Bone Health: Early Prevention of Osteoporosis

Bone Health: Early Prevention of Osteoporosis

Osteoporosis: The Facts

Osteoporosis and low-bone mass (commonly referred to as osteopenia) are a major public health threat to approximately 53.6 million Americans age 50 years and older. The prevalence of osteoporosis is higher among individuals with lower socio-economic status. Nutrition and other lifestyle exposures have the potential to influence bone health throughout the lifespan. For instance, the ability of bone to adequately absorb, store, and utilize minerals is greatly impacted by the presence of other nutrients. Dairy products provide more bone-beneficial nutrients per unit of energy than any other food group (i.e., protein, calcium, vitamin D, magnesium, potassium, zinc, and phosphorus) but are largely under-consumed relative to the amounts recommended by the U.S. Dietary Guidelines for Americans.

Peak Bone Mass

Children and adolescents are constantly growing, which makes their skeleton increasingly vulnerable to fractures.  30-50% of children experience a fracture by the end of their teenage years.  

Nutrition and physical activity are not only important for helping prevent fractures during growth; they have a long-lasting effect, helping to prevent osteoporosis later in life.  By the time an individual reaches their mid-20’s they achieve “peak bone mass” or in laymen’s terms, the maximum density and strength of the skeleton. Lifestyle choices have been shown to influence 20-40% of one’s peak bone mass.    

FACT: a small 5-10% change in peak bone mass can offset the chance of hip fracture by 25-50% later in life.

The National Osteoporosis Foundation just released a position statement on lifestyle factors that affect peak bone mass development (see below). 

Bone Health During Adulthood

Bones are like how my Dad describes a retirement savings plan. He always nags at me to “invest as much as you can while you’re young and don’t touch it until you have to.” When your body doesn’t get enough calcium from the diet, for example, it pulls it from bone. Good nutrition and proper physical activity can prevent bone loss during all stages of life. The figure below shows how suboptimal lifestyle factors can negatively influence bone health across the lifespan.

osteoporosis
Figure from Weaver et al. (2016)

Our Ongoing Research

Study of Women’s Health Across the Nation (SWAN)
SWAN is a multi-site longitudinal, epidemiologic study designed to examine the health of women during their middle years. The study is funded by the National Institutes of Health (NIH). Our team continues to investigate if optimizing food group (e.g., dairy, fruit, vegetable, etc) and nutrient (e.g., calcium, protein, etc) intakes prior to and during the menopause transition can prevent bone loss and resulting osteoporotic fractures in women.

Systematic Reviews of the Scientific Literature
We synthesize the scientific literature on controversial issues to ensure public policy and messaging is based on the totality of evidence. Select issues include: calcium supplements, plant vs. animal protein, dairy intake, fruit and vegetable intake, magnesium, and potassium.

Publications

Dairy Intake and Bone Health Across the Lifespan: A Systematic Review and Expert Narrative. (COMING SOON)
2020. Critical Reviews in Food Science and Nutrition

Calcium Supplement Use is Associated with Less Bone Mineral Density Loss, but does not Lessen the Risk of Bone Fracture Across the Menopause Transition: Data from the Study of Women’s Health Across the Nation.
2020. JBMR Plus

Dairy Intake is not Associated with Improvements in Bone Mineral Density or Risk of Fractures Across the Menopause Transition: Data from the Study of Women’s Health Across the Nation.
2020. Menopause

Calcium Supplementation and Coronary Artery Disease: A Methodological Confound?
2019. Journal of the American College of Nutrition

Fruits, Vegetables and Health: A Comprehensive Narrative, Umbrella Review of the Science and Recommendations for Enhanced Public Policy to Improve Intake.
2019. Critical Reviews in Food Science and Nutrition

Optimizing Dietary Protein for Lifelong Bone Health: A Paradox Unraveled.
2019. Nutrition Today

Animal Versus Plant Protein and Adult Bone Health: A Systematic Review and Meta-Analysis from the National Osteoporosis Foundation.
2018. PLoS One.

Dietary Protein and Bone Health: A Systematic Review and Meta-Analysis from the National Osteoporosis Foundation.
2017. American Journal of Clinical Nutrition

Dietary Protein Intake above the Current RDA and Bone Health: A Systematic Review and Meta-Analysis.
2017. Journal of the American College of Nutrition

Dried Plus, Prunes and Bone Health: A Comprehensive Review.
2017. Nutrients.

The National Osteoporosis Foundation’s Position Statement on Peak Bone Mass Development and Lifestyle Factors: a Systematic Review and Implementation Recommendations.
2016. Osteoporosis International

Calcium Plus Vitamin D Supplementation and Risk of Fractures: an Updated Meta-Analysis from the National Osteoporosis Foundation.
2016. Osteoporosis International

Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time has Come.https://pubmed.ncbi.nlm.nih.gov/28140318/
2016. Advances in Nutrition

Calcium and Vitamin D Disparities are Related to Gender, Age, Race, Household Income Level, and Weight Classification but not Vegetarian Status in the United States: Analysis of the NHANES 2001-2008 Data Set.
2013. Journal of the American College of Nutrition

Additional Resources

The National Osteoporosis Foundation

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