Advances in Nutrition for Bone Health

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1 Advances in Nutrition for Bone Health IOF INTERNATIONAL OSTEOPOROSIS FOUNDATION Dominique D Pierroz, PhD, Science Manager, IOF

2 MEMBERSHIP STRUCTURE CSA Committee of Scientific Advisors CCA Committee of Corporate Advisors CNS Committee of National Societies

3 NUTRITION AND BONE HEALTH AT IOF World Osteoporosis Day 2011 World Osteoporosis Day 2006 World Osteoporosis Day 2001

4 THE BONE BANK Dairy Products Proteins Genetics 60-80% Dairy Products Proteins Income (Bone Accrual) Expenses (Bone Loss) Capital: Mass/Density Geometry Microstructure Matrix/Mineral

5 Can Bone Mineral Mass Trajectory Be Changed?Nutritional Factors: CALCIUM, PROTEIN

6 EFFECTS OF CALCIUM SUPPLEMENTATION ON TOTAL BODY BONE MINERAL CONTENT Winzenberg, 2006

7 Children Bone Mass In Relation To Mother Nutritional Status During Pregnancy - Bone mineral density at age of 6 years positively correlated to milk products and calcium-rich foods consumption during pregnancy (Ganpule et al 2006) At the age of 8-9 years, abmd was higher if born from a mother with a healthy diet (vegetables, fruits, pasta, yoghourt, cheese) (Cole et al 2009) > Cross-sectional case-control studies

250 mg of calcium 1 glass of milk (2dl) S E R E 3 glasses of

9 Calcium equivalents 1 yoghurt (180g) 2 cheeses spreads 60g soft cheese 30g hard cheese 2 tablespoons of powdered milk 1 portion 250 mg of calcium 1 glass of milk (2dl) S E R E 3 glasses of mineral water rich in calcium (~5dl) 200g curde cheese 2 custards

10 CALCIUM CALCULATOR

11 DIETARY PROTEIN INTAKE ON BONE GROWTH Alexy, 2005

12 Protein equivalents RDA: g/kg body weight for adults 100g meat 100g soft cheese 80g hard cheese 100g fish 1 portion 20g of proteins 3 glasses of milk (6dl) 2 eggs 200g tofu or quorn 40g pulses + 80g grains (raw weight)

13 DAIRY PRODUCTS AND FRACTURES 1L of milk is ~32-35 g of protein (casein and whey ) Children who avoid drinking cow s milk are at increased risk for prepubertal bone fractures (Goulding et al, JADA 2004) -> 0-13 yrs: 22 observed fractures vs 8.4 expected Fractures during growth: potential role of a milkfree diet ( Konstantynowicz et al, Osteoporos Int 2007) -> 2-20 yrs: OR 4.6 in girls and 1.3 (NS) in boys

14 MILK PROCESSING (CHEESE PRODUCTION) Preservation of milk products Non-perishable and transportable form Readily availability More digestible form (Less Lactose)

15 Effects of Soft Cheese in Postmenopausal Women 6-wk trial in healthy, postmenopausal women vitamin D and calcium-fortified soft white cheese (treated) or usual diet (control). Bonjour, J Nutri 2012

16 % Changes Protein Supplement Attenuates Bone Loss In Patients With Recent Hip Fracture 1 Proximal Femur BMD [% changes from baseline] * p< % Length of Stay in Rehabilitation Hospital -5-6 Controls Prot.Sup. Schürch, Rizzoli et al, Ann Int med 1998

17 APPEALING DUAL ACTION FOR FRACTURE PREVENTION AT OLDER AGE

$34% Hip fracture Any$ RCTs / 11 pooled RCT > 30

18 EVIDENCE DOUBLE-BLIND RCTS Vitamin D 800 IU/d 30% 14% 34% Hip fracture Any Non-vert fractures Falls 12 RCTs / 11 pooled RCT > seniors 8 RCTS Bischoff-Ferrari HA et al. Archives of Internal Medicine 2009 Bischoff-Ferrari HA et al. NEJM 2012 Bischoff-Ferrari HA et al. BMJ

19 Effects of Calcium-Vitamin D on Fracture Risk Chapuy et al NEJM 1992 NEJM 1997 Dawson-Hughes et al Control Ca + Vit D

20 Cumulative incidence of falls % Cumulative Incidence of fractures % High-Dose Vitamin D ( IU) and Falls and Fractures in Older Women Vitamin D Placebo Falls Vitamin D Placebo Fractures 50 HR 1.16 (CI ) P = HR 1.26 (CI ) P = Time (Years) Sanders, JAMA 2010 Time (Years)

21 DIETARY SOURCE OF VITAMIN D

22 Sun Exposure Required to Produce 15 µg (600 IU) Vitamin D Caucasian Skin Non Caucasian Skin Morning Noon Afternoon Morning Noon Afternoon March April May June July August September October Face, Hands and Upper Limb Exposed to the Sun

23 VITAMIN D MAP

25 THANK YOU

28 EFFECTS OF CALCIUM SUPPLEMENTATION ON TOTAL BODY BONE MINERAL CONTENT Winzenberg, 2006

29 6-year mother s milk intake and offspring (at 6 years) associated BONE MASS Cole et al Osteoporos Int 2013

30 GROWTH HORMONE-IGF-I SYSTEM, AND BONE AND MUSCLE Perrini et al J Endocrinol 2010

31 Institute of Medicine Report Ross et al JCEM 2011

$fracture chronic$ diseases loss of

32 CLINICAL CONCEPT AND RELEVANCE sarcopenia fall disability frailty hip fracture chronic diseases loss of autonomy Reduced healthy life expectancy

33 RECOMMENDATIONS VITAMIN D

34 EXCITEMENT AROUND VITAMIN D Vitamin D may have the potential to extend healthy life expectancy by reducing the risk of falls and fractures, plus delaying chronic diseases at older age While we have evidence today from double blind RCTs regarding fall and fracture prevention with a daily dose of 800 IU Vitamin D we lack evidence from large clinical trials on effects of vitamin D outside bone and muscle we lack evidence from higher than 800 IU / d doses of vitamin D per day

Nutritional concepts for the prevention and treatment of osteoporosis: what, for whom, when? Objectives

Nutritional concepts for the prevention and treatment of osteoporosis: what, for whom, when? Bess Dawson-Hughes, MD Disclosures: Amgen, DSM, Nestle, Opko, Pfizer, Roche, Tricida Interrelationships of muscle