The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society Day 1 - June 5, 2001 Nutrition and Skeletal Health - A Review of Current Thinking Susan A. New, PhD Clinical Significance The clinically relevant points of the papers presented and discussed at The 1st Joint Meeting of the IBMS and ECTS are as follows: Vitamin D insufficiency/deficiency is a major problem in the elderly population and is prevalent in certain ethnic groups. It is a particular cause for concern in those living in nursing homes. Supplementation of vitamin D with Ca is effective in normalizing both the low vitamin D status and hyperparathyroidism, which is associated with increased bone resorption. There is an urgent requirement for supplementation studies investigating the influence of this nutrient on maintenance of bone mass and fracture prevention. Evidence showing a clear, positive link between the consumption of alkali-forming foods (in particular fruits and vegetables) and indices of bone health continues to emerge. In particular, it is pertinent to suggest that population-based nutrition studies re-examine the influence of the acidity of diets on indices of bone health, by way of measuring urinary acid excretion or assessing the dietary intake of protein:potassium ratios (known as net endogenous acid production, or NEAP). It would also be prudent to suggest that measurement of the acidity of the diet of individuals form part of the routine clinical assessment of patients, in association with quantification of the Ca and vitamin D nutrition. Further studies are required on the mechanisms of action of the detrimental effects of protein deficiency on indices of bone health in the elderly population. Clearly, protein insufficiency needs to be carefully monitored and energy/protein levels maintained, particularly in those population groups who are likely to be most at risk of fracture (including the aging population living in nursing homes) or who are already sufferers of the disease. References 1.McKenna MJ, Freaney R, Meade A, Muldowney FP. Hypovitaminosis D and elevated serum alkaline phosphatase in elderly Irish people. Am J Clin Nutr. 1985;41:101-109. 2.Khaw KT, Sneyd MJ, Compston J. Bone density, parathyroid hormone and 25 hydroxyvitamin D concentrations in middle aged women. BMJ. 1992;305:273-277. 3.Gallagher JC. Vitamin D treatment in osteoporosis and osteomalacia. In: Stevenson JC, Lindsay R, eds. Osteoporosis. London: Chapman & Hall Medical; 1998: 243-262. 4.Lips P, Plujim SM, Popp-Snijders C, Smit JH. Vitamin D deficiency, serum IGF-1 and markers of bone turnover predict fractures in the longitudinal aging study Amsterdam [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S73. 5.Feldkamp J, Schott M, Fritzen R, Scherbaum WA. Osteomalacia in immigrants from the Middle East. Bone. 2001;28(suppl 5):S204. 6.Serhan E, Holland MR. The effect of calcium and vitamin D supplementation in Indo-Asians suffering from hypovitaminosis D with or without secondary hyperparathyroidism. [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S205. 7.Coxam V, Gaumet-Meunier N, Davicco MJ, et al. Rationale for calcium/vitamin D-supplemented yogurts in the elderly. [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S203. 8.Iqbal SJ, Davies TD, Muhlbayer S, McHugh G, Badawy O. Biochemical measures and bone mineral density in Asian patients with severe vitamin D deficiency. [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S205. 9.Shiraishi A., Higashi S, Masaki T, et al. Alfacalcidol improves bone strength by stimulating bone formation and suppressing resorption; comparative studies with vitamin K2. [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S242. 10.Higashi S, Masaki T, Shiraishi A, et al. Increase in femoral bone strength by the treatment with alfacalcidol but not with plain vitamin D. [abstract]. 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Am J Clin Nutr. 1997;65:1831-1839. 27.New SA, Robins SP, Campbell MK, et al. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr. 2000;71:142-151. 28.Tucker KL, Hannan MT, Chen H, Cupples A, Wilson PWF, Kiel DP. Potassium and fruit & vegetables are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69:727-736. 29.New SA, Macdonald HM, Grubb DA, Reid DM. Positive association between net endogenous non-carbonic acid production (NEAP) and bone health: further support for the importance of the skeleton to acid-base balance. [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S94. 30.Frassetto L, Todd K, Morris RC Jr, Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from dietary protein and potassium contents. Am J Clin Nutr. 1998;68:576-583. 31.Abraham R, Walton J, Nicholls A, Justice J, Wardley-Smith B, Reeve J. Meat intake and other dietary determinants of rapid post-menopausal bone loss from the spine. [abstract]. Program and abstracts of The 1st Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society; June 5-10, 2001; Madrid, Spain. Bone. 2001;28(suppl):S185. 32.Sellmeyer DE, Stone KL, Sebastian A, Cummings SR, for the Study of Osteoporotic Fracture. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women Am J Clin Nutr. 2001;73:118-122. 33.New SA. Bone health: the role of micronutrients. Br Med Bull. 1999;55::619-633. 34.Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP. Dietary supplementation in elderly patients with fractured neck of femur. Lancet. 1990;335:1013-1016. Am J Clin Nutr, 7/02 Antioxidant Vitamins & Mortality in Older Persons Diet & Health: Nursing Perspective Health of Aging Population Vegetable Consumption Slows Cognitive Decline in Women Favorable Effect of Healthy Diet on Dev/Progression: Arthritis Gluten-Free Vegan Diet Improves Heart Risk Profile in RA Patients J Nutr, 2/04 J Clin Endo Metab, 3/05 Cancer Res, October 2007 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.