UniS
University of Surrey
Centre for Nutrition and Food Safety
Nutritional Strategies for the Ageing Skeleton
Dr Susan New Reader in Nutrition
EU Discussion Meeting Brussels, Thursday 4th November 2004
Definition of osteoporosis
Normal
Osteoporotic
“A progressive systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility of fracture.”1
1.WHO,
1994. Osteoporosis Clinical Guidelines for Prevention and Treatment. RCP July 2000
Osteoporosis is a major public health problem
8
No. of fractures (million)
6.26 m
7 6 5 4 3 2 1 0 1990 2050
COSTS (per annum) UK - £1.7 billion USA - $17.9 billion EU - Euros 13.9 billion
1.66 m
……….phenomenal future impact!
Change in bone mass with ageing
Consolidation
Attainment of Peak Bone Mass Age Related Bone Loss
Menopause
Men
Bone Mass
Women
0
10
20
30 40 Age (years)
50
60
70
Nutritional Aspects of Bone Health
1st-ever Textbook – now out!
Editors: New (UK) and Bonjour (CH)
Reid (UK) Johnell (Sweden) Massey (USA) Pettifor (S.Africa) Ralston (UK) Matkovic (USA) Wark (Aus) Abrams (USA) Meunier (France) Macdonald (UK) Reid (NZ) Rizzoli (CH) Cooper (UK) Calvo (USA) Burckhardt (CH) Melhus (Sweden) Weaver (USA) Ho (Hong Kong) Walsh & Strain (NI) Rude (USA) Flynn & Cashman (Ire) Booth (USA) Hannan & Tucker (USA) Shapses (USA) Karlsson (Sweden) Nieves & Cosman (USA) Seeman & Iuliano (AUS) Torgerson (UK) Dawson-Hughes (USA) Baxter-Jones & Whiting (Can)
• • • • • • • • • •
Ca Supplementation & Late-Menopausal Bone Health
101 100
LS BMD (% of baseline)
99 98 97 Calcium Placebo
Ba sel ine
on ths
on ths
on ths M 18 24
6M
M
Reference: Reid IR et al. New Eng J Med 1993;328:460-464 Reid IR et al. New Eng J Med 1993;329:1281(Letter)
12
M
on ths
Calcium, Vitamin D & Hip Fracture Prevention
•Influence
of Ca (1.2g) & vitamin D (800iu) on frequency of fractures in 3270 women for 18 months.
•No.
of hip fractures was 43% lower & No. of nonvertebral was 32% lower in the treated group
Reference: Chapuy MC et al. New Eng J Med 1992;327:1637-1642.
Acid-base homeostasis criticality to health
• As people age - overall renal function declines including the ability to excrete acid
Frassetto et al. Am J Physiol 1996;271:F1114-1122
Blood [H ] (neq/L)
44 42 40 38 36
r=0.34, p<0.005
44 42 40 38 36 34
r=0.37, p=0.002
+
34
Plasma [HCO- ] (meq/L) 3
28
r=-0.36, p<0.005
28 26 24
26
24
22
22
20 0
50 100 150
r=-0.37, p=0.002 20 40 60 80
NAE (meq/24 hr/70 kg) AGE (yrs) Reproduced with kind permission - Dr Lynda Frassetto (USA) (2003)
Acid-base homeostasis criticality to health
• With increasing age, humans become slightly but significantly more acidic
Frassetto et al. J Gerontol 1996;51A:B91-99
Fruit & vegetable intake and BMD STUDY 1 - evidence of +ve link? Baseline APOSS
Lumbar Spine BMD
1 0.95 0.9 0.85 0.8 0.75 0.7 1 2 3 Quartiles of K intake 4
0.64 0.6 1 2 3 4
Quartiles of K intake
Femoral Neck BMD
P<0.01
**
0.8 0.76 0.72
P<0.01
**
*
0.68
*
New et al. Am J Clin Nutr 1997;65:1831-1839
1996 Young Investigator’s Award. 1st World Congress of Osteoporosis, Holland
Fruit & vegetable intake and bone metabolism - further evidence of +ve link? STUDY 2
Baseline APOSS
14 13.5 13 12.5 12 11.5 11 10.5 10 1 2 3 4
pQCT Cort P<0.01
**
430 420 410 400 390 380 370 360 350 340 1
*
Dpd P<0.01 **
*
**
2
3
4
Quartiles of K intake
Quartiles of K intake
New et al. Am J Clin Nutr 2000;71:142-151
1996 Young Investigator’s Award. 1st World Congress of Osteoporosis, Holland
Change in dietary Na+ and K+ from pre-agricultural times
300
Then K+
Now Na+
meq/day
200
100
K+
0
Na+
in [K/Na] > 30
Reproduced with kind permission Reduction - Dr Lynda Frassetto (USA) (2003)
Association between NEAP and Bone Mass in 994 Scottish Women
With thanks to Professor Tony Sebastian (USA) for elaborate discussions
1.08 1.075 1.07 1.065 1.06 1.055 1.05 1.045 1.04 1.035 1.03 1
*
LS
P<0.04
900 895 890 885
*
FN
P<0.08
**
880 875 870 865 860
**
2
3
4
1
2
3
4
Quartiles of NEAP Intake
Quartiles of NEAP Intake
New SA et al (2003) Am J Clin Nutr 2004;79:131-138
2001 Young Investigator Award, 1st IBMS/ECTS Joint Conference, Spain. Bone 2001;28:S94
Nutrition & Bone Health at UniS I
Development of dietary methodologies for population studies: - Examples
Aberdeen Prospective Osteoporosis Screening Study (APOSS) – 5000 women, 55 years + Swiss Evaluation and Monitoring of Osteoporotic Fracture (SEMOF) – 7000 women, over 75 years
Nutrition & Bone Health at UniS II
Nutrition and bone health relationships
Population-based studies –
New et al (2004) Am J Clin Nutr 79:131-138. Macdonald, New & Reid (2004) Am J Clin Nutr 79: 150-159.
Longitiudinal studies –
Nurmi, Baxter-Jones, Cooper & New (2004) J Bone & Mineral Res;83:1325-1331. 36 month study in bone growth
Nutrition & Bone Health at UniS III
Randomised controlled supplementation trials: Long-term supplementation trial of potassium citrate vs. fruit & veg vs. placebo. April 2006. UK FSA £680k Long-term effects of the Atkins diet on bone metabolism. April 2006. UniS PhD Scholarship