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Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density

An Erratum to this article was published on 24 June 2003

Abstract

Objective: Nutrition is an important factor in the prevention and treatment of osteoporosis. Our goal was to examine the relationship between various nutrients and bone mass of several skeletal sites in elderly women, taking into account possible confounding variables.

Design/methods: A cross-sectional study in 136 healthy Caucasian, postmenopausal women, free of medications known to affect bone was carried out. Bone mineral density (BMD) and body composition (lean and fat tissue) were measured by dual X-ray absorptiometry using specialized software for different skeletal sites. Parathyroid hormone (PTH) and vitamin D, 25(OH)D, as possible confounders, were determined in serum samples. Dietary intake, including all supplements, was assessed by 3-day dietary record and analyzed using Food Processor®. Past physical activity and present walking were examined as well and accounted for as potential confounders. Simple and multiple regression models were created to assess the relationships between nutrients and BMD. To examine the co-linear variables and their possible independent association with bone, subgroup analyses were performed.

Results: Showed independent influence of calcium, energy, and protein, examined separately and in multiple regression models on BMD of several skeletal sites. Magnesium, zinc and vitamin C were significantly related to BMD of several skeletal sites in multiple regression models (controlled for age, fat and lean tissue, physical activity and energy intake), each contributing more than 1% of variance. Serum PTH and 25(OH)D did not show significant association with bone mass.

Conclusions: Despite the cross-sectional nature of our study we were able to show a significant relationship between BMD and several critical nutrients: energy, protein, calcium, magnesium, zinc and vitamin C. The exact involvement of these nutrients and their clinical significance in bone health need to be further elucidated in humans and conclusions about the effects of a single nutrient on bone mass must be given cautiously, taking into account its interaction and co-linearity with others. Understanding relationships among nutrients, not just limited to calcium and vitamin D, but others that have not been investigated to such extent, is an important step toward identifying preventive measures for bone loss and prevention of osteoporosis.

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Acknowledgements

This study was funded in part by the NRI/USDA 2001-00836, Donaghue Medical Research Foundation DF98-056, and the University of Connecticut Office for Sponsored Programs. The authors want to express their appreciation and thanks to all the women who participated in the study. Parts of this study were presented in a poster session at the International Bone and Mineral Society, June 2001, in Madrid, Spain.

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Guarantors: JZ Ilich and RA Brownbill.

Contributors: JZI is a principal investigator and was responsible for analyzing the data and writing the manuscript; RAB was responsible for collecting all data and analyzing nutritional and physical activity; LT was responsible for helping with the study and collecting information on nutritional supplements.

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Correspondence to J Z Ilich.

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Ilich, J., Brownbill, R. & Tamborini, L. Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density. Eur J Clin Nutr 57, 554–565 (2003). https://doi.org/10.1038/sj.ejcn.1601577

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Keywords

  • osteoporosis
  • bone mineral density
  • nutrition
  • calories
  • protein
  • vitamins
  • minerals

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