Dairy Intake Is Protective against Bone Loss in Older Vitamin D Supplement Users: The Framingham Study.

Background: Previous studies showed beneficial effects of specific dairy foods on bone health in middle-aged adults.Objective: We examined the association of milk, yogurt, cheese, cream, fluid dairy (milk + yogurt), and milk + yogurt + cheese intakes with bone mineral density (BMD) and 4-y percentage of change in BMD [▵%BMD; femoral neck, trochanter, and lumbar spine (LS)]. We further assessed whether these associations were modified by vitamin D supplement use in this cohort of older adults.Methods: Food-frequency questionnaire responses, baseline BMD (hip and spine, n = 862 in 1988-1989), and follow-up BMD (n = 628 in 1992-1993) were measured in the Framingham study, a prospective cohort study of older Caucasian men and women aged 67-93 y. Outcomes included baseline BMD and ▵%BMD. Dairy-food intakes (servings per week) were converted to energy-adjusted residuals, and linear regression was used, adjusting for covariates. These associations were further examined by vitamin D supplement use.Results: The mean age of the participants was 75 y. In the full sample, dairy-food items were not associated with BMD (P = 0.11-0.99) or with ▵%BMD (P = 0.29-0.96). Among vitamin D supplement users, but not among nonusers, higher milk, fluid dairy, and milk + yogurt + cheese intakes were associated with higher LS BMD (P = 0.011-0.009). Among vitamin D supplement users, but not among nonusers, higher milk + yogurt + cheese intakes were protective against trochanter BMD loss (P = 0.009).Conclusions: In this population of older adults, higher intakes of milk, fluid dairy, and milk + yogurt + cheese were associated with higher LS BMD, and a higher intake of milk + yogurt + cheese was protective against trochanter BMD loss among vitamin D supplement users but not among nonusers. These findings underscore that the benefits of dairy intake on the skeleton may be dependent on vitamin D intake.

Bone Mineral Density and Protein-Derived Food Clusters from the Framingham Offspring Study.

BACKGROUND: Dietary protein is beneficial to bone health; however, dietary patterns of protein intake and their relationship with bone mineral density (BMD) have not been evaluated. OBJECTIVE: To examine the relationship of dietary protein food clusters with BMD at the femoral neck, trochanter, total femur, and lumbar spine among middle-aged and older men and women. DESIGN: Cross-sectional study. PARTICIPANTS AND SETTING: Two thousand seven hundred fifty-eight community-dwelling individuals from the Framingham Offspring Study. METHODS: BMD was measured by Lunar DPX-L (Lunar Radiation Corporation) in 1996-2001. Dietary intakes were estimated using the Willett food frequency questionnaire in either 1995-1998 or 1998-2001, and the exam closest to a participant's BMD measurement was used. Cluster analysis (FASTCLUS procedure, k-means method) was used to classify participants into groups, determined by major sources of protein. Generalized linear regression was used to compare adjusted least-squares mean BMD across protein food clusters for all pairwise comparisons. RESULTS: From 2,758 participants (44% men; mean age 61±9 years, range=29 to 86 years), five protein food clusters were identified (chicken, fish, processed foods, red meat, and low-fat milk). Three of these food clusters showed associations with BMD. The red meat protein food cluster presented with significantly lower femoral neck BMD compared with the low-fat milk cluster (red meat 0.898±0.005 g/cm(2) vs low-fat milk 0.919±0.007 g/cm(2); P=0.04). Further, the processed foods protein cluster presented with significantly lower femoral neck BMD compared with the low-fat milk cluster (processed foods 0.897±0.004 g/cm(2) vs low-fat milk 0.919±0.007 g/cm(2); P=0.02). A similar, yet nonsignificant, trend was observed for other BMD sites examined. CONCLUSIONS: Diets with the greatest proportion of protein intake from red meat and processed foods may not be as beneficial to the skeleton compared with dietary patterns where the highest proportion of protein is derived from low-fat milk.

Association of total protein intake with bone mineral density and bone loss in men and women from the Framingham Offspring Study.

OBJECTIVE: To examine (i) the association of percentage of total energy intake from protein (protein intake %) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck, trochanter and lumbar spine (L2-L4) and (ii) Ca as an effect modifier. SETTING: The Framingham Offspring Study. SUBJECTS: Men (n 1280) and women (n 1639) completed an FFQ in 1992-1995 or 1995-1998 and underwent baseline BMD measurement by dual-energy X-ray absorptiometry in 1996-2000. Men (n 495) and women (n 680) had follow-up BMD measured in 2002-2005. DESIGN: Cohort study using multivariable regression to examine the association of protein intake % with each BMD, adjusting for covariates. Statistical interaction between protein intake % and Ca (total, dietary, supplemental) intake was examined. RESULTS: The mean age at baseline was 61 (sd 9) years. In the cross-sectional analyses, protein intake % was positively associated with all BMD sites (P range: 0·02-0·04) in women but not in men. Significant interactions were observed with total Ca intake (<800 mg/d v. ≥800 mg/d) in women at all bone sites (P range: 0·002-0·02). Upon stratification, protein intake % was positively associated with all BMD sites (P range: 0·04-0·10) in women with low Ca intakes but not in those with high Ca intakes. In the longitudinal analyses, in men, higher protein intake % was associated with more bone loss at the trochanter (P = 0·01) while no associations were seen in women, regardless of Ca intake. CONCLUSIONS: This suggests that greater protein intake benefits women especially those with lower Ca intakes. However, protein effects are not significant for short-term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater bone loss at the trochanter. Longer follow-up is required to examine the impact of protein on bone loss.

Polyunsaturated fatty acids and their relation with bone and muscle health in adults.

Age-related bone and muscle loss are major public health problems. Investigational therapies to reduce these losses include anti-inflammatory dietary supplementations, such as polyunsaturated fatty acids (PUFA). Surprisingly, this topic has received little attention in the osteoporosis community. Recent research highlights the role of PUFA in inflammatory regulation of bone remodeling via cellular pathways. Emerging research suggests significant roles for PUFA in reducing bone and muscle loss with aging; however, findings are conflicted for PUFA and fracture risk. Limited studies suggest a relation between higher omega-3 FA and better muscle/bone in older adults. This review highlights new research since 2008 and synthesizes our current understanding of PUFA in relation to bone and muscle. Across study designs, evidence indicates that PUFA has positive effects upon bone. As data are sparse, future clinical trials and prospective studies are important to determine the long term benefits of PUFA supplementation upon bone and muscle outcomes.

Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting.

BACKGROUND AND AIMS: Given the high risk of subsequent fracture among elderly persons with fracture, it is important to initiate secondary treatment for osteoporosis. Acute rehabilitation centers may offer a unique opportunity to introduce treatment. Therefore, we evaluated willingness-to-participate and compliance with evidence-based interventions for the secondary prevention of osteoporotic fracture in a non-randomized study conducted in the acute rehabilitation setting. We also described differences in baseline characteristics between study participants and non-participants. METHODS: All consecutive, community dwelling admissions to an acute rehabilitation unit (Boston, MA) with the diagnosis of fracture were screened for enrollment. Eligible subjects were offered a free, 6-month supply of alendronate/cholecalciferol (70 mg/2800 IU weekly), calcium and vitamin D supplements, and fall prevention strategies. Six-month compliance (> or =75% consumption of medication or supplement) with the interventions was determined at a home visit. RESULTS: Among 62 eligible subjects, 25 agreed to participate. Non-participants were older than participants (86 vs 80 yrs, p<0.01). There was no significant difference between other characteristics of participants and non-participants including sex, weight, type of fracture, cognitive status, and functional status. The most common reason for non-participation was reluctance to take another medication. Among participants, only 52% were compliant with alendronate and 58% were compliant with calcium and vitamin D supplementation at 6 months. CONCLUSIONS: Willingness- to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting, even when medications were provided free of cost. Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures.

Insights from the conduct of a device trial in older persons: low magnitude mechanical stimulation for musculoskeletal health.

BACKGROUND: Osteoporosis is a common complication of aging. Alternatives to pharmacologic treatment are needed for older adults. Nonpharmacologic treatment with low magnitude, high frequency mechanical stimulation has been shown to prevent bone loss in animal and human studies. METHODS: The VIBES (Vibration to Improve Bone Density in Elderly Subjects) study is a randomized, double-blind, sham-controlled trial of the efficacy of low magnitude, high frequency mechanical stimulation in 200 men and women aged 60 years and older with bone mineral density T-scores by dual X-ray absorptiometry between -1 and -2.5 at entry. Participants are healthy, cognitively intact residents of independent living communities in the Boston area who receive free calcium and Vitamin D supplements. They are randomly assigned to active or sham treatment and stand on their assigned platform once daily for 10 min. All platforms have adherence data collection software downloadable to a laptop computer. Adverse events are closely monitored. 174 participants were randomized and will be followed for 2 years. Almost all active subjects have attained 1 year of follow-up. Bone mineral density is measured by both dual X-ray absorptiometry and quantitative computed tomography at baseline and annually. The main analysis will compare mean changes from baseline in volumetric bone density by quantitative computed tomography in active and sham groups. Adherence and treatment effect magnitude will also be evaluated. Secondary analyses will compare changes in two biochemical markers of bone turnover as well as longitudinal comparisons of muscle and balance endpoints. RESULTS: The VIBES trial has completed its first year of data collection and encountered multiple challenges leading to valuable lessons learned about the areas of recruitment from independent living communities, deployment of multiuser mechanical devices using radio frequency identification cards and electronic adherence monitoring, organization of transportation for imaging at a central site, and the expansion of study aims to include additional musculoskeletal outcomes. CONCLUSIONS: These lessons will guide future investigations in studies of individuals of advanced age.

High vitamin C intake is associated with lower 4-year bone loss in elderly men.

Vitamin C is essential for collagen formation and normal bone development. We evaluated associations of total, supplemental, and dietary vitamin C intake with bone mineral density (BMD) at the hip [femoral neck, trochanter], spine, and radial shaft and 4-y BMD change in elderly participants from the Framingham Osteoporosis Study. Energy-adjusted vitamin C intakes were estimated from the Willett FFQ in 1988-89. Mean BMD and 4-y BMD change was estimated, for men and women, by tertile/category of vitamin C intake, adjusting for covariates. We tested for interaction with smoking, calcium, and vitamin E intake. Among 334 men and 540 women, the mean age was 75 y and mean vitamin D intake was 8.25 mug/d (women) and 8.05 mug/d (men). We observed negative associations between total and supplemental vitamin C intake and trochanter-BMD among current male smokers (P-trend = 0.01). Among male nonsmokers, total vitamin C intake was positively associated with femoral neck BMD (P-trend = 0.04). Higher total vitamin C intake was associated with less femoral neck and trochanter-BMD loss in men with low calcium (all P-trend

Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men.

CONTEXT: Although racial and ethnic differences in vitamin D status and bone mineral density (BMD) are recognized, less is known about how differences in vitamin D status impact BMD, especially among men. OBJECTIVE: Our objective was to examine the relation between serum 25-hydroxyvitamin D [25(OH)D] and BMD by race and ethnic group. DESIGN: We conducted a population-based, observational survey. PARTICIPANTS: PARTICIPANTS included 1114 Black, Hispanic, and White men, 30-79 yr of age. OUTCOMES: We assessed 25(OH)D by a competitive protein binding assay and BMD by dual-energy x-ray absorptiometry. RESULTS: Mean age +/- SD of the 331 Black, 362 Hispanic, and 421 White men was 48 +/- 12.8 yr. Mean 25(OH)D was lower among Black (25.0 +/- 14.7 ng/ml) and Hispanic (32.9 +/- 13.9 ng/ml) men compared with White men (37.4 +/- 14.0 ng/ml, P < 0.01). A higher percentage of both Black (44%) and Hispanic (23%) men had levels of 25(OH)D in the lowest quartile, compared with 11% of White men (P < 0.001). After adjusting for age, height, and weight, only White men showed significant positive correlation between 25(OH)D and BMD (range of correlations, 0.00-0.14). Serum 25(OH)D was not associated with BMD in Black or Hispanic men at any bone site. Results were similar when adjusted for age only. CONCLUSIONS: Our findings confirm substantial racial and ethnic group differences in BMD and serum 25(OH)D in men. Serum 25(OH)D and BMD are significantly related to one another in White men only. This may have implications for evaluation of bone health and supplementation in men with low levels of 25(OH)D. Further understanding of the biological mechanisms for these differences between race and ethnic groups is needed.

B vitamins, homocysteine, and bone disease: epidemiology and pathophysiology.

Observational studies indicate that mildly elevated homocysteine is a strong risk factor for osteoporotic fracture, yet there is no clear biologic mechanism for an effect of homocysteine on bone. The association could instead be attributed to B vitamins (folate, vitamin B(12), vitamin B(6)), as low levels of these nutrients are the primary determinants of homocysteine and may be associated with lower bone quality. Discovery of a direct effect of homocysteine or B vitamins on bone would be important in terms of interventions, as these factors can be modified with changes in diet or supplementation. This article reviews the connections of homocysteine and B vitamins to measures of bone quality and osteoporotic fracture. Although the literature suggests that these factors may be associated with bone health, most of the epidemiologic studies are observational, limiting conclusions regarding causality. More controlled -trials are needed to determine whether treatment with B vitamins would reduce fracture rates among community-dwelling cohorts.

Vitamin K intake and bone mineral density in women and men.

BACKGROUND: Low dietary vitamin K intake has been associated with an increased risk of hip fracture in men and women. Few data exist on the association between dietary vitamin K intake and bone mineral density (BMD). OBJECTIVE: We studied cross-sectional associations between self-reported dietary vitamin K intake and BMD of the hip and spine in men and women aged 29-86 y. DESIGN: BMD was measured at the hip and spine in 1112 men and 1479 women (macro x +/- SD age: 59 +/- 9 y) who participated in the Framingham Heart Study (1996-2000). Dietary and supplemental intakes of vitamin K were assessed with the use of a food-frequency questionnaire. Additional covariates included age, body mass index, smoking status, alcohol use, physical activity score, and menopause status and current estrogen use among the women. RESULTS: Women in the lowest quartile of vitamin K intake (macro x: 70.2 microg/d) had significantly (P < or = 0.005) lower mean (+/- SEM) BMD at the femoral neck (0.854 +/- 0.006 g/cm(2)) and spine (1.140 +/- 0.010 g/cm(2)) than did those in the highest quartile of vitamin K intake (macro x: 309 microg/d): 0.888 +/- 0.006 and 1.190 +/- 0.010 g/cm(2), respectively. These associations remained after potential confounders were controlled for and after stratification by age or supplement use. No significant association was found between dietary vitamin K intake and BMD in men. CONCLUSIONS: Low dietary vitamin K intake was associated with low BMD in women, consistent with previous reports that low dietary vitamin K intake is associated with an increased risk of hip fracture. In contrast, there was no association between dietary vitamin K intake and BMD in men.