There is a lot of evidence showing the direct relationship of nutrition and skeletal health. The need to optimize bone health over the lifetime is imperative with caution in nutritional strategies in reducing the impact of falls.
Bones break because the loads placed on them exceed the absorption capacity to absorb the relative energy involved. This is the result of many factors such as: reduction of bone mass, change in bone distribution, loss of cancellous or cortical microarchitectural or an accumulation of damaged bones. Bones are a living tissue where a continuous cycle takes place with active bone formation (through the action of osteocytes and osteoblasts) and bone resorption (osteoclasts). Continuous new bone synthesis is followed by calcification of the newly formed bone. Once completed, the cells are re-positioned above the trabecular surface.
Osteoporosis is defined as bone metabolic disease and is characterized by low bone mass and deterioration of bone tissue, leading to increased bone resilience and a consequent increase in fracture risk.Globally, it is estimated that one in three women and one in twelve men aged> 50 will suffer from osteoporosis during their lifetime.
Significant changes in skeletal mass appear during the life cycle. The health of adult bones is primarily determined by three main factors: maximal achievement of the maximum bone mass achieved during development and early adulthood, maintenance of bone mass in adulthood and reduction of bone loss at the advanced age. Menopause is a period of particular concern for women.
The maximum bone mass in the youngest population and the bone loss rate in postmenopausal and elderly women are determined by endogenous and exogenous factors, a combination of genetic, endocrine and nutritional factors. Factors such as nutrition and physical exercise play a key role in the development of bone mass. The peak of the maximum bone mass is before the age of 28 years.
Calcium and peak bone mass development
The low calcium intake during growth affects the maximum bone mass and is therefore likely to lead to impacts with the risk of fracture later in life. Studies show that girls in puberty are less likely to meet daily recommendations for calcium intake than boys. Also, clinical trials with calcium supplements in both children and adolescents have shown an overall positive effect of calcium on achieving maximum bone mass between 1 and 6% per year in the whole body and between 1 and 10% per year in specific skeletal areas compared with a placebo.
In a 5-year follow-up study of calcium supplementation with 96 girls in adolescence with multiple variables analysis, the difference in total bone density before and after treatment was attributable to calcium supplementation.
Vitamin D and bones
Vitamin D stimulates bone matrix formation and bone maturation, enhancing osteoclastic activity. Together with the parathyroid hormone, it regulates calcium and phosphorus metabolism and promotes the absorption of calcium from the intestine and kidneys.
Vitamin D and peak bone mass development
There is increasing evidence that vitamin D deficiency may be detrimental to bone mass especially in adolescent women and children. A prospective 3 year cohort study in 171 healthy girls aged 9-15 years compared subjects with inadequate Vitamin D levels (<20 nmol / l) to those with normal vitamin D levels (> 37.5 nmol / l) in bone mass increase and had found a difference of 4%. Lumbar spine variation was found to be 27% higher for subjects with adequate vitamin D intake compared to those with low levels.
Low levels of vitamin D are a risk factor for low growth of maximum bone mass. In a bone vitamin D supplementation study in 212 girls with a mean age of 11 years with adequate calcium levels, the bone mass gain was found to be 2% higher in the groups receiving supplemental vitamin D compared to the group receiving the placebo.
Vitamin K and bones
Vitamin K has significant function in the skeleton as a cofactor in the post-translational carboxylation of many bone proteins, with osteocalcin being the most abundant. Deficiency of vitamin K leads to the synthesis of sub-carboxylated osteocalcin. Data has shown that low serum or phylloquinone or subcarboxylated osteocalcin concentrations are associated with low maximum bone mass and increased risk for osteoporotic fractures. Recently published studies suggest the key role of vitamin K intake to optimize bone health.
Calcium and vitamin D are clearly crucial nutrients for optimal bone health. It is necessary to prevent low levels and deficiencies, particularly in vulnerable groups such as elderly adults, postmenopausal women, adolescent girls and women with amenorrhea. The synergistic effect of vitamin K is also critical to optimal bone health, as calcium supplements or vitamin D alone do not seem to be effective in fracture prevention.
Lanham-New, S. A. (2008). Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment: Symposium on ‘Diet and bone health’. Proceedings of the Nutrition Society, 67(2), 163-176.
: Complete D3, K2 & Co factors