advances in nutrition for bone...

www.iofbonehealth.org

IOF INTERNATIONAL OSTEOPOROSIS FOUNDATION

Food Matters Live 18 November 2014

Advances in Nutrition for

Bone Health

Dominique D Pierroz, PhD, Science Manager, IOF

MEMBERSHIP STRUCTURE

CSA Committee of

Scientific Advisors

CNS Committee of

National Societies

CCA Committee of

Corporate Advisors


NUTRITION AND BONE HEALTH AT IOF


World Osteoporosis Day 2011



THE BONE BANK


Capital:

Income

(Bone Accrual) Expenses

(Bone Loss)

Mass/Density

Geometry

Microstructure

Matrix/Mineral

Dairy

Products

Proteins

Genetics

60-80%

Dairy

Products

Proteins

Can Bone Mineral Mass Trajectory Be Changed ?Nutritional Factors: CALCIUM, PROTEIN


EFFECTS OF CALCIUM SUPPLEMENTATION ON TOTAL BODY BONE MINERAL CONTENT


Winzenberg, 2006

Children Bone Mass In Relation To Mother Nutritional Status During Pregnancy - Bone mineral density at age of 6 years positively

correlated to milk products and calcium-rich

foods consumption during pregnancy (Ganpule et al

2006)

At the age of 8-9 years, aBMD was higher if born

from a mother with a healthy diet (vegetables,

fruits, pasta, yoghourt, cheese) (Cole et al 2009)


> Cross-sectional case-control studies


https://iofbonehealth.org/calcium


Calcium equivalents

S E RE

1 portion

250 mg of calcium

3 glasses of mineral water

rich in calcium (~5dl)

1 yoghurt

(180g)

2 cheeses

spreads

2 custards 200g curde cheese

1 glass of milk

(2dl)

30g hard cheese

60g soft

cheese

2 tablespoons of

powdered milk

CALCIUM CALCULATOR


https://iofbonehealth.org/calcium-calculator

DIETARY PROTEIN INTAKE ON BONE GROWTH


Alexy, 2005


1 portion

20g of proteins

2 eggs

100g fish

100g meat

40g pulses + 80g

grains (raw weight) 200g tofu or quorn

3 glasses of

milk (6dl)

80g hard cheese

100g soft

cheese

Protein equivalents RDA: 0.8- 1.0 g/kg body weight for adults

DAIRY PRODUCTS AND FRACTURES

1L of milk is ~32-35 g of protein (casein and

whey )

Children who avoid drinking cow’s milk are at

increased risk for prepubertal bone fractures (Goulding et al, JADA 2004)

– -> 0 - 13 yrs: 22 observed fractures vs 8.4 expected

Fractures during growth: potential role of a milk-

free diet ( Konstantynowicz et al, Osteoporos Int 2007)

-> 2-20 yrs: OR 4.6 in girls and 1.3 (NS) in boys


MILK PROCESSING (CHEESE PRODUCTION) Preservation of milk products

Non-perishable and transportable form

Readily availability

More digestible form (Less Lactose)



6-wk trial in healthy, postmenopausal women vitamin D and calcium-fortified soft white cheese (treated) or usual diet (control).

Effects of Soft Cheese in Postmenopausal Women

Bonjour, J Nutri 2012


Protein Supplement Attenuates Bone Loss In Patients With Recent Hip Fracture

-6

-5

-4

-3

-2

-1

0

1

% C

hanges

p<0.05

Prot.Sup. Controls

*

Proximal Femur BMD

Schürch, Rizzoli et al, Ann Int med 1998

- 25% Length of Stay in Rehabilitation Hospital

[% changes from baseline]

APPEALING DUAL ACTION

FOR FRACTURE PREVENTION AT OLDER AGE


EVIDENCE DOUBLE-BLIND RCTS


30% ↓ 14% ↓

Hip fracture Any Non-vert fractures

34% ↓

Falls

Bischoff-Ferrari HA et al. Archives of Internal Medicine 2009

Bischoff-Ferrari HA et al. NEJM 2012

Bischoff-Ferrari HA et al. BMJ 2009 + 2011

12 RCTs / 11 pooled RCT > 30‘000 seniors

8 RCTS

Vitamin D

800 IU/d


Effects of Calcium-Vitamin D on Fracture Risk

Chapuy et al Dawson-Hughes et al NEJM 1992 NEJM 1997

Ca + Vit D

Control


High-Dose Vitamin D (500’000 IU) and

Falls and Fractures in Older Women

Cu

mu

lati

ve in

cid

ence

of

falls

%

75

50

25

0

100

Time (Years)

Vitamin D

Placebo

0 1 2 3 4 5 Cu

mu

lati

ve I

nci

den

ce o

f fr

actu

res

%

15

10

5

0

20

Time (Years)

Vitamin D

Placebo

0 1 2 3 4 5

HR 1.16

(CI 1.05-1.28)

HR 1.26

(CI 0.99-1.59)

Falls Fractures

P = 0.003 P =0.06

Sanders, JAMA 2010

DIETARY SOURCE OF VITAMIN D


Sun Exposure Required to Produce 15 µg (600 IU) Vitamin D


Morning Noon Afternoon Morning Noon Afternoon

March 50 15 35 65 20 50

April 45 10 10 60 10 15

May 25 5 10 30 10 10

June 20 5 5 25 5 10

July 20 5 5 30 5 10

August 30 5 5 35 5 10

September 45 10 10 55 10 15

October 85 15 25 100 20 30

Face, Hands and Upper Limb Exposed to the Sun

Caucasian Skin Non Caucasian Skin

VITAMIN D MAP


https://iofbonehealth.org/facts-and-statistics/vitamin-d-studies-map


THANK YOU

EFFECTS OF CALCIUM

SUPPLEMENTATION ON TOTAL BODY

BONE MINERAL CONTENT


Winzenberg, 2006


6-year mother’s milk intake and offspring (at 6 years) associated BONE MASS

Cole et al Osteoporos Int 2013


GROWTH HORMONE-IGF-I SYSTEM,

AND BONE AND MUSCLE

Perrini et al J Endocrinol 2010

Institute of Medicine Report


Ross et al JCEM 2011

CLINICAL CONCEPT AND RELEVANCE


Reduced healthy life expectancy

loss of autonomy

disability hip fracture

frailty sarcopenia fall chronic

diseases

RECOMMENDATIONS VITAMIN D



• Vitamin D may have the potential to extend healthy life expectancy by

reducing the risk of falls and fractures, plus delaying chronic diseases at

older age

• While we have evidence today from double blind RCTs regarding fall

and fracture prevention with a daily dose of 800 IU Vitamin D

we lack evidence from large clinical trials on effects of vitamin D

outside bone and muscle

we lack evidence from higher than 800 IU / d doses of vitamin D per

day

EXCITEMENT AROUND VITAMIN D

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