Nutritional Interventions in Osteoporosis

Susan J. Whiting, PhD; Hassanali Vatanparast, MD

Disclosures

Geriatrics and Aging. 2005;8(9):14-20. 

In This Article

Nutrients Not Reviewed in 2002: Evidence for Their Consideration

The nutrient and food components listed in Table 2 deserve special consideration for persons at risk of osteoporosis. For vitamin A, prospective population studies indicate a high intake of vitamin A (as retinol only, not provitamin A carotenes) causes bone loss and puts older adults at risk of fracture.[21] The Institute of Medicine has set an upper limit for retinol at 3,000µg/d, based on risk of liver damage and birth defects.[3] However, for bone, adverse effects may occur at retinol intakes much lower than this.[21] For that reason, patients should restrict fish liver oil and avoid vitamin supplements containing high levels of retinol.

Recent studies indicate that low intakes of vitamin B12 and high levels of serum homocysteine, which may occur in vitamin B12 deficiency, are associated with increased fracture risk.[22] As older adults are at risk for vitamin B12 deficiency due to loss of stomach acid, the Institute of Medicine has recommended synthetic cobalamin be ingested to ensure adequate absorption.[4]

Potassium supplements that are alkaline (where the anion is bicarbonate or a precursor to bicarbonate) have been shown to reduce urinary calcium losses.[23] The effect is attributed to the potassium cation, yet most dietary potassium is derived from intake of fresh fruits and vegetables that also provide bicarbonate equivalents. The Institute of Medicine set a high recommended intake of 4700mg/d potassium,[5] in part to prevent bone loss caused by ingestion of a typical Western diet that is high in salt and low in calcium.

Two lifestyle factors have also been implicated in bone health. Drinking cola soft drinks provides phosphoric acid and caffeine which could, together, negatively impact calcium metabolism. This has been demonstrated in children.[24] Further, for adolescents in North America, soft drinks likely replace milk, thus reducing calcium intake.[25] Alcoholic beverages consumed in moderation, however, have been associated with increased bone mineral density in cross-sectional or longitudinal studies.[26] Nevertheless, it would not be prudent to recommend alcohol consumption as the evidence is weak.

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