Article: Nutritional intake and bone health (https://doi.org/10.1016/S2213-8587(21)00119-4)
In this review published in Lancet Diabetes & Endocrinology, Rizzoli and colleagues provide a great summary of the role that nutrients, foods, and dietary patterns play in maintaining bone health. As they admit, sometimes the role of nutrition in bone health is poorly understood – there are complex pathways involved and interactions between several factors. Most of what we know of this topic comes from observational studies (i.e. we can’t necessarily confirm causation from the studies, but we have found strong associations), since randomised trials of diets are particularly difficult to conduct.
The main takeaway from this review is that a “balanced diet with an optimal protein and calcium intake and vitamin D sufficiency, together with regular weight-bearing physical exercise” is best for bone health.
● Several studies indicate that fracture risk might be lower with a higher dietary protein intake and sufficient calcium intake. Of course, dairy products are a valuable source of both nutrients and calcium.
● Maintaining a healthy gut with good microbiota is also important so that there is good calcium absorption after intake. There is evidence from several studies that fermented dairy products, sufficient fruit and vegetable intake and Mediterranean style diets are associated with lower fracture risk. This is probably because these foods/diets have positive effects on gut microbiota.
● Other minerals such as magnesium and phosphorus, and Vitamins A, B, C, D and K may have some effects on bone health, but it is likely that these may only be a concern for bone health in the case of deficiencies, which shows the importance of having a balanced diet. Of these, it appears that Vitamin D might be most important because it regulates absorption of calcium.
● There is also a strong association between protein/energy malnourishment and being underweight in the risk of osteoporosis or fractures. When malnourished or underweight it increases the risk of falls that can lead to fractures.
● In those with poor bone health, dietary measures such as caloric restriction and intermittent fasting need to be implemented carefully since there is some evidence that these measures can negatively affect markers of bone health, particularly amongst those who are unable to do weight-bearing exercise.
Review by Dr Joosup Kim ( LEAN Nutrition Tech)