Postmenopausal bone health and nutrition

Postmenopausal bone loss

Quick bibliography: Reviews/recent articles on postmenopausal bone health and nutrition.

**updated June 2021**

Classic review:

*Ilich, J. Z. & Kerstetter, J.E. (2000). Nutrition in Bone Health Revisited: A Story Beyond Calcium. Journal of the American College of Nutrition, 19(6), 715-737. [Cited by]

Osteoporosis is a complex, multi-factorial condition characterized by reduced bone mass and impaired micro-architectural structure, leading to an increased susceptibility to fractures. Although most of the bone strength (including bone mass and quality) is genetically determined, many other factors (nutritional, environmental and life-style) also influence bone. Nutrition is an important modifiable factor in the development and maintenance of bone mass and the prevention and treatment of osteoporosis. Approximately 80–90% of bone mineral content is comprised of calcium and phosphorus. Other dietary components, such as protein, magnesium, zinc, copper, iron, fluoride, vitamins D, A, C, and K are required for normal bone metabolism, while other ingested compounds not usually categorized as nutrients (e.g. caffeine, alcohol, phytoestrogens) may also impact bone health. Unraveling the interaction between different factors; nutritional, environmental, life style, and heredity help us to understand the complexity of the development of osteoporosis and subsequent fractures. This paper reviews the role of dietary components on bone health throughout different stages of life. Each nutrient is discussed separately, however the fact that many nutrients are co-dependent and simultaneously interact with genetic and environmental factors should not be neglected. The complexity of the interactions is probably the reason why there are controversial or inconsistent findings regarding the contribution of a single or a group of nutrients in bone health.

Recent reviews/articles:

*Brondani, J. E.,  Comim, F. V.,  Flores, L. M., Lígia Araújo, M., & Premaor, M. O. (2019).  Fruit and vegetable intake and bones: A systematic review and meta-analysis.  PLoS One, 14(5), e0217223.  [PDF] [Cited by]

Although intake of fruits and vegetables seemed to have a protective effect on bone metabolism, its effect on fractures remains uncertain. There was no association between the bone resorption marker CTx and 3 months of fruit and vegetable intake evaluated by four RCTs [randomized controlled trials]. There was an association between the increase of at least one serving of fruits and vegetables per day and decreases in the risk of fractures. The level of evidence for this association is moderate.”

*Kruger, M. C., Kuhn-Sherlock, B., Chin Chin, L., Todd, J. M., Lau, L. T., et al. (2018). Calcium and vitamin D fortified milk reduces bone turnover and improves bone density in postmenopausal women over 1 year. European journal of nutrition57(8), 2785-2794.  [Cited by]

“In Malaysia, hip fracture incidence is higher in Chinese women than other ethnic groups. This study compared the effects of a high-calcium vitamin D fortified milk with added FOS-inulin versus regular milk over 1 year on aspects of bone health in Chinese postmenopausal women in Malaysia. Compared with regular milk, the fortified milk suppressed bone turnover markers and tended to increase femoral neck bone density.”

*Seem, S.A., Yuan, Y. V., & Tou, J. C. (2019). Chocolate and chocolate constituents influence bone health and osteoporosis risk. Nutrition, 65, 74-84. [Cited by]

Bone loss resulting in increased risk for osteoporosis is a major health issue worldwide. Chocolate is a rich source of antioxidant and antiinflammatory flavonoids and dietary minerals with the potential to benefit bone health. However, other chocolate constituents such as cocoa butter, sugar, and methylxanthines may be detrimental to bone. Human studies investigating the role of chocolate consumption on serum bone markers and bone mineral density (BMD) have been inconsistent. A contributing factor is likely the different composition and thereby the nutrient and bioactive content among chocolate types. White and milk chocolate are high in sugar and low in flavonoids and most minerals. Dark chocolate (45–85% cocoa solids) is high in flavonoids, most minerals, and low in sugar with ≥70% cocoa solids resulting in higher fat and methylxanthine content. The aim of this review was to examine the relationship between chocolate consumption and its constiuents, including flavonoid content, on bone health and osteoporosis risk. Studies showed postmenopausal women had no bone effects at moderate chocolate intakes, whereas adolescents consuming chocolate had greater longitudinal bone growth. Based on flavonoid and mineral content, unsweetened cocoa powder appeared to be the best option followed by dark chocolate with higher cocoa content in terms of supporting and preserving bone health. Determining dietary recommendations for chocolate consumption relative to bone health is important because of the growing popularity of chocolate, particularly dark chocolate, and an expected increase in consumption owing to suggestions of health benefits against various degenerative diseases.”

*Wallace, T. C. (2017). Dried Plums, Prunes and Bone Health: A Comprehensive Review.Nutrients, 9(4), 401.  [PDF] [Cited by]

“The 2015–2020 Dietary Guidelines for Americans advocate for increasing fruit intake and replacing energy-dense foods with those that are nutrient-dense. Nutrition across the lifespan is pivotal for the healthy development and maintenance of bone. The National Osteoporosis Foundation estimates that over half of Americans age 50+ have either osteoporosis or low bone mass. Dried plums, also commonly referred to as prunes, have a unique nutrient and dietary bioactive profile and are suggested to exert beneficial effects on bone. To further elucidate and summarize the potential mechanisms and effects of dried plums on bone health, a comprehensive review of the scientific literature was conducted. The PubMed database was searched through 24 January 2017 for all cell, animal, population and clinical studies that examined the effects of dried plums and/or extracts of the former on markers of bone health. Twenty-four studies were included in the review and summarized in table form. The beneficial effects of dried plums on bone health may be in part due to the variety of phenolics present in the fruit. Animal and cell studies suggest that dried plums and/or their extracts enhance bone formation and inhibit bone resorption through their actions on cell signaling pathways that influence osteoblast and osteoclast differentiation. These studies are consistent with clinical studies that show that dried plums may exert beneficial effects on bone mineral density (BMD). Long-term prospective cohort studies using fractures and BMD as primary endpoints are needed to confirm the effects of smaller clinical, animal and mechanistic studies. Clinical and prospective cohort studies in men are also needed, since they represent roughly 29% of fractures, and likewise, diverse race and ethnic groups. No adverse effects were noted among any of the studies included in this comprehensive review. While the data are not completely consistent, this review suggests that postmenopausal women may safely consume dried plums as part of their fruit intake recommendations given their potential to have protective effects on bone loss.

For additional research about postmenopausal bone health and nutrition, please see the Science Primary Literature Database.

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