Phytonutrients for bone health during ageing.

Osteoporosis is a skeletal disease characterized by a decrease in bone mass and bone quality that predispose an individual to an increased risk of fragility fractures. Evidence demonstrating a positive link between certain dietary patterns (e.g. Mediterranean diet or high consumption of fruits and vegetables) and bone health highlights an opportunity to investigate their potential to protect against the deterioration of bone tissue during ageing. While the list of these phytonutrients is extensive, this review summarizes evidence on some which are commonly consumed and have gained increasing attention over recent years, including lycopene and various polyphenols (e.g. polyphenols from tea, grape seed, citrus fruit, olive and dried plum). Evidence to define a clear link between these phytonutrients and bone health is currently insufficient to generate precise dietary recommendations, owing to mixed findings or a scarcity in clinical data. Moreover, their consumption typically occurs within the context of a diet consisting of a mix of phytonutrients and other nutrients rather than in isolation. Future clinical trials that can apply a robust set of outcome measurements, including the determinants of bone strength, such as bone quantity (i.e. bone mineral density) and bone quality (i.e. bone turnover and bone microarchitecture), will help to provide a more comprehensive outlook on how bone responds to these various phytonutrients. Moreover, future trials that combine these phytonutrients with established bone nutrients (i.e. calcium and vitamin D) are needed to determine whether combined strategies can produce more robust effects on skeletal health.

Differential effects of two citrus flavanones on bone quality in senescent male rats in relation to their bioavailability and metabolism.

The effect of hesperidin (Hp) and naringin (Nar), two major citrus flavanones, on the regulation of bone metabolism was examined in male senescent rats. Twenty -month -old gonad-intact male Wistar rats received a casein-based diet supplemented with or without either 0.5% hesperidin (Hp), 0.5% naringin (Nar) or a mix of both flavanones (Hp+Nar, 0.25% each). After 3 months, daily Hp intake significantly improved femoral bone integrity as reflected by improvements in total and regional bone mineral densities (BMD) (9.7%-12.3% improvements, p<0.05) and trabecular bone volume fraction (24.3% improvement, p<0.05) at the femur compared with control group. In contrast, naringin exerted site-specific effects on BMD (10.2% improvement at the distal metaphyseal area, p<0.05) and no further benefit to bone mass was observed with the mix of flavanones. Bone resorption (DPD) was significantly attenuated by Hp and Nar given alone (40.3% and 26.8% lower compared to control, p<0.05, respectively) but not by the mixture of the two. All treatments significantly reduced expression of inflammatory markers to a similar extent (IL-6, 81.0-87.9% reduction; NO, 34.7-39.5% reduction) compared to control. Bone formation did not appear to be strongly affected by any of the treatments (no effect on osteocalcin levels, modest modulation of tibial BMP-2 mRNA). However, as previously reported, plasma lipid-lowering effects were observed with Hp and Nar alone (34.1%-45.1% lower for total cholesterol and triglycerides compared to control, p<0.05) or together (46% lower for triglycerides, p<0.05). Surprisingly the plasma circulating level of naringin (8.15µM) was >5-fold higher than that of hesperidin (1.44µM) at equivalent doses (0.5%) and a linear reduction in plasma levels was observed upon co-administration (0.25% each) indicating absence of competition for their intestinal absorption sites and metabolism. The higher efficacy of Hp at a lower plasma concentration than naringin, as well as the identification of the major circulating metabolite of hesperidin (hesperetin-7-O-glucuronide) underlines the importance of flavanone bioavailability and metabolism in their biological efficacy and suggests a structure-function relationship in the mechanism of action of the active metabolites.