Dietary Factors and Bone Health in Postmenopausal Women

Introduction: About 80% of those affected by osteoporosis are postmenopausal women. Therefore, identifying beneficial or harmful dietary factors for postmenopausal osteoporosis may have a significant public health impact.

Objectives: The overall objective of this thesis was to examine the relations between various dietary factors and bone health in postmenopausal women aged ≥ 45 years using different analytical approaches.

Methods: First, the associations between fruit and vegetables (F&V) intake and indicators of bone health were assessed using a systematic review approach. Electronic databases were searched and peer-reviewed observational and interventional studies published in English with F&V intake as a main dietary exposure were included. Data selection, extraction and evaluation of risk of bias were performed independently by two reviewers. Second, the associations between an overall diet quality index (HEI-2005) and its components with bone turnover markers (BTMs) were examined. Third, the relationships between alpha-tocopherol intake, serum alpha- and gamma-tocopherol, two concentration biomarkers of vitamin E intake, and their ratio and BTMs were assessed. For the second and third studies, cross-sectional data from the National Health and Nutrition Examination Survey 1999-2002 were used. Weighted multiple regression models with adjustments for relevant confounders were used to examine the relationship between exposures and serum bone-specific alkaline phosphatase (BAP), a biomarker of bone formation, and urinary N-Telopeptides/Creatinine (uNTx/Cr), a biomarker of bone resorption.

Results: There was significant between-study heterogeneity in design, definition and amount of F&V intake, outcomes, analyses and reporting of results in the eight included studies. Overall, cross-sectional and case-control analyses reported protective associations between F&V intake and bone health, whereas interventional and prospective cohort analyses did not.

There were no associations between total HEI-2005 scores and BTMs. However, the Milk Group component of HEI-2005 had a significant inverse relationship with uNTx/Cr.

Higher serum gamma-tocopherol and lower ratio of serum alpha- to gamma-tocopherol were associated with higher BAP concentrations but had no associations with NTx/Cr concentrations.

Conclusions: The results confirm the existing knowledge that a diet with adequate intake of dairy may reduce bone loss. Further research is needed to examine the potential anabolic effects of gamma-tocopherol on bone in postmenopausal women.

Year	Entry
1997	Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D; European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporos Int. July 1997;7(4):390-406.
2002	Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. November 12, 2002;167(suppl 10):S1-S34.
1994	Kanis JA; WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int. November 1994;4(6):368-381.
1996	Garnero P, Hausherr E, Chapuy M, Marcelli C, Grandjean H, Muller C, Cormier C, Bréart G, Meunier PJ, Delmas PD. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS prospective study. J Bone Miner Res. October 1996;11(10):1531-1538.
2010	Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010;8:47.
2011	Khosla S, Bellido TM, Drezner MK, Gordon CM, Harris TB, Kiel DP, Kream BE, LeBoff MS, Lian JB, Peterson CA, Rosen CJ, Williams JP, Winer KK, Sherman SS. Forum on aging and skeletal health: summary of the proceedings of an ASBMR workshop. J Bone Miner Res. November 2011;26(11):2565-2578.
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Year

Entry

1997

Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D; European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporos Int. July 1997;7(4):390-406.

2002

Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. November 12, 2002;167(suppl 10):S1-S34.

1994

Kanis JA; WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int. November 1994;4(6):368-381.

1996

Garnero P, Hausherr E, Chapuy M, Marcelli C, Grandjean H, Muller C, Cormier C, Bréart G, Meunier PJ, Delmas PD. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS prospective study. J Bone Miner Res. October 1996;11(10):1531-1538.

2010

Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010;8:47.