall, those with the highest dosage and longest duration of use had the greatest increase in fracture risk.

These results were based on the comparison of 13,556 people with hip fractures to over 135,000 otherwise similar people who did not experience fractures. The authors of this large study concluded, “For elderly patients who require long-term and particularly high-dose PPI therapy, it may be prudent to reemphasize increased calcium intake, preferably from a dairy source, and coingestion of a meal when taking insoluble calcium supplements.”

Why would these drugs cause this?

Some forms of calcium, like calcium carbonate, dissolve better in an acid solution. Inhibition of stomach acid production with GERD medications may decrease the amount of calcium that is absorbed from a supplement or a meal. The researchers recommended taking a calcium supplement with meals because the meals can stimulate the release of stomach acids and likely help calcium compounds dissolve and be absorbed better.

Calcium citrate supplements are not affected like calcium carbonate by a lack of stomach acid. If you are taking GERD medications and a calcium carbonate supplement, talk to your doctor about switching to a calcium citrate supplement.

Source
Yang, Yu-Xiao, et al. “Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture.” Journal of the American Medical Association 296 (2006): 2947-53. (See article abstract)

An article in the December 27, 2006 issue of the Journal of the American Medical Association reported that the effects of 5 years of treatment with Fosamax (alendronate) were still apparent in postmenopausal women after an additional 5 years of not taking the drug. However, women who continued taking the drug for a total of ten years at doses of 5 or 10 mg per day maintained greater bone mineral density (BMD).

Researchers at the University of California at San Francisco studied over 1000 postmenopausal women who participated in this study. All women had previously taken alendronate in a 5-year study called the Fracture Intervention Trial (FIT Study) that found substantial increases in BMD and reduced fracture risk. The new study, called the Fracture Intervention Trial Long-term Extension (FLEX Study), divided these women into 3 groups: placebo, 5 mg per day alendronate, and 10 mg per day alendronate.

The good news in this study was that the incidence of non-vertebral fractures in women in the placebo group was the same as it was in the treated groups. The bad news was that the placebo group experienced a greater incidence of clinically diagnosed vertebral fractures. The researchers concluded that, “. . . for many women, discontinuation of alendronate after 5 years for up to 5 more years does not significantly increase fracture risk, but women at high risk for clinical vertebral fractures, such as those with vertebral fracture or very low BMD, may benefit by continuing beyond 5 years.”

If you have been taking alendronate for 5 years or longer, you may want to discuss taking a “Fosamax vacation” with your physician. If the mutual decision is to take the vacation, it becomes especially important that you also discuss the potential need for more frequent testing of BMD during the vacation.

Do not take a vacation from all of the nutrition and lifestyle aspects of osteoporosis treatment and prevention. See Current Treatment Options.

Source
Black, Dennis M., et al. “Effects of Continuing or Stopping Alendronate After 5 Years of Treatment.” Journal of the American Medical Association 296 (2006): 2927-37. (See article abstract)

Bone-healthy nutrition practices are not limited to the bones. Vitamin D is a good case-in-point. It is well known that vitamin D is one of the most important nutrients for bone health, but researchers are finding that vitamin D is associated with many health problems unrelated to bones.

An article in the December 20, 2006 issue of the Journal of the American Medical Association reported that a study of 257 US military personnel found that those with greater levels of 25-hydroxyvitamin D in their blood had a significantly reduced risk of developing multiple sclerosis (MS). The greatest reduction was seen in non-Hispanic whites. The researchers noted that this may have been because there was a greater range of vitamin D status in the white participants than there was in other ethnic groups. Although this study only shows an association with MS and does not prove cause and effect, it does provide at least another bit of support for maintaining good vitamin D status.

These researchers feel that their results demonstrate a need for clinical trials to determine if vitamin D supplementation can help to prevent MS.

Source
Munger, Kassandra L., et al. “Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis.” Journal of the American Medical Association 296, Pages 2832-2838

Too much of the retinol or retinyl forms of vitamin A may harm bone health. Even daily intake of 100 percent of the vitamin A "daily value" listed on dietary supplement bottles appears to increase the risk for developing osteoporosis. Read more about this important issue.