Special Issue "Osteoporosis Prevention and Nutrition"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: closed (15 August 2020).

Special Issue Editor

Prof. Dr. Karl Michaëlsson
E-Mail Website
Guest Editor
Uppsala University, Department of Surgical Sciences, Section Orthopaedic, SE-75185 Uppsala, Sweden
Interests: vitamin D; calcium; dairy; fragility fractures; physical activity; osteoporosis; epidemiology

Special Issue Information

Dear Colleagues,

It is estimated that 25 million men and 140 million women globally will have a fracture each year. About 3.5 million new fragility fractures occur annually in Europe alone and fragility fractures can, in some high-incidence countries, encompass 10% of the total health care costs. Fragility fractures therefore impose a huge personal and economic toll, and high mortality rates are often an additional consequence. With a growing number of elderly individuals, the number of fragility fracture cases is expected to double worldwide over the next 40 years, presenting significant challenges to medical systems, health care budgets and the well-being of older populations.

Hip fractures are considered the most devastating type of fragility fracture associated with substantial pain and suffering, disability, increased mortality for the individual and high costs for the society. Worldwide 1.6 million hip fractures are estimated to occur each year at an average of 80 years of age. As for fragility fractures in general, Scandinavian countries have the highest rates. Thus, a Swedish man has a higher risk of having a hip fracture than a woman from the United Kingdom, the Netherlands, or Finland, an observation that cannot readily be explained by known lifestyle or genetic determinants, climate, vitamin D status, longevity, or geographical differences in bone mineral density (BMD). The risk of hip fracture increases 44 fold in Swedish women from 55 to 85 years of age, so that the lifetime cumulative incidence of hip fracture is 25% in women and 12% in men. Hip fractures account for half of all costs imposed by fractures in the middle-aged and older populations and on average 1% total health care costs in Europe. The impact is even greater in Scandinavia given our high incidences.

To reduce the burden from fractures in society, it is important to explore preventive strategies that may impact risk and which are modifiable by intervention. According to twin studies, lifestyle for the occurrence of fragility fracture as well as bone loss prevention is becoming of greater importance with growing age. One such modifiable lifestyle factor is our diet. Much research relating to diet and bone health has historically been spent on calcium and vitamin D. However, many other nutrients and food components in our diets, as well as individual foods may influence bone health. We aim to provide a selection of different nutritional aspects for the prevention of fragility fractures in this special issue ‘Osteoporosis Prevention and Nutrition’ of Nutrients. Although not restricted to only these, some topics might be:

  • Calcium and vitamin D supplementation for the prevention of fragility fractures. Who needs it?
  • Dairy consumption for the prevention of fragility fractures
  • A healthy diet also suitable for the prevention of fragility fractures?
  • Advantages and limitations of Mendelian randomization studies to disentangle nutrients of causal importance for bone and prevention of fractures.
  • Vitamin A in relation to bone health.
  • Vitamin K in relation to bone turnover markers, bone health and fractures.
  • Magnesium intake and bone.
  • The effects of phytoestrogens on bone mineral density and fractures in postmenopausal women
  • Osteomicrobiology – a novel field of research connecting intestinal microbiota with skeletal health.

Prof. Dr. Karl Michaëlsson
Guest Editor

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Keywords

  • Fracture
  • Osteoporosis
  • Calcium
  • Vitamin D
  • Vitamin A and retinol
  • Healthy diet
  • Milk
  • Dairy
  • Microbiota

Published Papers (8 papers)

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Research

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Article
The Beneficial Effect of Boswellic Acid on Bone Metabolism and Possible Mechanisms of Action in Experimental Osteoporosis
Nutrients 2020, 12(10), 3186; https://doi.org/10.3390/nu12103186 - 18 Oct 2020
Cited by 1 | Viewed by 1428
Abstract
Estrogen is instrumental in the pathological process of osteoporosis because a deficiency of this hormone increases the release of bone-resorbing cytokines. Acetyl-11-keto-β-boswellic acid (AKBA), a constituent from Boswellia serrata, has an anti-inflammatory effect by inhibiting tumor necrosis factor-α (TNF-α) expression, which leads [...] Read more.
Estrogen is instrumental in the pathological process of osteoporosis because a deficiency of this hormone increases the release of bone-resorbing cytokines. Acetyl-11-keto-β-boswellic acid (AKBA), a constituent from Boswellia serrata, has an anti-inflammatory effect by inhibiting tumor necrosis factor-α (TNF-α) expression, which leads to a decline in receptor activator of nuclear factor-kappa B (NF-κB) ligand, and consequently, a reduction in osteoclast activity. Hence, AKBA may be beneficial against bone loss during osteoporosis. Therefore, the current study intended to evaluate the beneficial effects of AKBA in ovariectomy-induced osteoporosis and to investigate its mechanism of action. Sham-operation or ovariectomy female Sprague Dawley rats were used for evaluating the antiosteoporotic effect of AKBA in this study. AKBA (35 mg/kg, p.o.) and estradiol (0.05 mg/kg, i.m.) were administered for 42 days. At the end of the experiment, body and uterus weights, serum and urine calcium and phosphorus, serum alkaline phosphatase, and urinary creatinine levels, besides serum levels of NF-κB and TNF-α were determined. Weight, length, thickness, hardness, calcium content, as well as the bone mineral density of femur bone and lumbar vertebra were measured. A histopathological examination was also carried out. AKBA ameliorated all tested parameters and restored a normal histological structure. Thus, AKBA showed good antiosteoporotic activity, which may be mediated through its suppression of the NF-κB-induced TNF-α signaling pathway. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Article
Effect of Co-Administration of Panax ginseng and Brassica oleracea on Postmenopausal Osteoporosis in Ovariectomized Mice
Nutrients 2020, 12(8), 2415; https://doi.org/10.3390/nu12082415 - 12 Aug 2020
Cited by 1 | Viewed by 1031
Abstract
Postmenopausal osteoporosis is a common disorder resulting from increased osteoclastic activity. To determine the effect of Panax ginseng on postmenopausal osteoporosis, ovariectomized (OVX) mice were treated with 500 mg/kg/day P. ginseng extract (Pg) alone or in combination with hot water extract of Brassica [...] Read more.
Postmenopausal osteoporosis is a common disorder resulting from increased osteoclastic activity. To determine the effect of Panax ginseng on postmenopausal osteoporosis, ovariectomized (OVX) mice were treated with 500 mg/kg/day P. ginseng extract (Pg) alone or in combination with hot water extract of Brassica oleracea (Bo) daily for 10 weeks, and the effect of the treatments on OVX-induced bone loss was examined. Bone weight, bone mineral density (BMD), osteoclast (OC) formation, OC marker expression, and biochemical parameters in blood were determined. OVX significantly increased body weight and decreased bone weight compared with those in the Sham group (p < 0.01). Pg or Bo alone did not affect OVX-induced bone loss, but a combination of Pg and Bo (Pg:Bo) recovered bone weight. The bones of OVX mice showed lower BMD than that of Sham mice, and the Pg:Bo = 3:1 restored the decreased BMD. Single treatment with Pg or Bo did not alter OC formation; however, the Pg:Bo = 3:1 inhibited OC formation. In addition, Pg and Bo lowered the OVX-induced elevation in blood glucose level. Thus, we suggest that Pg in combination with proper materials, such as Bo, might be a potential candidate treatment with minimal side effects protect against postmenopausal osteoporosis. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Article
Anti-Osteoporotic Effects of Combined Extract of Lycii Radicis Cortex and Achyranthes japonica in Osteoblast and Osteoclast Cells and Ovariectomized Mice
Nutrients 2019, 11(11), 2716; https://doi.org/10.3390/nu11112716 - 09 Nov 2019
Cited by 6 | Viewed by 1356
Abstract
Osteoporosis is characterized by low bone density and quality with high risk of bone fracture. Here, we investigated anti-osteoporotic effects of natural plants (Lycii Radicis Cortex (LRC) and Achyranthes japonica (AJ)) in osteoblast and osteoclast cells in vitro and ovariectomized mice in [...] Read more.
Osteoporosis is characterized by low bone density and quality with high risk of bone fracture. Here, we investigated anti-osteoporotic effects of natural plants (Lycii Radicis Cortex (LRC) and Achyranthes japonica (AJ)) in osteoblast and osteoclast cells in vitro and ovariectomized mice in vivo. Combined LRC and AJ enhanced osteoblast differentiation and mineralized bone-forming osteoblasts by the up-regulation of bone metabolic markers (Alpl, Runx2 and Bglap) in the osteoblastic cell line MC3T3-E1. However, LRC and AJ inhibited osteoclast differentiation of monocytes isolated from mouse bone marrow. In vivo experiments showed that treatment of LRC+AJ extract prevented OVX-induced trabecular bone loss and osteoclastogenesis in an osteoporotic animal model. These results suggest that LRC+AJ extract may be a good therapeutic agent for the treatment and prevention of osteoporotic bone loss. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Article
A New Calcium Oral Controlled-Release System Based on Zeolite for Prevention of Osteoporosis
Nutrients 2019, 11(10), 2467; https://doi.org/10.3390/nu11102467 - 15 Oct 2019
Cited by 1 | Viewed by 1155
Abstract
Osteoporosis, a systemic skeleton disease, can be prevented by increasing calcium levels in serum via administration of calcium salts. However, traditional calcium-based formulations have not appeared to be effective, hence the purpose of the present work has been to prepare and test in [...] Read more.
Osteoporosis, a systemic skeleton disease, can be prevented by increasing calcium levels in serum via administration of calcium salts. However, traditional calcium-based formulations have not appeared to be effective, hence the purpose of the present work has been to prepare and test in vitro/vivo a formulation able to gradually release calcium during transit over the GI tract, thus increasing bioavailability and reducing daily dose, and hence, side effects. Calcium controlled-release granules based on zeolite and Precirol® were prepared. In the best case, represented by granules sized 1.2 mm, containing 20% Precirol®, 19% zeolite, 60% calcium (granule), the release lasted ≈6 h. The release is controlled by diffusion of calcium ions through the aqueous channels forming within granules, once these come into contact with physiological fluids. Such a diffusion is hindered by the interaction of calcium ions with the negatively charged surface of the zeolite. Ovariectomy was used to make rats osteopenic. For in vivo studies, rats were divided into the following groups. Sham: not treated; ova: ovariectomized (ova); CaCl2 1.0 g: ova, treated with 1.0 g/die Ca2+; CaCl2 0.5 g: ova, treated with 0.5 g/die Ca2+; granule 1.0 g, or granule 0.5 g: ova, treated with granules equivalent to 1.0 g/die or 0.5 g/die Ca2+ in humans. Ca2+ amounts in femur bone and bone marrow, femur mechanical characteristics, and femur medullary canalicule diameter were measured and the same efficacy rank order was obtained: ova < CaCl2 0.5 g < CaCl2 1.0 g < granule 0.5 g ≈ granule 1.0 g ≈ sham. The results show promise of an effective prevention of osteoporosis, based on a controlled-rate administration of a calcium dose half that administered by the current therapy, with reduced side effects. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Review

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Review
Milk Consumption for the Prevention of Fragility Fractures
Nutrients 2020, 12(9), 2720; https://doi.org/10.3390/nu12092720 - 05 Sep 2020
Cited by 4 | Viewed by 1757
Abstract
Results indicating that a high milk intake is associated with both higher and lower risks of fragility fractures, or that indicate no association, can all be presented in the same meta-analysis, depending on how it is performed. In this narrative review, we discuss [...] Read more.
Results indicating that a high milk intake is associated with both higher and lower risks of fragility fractures, or that indicate no association, can all be presented in the same meta-analysis, depending on how it is performed. In this narrative review, we discuss the available studies examining milk intake in relation to fragility fractures, highlight potential problems with meta-analyses of such studies, and discuss potential mechanisms and biases underlying the different results. We conclude that studies examining milk and dairy intakes in relation to fragility fracture risk need to study the different milk products separately. Meta-analyses should consider the doses in the individual studies. Additional studies in populations with a large range of intake of fermented milk are warranted. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Review
Is a Healthy Diet Also Suitable for the Prevention of Fragility Fractures?
Nutrients 2020, 12(9), 2642; https://doi.org/10.3390/nu12092642 - 30 Aug 2020
Viewed by 1532
Abstract
Osteoporosis and sarcopenia contribute to the risk of fracture in the population. These conditions share common features, and it is known that a healthy diet may have beneficial effects on both, theoretically resulting in fewer fractures. The present narrative review gives an overview [...] Read more.
Osteoporosis and sarcopenia contribute to the risk of fracture in the population. These conditions share common features, and it is known that a healthy diet may have beneficial effects on both, theoretically resulting in fewer fractures. The present narrative review gives an overview of recent epidemiological research related to the association between healthy diets/dietary patterns, bone health and fragility fractures. The review also gives a brief overview on general dietary recommendations and advice as the cornerstone of public health nutrition. Although muscle health and sarcopenia contribute to the risk of fractures, these endpoints were not the focus of this review. Healthy diets are nutrient dense and contain bioactive components that are needed for the constant remodeling of the skeleton and to slow the rate of bone loss and muscle wasting, thus contributing to the prevention of fragility fractures. Compliance with healthy dietary patterns were predominantly found to be inversely associated with bone outcomes, although this was not entirely consistent across all studies. Different a priori diet scores, such as the Mediterranean diet score and the Dietary Inflammatory Index, as well as a posteriori data driven dietary patterns, such as the prudent or healthy dietary pattern, were inversely associated with fragility fractures in different populations. In conclusion, different healthy dietary patterns may contribute to bone health and less fractures. Following current dietary guidelines is thus advisable for the prevention of fragility fractures. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Review
Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
Nutrients 2020, 12(4), 1011; https://doi.org/10.3390/nu12041011 - 07 Apr 2020
Cited by 16 | Viewed by 3712
Abstract
Vitamin D and calcium have different biological functions, so the need for supplementation, and its safety and efficacy, need to be evaluated for each separately. Vitamin D deficiency is usually the result of low sunlight exposure (e.g., in frail older people, those who [...] Read more.
Vitamin D and calcium have different biological functions, so the need for supplementation, and its safety and efficacy, need to be evaluated for each separately. Vitamin D deficiency is usually the result of low sunlight exposure (e.g., in frail older people, those who are veiled, those with dark-skin living at higher latitudes) and is reversible with calciferol 400–800 IU/day. Calcium supplements produce a 1% increase in bone density in the first year of use, without further increases subsequently. Vitamin D supplements do not improve bone density in clinical trials except in analyses of subgroups with baseline levels of 25-hydroxyvitamin D <30 nmol/L. Supplementation with calcium, vitamin D, or their combination does not prevent fractures in community-dwelling adults, but a large study in vitamin D-deficient nursing home residents did demonstrate fracture prevention. When treating osteoporosis, co-administration of calcium with anti-resorptive drugs has not been shown to impact on treatment efficacy. Correction of severe vitamin D deficiency (<25 nmol/L) is necessary before use of potent anti-resorptive drugs to avoid hypocalcemia. Calcium supplements cause gastrointestinal side effects, particularly constipation, and increase the risk of kidney stones and, probably, heart attacks by about 20%. Low-dose vitamin D is safe, but doses >4000 IU/day have been associated with more falls and fractures. Current evidence does not support use of either calcium or vitamin D supplements in healthy community-dwelling adults. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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Review
Nutritional Support and Physical Modalities for People with Osteoporosis: Current Opinion
Nutrients 2019, 11(12), 2848; https://doi.org/10.3390/nu11122848 - 20 Nov 2019
Cited by 9 | Viewed by 3826
Abstract
Osteoporosis is a vital healthcare issue among elderly people. During the aging process, a gradual loss of bone mass results in osteopenia and osteoporosis. Heritable factors account for 60–80% of optimal bone mineralization, whereas modifiable factors such as nutrition, weight-bearing exercise, body mass, [...] Read more.
Osteoporosis is a vital healthcare issue among elderly people. During the aging process, a gradual loss of bone mass results in osteopenia and osteoporosis. Heritable factors account for 60–80% of optimal bone mineralization, whereas modifiable factors such as nutrition, weight-bearing exercise, body mass, and hormonal milieu affect the development of osteopenia and osteoporosis in adulthood. Osteoporosis substantially increases the risk of skeletal fractures and further morbidity and mortality. The effective prevention of fractures by reducing the loss of bone mass is the primary goal for physicians treating people with osteoporosis. Other than pharmacologic agents, lifestyle adjustment, nutritional support, fall prevention strategies, exercise, and physical modalities can be used to treat osteoporosis or prevent further osteoporotic fracture. Each of these factors, alone or in combination, can be of benefit to people with osteoporosis and should be implemented following a detailed discussion with patients. This review comprises a systematic survey of the current literature on osteoporosis and its nonpharmacologic and nonsurgical treatment. It provides clinicians and healthcare workers with evidence-based information on the assessment and management of osteoporosis. However, numerous issues regarding osteoporosis and its treatment remain unexplored and warrant future investigation. Full article
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
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