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Nutrition: its role in bone health

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At a given age, bone mass is determined by the amount of bone accumulated at the end of skeletal growth (the so-called peak bone mass), and by the amount of bone lost subsequently. Nutritional intake is an environmental factor that influences both bone capital accumulation, which is fully achieved by the end of the second decade of life, and bone loss, which occurs during the second half of existence. Nutrients may act directly by modifying bone turnover, or indirectly via changes in calciotropic hormone secretion. The study of the association between nutrition and a bone phenotypic expression may provide inconsistent results, in part because of the low accuracy and reproducibility of the various tools used to assess dietary intakes. Sufficient dietary calcium and protein are necessary for bone health during growth as well as in the elderly.

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Bone mass accrual

Body mineral stores almost double during puberty, through an increase in the size of the skeleton with minor changes in volumetric bone density, i.e., the amount of bone in bone.6, 7 By the end of the second decade of life, most of the body mineral capital has been accumulated, though a very small proportion of bone consolidation may occur during the third decade, particularly in males.8 Puberty is the period during which the sex difference in bone mass observed in adult subjects becomes fully

Calcium and bone growth

Observational studies have shown that increasing calcium intake is associated with a greater gain in bone mass and hence a higher peak bone mass.8 This observation is of interest since it is estimated that a 10% increase in peak bone mass could reduce the risk of osteoporotic fractures during adult life by 50%. Furthermore, several prospective randomized, double-blind, placebo-controlled intervention trials have concluded that calcium supplementation increases bone mass gain, although the

Protein and bone growth

Protein intake in children and adolescents influences bone growth and bone mass accumulation.25 In ‘well’ nourished children and adolescents, it appears that variations in the protein intake within the ‘normal’ range can be associated with modifications in skeletal growth, thereby modulating the genetic potential in peak bone mass attainment.

Prospective observational studies suggest that both calcium and protein intakes are independent variables of bone mineral mass acquisition, particularly

Dairy products and bone growth

In addition to calcium, phosphorus, calories, and vitamins, one litre of milk provides 32–35 g of protein, mostly casein, but also whey protein which contains numerous growth-promoting elements.29, 30 In growing children, long-term milk avoidance is associated with smaller stature and lower bone mineral mass, either at specific sites or at whole-body levels.31, 32, 33, 34, 35, 36, 37, 38, 39 Low milk intake during childhood and/or adolescence increases the risk of fracture before puberty (a

Calcium and bone remodelling

After menopause, changes in sex hormone levels and nutrition are associated with an increase in bone remodelling, leading thereby to an increase in bone fragility. In adults, obligatory calcium losses have to be offset by sufficient calcium intakes and efficacious intestinal absorption. Otherwise, bone is used as a source of calcium to maintain homeostasis in extracellular calcium concentration (Figure 2). This homeostatic mechanism is altered in the elderly, with altered vitamin D synthesis in

Specific bone diseases

Neurofibromatosis results from deficiency in neurofibromin, an Nf1 protein product which is a tumour-suppressor protein. Mice with a specifically osteoblast ablated Nf1 gene displayed an increased bone mass phenotype, with increased bone formation and resorption. This bone phenotype can be rescued by nutritional restriction of protein intake.142 In contrast, an opposite phenotype was found in mice with ablation of the transcription factor ATF-4, a situation analogous to the Coffin–Lowry

Acknowledgements

Mrs M. Perez is gratefully acknowledged for her secretarial help.

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