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Health News 46 - Osteoporosis and Bones
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Fight Osteoporosis: Bone Up on B12

March 28, 2005 By Rosalie Marion Bliss
Women are about four times more likely than men to develop osteoporosis, or weak, porous bones. But a new study links vitamin B12 deficiency with low bone mineral density in men, and confirms similar, previously reported findings in women.

Researchers funded by the Agricultural Research Service (ARS) reported the findings in the Journal of Bone and Mineral Research. The study was led by epidemiologist Katherine Tucker with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Mass. Tucker directs the HNRCA's Dietary Assessment and Epidemiology Research Program.

While vitamin B12 deficiency has been linked with low levels of markers of bone formation, the mechanism behind the relationship is not known.

The scientists examined the relationship between vitamin B12 blood levels and indicators of bone health measured in 2,576 men and women, aged 30 to 87, participating in the Framingham Osteoporosis Study. They found that those with vitamin B12 levels lower than 148 picomoles per liter (pM/L) were at greater risk of osteoporosis than those with higher levels. Plasma B12 levels below 185 pM/L are considered "very low," according to some experts.

The study found that those with vitamin B12 concentrations below 148 pM/L had significantly lower average bone mineral density--at the hip in men, and at the spine in women--than those with concentrations above. The range of symptoms of B-12 deficiency includes anemia, balance disturbances and cognitive decline. Osteoporosis usually progresses with no outward effect until a fracture occurs.

Low stomach acid and aging can lower the ability to absorb the vitamin. Those over age 50 are encouraged to consume fortified foods or supplements containing B12. This study suggests adequate vitamin B12 intake is important for maintaining bone mineral density. Animal protein foods, such as fish, liver, beef, pork, milk and cheese are good sources of vitamin B12.

ARS is the U.S. Department of Agriculture's chief scientific research agency.


Vitamin D Low in Females with Osteoporosis

New York researchers say more than half of women currently treated for osteoporosis don't have enough vitamin D in their bodies.

The researchers, in a study discussed at the American Society for Bone and Mineral Research in Seattle in October, 2004, said vitamin D inadequacy is still highly prevalent in this population.

"While women may know that calcium is an important part of bone health, this research shows that some women on treatment for osteoporosis are unaware of the important role vitamin D plays or are simply not getting adequate amounts as part of their treatment regimen," said Dr. Ethel Siris of the Columbia University College of Physicians and Surgeons.

More than 10 million people in the United States are estimated to have osteoporosis and 80 percent are women. Vitamin D, an essential component of osteoporosis therapy, helps to ensure the body absorbs and retains calcium and phosphorus, both critical for building bone.

The National Osteoporosis Foundation advises getting recommended daily amounts of vitamin D and calcium as one of the five steps involved in bone health and osteoporosis prevention.

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Homocysteine Linked to Osteoporosis

Homocysteine, an amino acid linked to heart disease and Alzheimer's, is now thought to be linked to yet another degenerative disease — osteoporosis.

Two new studies published in the May 13 2004 issue of the New England Journal of Medicine indicate that moderately high homocysteine levels can be added to the list of osteoporosis risk factors.

Researchers have known that very high plasma homocysteine levels are characteristic of homocystinuria, a rare genetic disease accompanied by the early onset of osteoporosis. The early onset of osteoporosis in people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, increasing the risk of osteoporotic fracture. In addition, a past study indicated homocysteine levels may be linked to age-dependent bone loss. However, the role moderately elevated plasma homocysteine levels play in osteoporotic fractures is unknown.

Consequently, the researchers studied 2,406 subjects, aged 55 years or older, enrolled in two separate prospective, population-based studies to determine if there was a link between circulating homocysteine levels and the risk of incident osteoporosis fracture. The researchers followed the subjects for up to 8.1 years.

Osteoporosis-related fractures occurred in 191 of the subjects. The study authors adjusted for age, sex, body mass index, smoking, recent falls, dementia, diabetes mellitus, peripheral arterial disease, nutritional deficiency, and other fracture risk factors. Overall, the more homocysteine levels rose, the greater the risk of having a fracture.

Subjects who had the highest levels of homocysteine according to age had a 90 percent increase of fracture risk. The homocysteine-related fracture risk was independent of bone mineral density and other potential risk factors for fracture.

According to the researchers, 'An increased homocysteine level appears to be a strong and independent risk factor for osteoporotic fractures in older men and women.'  They called for further studies to determine whether B vitamins, known to lower homocysteine levels, can also lower the risk of fractures.

Reference: McLean RR, Jacques PF, Selhub J, Tucker KL, Samelson EJ, Broe KE, Hannan MT, Cupples LA, Kiel DP. Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med. 2004 May 13;350(20):2042-9.

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Calcium Plus Vitamin D Can Reverse Bone Loss Occurring in High Protein Diets

In a study in the April 2002 American Journal of Clinical Nutrition, researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University demonstrated that adequate calcium and vitamin D can reverse bone loss that can occur with high protein diets. 

Three hundred forty-two healthy men and women over the age of sixty-five were randomized to receive 500 milligrams calcium per day along with vitamin D or a placebo for a period of three years, and diets and bone mass density were assessed. Protein intake for the participants ranged from 79 to 96 grams per day, well above the recommended protein intake for healthy people of 40 to 60 grams per day. A high protein diet is common for people following the Atkins plan or the South Beach Diet and may benefit older individuals in preventing muscle wasting and promoting wound healing.

The group receiving calcium experienced an increase in bone mass density, whereas the placebo group experienced a reduction in calcium levels with rising protein intake. Protein source did not effect bone density. The researchers explained that sufficient calcium intake may be conducive to protein aiding calcium absorption.

Lead author, Senior Scientist and Chief of the Calcium and Bone Metabolism Laboratory at the Human Nutrition Research Center on Aging, Bess Dawson-Hughes, MD summarized, "Our results suggest that a higher calcium intake is going to be protective against any adverse effects of protein on bone, and may allow protein to have a positive effect. These results help us to better understand the mechanics behind calcium and vitamin D supplementation and their effect on bone mass density. This study is a significant confirmation that adequate calcium in the diet is crucial. This report, however, also shows that there is much more research needed in this area."

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