Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Identification of a dietary pattern prospectively associated with bone mass in Australian young adults. The Relation between Dietary Protein, Calcium and Bone Health in Women: Results from the EPIC-Potsdam Cohort Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Protein intake: effects on bone mineral density and the rate of bone loss in elderly women. Calcium intake in health maintenance – a systematic review Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. A diet high in protein, dairy, and calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional high-carbohydrate diet in adults. Protein consumption and bone fractures in women. Whey Protein Supplementation and Higher Total Protein Intake Do Not Influence Bone Quantity in Overweight and Obese Adults Following a 36-Week Exercise and Diet Intervention. Effects of food groups and dietary nutrients on bone loss in elderly Chinese population [Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Areal and volumetric bone mineral density and geometry at two levels of protein intake during caloric restriction: a randomized, controlled trial. Association of protein intake with bone mineral density and bone mineral content among elderly women: The OSTPRE fracture prevention study Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Correlates of Quantitative Ultrasound in the Women’s Healthy Lifestyle Project
 Comparison of 2 weight-loss diets of different protein content on bone health: a randomized trial. Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. Effect of dietary protein supplements on calcium excretion in healthy older men and women. Diets higher in dairy foods and dietary protein support bone health during diet- and exercise-induced weight loss in overweight and obese premenopausal women. Veganism, bone mineral density, and body composition: a study in Buddhist nuns Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women The Effect of a Whey Protein Supplement on Bone Mass in Older Caucasian Adults. Bone Size and Bone Mass in 10-Year-Old Danish Children: Effect of Current Diet
 Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women Oligo-amenorrheic long-distance runners may lose more bone in spine than in femur. The effects of a two-year randomized, controlled trial of whey protein supplementation on bone structure, IGF-1, and urinary calcium excretion in older postmenopausal women. Vitamin K intake and hip fractures in women: a prospective study. Fish Consumption, Bone Mineral Density, and Risk of Hip Fracture Among Older Adults: The Cardiovascular Health Study Dietary protein is associated with musculoskeletal health independently of dietary pattern: the Framingham Third Generation Study. Protein intake and lumbar bone density: the Multi-Ethnic Study of Atherosclerosis (MESA). New approach to osteopenia in phenylketonuric patients The ratio of animal protein intake to potassium intake is a predictor of bone resorption in space flight analogues and in ambulatory subjects. Short-term changes in calcium but not protein intake alter the rate of bone resorption in healthy subjects as assessed by urinary pyridinium cross-link excretion. Protein Supplements Increase Serum Insulin-Like Growth Factor-I Levels and Attenuate Proximal Femur Bone Loss in Patients with Recent Hip Fracture Dietary changes favorably affect bone remodeling in older adults. Dietary Protein and Vitamin D Intake and Risk of Falls: A Secondary Analysis of Postmenopausal Women from the Study of Osteoporotic Fractures Long-term effects of nutrient intervention on markers of bone remodeling and calciotropic hormones in late-postmenopausal women. The effectiveness of education or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review protocol Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss. Dietary protein and calcium interact to influence calcium retention: a controlled feeding study. Associations of Baltic Sea and Mediterranean dietary patterns with bone mineral density in elderly women. [Comparative study of dietary intake and nutritional status in elderly women with and without hip fracture]. Effects of dairy food supplements on bone mineral density in teenage girls Factors Associated with Appendicular Bone Mass in Older Women Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. Whole-body vibration can reduce calciuria induced by high protein intakes and may counteract bone resorption: A preliminary study Soy proteins and isoflavones affect bone mineral density in older women: a randomized controlled trial. Effect of protein supplementation during a 6-month strength and conditioning program on areal and volumetric bone parameters. Bone gain in young adult women. Maternal first-trimester diet and childhood bone mass: the Generation R Study.
UNLABELLED The role of protein intake in osteoporosis is unclear . In a case-control study in Utah ( n = 2501 ) , increasing level of protein intake was associated with a decreased risk of hip fracture in men and women 50 - 69 years of age but not in those 70 - 89 years of age . Protein intake may be important for optimal bone health . INTRODUCTION Protein is an important component of bone , but the role of dietary protein intake in osteoporosis and fracture risk remains controversial . MATERIAL AND METHODS The role of dietary protein intake in osteoporotic hip fracture was evaluated in a statewide case-control study in Utah . Patients , 50 - 89 years of age , with hip fracture ( cases ) were ascertained through surveillance of 18 Utah hospitals during 1997 - 2001 . Age- and gender-matched controls were r and omly selected . Participants were interviewed in their place of residence , and diet was assessed using a picture-sort food frequency question naire previously reported to give a useful measure of usual dietary intake in the elderly Utah population . The association between  protein intake  and risk of hip fracture was examined across quartiles of protein intake and stratified by age group for 1167 cases ( 831 women , 336 men ) and 1334 controls ( 885 women , 449 men ) . RESULTS In logistic regression analyses that controlled for gender , body mass index , smoking status , alcohol use , calcium , vitamin D , potassium , physical activity , and estrogen use in women , the odds ratios ( OR ) of hip fracture decreased across increasing quartiles of total protein intake for participants 50 - 69 years of age ( OR : 1.0 [ reference ] ; 0.51 [ 95 % CI : 0.30 - 0.87 ] ; 0.53 [ 0.31 - 0.89 ] ; 0.35 [ 0.21 - 0.59 ] ; p < 0.001 ) . No similar associations were observed among participants 70 - 89 years of age . Results from analyses stratified by low and high calcium and potassium intake did not differ appreciably from the results presented above . CONCLUSION Higher total protein intake was associated with a reduced risk of hip fracture in men and women 50 - 69 years of age but not in men and women 70 - 89 years of age . The association between  dietary protein intake  and risk of hip fracture may be modified by age . Our study supports the hypothesis that adequate dietary protein is important for optimal bone health in the elderly 50 - 69 years of age BACKGROUND Different sources of dietary protein may have different effects on bone metabolism . Animal foods provide predominantly acid precursors , whereas protein in vegetable foods is accompanied by base precursors not found in animal foods . Imbalance between dietary acid and base precursors leads to a chronic net dietary acid load that may have adverse consequences on bone . OBJECTIVE We wanted to test the hypothesis that a high dietary ratio of animal to vegetable foods , quantified by protein content , increases bone loss and the risk of fracture . DESIGN This was a prospect i ve cohort study with a mean ( + /-SD ) of 7.0+/-1.5 y of follow-up of 1035 community-dwelling white women aged > 65 y.  Protein intake  was measured by using a food-frequency question naire and  bone mineral density was measured by dual-energy X-ray absorptiometry . RESULTS Bone mineral density was not significantly associated with the ratio of animal to vegetable protein intake . Women with a high ratio had a higher rate of bone loss at the femoral neck than did those with a low ratio ( P = 0.02 ) and a greater risk of hip fracture ( relative risk = 3.7 , P = 0.04 ) . These associations were unaffected by adjustment for age , weight , estrogen use , tobacco use , exercise , total calcium intake , and total protein intake . CONCLUSIONS Elderly women with a high dietary ratio of animal to vegetable protein intake  have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio . This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture . This possibility should be confirmed in other prospect i ve studies and tested in a r and omized trial BACKGROUND Relatively little is known about the relations between dietary patterns and bone health in adolescence , which is a period of substantial bone mass accrual . OBJECTIVES We derived dietary patterns that were hypothesized to be related to bone health on the basis of their protein , calcium , and potassium contents and investigated their prospect i ve associations with bone mineral density ( BMD ) , bone area , and bone mineral content ( BMC ) in a cohort of young adults . DESIGN The study included 1024 young adults born to mothers who were participating in the Western Australian Pregnancy Cohort ( Raine ) Study .  Dietary information was obtained from food-frequency question naires at 14 and 17 y of age . Dietary patterns were characterized according to protein , calcium , and potassium intakes with the use of reduced-rank regression . BMD , bone area , and BMC were estimated with the use of a total body dual-energy X-ray absorptiometry scan at 20 y of age . RESULTS We identified 2 major dietary patterns . The first pattern was positively correlated with intakes of protein , calcium , and potassium and had high factor loadings for low-fat dairy products , whole grains , and vegetables . The second pattern was positively correlated with protein intake but negatively correlated with intakes of calcium and potassium and had high factor loadings for meat , poultry , fish , and eggs . After adjustment for anthropometric , sociodemographic , and lifestyle factors , a higher z score for the first pattern at 14 y of age was positively associated with BMD and BMC at 20 y of age [ differences : 8.6 mg/cm(2 ) ( 95 % CI : 3.0 , 14.1 mg/cm(2 ) ) and 21.9 g ( 95 % CI : 6.5 , 37.3 g ) , respectively , per SD increase in z score ] . The z score for this same pattern at 17 y of age was not associated with bone outcomes at 20 y of age . The second pattern at 14 or 17 y of age was not associated with BMD , BMC , or bone area . CONCLUSIONS A dietary pattern characterized by high intakes of protein , calcium , and potassium in midadolescence was associated with higher BMD and BMC at 20 y of age . Our results indicate that high consumption of low-fat dairy products , whole grains , and vegetables in adolescence are associated with beneficial effects on bone development Background / Aims : The role of dietary protein in bone health is controversial . The objective of the present study was to examine the association between protein intake , dietary calcium , and bone structure measured by broadb and ultrasound attenuation ( BUA ) . Methods : Our analysis includes 8,178 female study participants of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) Potsdam Study . Ultrasound bone measurements were performed on the right os calcis , and BUA was determined . Dietary intake was assessed by a st and ardized food frequency question naire . We applied linear regression models to estimate the association between dietary protein and BUA . Results : After multivariate adjustment , high intake of animal protein was associated with decreased BUA values ( β = –0.03 ; p = 0.010 ) whereas high vegetable protein intake was related to an increased BUA ( β = 0.11 ; p = 0.007 ) . The effect of dietary animal protein on BUA was modified by calcium intake . Conclusion : High consumption of protein from animal origin may be unfavourable , whereas a higher vegetable protein intake may be beneficial for bone health . Our results strengthen the hypothesis that high calcium intake combined with adequate protein intake based on a high ratio of vegetable to animal protein may be protective against osteoporosis BACKGROUND There is currently no consensus on the effect of dietary protein intake on the skeleton , but there is some indication that low calcium intakes adversely influence the effect of dietary protein on fracture risk . OBJECTIVE The objective of the present study was to determine whether supplemental calcium citrate malate and vitamin D influence any associations between  protein intake and change in bone mineral density ( BMD ) . DESIGN Associations between protein intake and change in BMD were examined in 342 healthy men and women ( aged > or = 65 y ) who had completed a 3-y , r and omized , placebo-controlled trial of calcium and vitamin D supplementation . Protein intake was assessed at the midpoint of the study with the use of a food-frequency question naire and  BMD  was assessed every 6 mo by dual-energy X-ray absorptiometry . RESULTS The mean ( + /-SD ) protein intake of all subjects was 79.1 + /- 25.6 g/d and the mean total calcium intakes of the supplemented and placebo groups were 1346 + /- 358 and 871 + /- 413 mg/d , respectively . Higher protein intake was significantly associated with a favorable 3-y change in total-body BMD in the supplemented group ( in a model containing terms for age , sex , weight , total energy intake , and dietary calcium intake ) but not in the placebo group . The pattern of change in femoral neck BMD with increasing protein intake in the supplemented group was similar to that for the total body . CONCLUSION Increasing protein intake may have a favorable effect on change in BMD in elderly subjects supplemented with calcium citrate malate and vitamin BACKGROUND The role of dietary protein in bone metabolism is controversial . OBJECTIVE We investigated the associations of dietary protein intake with baseline bone mineral density ( BMD ) and the rate of bone loss over 3 y in postmenopausal elderly women . DESIGN Women aged 65 - 77 y ( n = 489 ) were enrolled in an osteoporosis intervention trial . We studied the associations of protein intake as a percentage of energy with baseline BMD and the rate of bone loss in 96 women in the placebo group ( n = 96 ) . We also examined the effect of the interaction of dietary  calcium  intake with protein intake on BMD . RESULTS In the cross-sectional study , a higher intake of protein was associated with higher BMD . BMD was significantly higher ( P < 0.05 ) in the spine ( 7 % ) , midradius ( 6 % ) , and total body ( 5 % ) in subjects in the highest quartile of protein intake than in those in the lower 2 quartiles . This positive association was seen in women with calcium intakes > 408 mg/d . There was no significant effect of protein intake on hip BMD . In the longitudinal study of the placebo group , there was no association between protein intake and the rate of bone loss . CONCLUSIONS The highest quartile of protein intake (: 72 g/d ) was associated with higher BMD  in elderly women at baseline only when the calcium intake exceeded 408 mg/d . In the longitudinal study , no association was seen between protein intake and the rate of bone loss , perhaps because the sample size was too small or the follow-up period of 3 y was not long enough to detect changes Background Calcium ( Ca ) is an essential nutrient for the human body . Despite lively research , there is uncertainty about Ca requirements in terms of desirable health outcomes including an upper intake level above which the potential for harm increases . Objectives The aim was to conduct a review to up date requirements and desirable or harmful health effects of Ca on the current scientific evidence . Methods We search ed Medline and Swemed from January 2000 to December 2011 and included all systematic review s that reported Ca supplementation or usual Ca intake on health outcomes . Meta-analyses , r and omized clinical trials and cohort studies were included in the second search between May 2009 and March 2011 and an additional search covering studies till the end of 2011 . This review concentrated on studies reporting independent effects of Ca , although a few recent trials report sole effects of Ca on health outcomes , most trials use Ca in combination with vitamin D vs. placebo . Results In total , we review ed 38 studies addressing the effects of Ca on bone , pregnancy-related outcomes , cancers , cardiovascular outcomes , obesity , and mortality .  There was a lot of heterogeneity in the study protocol s , which made it difficult to draw any strong conclusions . According to the literature , high Ca intake seems to have a small positive effect on bone mineral content ( BMC ) or bone mineral density ( BMD ) in children and postmenopausal women . We did not find any consistent evidence on the effects of Ca on bone health in premenopausal women or men . Also , the evidence that Ca supplementation reduces fracture incidence is scarce and inconsistent . Maternal diet may influence the peak bone mass of offspring but more studies are required . There was no overall effect of Ca intake on cancers . Ca was associated with a decreased risk of breast cancer and a slightly increased risk of prostate cancer in two of the three studies . No associations were found with other cancers . We found no consistent association between cardiovascular outcomes and  Ca  intake except for blood pressure . A small decrease of 2–4 mmHg in systolic blood pressure was found in pregnant and in hypertensive subjects with Ca supplementation . Review ed studies did not show consistent evidence relating Ca intake to either mortality or obesity . Conclusion Based on this evidence , there is no need to change the Nordic recommendations for Ca intake . However , due to heterogeneity in the studies it is difficult to interpret the results and provide single summary statement BACKGROUND The effects of dietary protein on bone health are controversial . OBJECTIVE We examined the relation between protein intake with fracture and  bone mineral density ( BMD )  within the Women 's Health Initiative ( WHI ) . DESIGN This prospect i ve analysis included 144,580 women aged 50 - 79 y at baseline in the WHI clinical trials ( CTs ) and observational study ( OS ) that recruited participants in 1993 - 1998 with follow-up through 2011 . Self-reported clinical fractures were collected semiannually through the original end of the trials ( WHI CTs ) and annually ( WHI OS ) by question naires . Hip fracture was adjudicated by a central review of radiology reports . BMDs for total body , hip , and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry .  Protein intake was assessed via food-frequency question naire and calibrated by using biomarkers of energy and protein intakes . Associations between protein intake and fracture were estimated by using Cox proportional hazards regression , and the relation between protein intake and BMD was estimated by using linear regression . RESULTS Median biomarker-calibrated protein intake was 15 % of energy intake . Per 20 % increase in calibrated protein intake ( percentage of energy ) , there was no significant association with total fracture ( HR : 0.99 ; 95 % CI : 0.97 , 1.02 ) or hip fracture ( HR : 0.91 ; 95 % CI : 0.84 , 1.00 ) , but there was an inverse association with forearm fracture ( HR : 0.93 ; 95 % CI : 0.88 , 0.98 ) . Each 20 % increase in calibrated protein intake was associated with a significantly higher BMD for total body ( mean 3-y change : 0.003 g/cm² ; 95 % CI : 0.001 , 0.005 g/cm² ) and hip ( mean 3-y change : 0.002 g/cm² ; 95 % CI : 0.001 , 0.004 g/cm² ) . CONCLUSIONS Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs . These data suggest higher protein intake is not detrimental to bone health in postmenopausal women Elderly women are at increased risk for bone loss and fractures . In previous cross-sectional and longitudinal studies of women residing in northern latitudes , bone loss was most pronounced during winter months and in those consuming less than 1 g calcium per day . In this study we sought to test the hypothesis that calcium supplementation by either calcium carbonate or dietary means would prevent seasonal bone loss and preserve bone mass . Sixty older postmenopausal women without osteoporosis were r and omized to one of three treatment arms : Dietary milk supplementation ( D-4 glasses of milk/day ) , Calcium carbonate ( CaCO3 - 1000 mg/day in two divided doses ) , or placebo ( P ) . After 2 yr , placebo-treated women consumed a mean of 683 mg/day of calcium and lost 3.0 % of their greater trochanteric ( GT ) bone mineral density ( BMD ) ( P < 0.03 vs. baseline ) ; Dietary supplemented women averaged a calcium intake of 1028 mg/day and sustained minimal loss from the GT ( -1.5 % ; P = 0.30 ) , whereas CaCO3-treated women ( total Ca intake , 1633 mg/day ) suffered no bone loss from the GT and showed a significant increase in spinal and femoral neck BMD ( P < 0.05 ) . Femoral bone loss occurred exclusively during the two winters of the study ( i.e. total loss , -3.2 % ; P < 0.02 in placebo-treated women ) with virtually no change in GT BMD during summer . Serum 25-OH vitamin D declined by more than 20 % ( P < 0.001 ) in all groups during the winter months but returned to baseline in summer ; PTH levels rose approximately 20 % ( P < 0.001 ) during winter but did not return to baseline during the summers . Urine N-telopeptide and osteocalcin levels increased significantly but only in the P-treated women and only during winter . Serum insulin growth factor binding protein 4 , an inhibitory insulin growth factor binding protein , rose 15 % ( P < 0.03 ) from summer to winter , but this increase was significant only in those women consuming < 1000 mg/day of calcium . By multivariate analysis , total calcium intake was the strongest predictor of bone loss from the hip . Urinary N-telopeptide also closely correlated with GT BMD but only during winter ( P = 0.003 ) . We conclude that calcium supplementation prevents bone loss  in elderly women by suppressing bone turnover during the winter when serum 25-OH vitamin D declines and serum PTH increases . The precise amount of calcium necessary to preserve BMD in elderly women requires further studies , although in this study , at least 1000 mg/day of supplemental calcium was adequate prophylaxis against femoral bone loss OBJECTIVE To identify nutrients , foods , and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners . DESIGN AND SETTING Two-year , prospect i ve cohort study . Observational data were collected in the course of a multicenter r and omized trial of the effect of oral contraceptives on bone health . PARTICIPANTS One hundred and twenty-five female competitive distance runners ages 18 - 26 years . ASSESSMENT OF RISK FACTORS Dietary variables were assessed with a food frequency question naire . MAIN OUTCOME MEASUREMENTS Bone mineral density and content ( BMD/ BMC ) of the spine , hip , and total body were measured annually by dual x-ray absorptiometry ( DEXA ) .  Stress fractures were recorded on monthly calendars , and had to be confirmed by radiograph , bone scan , or magnetic resonance imaging . RESULTS Seventeen participants had at least one stress fracture during follow-up . Higher intakes of calcium , skim milk , and dairy products were associated with lower rates of stress fracture . Each additional cup of skim milk consumed per day was associated with a 62 % reduction in stress fracture incidence ( P < .05 ) ; and a dietary pattern of high dairy and low fat intake was associated with a 68 % reduction ( P < .05 ) . Higher intakes of skim milk , dairy foods , calcium , animal protein , and potassium were associated with significant ( P < .05 ) gains in whole-body BMD and BMC . Higher intakes of calcium , vitamin D , skim milk , dairy foods , potassium , and a dietary pattern of high dairy and low fat were associated with significant gains in hip BMD . CONCLUSIONS In young female runners , low-fat dairy products and the major nutrients in milk ( calcium , vitamin D , and protein ) were associated with greater bone gains and a lower stress fracture rate . Potassium intake was also associated with greater gains in hip and whole-body BMD Weight loss causes  bone mineral loss .  Higher protein diets continue to be criticized for further potential harmful bone effects , including elevated urinary calcium , but may promote bone health if protein sources include dairy . Overweight middle-aged subjects ( n = 130 , 59 males ) were r and omized to a diet providing 1.4 g.kg(-1).d(-1 ) protein and 3 daily servings of dairy ( PRO ) or 0.8 g.kg(-1).d(-1 ) protein and 2 daily servings of dairy ( CARB ) for 4 mo of weight loss plus 8 mo of weight maintenance . Diets prescribed 6276 kJ/d for females and 7113 kJ/d for males . Bone mineral content and density ( BMD ) for whole body ( WB ) , lumbar spine ( LS ) and total hip ( TH ) were measured using dual X-ray absorptiometry , and dietary intake using 3-d weighed food records . Urinary calcium was measured using 24-h collection at 0 and 8 mo for a sub sample ( n = 42 ) . Participants lost body weight ( mean , 95 % CI ) of 8.2 % ( 7.5 - 8.9 % ) at 4 mo , 10.6 % ( 9.5 - 11.8 % ) at 8 mo , and 10.5 % ( 8.9 - 12.0 % ) at 12 mo without differences between groups at any time ( P = 0.64 ) . At 12 mo , PRO BMD was higher by 1.6 % ( 0.3 - 3.0 % ) at WB , 2.1 % ( 0.6 - 3.7 % ) at LS , and 1.4 % ( 0.2 - 2.5 % ) at TH compared with  CARB  .  PRO calcium intake was higher ( PRO : 1140 + /- 58 mg/d , CARB : 766 + /- 46 ; P < 0.01 ) , as was urinary calcium ( PRO : 163 + /- 15 mg/d , CARB : 100 + /- 9.2 ; P < 0.01 ) . A reduced-energy diet supplying 1.4 g.kg(-1).d(-1 ) protein and 3 dairy servings increased urinary calcium excretion but provided improved calcium intake and attenuated bone loss over 4 mo of weight loss and 8 additional mo of weight maintenance Dietary protein increases urinary calcium losses and has been associated with higher rates of hip fracture in cross-cultural studies . However , the relation between protein and risk of  osteoporotic bone fractures among individuals has not been examined in detail . In this prospect i ve study , usual dietary intake was measured in 1980 in a cohort of 85,900 women , aged 35 - 59 years , who were participants in the Nurses ' Health Study . A mailed food frequency question naire was used and incident hip ( n = 234 ) and distal forearm ( n = 1,628 ) fractures were identified by self-report during the following 12 years . Information on other factors related to osteoporosis , including obesity , use of postmenopausal estrogen , smoking , and physical activity , was collected on biennial question naires . Dietary measures were up date d in 1984 and 1986 . Protein was associated with an increased risk of forearm fracture ( relative risk ( RR ) = 1.22 , 95 % confidence interval ( Cl ) 1.04 - 1.43 , p for trend = 0.01 ) for women who consumed more than 95 g per day compared with those who consumed less than 68 g per day . A similar increase in risk was observed for animal protein , but no association was found for consumption of vegetable protein . Women who consumed five or more servings of red meat per week also had a significantly increased risk of forearm fracture ( RR = 1.23 , 95 % Cl 1.01 - 1.50 ) compared with women who ate red meat less than once per week . Recall of teenage diet did not reveal any increased risk of forearm fracture for women with higher consumption of animal protein or red meat during this earlier period of life . No association was observed between  adult protein intake  and the incidence of hip fractures , though power to assess this association was low BACKGROUND Controversy exists concerning the effects of higher total protein intake ( TPro ) on bone health , which may be associated with reduced bone mineral density ( BMD ) . However , whey protein ( WP ) may induce bone formation because of its basic component , milk basic protein . OBJECTIVE This study assessed the effects of WP supplementation , TPro , and change in TPro ( postsupplementation - presupplementation ) on BMD and bone mineral content ( BMC ; total body , lumbar spine , total femur , and femoral neck ) in overweight and class I obese middle-aged adults following an exercise intervention . METHODS This analysis used data from a double-blind , r and omized , placebo-controlled 36-wk WP supplementation trial , wherein participants consumed a 1.7-MJ ( 400-kcal ) supplement ( 0 , 20 , 40 , or 60 g WP/d ) along with their otherwise unrestricted diet while participating in a resistance and aerobic exercise intervention ( 3 d/wk ) . TPro was the summation of WP and habitual dietary intakes ( 4-d food record ) . Statistical analyses for WP were based on group and bone data [ n = 186 , 108 women ; mean ± SD age : 49 ± 8 y ; body mass index ( BMI ; in kg/m2 ) : 30.1 ± 2.8 ] , whereas TPro was based on dietary and bone data ( n = 113 , 70 women ; age 50 ± 8 y ; BMI 30.1 ± 2.9 ) . RESULTS WP supplementation , regardless of dose , did not influence BMD or BMC following the intervention . By using a multiple linear regression model , TPro ( expressed as g/d or g · kg-1 · d-1 ) and change in TPro ( expressed as g/d ) were not associated with responses over time in total or regional BMD or BMC . By using a cluster analysis approach [ < 1.0 ( n = 41 ) , 1.0 - 1.2 ( n = 28 ) , and ≥1.2 g · kg-1 · d-1 ( n = 44 ) ] , TPro was also not associated with responses in total or regional BMD or BMC over time . CONCLUSION WP supplementation and total dietary protein intake did not negatively or beneficially influence bone quantity in overweight and obese adults during a 9-mo exercise intervention . This trial was registered at clinical trials.gov as NCT00812409 Objective To examine the effects of food groups and dietary nutrients on  bone loss in elderly Chinese population . Design Prospect i ve cohort study . Setting : A longitudinal study started at 2001 in Hong Kong . Participants 1225 Chinese men and 992 women aged 65 years and over in the community . Methods Daily intake of food groups and dietary nutrients at baseline was assessed by a food frequency question naire . Nutrient intake was adjusted for energy intake by residual method . Linear regression was used to examine the association of BMD change and food group or energy-adjusted nutrient intake with adjustment for demographic , anthropometric , lifestyle factors , and daily energy intake ( for food group only ) . Results Higher fish intake was associated with smaller bone loss in hip ( B=−0.611 , p=0.004 ) and femoral neck ( B=−0.724 , p=0.040 ) in men . None of the food groups were associated with bone loss in both measured sites in women . For men , lower intake of protein ( B=−0.012 , p=0.003 ) , phosphorus ( B=−0.0008 , p=0.001 ) , sodium ( B=−0.0002 , p=0.023 ) and isoflavone ( B=−1.084 , p=0.030 ) was associated with greater BMD loss in hip , whereas lower intake of protein ( B=−0.018 , p=0.006 ) and sodium ( B=−0.0004 , p=0.018 ) was associated with greater BMD loss in femoral neck . However , these significant associations disappeared after further adjustment for energy-adjusted calcium and vitamin D intakes . None of the nutrients were associated with BMD loss in both measured sites in women . Conclusions Greater fish intake may help to reduce bone loss in this sample of elderly Chinese men . The significant association between various nutrients and bone loss  in elderly Chinese men was likely due to the influence of dietary calcium and vitamin D intakes . The role of food groups and dietary nutrients on bone health in this sample of elderly Chinese women seems to be minimal One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life Weight reduction induces bone loss by several factors , and the effect of higher protein ( HP ) intake during caloric restriction on bone mineral density ( BMD ) is not known . Previous study design s examining the longer-term effects of HP diets have not controlled for total calcium intake between groups and have not examined the relationship between bone and endocrine changes . In this r and omized , controlled study , we examined how BMD ( areal and volumetric ) , turnover markers , and hormones [ insulin-like growth factor 1 ( IGF-1 ) , IGF-binding protein 3 ( IGFBP-3 ) , 25-hydroxyvitamin D , parathyroid hormone ( PTH ) , and estradiol ] respond to caloric restriction during a 1-year trial using two levels of protein intake . Forty-seven postmenopausal women ( 58.0 ± 4.4 years ; body mass index of 32.1 ± 4.6 kg/m(2 ) ) completed the 1-year weight-loss trial and were on a higher ( HP , 24 % , n = 26 ) or normal protein ( NP , 18 % , n = 21 ) and fat intake ( 28 % ) with controlled calcium intake of 1.2 g/d . After 1 year , subjects lost 7.0 % ± 4.5 % of body weight , and protein intake was 86 and 60 g/d in the HP and NP groups , respectively . HP compared with NP diet attenuated loss of BMD at the ultradistal radius , lumbar spine , and total hip and trabecular volumetric BMD and bone mineral content of the tibia . This is consistent with the higher final values of IGF-1 and IGFBP-3 and lower bone-resorption marker ( deoxypyridinoline ) in the HP group than in the NP group ( p < .05 ) . These data show that a higher  dietary protein during weight reduction increases serum IGF-1 and attenuates total and trabecular bone loss at certain sites in postmenopausal women Abstract It has been hypothesized that high protein intakes are associated with lower bone mineral content ( BMC ) . Previous studies yield conflicting results and thus far no studies have undertaken the interaction of body mass index ( BMI ) and physical activity with protein intakes in relation to BMC and bone mineral density ( BMD ) . Objective To evaluate the associations of dietary total protein ( TP ) , animal protein ( AP ) and plant protein ( PP ) intakes with BMC and BMD and their changes . We tested also the interactions of protein intake with , obesity ( BMI ≤30 vs. > 30 kg/m2 ) and physical activity level ( passive vs. active ) . Design / Setting Prospect i ve cohort study ( Osteoporosis Risk-Factor and Fracture-Prevention Study ) . Participants / measures At the baseline , 554 women aged 65 - 72 years filled out a 3-day food record and a question naire covering data on lifestyle , physical activity , diseases , and medications . Intervention group received calcium 1000 mg/d and cholecalciferol 800 IU for 3 years . Control group received neither supplementation nor placebo . Bone density was measured at baseline and year 3 , using dual energy x-ray absorptiometry . Multivariable regression analyses were conducted to examine the associations between protein intake and BMD and BMC . Results In cross-sectional analyses energy-adjusted TP ( P≤0·029 ) and AP ( P≤0·045 ) but not PP ( g/d ) were negatively associated with femoral neck ( FN ) BMD and BMC . Women with TP≥1·2 g/kg/body weight ( BW ) ( Ptrend≤0·009 ) had lower FN , lumbar spine ( LS ) and total BMD and BMC . In follow-up analysis , TP ( g/kg/BW ) was inversely associated with LS BMD and LS BMC . The detrimental associations were stronger in women with BMI < 30 kg/m2 . In active women , TP ( g/kg/BW ) was positively associated with LS BMD and FN BMC changes . Conclusions This study suggests detrimental associations between protein intake and bone health . However , these negative associations maybe counteracted by BMI > 30 kg/m2 and physical activity Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population Abstract : Quantitative ultrasound ( QUS ) assessment of bone is a strong predictor of hip fractures and is currently an FDA -approved tool to identify women at risk of osteoporosis . However , few studies have investigated the lifestyle and genetic correlates of QUS in women . This study investigated the cross-sectional associates of several lifestyle , demographic and genetic factors with calcaneal QUS parameters ( broadb and ultrasound attenuation ( BUA ) and speed of sound ( SOS ) ) in 393 women aged 45–53 years .  Leisure-time and historical physical activity , dietary calcium and protein , body composition , vitamin D receptor genotypes , menopause status , other health behaviors , calcaneal QUS parameters and bone mineral density ( BMD ) were assessed at a single clinic visit .  Lean mass , recent physical activity and African-American race were the strongest correlates of SOS whereas dietary protein , calcium and recent physical activity were the strongest correlates of BUA . These predictors explained 13 % and 6 % of the variance in SOS and BUA , respectively . Smoking , alcohol intake , education , hormone replacement therapy , calcium and vitamin D supplements , historical physical activity and vitamin D receptor genotypes were not significantly associated with BUA or SOS . Lean body mass and premenopausal status were the strongest correlates of lumbar BMD whereas lean body mass , physical activity , African-American race and body mass index were significantly related to femoral neck BMD . Physical activity remained predictive of SOS after controlling for lumbar BMD . The spectrum and magnitude of risk factors for SOS and BUA , including lean body mass , physical activity , race , protein and calcium intake , parallel previously observed predictors of BMD BACKGROUND It has been hypothesized that hip-fracture rates are higher in developed than in developing countries because high-protein ( HP ) Western diets induce metabolic acidosis and hypercalciuria . Confounders include interactions between dietary protein and calcium , sodium , and potassium . OBJECTIVE We determined whether an HP or a high-normal-protein ( HNP ) weight-loss diet caused greater loss in bone mineral density ( BMD ) over 24 mo . DESIGN The Weight Loss , Protein and Bone Density Study was conducted from 2008 to 2011 in 323 overweight [ body mass index ( BMI ; in kg/m(2 ) ) > 27 ] postmenopausal women , with a total hip BMD t score less than -2.0 . Subjects were r and omly assigned to receive an isocaloric calcium-replete HP ( ≥90 g protein/d ) or HNP ( < 80 g protein/d ) weight-loss diet , with the aim of a difference of 20 g protein/d . A total of 186 subjects ( 90 subjects in the HP group , 96 subjects in the HNP group ) completed 12 mo , and 137 subjects ( 69 subjects in the HP group , 68 subjects in the HNP group ) completed 24 mo . RESULTS Biomarkers confirmed a difference in protein intake of 16 and 13.1 g at 12 and 24 mo , respectively . Mean ( ±SE ) weight loss was equal ; HP subjects lost 7.9 ± 0.9 kg and HNP subjects lost 8.9 ± 0.9 kg at 24 mo . Subjects lost 1 - 2 % BMD annually at lumbar spine vertebrae 2 - 4 , the forearm , the femoral neck , and hip . ANCOVA showed no effect of the HP or HNP diet ( P > 0.05 for diet and diet-time interactions ) . A diet-by-time analysis showed that the HNP diet increased C-terminal telopeptide and osteocalcin ( P ≤ 0.001 for each ) despite hypercalciuria ( P = 0.029 ) . CONCLUSION High dietary protein intake during weight loss has no clinical ly significant effect on bone density but slows bone turnover . This trial was registered at the Australian and New Zeal and Clinical Trials Registry ( http://www.anzctr.org.au ) as ACTRN12608000229370 BACKGROUND Protein and alkalizing minerals are increasingly described as playing a major role in influencing bone status , not only in the elderly but also in children and adolescents . OBJECTIVE We examined whether the long-term dietary protein intake and diet net acid load are associated with bone status in children . DESIGN In a prospect i ve study design in 229 healthy children and adolescents aged 6 - 18 y , long-term dietary intakes were calculated from 3-d weighed dietary records that were collected yearly over the 4-y period before a one-time bone analysis . Dietary acid load was characterized as potential renal acid load ( PRAL ) by using an algorithm including dietary protein , phosphorus , magnesium , and potassium . Proximal forearm bone variables were measured by peripheral quantitative computed tomography . RESULTS After adjustment for age , sex , and energy intake and control for forearm muscularity , BMI , growth velocity , and pubertal development , we observed that long-term  dietary protein intake  was significantly positively associated with periosteal circumference ( P < 0.01 ) , which reflected bone modeling , and with cortical area ( P < 0.001 ) , bone mineral content ( P < 0.01 ) , and polar strength strain index ( P < 0.0001 ) , which reflected a combination of modeling and remodeling . Children with a higher dietary PRAL had significantly less cortical area ( P < 0.05 ) and bone mineral content ( P < 0.01 ) . Long-term calcium intake had no significant effect on any bone variable . CONCLUSIONS Long-term dietary protein intake appears to act anabolically on diaphyseal bone strength during growth , and this may be negated , at least partly , if dietary PRAL is high , ie , if the intake of alkalizing minerals is low Currently there is no consensus on the impact of dietary protein on calcium and bone metabolism . This study was conducted to examine the effect of increasing protein intake on urinary calcium excretion and to compare circulating levels of IGF-I and biochemical markers of bone turnover in healthy older men and women who consumed either a high or a low protein food supplement for 9 wk . Thirty-two subjects with usual protein intakes of less than 0.85 g/kg.d were r and omly assigned to daily high ( 0.75 g/kg ) or low ( 0.04 g/kg ) protein supplement groups . Isocaloric diets were maintained by advising subjects to reduce their intake of carbohydrates . Selected biochemical measurements were made at baseline and on d 35 and either d 49 or 63 . Changes in urinary calcium excretion in the two groups did not differ significantly over the course of the study . The high protein group had significantly higher levels of serum IGF-I ( P = 0.008 ) and lower levels of urinary N-telopeptide ( P = 0.038 ) over the period of d 35 - 49 or 63 . We conclude that increasing protein intake from 0.78 to 1.55 g/kg.d with meat supplements in combination with reducing carbohydrate intake did not alter urine calcium excretion , but was associated with higher circulating levels of IGF-I , a bone growth factor , and lowered levels of urinary N-telopeptide , a marker of bone resorption . In contrast to the widely held belief that increased protein intake results in calcium wasting , meat supplements , when exchanged isocalorically for carbohydrates , may have a favorable impact on the skeleton in healthy older men and women CONTEXT Consolidation and maintenance of peak bone mass in young adulthood may be compromised by inactivity , low dietary calcium , and diet-induced weight loss . OBJECTIVE We aim ed to determine whether higher intakes of dairy foods , dietary calcium , and protein during diet- and exercise-induced weight loss affected markers of bone health . PARTICIPANTS Participants included premenopausal overweight and obese women . DESIGN /INTERVENTION Ninety participants were r and omized into three groups ( n = 30 per group ) : high protein and high dairy ( HPHD ) , adequate protein and medium dairy ( APMD ) , and adequate protein and low dairy ( APLD ) , differing in dietary protein ( 30 , 15 , or 15 % of energy , respectively ) , dairy foods ( 15 , 7.5 , or < 2 % of energy from protein , respectively ) , and dietary calcium ( ∼1600 , ∼1000 , or < 500 mg/d , respectively ) . OUTCOME MEASURES Serum and urine bone turnover biomarkers , serum osteoprotegerin ( OPG ) , receptor activator of nuclear factor-κB lig and ( RANKL ) , PTH , 25-hydroxyvitamin D , leptin , and adiponectin measured at 0 and 16 wk . RESULTS All groups lost equivalent body weight ( P < 0.05 ) . N-telopeptide , C-telopeptide ( CTX ) , urinary deoxypyridinoline , and osteocalcin increased in APLD ( P < 0.01 ) , whereas in HPHD , osteocalcin and procollagen 1 amino-terminal propeptide ( P1NP ) increased ( P < 0.05 ) , and all resorption markers remained unchanged . P1NP to CTX and OPG to RANKL ratios increased in HPHD ( P < 0.005 ) , and P1NP to CTX ratio decreased in APLD ( P < 0.05 ) . PTH decreased in HPHD and APMD vs. APLD ( P < 0.005 ) , and 25-hydroxyvitamin D increased in HPHD ( P < 0.05 ) , remained unchanged in APMD , and decreased in APLD ( P < 0.05 ) . Leptin decreased and adiponectin increased in APMD and HPHD only ( P < 0.001 ) . CONCLUSIONS Hypoenergetic diets higher in dairy foods , dietary calcium , and protein with daily exercise , favorably affected important bone health biomarkers vs. diets with less of these bone-supporting nutrients Summary This cross-sectional study showed that , although vegans had lower dietary calcium and protein intakes than omnivores , veganism did not have adverse effect on bone mineral density and did not alter body composition . Introduction Whether a lifelong vegetarian diet has any negative effect on bone health is a contentious issue . We undertook this study to examine the association between lifelong vegetarian diet and bone mineral density and body composition in a group of postmenopausal women . Methods One hundred and five Mahayana Buddhist nuns and 105 omnivorous women ( average age = 62 , range = 50–85 ) were r and omly sample d from monasteries in Ho Chi Minh City and invited to participate in the study . By religious rule , the nuns do not eat meat or seafood ( i.e. , vegans ) . Bone mineral density ( BMD ) at the lumbar spine ( LS ) , femoral neck ( FN ) , and whole body ( WB ) was measured by DXA ( Hologic QDR 4500 ) . Lean mass , fat mass , and percent fat mass were also obtained from the DXA whole body scan . Dietary calcium and protein intakes were estimated from a vali date d food frequency question naire . Results There was no significant difference between vegans and omnivores in LSBMD ( 0.74 ± 0.14 vs. 0.77 ± 0.14 g/cm2 ; mean ± SD ; P = 0.18 ) , FNBMD ( 0.62 ± 0.11 vs. 0.63 ± 0.11 g/cm2 ; P = 0.35 ) , WBBMD ( 0.88 ± 0.11 vs. 0.90 ± 0.12 g/cm2 ; P = 0.31 ) , lean mass ( 32 ± 5 vs. 33 ± 4 kg ; P = 0.47 ) , and fat mass ( 19 ± 5 vs. 19 ± 5 kg ; P = 0.77 ) either before or after adjusting for age . The prevalence of osteoporosis ( T scores ≤ −2.5 ) at the femoral neck in vegans and omnivores was 17.1 % and 14.3 % ( P = 0.57 ) , respectively . The median intake of dietary calcium was lower in vegans compared to omnivores ( 330 ± 205 vs. 682 ± 417 mg/day , P < 0.001 ) ; however , there was no significant correlation between dietary calcium and BMD . Further analysis suggested that whole body BMD , but not lumbar spine or femoral neck BMD , was positively correlated with the ratio of animal protein to vegetable protein . Conclusion These results suggest that , although vegans have much lower intakes of dietary calcium and protein than omnivores , veganism does not have adverse effect on bone mineral density and does not alter body composition Summary A longitudinal analysis of bone microstructure in postmenopausal women of the Geneva Retirees Cohort indicates that age-related cortical bone loss is attenuated at non-bearing bone sites in fermented dairy products consumers , not in milk or ripened cheese consumers , independently of total energy , calcium , or protein intakes . Introduction Fermented dairy products ( FDP ) , including yogurts , provide calcium , phosphorus , and proteins together with prebiotics and probiotics , all being potentially beneficial for bone . In this prospect i ve cohort study , we investigated whether FDP , milk , or ripened cheese consumptions influence age-related changes of bone mineral density ( BMD ) and microstructure . Methods Dietary intakes were assessed at baseline and after 3.0 ± 0.5 years with a food frequency question naire in 482 postmenopausal women enrolled in the Geneva Retirees Cohort . Cortical ( Ct ) and trabecular ( Tb ) volumetric ( v ) BMD and microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computerized tomography , in addition to areal ( a ) BMD and body composition by dual-energy X-ray absorptiometry , at the same time points . Results At baseline , FDP consumers had lower abdominal fat mass and larger bone size at the radius and tibia . Parathyroid hormone and β-carboxyterminal cross-linked telopeptide of type I collagen levels were inversely correlated with FDP consumption . In the longitudinal analysis , FDP consumption ( mean of the two assessment s ) was associated with attenuated loss of radius total vBMD and of Ct vBMD , area , and thickness . There was no difference in aBMD and at the tibia . These associations were independent of total energy , calcium , or protein intakes . For other dairy products categories , only milk consumption was associated with lower decrease of aBMD and of failure load at the radius . Conclusion In this prospect i ve cohort of healthy postmenopausal women , age-related Ct bone loss was attenuated at non-bearing bone sites in FDP consumers , not in milk or ripened cheese consumers , independently of total energy , calcium , or protein intakes . Study registration IS RCT N11865958 ( http://www.is rct n.com CONTEXT It has been assumed that the increase in urine calcium ( Ca ) that accompanies an increase in dietary protein was due to increased bone resorption . However , studies using stable Ca isotopes have found that dietary protein increases Ca absorption without increasing bone resorption . OBJECTIVE The objective of the study was to investigate the impact of a moderately high protein diet on bone mineral density ( BMD ) . DESIGN This was a r and omized , double-blind , placebo-controlled trial of protein supplementation daily for 18 months . SETTING The study was conducted at two institutional research centers . PARTICIPANTS Two hundred eight older women and men with a body mass index between 19 and 32 kg/m(2 ) and a self-reported protein intake between 0.6 and 1.0 g/kg participated in the study . INTERVENTION Subjects were asked to incorporate either a 45-g whey protein or isocaloric maltodextrin supplement into their usual diet for 18 months . MAIN OUTCOME MEASURE BMD by dual-energy x-ray absorptiometry , body composition , and markers of skeletal and mineral metabolism were measured at baseline and at 9 and 18 months . RESULTS There were no significant differences between groups for changes in L-spine BMD ( primary outcome ) or the other skeletal sites of interest . Truncal lean mass was significantly higher in the protein group at 18 months ( P = .048 ) . C-terminal telopeptide ( P = .0414 ) , IGF-1 ( P = .0054 ) , and urinary urea ( P < .001 ) were also higher in the protein group at the end of the study period . There was no difference in estimated glomerular filtration rate at 18 months . CONCLUSION Our data suggest that protein supplementation above the recommended dietary allowance ( 0.8 g/kg ) may preserve fat-free mass without adversely affecting skeletal health or renal function in healthy older adults Abstract : Lifestyle factors , such as diet , are believed to be involved in modifying bone health , although the results remain controversial , particularly in children and adolescents . The objective of the study was to identify associations between dietary factors and whole body bone measurements in 10-year-old children . The study was a cross-sectional analysis of a r and om sample of 105 healthy Danish children , aged 10 years ( 9.97 ± 0.09 ) . Whole body bone mineral content ( BMC ) and bone area ( BA ) were determined by dual-energy X-ray absorptiometry . The influence of diet ( 7 day food records ) on BMC and BA were examined in bi- and multivariate analyses . The mean intakes of calcium , protein , phosphorus and sodium were 1226 mg , 78 g , 1523 mg and 3.3 g , respectively . In bivariate analyses , BMC and BA were strongly positively correlated with height ( p<0.001 ) and weight ( p<0.001 ) , and with intakes of energy ( p<0.005 ) and several nutrients . BMC was adjusted for size by including BA , height and weight in the multiple linear regression , and BA was adjusted for size by including height and weight in the multiple linear regression . In multivariate analyses , size-adjusted BMC was positively associated with calcium intake ( p = 0.02 ) . Size-adjusted BA was positively associated with dietary protein ( p = 0.003 ) , and negatively associated with intakes of sodium ( p = 0.048 ) and phosphorus ( p = 0.01 ) . In conclusion , calcium intake was positively associated with bone mineralization . There was a positive association between protein and BA , while for phosphorus and sodium the association was negative . The findings suggest that in addition to calcium , the intake of other nutrients influences bone development in prepubertal children Summary Vitamin K mediates the synthesis of proteins regulating bone metabolism . We have tested whether high vitamin K2 intake promotes bone mineral density and bone strength . Results showed that K2 improved BMC and femoral neck width , but not DXA-BMD . Hence high vitamin K2 intake may contribute to preventing postmenopausal bone loss . Introduction Vitamin K is involved in the synthesis of several proteins in bone . The importance of K vitamins for optimal bone health has been suggested by population -based studies , but intervention studies with DXA-BMD as a clinical endpoint have shown contradicting results . Unlike BMC , DXA-BMD does not take into account the geometry ( size , thickness ) of bone , which has an independent contribution to bone strength and fracture risk . Here we have tested whether BMC and femoral neck width are affected by high vitamin K intake . Methods A r and omized clinical intervention study among 325 postmenopausal women receiving either placebo or 45 mg/day of vitamin K2 ( MK-4 , menatetrenone ) during three years .  BMC and hip geometry were assessed by DXA . Bone strength indices were calculated from DXA-BMD , femoral neck width ( FNW ) and hip axis length ( HAL ) . Results K2 did not affect the DXA-BMD , but BMC and the FNW had increased relative to placebo . In the K2-treated group hip bone strength remained unchanged during the 3-year intervention period , whereas in the placebo group bone strength decreased significantly . Conclusions Vitamin K2 helps maintaining bone strength at the site of the femoral neck in postmenopausal women by improving BMC and FNW , whereas it has little effect on DXA-BMD PURPOSE Strenuous training can be associated with amenorrhea leading to amenorrhea-related accelerated bone loss . Insufficient calorie energy , calcium , and /or protein intakes can also be frequently encountered in women with intense training , possibly contributing to bone loss . Long-distance runners with or without regular menses ( age range 19 - 37 yr ) were prospect ively studied . METHODS Changes in areal bone mineral density ( BMD ) were measured at 1-yr interval . RESULTS Among 10 eumenorrheic , 11 oligo-amenorrheic , and 9 oral contraceptive users , there was no difference in energy , calcium , or protein intakes . Baseline BMD values were significantly lower in the oligo-amenorrheic group than in the two others at the level of lumbar spine ( anteroposterior view : 0.941+/-0.039 in oligo-amenorrheic vs 1.077+/-0.029 or 1.051 + /-0.017 g x cm(-2 ) , P < 0.005 , in the eumenorrheic and contraceptive user groups , respectively ) but not in weight-bearing bone such as proximal and midshaft femur . Over a 1-yr interval , during which the three groups did not differ in terms of running distances and dietary intakes , oligo-amenorrheic women displayed a significant decrease in lumbar spine BMD in lateral view ( -0.049+/-0.012 in oligo-amenorrheic vs -0.001+/-0.013 and 0.014+/-0.012 g x cm(-2 ) , p < 0.005 , in the eumenorrheic and contraceptive user groups , respectively ) . We did not detect any significant change in femoral neck , trochanter , or midshaft BMD . CONCLUSIONS Oligo-amenorrhea in long-distance runners , with adequate dietary intakes , was associated with a decrease in BMD affecting more the lumbar spine than the proximal and midshaft femur during a 1-yr follow-up The effects of dietary protein on bone structure and metabolism have been controversial , with evidence for and against beneficial effects . Because no long-term r and omized , controlled studies have been performed , a two-year study of protein supplementation in 219 healthy ambulant women aged 70 to 80 years was undertaken . Participants were r and omized to either a high-protein drink containing 30 g of whey protein ( n = 109 ) or a placebo drink identical in energy content , appearance , and taste containing 2.1 g of protein ( n = 110 ) . Both drinks provided 600 mg of calcium . Dual-energy X-ray absorptiometric ( DXA ) hip areal bone mineral density ( aBMD ) , 24-hour urinary calcium excretion , and serum insulin-like growth factor 1 ( IGF-1 ) were measured at baseline and at 1 and 2 years . Quantitative computed tomographic ( QCT ) hip volumetric bone mineral density ( vBMD ) and a femoral neck engineering strength analysis were undertaken at baseline and at 2 years . Baseline average protein intake was 1.1 g/kg of body weight per day . There was a significant decrease in hip DXA aBMD and QCT vBMD over 2 years with no between-group differences . Femoral neck strength was unchanged in either group over time . The 24-hour urinary calcium excretion increased significantly from baseline in both groups at 1 year but returned to baseline in the placebo group at 2 years , at which time the protein group had a marginally higher value . Compared with the placebo group , the protein group had significantly higher serum IGF-1 level at 1 and 2 years ( 7.3 % to 8.0 % , p < .05 ) . Our study showed that in protein-replete healthy ambulant women , 30 g of extra protein increased IGF-1 but did not have beneficial or deleterious effects on bone mass or strength . The effect of protein supplementation in population s with low dietary protein intake requires urgent attention BACKGROUND Vitamin K mediates the gamma-carboxylation of glutamyl residues on several bone proteins , notably osteocalcin . High serum concentrations of undercarboxylated osteocalcin and low serum concentrations of vitamin K are associated with lower bone mineral density and increased risk of hip fracture . However , data are limited on the effects of dietary vitamin K. OBJECTIVE We investigated the hypothesis that high intakes of vitamin K are associated with a lower  risk of hip fracture in women . DESIGN We conducted a prospect i ve analysis within the Nurses ' Health Study cohort . Diet was assessed in 72327 women aged 38 - 63 y with a food-frequency question naire in 1984 ( baseline ) . During the subsequent 10 y of follow-up , 270 hip fractures result ing from low or moderate trauma were reported . RESULTS Women in quintiles 2 - 5 of vitamin K intake had a significantly lower age-adjusted relative risk ( RR : 0.70 ; 95 % CI : 0.53 , 0.93 ) of hip fracture than women in the lowest quintile ( < 109 microg/d ) . Risk did not decrease between quintiles 2 and 5 and risk estimates were not altered when other risk factors for osteoporosis , including calcium and vitamin D intakes , were added to the models . Risk of hip fracture was also inversely associated with lettuce consumption ( RR : 0.55 ; 95 % CI : 0.40 , 0.78 ) for one or more servings per day compared with one or fewer servings per week ) , the food that contributed the most to dietary vitamin K intakes . CONCLUSIONS Low intakes of vitamin K may increase the  risk of hip fracture in women . The data support the suggestion for a re assessment of the vitamin K requirements that are based on bone health and blood coagulation Marine n-3 polyunsaturated fatty acids ( PUFAs ) eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) may be beneficial for bone health , but few studies have investigated the association with fish consumption . Our aim was to study associations of fish and EPA + DHA consumption with bone mineral density ( BMD ) and hip fracture risk and determine whether high linoleic acid ( LA ) intake , the major dietary n-6 PUFA , modifies the associations . The study population consisted of 5045 participants aged 65 years and older from the Cardiovascular Health Study . Data on BMD were available for 1305 participants . Food-frequency question naire was used to assess dietary intake , and hip fracture incidence was assessed prospect ively by review of hospitalization records . After multivariable adjustment , femoral neck BMD was 0.01 g/cm2 lower in the highest versus lowest tuna/other-fish intake category ( p = .05 for trend ) .  EPA + DHA intake ( higher versus lower median of 0.32 g/day ) was associated with lower femoral neck BMD ( 0.66 versus 0.71 g/cm2 , p < .001 ) among those with LA intake greater than the median 12.1 g/day ( p = .03 for interaction ) . No significant associations were found with total-hip BMD . During mean follow-up of 11.1 years , 505 hip fractures occurred . Fish or EPA + DHA  consumption was not significantly associated with fracture incidence [ hazard ratio ( HR ) for extreme categories : HR = 1.23 , 95 % confidence interval ( CI ) 0.83–1.84 for tuna/other fish ; HR = 1.16 , 95 % CI 0.91–1.49 for fried fish ; and HR = 0.98 , 95 % CI 0.71–1.36 for EPA + DHA ] . High LA intake did not modify these associations . In this large prospect i ve cohort of older adults , fish consumption was associated with very small differences in BMD and had no association with hip fracture risk . © 2010 American Society for Bone and Mineral Research Background : Above-average dietary protein , as a single nutrient , improves musculoskeletal health . Evaluating the link between dietary protein and musculoskeletal health from a whole-diet perspective is important , as dietary guidelines focus on dietary patterns . Objective : We examined the prospect i ve association of novel dietary protein food clusters ( derived from established dietary pattern techniques ) with appendicular lean mass ( ALM ) , quadriceps strength ( QS ) , and bone mineral density ( BMD ) in 2986 men and women , aged 19 - 72 y , from the Framingham Third Generation Study . Design : Total protein intake was estimated by food-frequency question naire in 2002 - 2005 . A cluster analysis was used to classify participants into mutually exclusive groups , which were determined by using the percentage of contribution of food intake to overall protein intake . General linear modeling was used to 1 ) estimate the association between protein intake ( grams per day ) and BMD , ALM , appendicular lean mass normalized for height ( ALM/ht2 ) , and QS ( 2008 - 2011 ) and to 2 ) calculate adjusted least-squares mean outcomes across quartiles of protein ( grams per day ) and protein food clusters . Results : The mean ± SD age of subjects was 40 ± 9 y ; 82 % of participants met the Recommended Daily Allowance ( 0.8 g · kg body weight-1 · d-1 ) . The following 6 dietary protein food clusters were identified : fast food and full-fat dairy , fish , red meat , chicken , low-fat milk , and legumes  . BMD was not different across quartiles of protein intake ( P-trend range = 0.32 - 0.82 ) ; but significant positive trends were observed for ALM , ALM/ht2 ( P < 0.001 ) , and QS ( P = 0.0028 ) . Individuals in the lowest quartile of total protein intake ( quartile 1 ) had significantly lower ALM , ALM/ht2 , and QS than did those in the higher quartiles of intake ( quartiles 2 - 4 ; ( P ranges = 0.0001 - 0.003 , 0.0007 - 0.003 , and 0.009 - 0.05 , respectively ) . However , there were no associations between protein clusters and any musculoskeletal outcome in adjusted models . Conclusions : In a protein-replete cohort of adults , dietary protein is associated with ALM and QS but not with BMD . In this study , dietary protein food patterns do not provide further insight into beneficial protein effects on muscle outcomes Dietary protein has been shown to increase urinary Ca excretion in r and omised controlled trials , and diets high in protein may have detrimental effects on bone health ; however , studies examining the relationship between dietary protein and bone health have conflicting results . In the present study , we examined the relationship between dietary protein ( total , animal and vegetable protein ) and lumbar spine trabecular volumetric bone mineral density ( vBMD ) among participants enrolled in the Multi-Ethnic Study of Atherosclerosis ( n 1658 ) .  Protein intake was assessed using a FFQ obtained at baseline examination ( 2000 - 2 ) . Lumbar spine vBMD was measured using quantitative computed tomography ( 2002 - 5 ) , on average 3 years later . Multivariable linear and robust regression techniques were used to examine the associations between dietary protein and vBMD . Sex and race/ethnicity jointly modified the association of dietary protein with vBMD ( P for interaction = 0·03 ) . Among white women , higher vegetable protein intake was associated with higher vBMD ( P for trend = 0·03 ) , after adjustment for age , BMI , physical activity , alcohol consumption , current smoking , educational level , hormone therapy use , menopause and additional dietary factors . There were no consistently significant associations for total and animal protein intakes among white women or other sex and racial/ethnic groups . In conclusion , data from the present large , multi-ethnic , population -based study suggest that a higher level of protein intake , when substituted for fat , is not associated with poor bone health . Differences in the relationship between protein source and race/ethnicity of study population s may in part explain the inconsistent findings reported previously Aim : To study bone mineralization in a group of phenylketonuric patients and to search for a possible relationship between bone mineral density , dietary control , serum minerals and nutrition intake . The response to treatment with low‐dose 1.25‐(OH)2 vitamin D in patients with osteopenia was evaluated . Methods : Twenty‐eight phenylketonuric patients ( age range : 10–33 y ) on dietary treatment were investigated . Bone density at the lumbar spine ( Dual Energy X‐ray Absorptiometry ) , bone formation markers ( osteocalcin and bone alkaline phosphatase ) , serum minerals , index of dietary control and protein , vitamin D and mineral intakes were determined . Results : Of the patients studied , 78.6 % had good dietary compliance ( 462 ± 89 μmol/L ) . Mean protein , vitamin D and mineral intakes met the recommended dietary allowances ( RDAs ) . Nevertheless , 8 patients had calcium intakes lower than 1000 g/d , and a positive correlation between Z‐score and calcium ( r= 0.585 ; p= 0.002 ) or phosphorus intake ( r= 0.546 ; p= 0.005 ) was observed . Osteopenia was detected in 14 patients ( 50 % ) . Moreover , bone alkaline phosphatase in phenylketonuric patients older than 18 y of age was significantly lower than that in controls ( p > 0.0001 ) . No correlation was found between bone mineral density , age , serum minerals , bone formation markers or index of dietary control . Treatment with 0.25 μg/d calcitriol significantly increased bone density in 6 patients BACKGROUND Bone loss is a critical concern for space travelers , and a dietary countermeasure would be of great benefit . Dietary protein and potassium-associated bicarbonate precursors may have opposing effects on the acid-base balance in the body and therefore on bone loss . OBJECTIVE In 2 studies , we examined the ability of dietary protein and potassium to predict markers of bone metabolism . DESIGN In the first study , 8 pairs of male identical twins were assigned to 1 of 2 groups : bed rest ( sedentary , or SED , group ) or bed rest with supine treadmill exercise in a lower-body negative pressure chamber ( EX group ) . In a second study , groups of 4 subjects lived in a closed chamber for 60 or 91 d , and dietary data were collected for two or three 5-d sessions . Urinary calcium , N-telopeptide , and pyridinium cross-links were measured before bed rest ; on bed rest days 5 - 6 , 12 - 13 , 19 - 20 , and 26 - 27 ; and daily during the chamber studies . Data were analyzed by Pearson 's correlation ( P < 0.05 ) . RESULTS The ratio of animal protein intake to potassium intake was significantly correlated with N-telopeptide in the SED group during bed rest weeks 3 and 4 ( r = 0.77 and 0.80 ) and during the 91-d chamber study ( r = 0.75 ) . The ratio of animal protein intake to potassium intake was positively correlated with pyridinium cross-links before bed rest in the EX group ( r = 0.83 ) , in the EX group during bed rest week 1 ( r = 0.84 ) , and in the SED group during bed rest week 2 ( r = 0.72 ) but not during either chamber study . In both studies , these relations were not significant with the ratio of vegetable protein intake to potassium intake . CONCLUSIONS The ratio of animal protein intake to potassium intake may affect bone in ambulatory and bed-rest subjects . Changing this ratio may help to prevent bone loss on Earth and during space flight This study was conducted to determine whether the markers of bone resorption , pyridinium cross-links of collagen , are sensitive to changes in dietary protein and calcium intake . Fifteen young healthy subjects ( 7 males and 8 females ) participated in three 5-d diet periods . Dietary intake during each dietary period consisted of : 1 ) low nitrogen and low calcium [ 0.49 + /- 0.11 g protein/ ( kg.d ) , 429 + /- 190 mg calcium/d ] ; 2 ) low nitrogen and high calcium [ 0.44 + /- 0.08 g protein/(kg.d ) , 1643 + /- 171 mg calcium/d ] ; and 3 ) a high nitrogen and high calcium [ 2.71 + /- 0.75 g protein/(kg.d ) , 1589 + /- 633 mg calcium/d ] diet , and this was compared with subjects ' baseline dietary intake [ 0.99 + /- 0.51 g protein/(kg.d ) , 589 + /- 152 mg calcium/d ] . The order of these diets was r and omly assigned . Twenty-four-hour and 3-h urine sample s were collected before and during each dietary period and were analyzed for pyridinium cross-links ( pyridinoline , deoxypyridinoline ) , nitrogen and creatinine . The rate of pyrdinium cross-link excretion did not vary with protein intake but was approximately 33 % lower ( P < 0.01 ) during periods of high compared with low calcium intake . These data indicate that a short-term increase in calcium intake is accompanied by a reduced rate of bone resorption and that this effect is independent of dietary protein intake Fracture of the proximal femur is the most dramatic clinical sequela of osteoporosis [ 1 , 2 ] . It is associated with a high mortality rate , need for long-term medical care , and prolonged disability [ 3 - 5 ] . Protein malnutrition is often seen in elderly persons and is more severe in patients with hip fracture [ 6 - 11 ] . Protein deficiency may contribute to the occurrence of hip fracture by reducing muscle strength , impairing movement coordination , and diminishing the protective layer of soft tissue padding [ 9 , 10 , 12 - 14 ] It may also be associated with lower bone mineral density at the proximal femur [ 15 ] . Furthermore , malnutrition in general and protein deficiency in particular at admission and during recovery may adversely influence clinical outcome after hip fracture [ 7 , 9 , 10 , 16 - 18 ] . Protein restriction has been shown to reduce plasma levels of insulin-like growth factor-I ( IGF-I ) by inducing resistance to the action of growth hormone in the liver and increasing the metabolic clearance rate of the growth factor [ 19 - 23 ] . Furthermore , evidence shows that protein depletion may blunt the effect of IGF-I on target organs [ 20 ] . Thus , low protein intake in elderly persons may be detrimental to skeletal integrity , muscle strength , and immune response [ 11 , 24 - 27 ] because of decreased production and action of IGF-I , which favorably influences these systems [ 28 - 33 ] . Previous studies [ 16 , 17 ] have shown that a 5-week course of protein supplements can reduce the medical complication rate and duration of hospital stay in patients with recent hip fracture . These findings were independent of energy , calcium , and vitamin D intake [ 17 ] . Whether these observations were related to the restoration of decreased IGF-I levels and whether bone may benefit from long-term protein supplementation are not known . We investigated whether protein supplements in vitamin D-replete patients with a recent hip fracture who were receiving calcium supplements could increase circulating IGF-I levels and favorably influence bone mineral density . Methods Patients Patients were recruited in the orthopedic ward of Geneva University Hospital , the referral center that receives 94.6 % of all patients with hip fracture from an area with a population of approximately 400 000 persons [ 5 ] . The protocol was approved by the ethical committee of the Geneva University Hospital Department of Surgery . Inclusion criteria were age greater than 60 years ; recent hip fracture ( within 2 weeks ) attributable to osteoporosis ( that is , a fracture after a minor trauma , such as a fall from st and ing height ) ; and the ability to give written , informed consent . Exclusion criteria were pathologic fracture ; fracture caused by severe trauma ; history of contralateral hip fracture ; severe mental impairment ; active metabolic bone disease ; renal failure ( plasma creatinine concentration 200 mol/L ) ; acute illness that could interfere with the study protocol ; severe malnutrition ( serum albumin level < 15 g/L ) ; consumption of drugs known to alter bone metabolism , such as calcitonin , fluoride , sex hormones , corticosteroids , or bisphosphonates ; and life expectancy of less than 1 year . Using a r and om number table , we assigned patients to receive an oral protein supplement composed of 90 % milk proteins or a placebo made isocaloric by the addition of maltodextrins . Patients took the assigned intervention 5 days a week for 6 months in addition to their regular diet . All patients received one oral dose of vitamin D3 , 200 000 IU ( vitamine D3B.O.N. , Doms-Adrian , Courbevoie , France ) , to correct any possible vitamin D deficiency [ 34 ] . The daily protein supplement ( Meritene , S and oz Nutrition Ltd. , Berne , Switzerl and ) provided 1050 kJ ( 250 kcal ) of energy in the form of 20 g of proteins , 3.1 g of lipids , and 35.7 g of carbohydrates ( 54.4 g in placebo ) . The other constituents of the 65 g powder supplement were vitamin A ( 1000 IU ) , vitamin K1 ( 30 g ) , vitamin C ( 20 mg ) , calcium ( 550 mg ) , magnesium ( 91 mg ) , phosphorus ( 429 mg ) , and sodium ( 228 mg ) . The supplement is design ed to normalize but not overcompensate for the insufficient dietary intake of protein of elderly persons with a recent fracture of the proximal femur [ 16 ] . Compliance was verified by weekly phone calls and by counting the remaining nutritional supplement bags , which were forwarded monthly by mail . Clinical Data Medical history , clinical characteristics , anthropometric data , and performance status according to an Activities of Daily Living score [ 35 ] were evaluated . Dietary intakes were recorded by using a food-frequency question naire [ 36 ] about the week before the fracture . Food intakes were analyzed by using a nutrient software system ( Fruitdor , Astra-Calve , Paris , France ) . Dietary intake of calcium , phosphorus , and protein was calculated from intake of dairy products , meat , fish , and vegetables . Because many patients were unable to st and a few days after hip fracture , their height was determined with a fathom measure while they were recumbent . Body weight was determined with a scale that correlated highly with that provided by measurement of whole body bone , fat , and lean mass as assessed by dual x-ray absorptiometry [ 37 ] . Mid-arm circumference was measured with a tape measure ( coefficient of variation , 2 % ) . Isometric muscle strength of the biceps of the dominant arm was evaluated with a dynamometer ( Lido , Lidoactive Isokinetic System , Loredan Biomedical Inc. , West Sacramento , California ) , which measures the peak torque ( coefficient of variation < 5 % ) . The grip strength of the same arm was measured with a dynamometer ( Vigorimeter , Martin Medizin-Technik , Tuttlingen , Germany ) [ 38 ] . The mean of three measurements was used for calculation . Biochemical Data Within 120 hours after surgery , we used st and ard methods to analyze venous blood sample s for protein-corrected plasma levels of calcium , phosphate , creatinine , total proteins , albumin , and prealbumin . We also measured levels of IGF-I ( Nichols Institute , San Juan Capistrano , California ) after acid-ethanol extraction and cryoprecipitation [ 39 ] , intact parathyroid hormone ( Immulite , Diagnostic Products , Los Angeles , California ) , calcitriol , calcidiol ( Incstar , Stillwater , Minnesota ) , and osteocalcin ( CIS-BIO International , Gif-sur-Yvette , France ) . Biochemical measurements were repeated 6 and 12 months after the fracture . Serum IGF-I binding proteins were measured by Western lig and blot analysis [ 40 ] . Briefly , 3 L of serum was boiled and separated onto 15 % sodium dodecylsulfate polyacrilamide gel electrophoresis under nonreducing conditions . Proteins were electrically blotted onto a nitrocellulose membrane , and IGF-I binding proteins were detected after incubating the membranes with radioiodinated IGF-I at 4C for 24 hours . Insulin-like growth factor binding proteins were quantified by phosphorimaging ( Molecular Dynamics , Sunnyvale , California ) . The intensity of the b and s corresponding to the appropriate molecular weights [ 40 ] was expressed as the percentage of total bound radioactive IGF-I. Measurements of calcium , phosphate , and creatinine were obtained from the second fasting morning urine . The ratio of hydroxyproline to creatinine in the same sample was taken as a reflection of bone resorption . Markers of bone resorption ( pyridinoline and deoxypyridinoline ) in the first morning spot urine were measured by detecting fluorescence emission after acid hydrolysis and separation with isocratic reverse-phase high-performance liquid chromatography ( BioRad System , Munich , Germany ) , and the values were adjusted to the creatinine concentration . Immunologic Data Concentrations of IgA , IgG , IgM , and isohemagglutinins were measured by using st and ard methods . Cell-mediated immunity was assessed by using a skin-test antigens for cellular hypersensitivity system ( STACH , Institut Merieux , Lyon , France ) , which evaluates the size of the skin reaction to various antigens injected intradermally [ 41 ] . Bone Mass Assessment We measured areal bone mineral density at the lumbar spine ( anteroposterior and lateral views ) , the contralateral proximal femur ( femoral neck and trochanter ) , and the contralateral mid-femoral shaft . We also measured whole-body bone mineral content , fat , and lean mass by using dual x-ray absorptiometry ( Hologic QDR-2000 , Waltham , Massachusetts ) . The coefficients of variation of these measurements are reported elsewhere [ 37 , 42 ] . Vertebral Deformity Two series of lateral radiography of the thoracic and lumbar spine were taken at the start of the study and at 12 months . The films were examined by a single investigator ( who was unaware of treatment group assignment ) according to a 6-point analysis procedure for each vertebral body from T4 to L4 [ 43 , 44 ] ( intra-observer coefficient of variation , 1.8 % to 3.1 % ) . At baseline , fracture was defined by a decrease of 20 % in the ratio of anterior or middle height to posterior height . Patients were considered to have a new vertebral deformity if the anterior , middle , or posterior height decreased by more than 20 % between the two examinations . Statistical Analysis All values are given as the mean SD for baseline measurement and the mean SE for comparisons of outcome results . All analyses were performed by using the SAS procedure ( Cary , North Carolina ) . One-way analysis of variance was used . A two-tailed P value less than 0.05 was considered significant . Role of the Funding Sources This study was supported by grants from S and oz Nutrition Ltd. , Berne , Switzerl and , and the Swiss National Research Science Foundation . The skin-test antigens for cellular hypersensitivity system was supplied by Rhone-Poulenc , Thalwil , Switzerl and . No organization influenced the design , conduct , or reporting of the study . Results Of 842 patients evaluated from April 1992 to February 1994 , 82 were recruited into the r and omized , double-blind , placebo-controlled trial . This low enrollment rate was due to patients ' poor medical or cognitive conditions and reluctance to give informed consent . OBJECTIVE To determine whether dietary counseling to increase milk intake could produce useful changes in the calcium economy and what , if any , other nutrition-related changes might be produced . DESIGN R and omized , open trial . SUBJECTS/ SETTING Two hundred four healthy men and women , aged 55 to 85 years , who habitually consumed fewer than 1.5 servings of dairy foods per day . Six academic health centers in the United States . INTERVENTION Subjects were instructed to consume 3 servings per day of nonfat milk or 1 % milk as a part of their daily diets , or to maintain their usual diets , for a 12-week intervention period , which followed 4 weeks of baseline observations . MAIN OUTCOME MEASURES Energy and nutrient intake assessed from milk intake logs and 3-day food records ; serum calciotrophic hormone levels at baseline and at 8 and 12 weeks ; urinary excretion of calcium and N-telopeptide at 12 weeks . STATISTICAL ANALYSES Repeated- measures analysis of variance . RESULTS In the milk-supplemented group , calcium intake increased by 729 + /- 45 mg/day ( mean + /- st and ard error ) , serum parathyroid hormone level decreased by approximately 9 % , and urinary excretion of N-telopeptide , a bone resorption marker , decreased by 13 % . Urine calcium excretion increased in milk-supplemented subjects by 21 + /- 7.6 mg/day ( mean + /- st and ard error ) , less than half the amount predicted to be absorbed from the increment in calcium intake . All of these changes were significantly different from baseline values in the milk group and from the corresponding changes in the control group . Bone-specific alkaline phosphatase level ( a bone formation marker ) fell by approximately 9 % in both groups . Serum level of insulin-like growth factor-1 ( IGF-1 ) rose by 10 % in the milk group ( P < .001 ) , and the level of insulin-like growth factor binding protein-4 ( IGFBP-4 ) fell slightly ( 1.9 % ) in the milk group and rose significantly ( 7.9 % ) in the control group ( P < .05 ) . APPLICATIONS/ CONCLUSIONS The changes observed in the calcium economy through consumption of food sources of calcium are similar in kind and extent to those reported previously for calcium supplement tablets . The increase in IGF-1 level and the decrease in IBFBP-4 level are new observations that are beneficial for bone health . Important improvements in skeletal metabolism can feasibly occur in older adults by consumption of food sources of calcium . Dietitians can be confident that food works , and that desired calcium intakes can be achieved using food sources More than 90 % of hip fractures in older Americans result from a fall . Inadequate intake of dietary protein and vitamin D are common in older adults , and diets in low these could contribute to loss of muscle mass and strength or coordination , in turn increasing the risk of falling . The objective of the study was to evaluate the relationship between protein and vitamin D intake with the occurrence of falls in older women in the Study of Osteoporotic Fracture , a prospect i ve cohort of more than 4000 postmenopausal women participating from January 1997 to September 1998 . Incident falls were ascertained for one year .  Protein and vitamin D intake  was assessed by a food frequency question naire ; associations with a reported fall were estimated with logistic regression , adjusted for fall-related covariates and energy . Protein and vitamin D were modeled separately because of high correlation ( rho = 0.55 , P < 0.001 ) . A total of 1429 women reported a fall within one year . In separate , unadjusted models  dietary protein  ( per 1 g/kg increase ) and  vitamin D  ( per 100 International Unit ( IU ) increase ) significantly increased the odds ratio ( OR ) of falling ( OR 1.35 95 % CI 1.15–1.59 , OR 1.11 95 % CI 1.03–1.19 , respectively ) . Once fall-related covariates were added to each model ,  dietary protein and vitamin D  were noncontributory to falls . While we could find no direct association between vitamin D and protein intake and fall prevention , adequate intake of these two nutrients are critical for musculoskeletal health in older adults BACKGROUND Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly . Other nutrients also affect bone health , and adequate intakes may influence bone turnover and balance . OBJECTIVE We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement , a calcium and vitamin D supplement , and dietary instruction aim ed at increasing calcium intake through foods . DESIGN Ninety-nine healthy postmenopausal women participated in a 3-y , r and omized trial , receiving either 1 ) supplemental calcium ( 1450 mg/d ) and vitamin D [ 10 microg ( 400 IU)/d ] , 2 ) calcium , vitamin D , and other nutrients ( multinutrient supplement ) , or 3 ) dietary instruction ( dietary control group ) . Data are from 83 subjects who completed the trial . RESULTS Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups . Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter . Bone turnover markers followed a similar pattern , and none of the changes in biochemical concentrations differed significantly between groups . CONCLUSIONS All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations . The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone . The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates Review question / objective The objective of this review is to identify the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with end stage kidney disease ( ESKD ) receiving hemodialysis ( HD ) . Background Hyperphosphatemia occurs in people with ESKD as a result of the kidneys ' reduced ability to excrete an ingested phosphate load.1,2 Hyperphosphatemia significantly lowers the serum calcium concentration , stimulating the release of parathyroid hormone ( PTH ) , causing secondary hyperparathyroidism.3–6 In ESKD , hyperphosphatemia also slows the activation of vitamin D which leads to impaired absorption of calcium from the gastrointestinal tract , result ing in reduced mobilization of calcium and phosphate from the bones , and causing metabolic bone disease.2,6,7 The reduced mobilization of both phosphate and calcium enables these two minerals to bind together creating a calcium‐phosphate product . At a serum concentration of > 1.78mmol/L the calcium‐phosphate product crystallizes and is deposited within the soft tissue and vasculature.6,8,9 In ESKD the development of vascular calcification of the arterial media ( i.e. calciphylaxis ) is a major contributing factor of morbidity and mortality.4,5,9,10 Methods of phosphate control Hyperphosphatemia is a wellrecognized risk factor for renal osteodystrophy and cardiovascular mortality in people with ESKD.1,4,11 Collectively this is called chronic kidney disease ‐ mineral bone disorder ( CKD‐MBD ) . Treatment of hyperphosphatemia requires a combination of dietary phosphate restrictions , use of oral phosphate binder therapy to reduce intestinal phosphate absorption , vitamin D3 ( calcitriol ) supplementation and adequate dialysis prescription to promote removal of phosphate.12–15 The treatment goal is to maintain serum phosphate levels at near normal , 0.7 ‐ 1.6mmol/L ( 3.5 ‐ 5.5 mg/dL)16 , and that sustained control of serum phosphate is a strong predictor of improved survival in people receiving HD.11 However approximately 40 % of patients receiving HD have a serum phosphate level of > 1.6mmol/L.16 Dietary phosphate restriction The implementation of dietary phosphate restrictions is the first step in treating hyperphosphatemia . The average daily adult diet contains approximately 800‐1500 mg of phosphate which is absorbed mostly in the duodenum and jejunum.17 However , there is a linear relationship between phosphate and protein intake.1 In general , foods high in phosphate such as milk and meat are rich in protein . For each gram of protein , there is approximately 13‐15 mg of phosphate.17 The recommended protein intake for a HD patient is 0.8 g per kg of body weight per day.7,18 However , the dietary restrictions necessary to sustain acceptable serum phosphate in HD patients could lead to protein malnutrition.4,7,19 Therefore , dietary phosphate restriction is not sufficient to control serum phosphate levels to current national/international guidelines .19 Phosphate binders The mainstay treatment of hyperphosphatemia is the use of oral phosphate binder medication.1,20 Phosphate binders lower phosphate absorption in the intestines by binding to and sequestering phosphate in the gastrointestinal tract , forming insoluble products that are not readily absorbed.21 The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) involving 23,898 patients on HD at 923 facilities in 12 countries found that 88 % of patients were prescribed phosphate binders and 12 % were not . This study found a 25 % lower mortality rate ( HR , 0.75 ; 95 % CI , 0.68‐0.83 ) in patients who were prescribed phosphate binders versus those not prescribed phosphate binder medication.11 However , most people receiving phosphate binding medication do not achieve target serum phosphate level.3 Hemodialysis The basic conventional four‐hour thrice‐weekly HD removes approximately 700‐1,000 mg of phosphate per session , result ing in a weekly reduction of 2100‐3000mg.8,21,22 Effective phosphate removal through HD is complicated by phosphate 's biphasic elimination from the body . Kinetic studies have shown that serum phosphate levels drop rapidly in the first one to two hours of HD treatment and then reach a plateau.8,22 Soon after HD , a rebound of serum phosphate occurs to a rise of about 30‐40 % . This is because of the slow influx of elements to the extracellular space after a st and ard HD session.3,8,22 It has been recognized that increasing dialysis frequency or duration leads to reduced serum phosphate.19 Data from the Frequent Haemodialysis Network nocturnal trial showed that daily or extended nocturnal HD led to an average decrease in serum phosphate levels of 0.4mmol/L ( 95 % CI : 0.3‐0.7mmol/L ) compared with conventional four‐hour thrice‐weekly HD treatment.23 In spite of the relatively low removal rates of phosphorus achieved by HD it is indicative that HD alone can not correct the phosphate levels that are associated with the usual dietary content of phosphate.21,22 Therefore , successful treatment of hyperphosphatemia requires patients adhering to a combination of dietary phosphate restrictions,8 use of oral phosphate binder therapy to reduce intestinal phosphate absorption21 and adequate HD prescription to promote removal of phosphate.24 Adherence to phosphate control Research on adherence to phosphate control date s back to 1960.14 However , the use of education and behavioral interventions to improve long term adherence to phosphate control has been subjected to less investigation in people with ESKD . Several research studies indicate education and behavioral interventions could help individuals change their behavior and hence increase adherence to phosphate control.5,13,20,25,26 A number of studies have used different educational interventions , carried out by either nurses or dieticians . The education sessions were one‐on‐one or group , and verbal or video was used to provide the education.13,14,27,28 Also , structured psychological approaches aim ed at helping patients to change their beliefs , consequently developing healthy behavior , have been used to produce positive results in improving adherence to diet , medication and HD treatment.28–31 These studies illustrate that theoretical and empirically based behavioral approaches are feasible and can result in a positive reduction of serum phosphate level . However , further developments of clinical ly useful behavioral and educational strategies are needed to sustain long term adherence with phosphate control . A literature search of the Cochrane central register of controlled trials , JBI , Prospero international prospect i ve register of systematic review and Campbell collaboration systematic review s was conducted and only one systematic review of relevance to this topic was found . This systematic review was of r and omized controlled trials of educational and counselling interventions to improve dietary phosphate adherence in both HD and pre‐dialysis patients .26 However , this systematic review did not include all treatment methods that are used in combination to control phosphate . The control of serum phosphate levels in people receiving HD continues to be a challenge for practitioners and is of clinical significance to patient outcomes . If left untreated hyperphosphatemia significantly increases the risk of morbidity and mortality in people with ESKD.12 It is important to review studies that have been undertaken comparing the outcomes of education and behavioral interventions , regardless of study design , targeting patient adherence to dietary phosphate intake , phosphate binder medication and HD treatment CONTEXT It is estimated that 80 % of all women have used oral contraceptives ( OCP ) , but OCP use may prevent attainment of maximal peak bone mass in young women and thus increase the risk of osteoporosis later in life . OBJECTIVE This study examined whether increased calcium intake could reduce the detrimental effects of OCP use on bone mass in young women . DESIGN The study design was a 1-yr intervention . SETTING The study was performed in a general community setting . SUBJECTS One hundred fifty-four young ( 18 - 30 yr old ) healthy women with a dietary calcium intake of less than 800 mg/d began the study , and 135 completed the trial . INTERVENTION Subjects were r and omly assigned to one of three diet intervention groups : 1 ) control , continuous established ( < 800 mg/d ) dietary calcium intake ; 2 ) medium dairy , increase calcium intake to approximately 1000 - 1100 mg/d ; and 3 ) high dairy , increase calcium intake to approximately 1200 - 1300 mg/d . R and omization was stratified by OCP use . MAIN OUTCOME MEASURES The main outcome measures were total body bone mineral density ( BMD ) and content ( BMC ) ; total hip BMD , BMC , and bone area ; and spine BMD , BMC , and bone area . RESULTS Dairy product intervention positively impacted the percentage change in total hip BMD and BMC . In addition , dairy product intake prevented a negative percentage change in total hip and spine BMD in OCP users . CONCLUSION Dairy product intake , at levels necessary to achieve the recommended intakes of calcium , protected the total hip BMD and spine BMD from loss observed in young healthy women with low calcium intakes who were using OCP BACKGROUND The effect of meat protein on calcium retention at different calcium intakes is unresolved . OBJECTIVE The objective was to test the effect of dietary protein on calcium retention at low and high intakes of calcium . DESIGN In a r and omized controlled feeding study with a 2 x 2 factorial crossover design , healthy postmenopausal women ( n = 27 ) consumed either approximately 675 or approximately 1510 mg Ca/d , with both low and high protein ( providing 10 % and 20 % energy ) for 7 wk each , separated by a 3-wk washout period . After 3 wk , the entire diet was extrinsically labeled with (47)Ca , and isotope retention was monitored by whole-body scintillation counting . Clinical markers of calcium and bone metabolism were measured . RESULTS High compared with low dietary protein significantly increased calcium retention from the low-calcium ( 29.5 % compared with 26.0 % absorbed ) but not the high-calcium diet ( 18 % absorbed ) . For the low-calcium diet , this effect nearly balanced a protein-related 0.5-mmol/d greater urinary calcium excretion . Protein-related calciuretic effects were independent of dietary calcium . Testing at 1 , 2 , 3 , 5 , and 7 wk showed no long-term adaptation in urinary acidity or urinary calcium excretion . High compared with low dietary protein decreased urinary deoxypyridinoline and increased serum insulin-like growth factor I without affecting parathyroid hormone , osteocalcin , bone-specific alkaline phosphatase , or tartrate-resistant acid phosphatase . CONCLUSIONS In healthy postmenopausal women , a moderate increase in dietary protein , from 10 % to 20 % of energy , slightly improved calcium absorption from a low-calcium diet , nearly compensating for a slight increase in urinary calcium excretion . Under practical dietary conditions , increased dietary protein from animal sources was not detrimental to calcium balance or short-term indicators of bone health OBJECTIVE Dietary quality in relation to bone health has been analysed in relatively few studies . The current study aim ed to assess the association of the Baltic Sea diet ( BSD ) and the Mediterranean diet ( MD ) with  bone mineral density ( BMD ) among elderly women . DESIGN Lumbar , femoral and total body BMD were measured by dual-energy X-ray absorptiometry at baseline and year 3 . Dietary intake was measured by 3 d food record at baseline . BSD and MD scores were calculated from food and alcohol consumption and nutrient intake . Information on lifestyle , diseases and medications was collected by question naires . Longitudinal associations of BSD and MD scores with BMD were analysed using linear mixed models . SETTING Interventional prospect i ve Kuopio Osteoporosis Risk Factor and Fracture Prevention study including women aged 65 - 71 years and residing in Kuopio province , Finl and . SUBJECTS Women ( n 554 ) with mean age of 67·9 ( sd 1·9 ) years and mean BMI of 28·8 ( sd 4·7 ) kg/m2 . RESULTS Higher BSD scores were associated with higher intakes of fruit and berries , vegetables , fish and low-fat dairy products , and lower intake of sausage . Higher MD scores were associated with higher consumption of fruit and berries and vegetables . BSD and MD scores were associated with higher PUFA : SFA and higher fibre intake . Femoral , lumbar or total body BMD was not significantly different among the quartiles of BSD or MD score . CONCLUSION The lack of associations suggest that Baltic Sea and Mediterranean dietary patterns may not adequately reflect dietary factors relevant to bone health AIM To compare the nutritional status and dietary intake of elderly women admitted with hip fracture ( HF ) versus a control group without fracture and without known abnormalities of bone mineral density . DESIGN Descriptive and observational study . LOCATION Hospital Neurotraumatológico in Jaen ( Spain ) and three urban Primary Health Care centers in Jaen city ( San Felipe , Virgen de la Capilla and El Valle ) . PARTICIPANTS A total of 44 women with HF , which was considered osteoporotic , and a control group composed of 42 women with a similar age range , selected r and omly from the medical out patients who visit their Primary Health Care centers . MEASUREMENTS We record sociodemographic data . Dietary intake before the fracture and anthropometric variables  in the first 72hours after admission were assessed . RESULTS Patients with HF had lower weight ( 67.2±10.1 kg versus 72.0±10.1 kg , P<.05 ) , BMI ( 27.6±3.7kg/m(2 ) versus 31.3±4.6kg/m(2 ) , P<.001 ) , as well as lower arm and leg circumferences than the control patients . A significantly higher intake , in terms of macronutrients and energy consumption , was detected in the control group , as well as lower than recommended intake of calcium and vitamin D in both groups , which was more marked in patients with HF . Logistic regression found that the HF was associated with a lower BMI as well as lower intakes of protein , carbohydrates and calcium . CONCLUSIONS Adequate nutritional status and adequate intake of essential macro- and micronutrients seem to prevent osteoporotic HF Summary Background Bone mineral density ( BMD ) is largely genetically determined and this influence is most powerful in the period of rapid skeletal development in childhood and late adolescence but environmental factors such as exercise and dietary calcium intake may influence up to 20 % . Aims of the study The aims of the study were to examine healthy late adolescent females for the effects and benefits of a high calcium intake from dairy product foods on bone mineral density , body composition , lipids and biochemistry . The secondary aim is determine whether a high intake of dairy product foods in the diet is acceptable for this age group long term . Methods Ninety-one teenage girls who participated in a two-year r and omised controlled study on the effect of dairy food supplementation on dietary patterns , body composition and bone density in post-pubertal teenage girls were approached one year after the cessation of the study to determine the effects of the cessation of dairy supplements on bone mineral density , dietary habits , biochemical markers , body composition and blood lipids . Bone mineral density and bone mineral content were assessed at the hip , spine and total body . Anthropometric data were collected , and exercise , Tanner , dietary assessment , preference and compliance question naires were administered . Lipid profiles , hydroxyproline excretion and urinary calcium and sodium excretion measurements were performed . Results There were no significant differences between the 2 groups for height , weight , lean and fat mass . The supplemented group had significantly higher calcium , phosphorus and protein intake during the supplementation period ( p<0.001 ) . No differences were seen between the groups 12 months after supplementation finished . There were no significant differences in exercise level , preference or acceptability of dairy products or in the lipids and bone markers between baseline the end of supplementation and 1 year follow-up . There was a significant increase in trochanter ( 4.6 % ) , lumbar spine ( 1.5 % ) and femoral neck ( 4.8 % ) BMD ( p<0.05 ) in the high calcium group at the end of supplementation . There was an increase in bone mineral content at the trochanter ( p<0.05 ) and lumbar spine ; however the latter was not statistically significant , in the high calcium group at the end of supplementation . There was no difference in vertebral height or width at any stage of the study , indicating no influence on bone size . Conclusions In this 3 year study ( 2 years of supplementation , 1 year follow-up ) , teenage girls , aged 15–18 years , were able to significantly increase their BMD at the trochanter , femoral neck and lumbar spine when supplemented with dairy product foods to a mean calcium intake of 1160 mg/d . There was also an effect seen on the BMC particularly at the trochanter and to a lesser extent at the lumbar spine . The dietary calcium intake achieved did not adversely affect body weight , fat and lean mass or blood lipid profiles . Twelve months after the supplementation finished the girls had returned to their baseline diet , indicating self- selection of a high dairy product diet may be hard to achieve Fractures are an important cause of disability in elderly women , especially among those with osteopenia . Decreased bone mass increases the risk for most types of fractures [ 1 - 4 ] . In particular , we recently reported [ 5 ] that most fractures in elderly women are associated with low bone mass at appendicular sites ( the radius and calcaneus ) . The risk for these fractures , including some fractures not previously linked to osteopenia , such as of the leg and h and , increased 40 % to 80 % for each st and ard deviation reduction in appendicular bone mass [ 5 ] . We also found that appendicular bone mass predicts the risk for all nonspine fractures as well as for bone mass measured at the hip and spine [ 6 ] . Despite the strong relation between appendicular bone mass and risk for fracture , little consensus exists about the many proposed risk factors for decreased bone mass [ 7 , 8 ] , perhaps because most studies have examined a limited number of risk factors in relatively small selected cohorts . To determine what factors might contribute to osteopenia in older women , we examined a wide variety of potential correlates of appendicular bone mass in the Study of Osteoporotic Fractures , a large multicenter , community-based study of elderly women . Methods Patients From September 1986 to October 1988 , women who were at least 65 years old were recruited in four areas of the United States : Portl and , Oregon ; Minneapolis , Minnesota ; Baltimore , Maryl and ; and the Monongahela Valley near Pittsburgh , Pennsylvania . Age-eligible women were identified from membership lists from several sources , as previously reported [ 1 ] . We excluded black women because of the reduced incidence of hip fractures in this group [ 9 ] , and we excluded women who were unable to walk without the assistance of another person or who had bilateral hip replacements . Measurement of Bone Mass Bone mass ( in g/cm2 ) was measured using OsteoAnalyzers ( Siemens-Osteon , Wahiawa , Hawaii ) . We scanned three sites : the distal radius , the midradius , and the calcaneus . The protocol for the bone mass measurements has been described elsewhere [ 1 ] . To describe the reproducibility of these measurements , a participant in the study was measured five times on 5 consecutive days at each of the four clinical centers . The average coefficients of variation in these older women ( st and ard deviation/mean for each subject ) were 1.5 % for the distal radius , 2.0 % for the midradius , and 1.3 % for the calcaneus . To assess variations between scanners at the four centers , two investigators were measured by all four machines ; the mean of their coefficients of variation in these younger subjects was 0.4 % for the distal radius , 0.5 % for the midradius , and 1.2 % for the calcaneus [ 10 ] . The correlation coefficients between the measurement sites were distal and midradius , 0.75 ; calcaneus and distal radius , 0.66 ; and calcaneus and midradius , 0.63 . Predictor Variables Participants completed a self-administered question naire and were interviewed and examined at the clinical center . A selected medical history was obtained , including a history of a physician diagnosis of osteoporosis , spine fracture , arthritis , gastric surgery , hyperthyroidism , and stroke . Reproductive history , including age of last menstrual period , genitourinary surgery ( hysterectomy , oophorectomy ) , number of pregnancies , and breast-feeding , was recorded . Previous fractures in subjects and their parents or sisters were noted . We collected detailed records about specific health habits including lifetime smoking history , alcohol use , and caffeine intake .  Women who had smoked less than 100 cigarettes in their lifetime were considered nonsmokers . We assumed that a cup of coffee contained 95 mg of caffeine and that tea and cola drinks contained 55 mg and 45 mg , respectively . Participants were asked to bring all prescription and nonprescription medications with them to the interview for verification . The dose and duration of use of  sex hormones , diuretics , corticosteroids , thyroid supplements , aluminum-containing antacids , vitamin D , sedative hypnotics , and antiepileptic medications were obtained . The frequency and duration of use of calcium supplements were recorded ; use of TUMS ( which can be taken as an antacid or calcium supplement ) was recorded separately . Responses to the question naire were checked by a trained interviewer and were verified against the labels of medications that the subject brought to the interview . Recent dietary history ( past 12 months ) , particularly calcium , phosphorus , and protein intake , was assessed by a checklist-interview method developed from the HANES-II survey [ 11 ] . Food models were used to estimate portion sizes , and foods that account for 80 % of calcium intake in most adults were included . This instrument has a correlation of 0.76 with calcium intake assessed by a 7-day diet diary , but it tends to underestimate calcium intake by approximately 150 mg/day [ 12 ] . The frequency of milk consumption as a child and young adult was also assessed by question naire . Physical activity was examined with a modified Paffenbarger survey that has been vali date d in postmenopausal women [ 13 - 16 ] . The type and duration of weight-bearing recreational activities from the previous 12 months were recorded , and these were converted into weekly caloric expenditure . Other current activities , such as stair climbing , walking , and heavy household chores , were included . Intensity-weighted measures were calculated by design ating activities as low ( for example , walking or gardening ) , medium ( dancing or tennis ) , or high intensity ( jogging or skiing ) and multiplying the reported frequency of the activity by 2.5 , 5 , and 7.5 , respectively . Weight ( in light indoor clothes with shoes removed ) was recorded with a balance beam scale , and height was measured using a st and ard held-expiration technique with a wall-mounted Harpenden stadiometer [ 17 ] . Maximal right knee extension , triceps ( arm extension ) , and hip abduction torque strength were measured with a h and -held isometric dynamometer ( Sparks Instruments and Academics , Coralville , Iowa ) . Grip strength of the right and left h and was assessed as the average of two attempts with the dynamometer . Waist , hip , and abdominal circumferences were measured using st and ard methods [ 18 ] . Statistical Methods The cohort was r and omly divided into equal-sized ( n = 4852 ) training and validation groups . In the training group , we analyzed potential associations with bone mass in univariate analyses , adjusted for age . We then adjusted associations ( P < 0.05 ) for other plausible confounding effects . For example , associations between the use of thiazide diuretics and bone mass were also adjusted for body weight , because those who were taking diuretics tended to be heavier . Potentially nonlinear associations between bone mass and continuous variables , such as calcium intake , were examined by plotting bone mass against the median of each decile of the predictor variable . Associations were tested for statistical significance with simple linear regression , Student t-test , or analysis of variance . Variables that were associated with bone mass in univariate analyses ( P < 0.05 ) were examined by multivariate analyses using PROC GLM ( SAS Institute , Inc. , Cary , North Carolina ) . Some categories of predictor variables , such as calcium intake and muscle strength , contained several variables associated with bone mass in univariate analyses . After examining these variables for multicollinearity , separate models for strength , family history of fractures , dietary calcium , and physical activity were analyzed to determine the individual variables that explained most of the variance of bone mass within each category . For example , grip strength explained most of the variance for bone mass related to strength ; thus , we selected this variable as the measure of strength for subsequent multivariate analyses . Both current dietary calcium and calcium from milk ( ingested between ages 18 to 50 years ) contributed to bone mass variance ; therefore , both were included in the final multivariate models . A history of any maternal fracture after age 50 accounted for most of the bone mass variance from family history , and intensity-weighted lifetime physical activity accounted for most of the variance from physical activity . Selected variables ( see Table 2 ) were then entered into a single multivariate model . We found that results from multivariate models were very similar in both training and validation groups ; thus results are reported for the entire ( combined ) cohort . Results were generally similar for the three bone mass sites , and for those analyses that were concordant at all three sites , only the results for the distal radius are presented . We presented results at the other two sites only when they differed from the distal radius . Results The average age at enrollment was 71.1 years , and the age distributions were similar in the training and validation groups ( Table 1 ) . Thirteen percent of patients reported a previous wrist or hip fracture . Table 1 . Baseline Characteristics of Patients Demographic and Anthropometric Data Bone mass was strongly and inversely associated with age , decreasing by approximately 5 % with every additional 5 years of age after 65 years ( Table 2 ) . Northern European ancestry , hair color , and educational level were not associated with bone mass ( Table 3 ) . Table 2 . Univariate and Multivariate Correlates of Distal Radius Bone Mass Table 3 . Variables Not Associated with Distal Radius Bone Mass , Age-Adjusted Univariate Analyses * Several anthropometric measurements were strongly associated with bone mass ( see Table 2 ) . Both weight [ in kilograms ] and obesity ( as Quetelet index , in kilograms per square meter ) were associated with increased bone mass : after adjusting for age , bone mass increased 5.0 % for every 10-kg increase in weight ( Figure 1 ) . Although weight and Quetelet were highly correlated ( r = 0.91 ) , weight was more strongly associated with bone mass Dietary supplements that prevent bone loss at the hip and that can be applied safely in the elderly are likely to reduce hip fractures . A daily dietary supplement of 750 mg calcium or 15 microg 25OH vitamin D3 on bone loss at the hip and other sites , bone turnover and calcium-regulating hormones were studied over 4 yr in elderly volunteers using a r and omized , double-blind , placebo-controlled trial . Bone mineral density ( BMD ) was measured by dual x-ray absorptiometry and bone structure by radiographs . Calcium biochemistry and bone turnover markers were measured in blood and urine . The 316 women entering the trial had a mean age of 73.7 yr and the 122 men of 75.9 yr . Baseline median calcium intake was 546 mg/day , and median serum 25OH vitamin D3 was 59 nmol/L. On placebo , loss of BMD at total hip was 2 % and femoral medulla expansion was 3 % over 4 yr . Calcium reduced bone loss , secondary hyperparathyroidism , and bone turnover . 25OH vitamin D3 was intermediate between placebo and calcium . Fracture rates and drop-out rates were similar among groups , and there were no serious adverse events with either supplement . A calcium supplement of 750 mg/day prevents loss of BMD , reduces femoral medullary expansion , secondary hyperparathyroidism , and high bone turnover . A supplement of 15 microg/day 25OH vitamin D3 is less effective , and because its effects are seen only at low calcium intakes , suggests that its beneficial effect is to reverse calcium insufficiency Abstract Excess protein intake can adversely affect the bone via an increase in calcium excretion , while suitable mechanical loading promotes osteogenesis . We therefore investigated whether vibration exposure could alleviate the bone mineral losses associated with a metabolic acidosis . Ten healthy individuals aged 22 – 29 years ( median = 25 ) underwent three 5-day study periods while monitoring their dietary intake . The study consisted of recording the participants ' usual dietary intake for 5 consecutive days . Participants were then r and omly divided into two groups , one of which received a protein supplement ( 2 g · kg−1 body mass · day−1 ; n = 5 ) and the other whole-body low-magnitude ( 3.5 g ) , low-frequency ( 30 Hz ) mechanical vibration ( WBV ) delivered through a specially design ed vibrating plate for 10 min each day ( n = 5 ) . Finally , for the third treatment period , all participants consumed the protein supplement added to their normal diet and were exposed to WBV exercise for 10 min per day . Daily urine sample s were collected throughout the experimental periods to determine the excretion of calcium , phosphate , titratable acid , urea , and C-telopeptide . As expected , when the participants underwent the high protein intake , there was an increase in urinary excretion rates of calcium ( P < 0.001 ) , phosphate ( P < 0.003 ) , urea ( P < 0.001 ) , titratable acid ( P < 0.001 ) , and C-telopeptide ( P < 0.05 ) compared with baseline values . However , high protein intake coupled with vibration stimulation result ed in a significant reduction in urinary calcium ( P = 0.006 ) , phosphate excretion ( P = 0.021 ) , and C-telopeptide ( P < 0.05 ) compared with protein intake alone , but did not affect titratable acid and urea output . The participants showed no effect of WBV exercise alone on urinary excretion of calcium , phosphate , urea , titratable acid , or C-telopeptide . The results indicate that vibration stimulation can moderate the increase in bone resorption and reduction in bone formation caused by a metabolic acidosis BACKGROUND Soy foods contain several components ( isoflavones and amino acids ) that potentially affect bone . Few long-term , large clinical trials of soy as a means of improving bone mineral density ( BMD ) in late postmenopausal women have been conducted . OBJECTIVE Our goal was to evaluate the long-term effect of dietary soy protein and /or soy isoflavone consumption on skeletal health in late postmenopausal women . DESIGN We conducted a r and omized , double-blind , placebo-controlled clinical trial in 131 healthy ambulatory women aged > 60 y. Ninety-seven women completed the trial . After a 1-mo baseline period , subjects were r and omly assigned into 1 of 4 intervention groups : soy protein ( 18 g ) + isoflavone tablets ( 105 mg isoflavone aglycone equivalents ) , soy protein + placebo tablets , control protein + isoflavone tablets , and control protein + placebo tablets . RESULTS Consumption of protein powder and isoflavone pills did not differ between groups , and compliance with the study powder and pills was 80 - 90 % . No significant differences in BMD were observed between groups from baseline to 1 y after the intervention or in BMD change between equol and non-equol producers . However , there were significant negative correlations between total dietary protein ( per kg ) and markers of bone turnover ( P < 0.05 ) . CONCLUSIONS Because soy protein and isoflavones ( either alone or together ) did not affect BMD , they should not be considered as effective interventions for preserving skeletal health in older women . The negative correlation between dietary protein and bone turnover suggests that increasing protein intakes may suppress skeletal turnover . This trial was registered at Clinical Trials.gov as NCT00668447 BACKGROUND Skeletal loading and proper nutrition are necessary for optimal bone health . The appropriate amount of dietary protein to maximize skeletal health , however , is under constant debate . OBJECTIVE To determine if 6 months of protein supplementation in conjunction with a strength and conditioning training program improves areal and volumetric bone mineral density ( BMD ) . DESIGN Fifty-two apparently healthy males and females ages 18 - 25 years were r and omized to protein supplement ( PRO , Myoplex , EAS , Inc. Golden CO ) containing 280 kcal , 42 g protein , 21 g carbohydrate , and 1.5 g fat ) or calorically equivalent carbohydrate control ( CS ) . All subjects participated in a 5 sessions/week strength and conditioning program .  Volumetric and areal BMD measurements were made by peripheral quantitative computed tomography ( pQCT ) of the tibia and whole body DXA . pSSI a measure of torsional bone strength , based on structural and material properties was obtained by pQCT . RESULTS Measurements at the 20 % tibia by pQCT revealed that overall there were significant increases in cortical vBMD ( 4.3 + /- 1.3 mg/cm(3 ) ) , cortical area ( 1.9 + /- 0.6 cm(2 ) ) , cortical thickness ( 0.05 + /- 0.02 mm ) and pSSI ( 67 + /- 24 mm(3 ) ) , and a decrease in endosteal circumference ( - 0.5 + /- 0.2 mm ) over the intervention period ( all , P < 0.05 ) . None of the changes in DXA measures were found to differ by group or sex , there was a trend for a greater increase in whole body BMC among the carbohydrate compared to protein supplemented group and a greater increase among males ( 16 + /- 8 g ) compared to females ( -9 + /- 9 g ) ( P = 0.06 ) . CONCLUSIONS The results of this study indicate that the consumption of additional protein does not improve measurements of vBMD or bone size during a 6-month strength and conditioning program . Longer duration studies may be necessary to determine the influence of increased dietary protein on bone in young adults . Males and females may have different bone responses to increased protein intake while participating in a strength and conditioning program OBJECTIVE To test whether bone mass increases in healthy nonpregnant white women during early adult life after cessation of linear growth ; and to test whether various self-chosen levels of physical activity and nutrient intake or use of oral contraceptives influences this increase in bone mass . DESIGN Longitudinal prospect i ve study of up to 5 years of 156 healthy college-aged women full-time students attending professional schools in universities in the Omaha , Neb , area . SETTING University medical center . PARTICIPANTS A convenience sample of healthy women students from Omaha-area professional schools . Any c and i date with an illness , condition , or medication ( except  oral contraceptives ) thought to affect general health or bone mass was excluded . INTERVENTIONS None . OUTCOME MEASURES Clinical and family histories of disease , particularly osteoporosis ; oral contraceptive use ; bone mineral densities of the spine , forearm , and total body by dual- and single-photon absorptiometry ; estimates of nutrient intake by repeated 7-day diet diaries ;  and  measures of physical activity using a physical activity monitor . RESULTS The median gain in bone mass for the third decade of life , expressed as a percentage per decade , was 4.8 % for the forearm , 5.9 % for lumbar bone mineral content , 6.8 % for lumbar bone mineral density , and 12.5 % for total body bone mass ( P < .0001 in all cases ) . By both bivariate and multiple regression analysis the rate of gain in bone density of the spine was negatively correlated with age and positively correlated with calcium/protein intake ratio and physical activity ( multiple r = .31 ; P = .004 ) . Bivariate analysis showed that use of oral contraceptives was associated with greater gain in total body bone mass ( r = .31 , P = .01 ) . The estimated age when mineral acquisition ceased ranged from 28.3 years to 29.5 years at the several study sites . CONCLUSIONS Gain in bone mass occurs in healthy young women during the third decade of life . Physical activity and dietary calcium intake both exert a positive effect on this bone gain . Use of oral contraceptives exerts a further independent positive effect . Changes in life-style among college-aged women , involving relatively modest increases in physical activity and calcium intake , may significantly reduce the risk of osteoporosis late in life BACKGROUND Maternal diet during pregnancy has been suggested to influence bone health in later life . OBJECTIVE We assessed the association of  maternal first-trimester dietary intake during pregnancy with childhood bone mass .  DESIGN In a prospect i ve cohort study in 2819 mothers and their children , we measured first-trimester daily energy , protein , fat , carbohydrate , calcium , phosphorus , and magnesium intakes by using a food-frequency question naire and homocysteine , folate , and vitamin B-12 concentrations in venous blood . We measured childhood total body bone mass by using dual-energy X-ray absorptiometry at the median age of 6.0 y. RESULTS Higher first-trimester maternal protein , calcium , and phosphorus intakes and vitamin B-12 concentrations were associated with higher childhood bone mass , whereas carbohydrate intake and homocysteine concentrations were associated with lower childhood bone mass ( all P-trend < 0.01 ) . Maternal fat , magnesium intake , and folate concentrations were not associated with childhood bone mass . In the fully adjusted regression model that included all dietary factors significantly associated with childhood bone mass , maternal phosphorus intake and homocysteine concentrations most-strongly predicted childhood bone mineral content ( BMC ) [ β = 2.8 ( 95 % CI : 1.1 , 4.5 ) and β = -1.8 ( 95 % CI : -3.6 , 0.1 ) g per SD increase , respectively ] , whereas maternal protein intake and vitamin B-12 concentrations most strongly predicted BMC adjusted for bone area [ β = 2.1 ( 95 % CI : 0.7 , 3.5 ) and β = 1.8 ( 95 % CI : 0.4 , 3.2 ) g per SD increase , respectively ] . CONCLUSION Maternal first-trimester dietary factors are associated with childhood bone mass , suggesting that fetal nutritional exposures may permanently influence bone development
In older people with osteoporosis , higher protein intake ( ≥ 0.8-g/kg body weight/day , i.e. , above the current RDA ) is associated with higher BMD , a slower rate of bone loss , and reduced risk of hip fracture , provided that dietary calcium intakes are adequate .
Intervention with dietary protein supplements attenuate age-related BMD decrease and reduce bone turnover marker levels , together with an increase in IGF-I and a decrease in PTH .
There is no evidence that diet-derived acid load is deleterious for bone health .
Thus , insufficient dietary protein intakes may be a more severe problem than protein excess in the elderly .
A summary of systematic review s and meta-analyses addressing the benefits and risks of dietary protein intakes  for  bone health in adults suggests that dietary protein levels even above the current RDA may be beneficial in reducing bone loss and hip fracture risk , provided calcium intakes are adequate .
Several systematic review s and meta-analyses have addressed the benefits and risks of dietary protein intakes for bone health in adults .
Adequate supplies of dietary protein are required for optimal bone growth and maintenance of healthy bone .
Variation in protein intakes within the “ normal ” range accounts for 2–4 % of BMD variance in adults .