Calcified Tissue International

, Volume 57, Issue 2, pp 86–93 | Cite as

Diet, bone mass, and osteocalcin: A cross-sectional study

  • K. Michaëlsson
  • L. Holmberg
  • H. Mallmin
  • A. Wolk
  • R. Bergström
  • S. Ljunghall
Clinical Investigations


To determine the relationships among nutrient intake, bone mass, and bone turnover in women we have investigated these issues in a population-based, crosssectional, observational study in one county in central Sweden. A total of 175 women aged 28–74 at entry to the study were included. Dietary assessment was made by both a semiquantitative food frequency questionnaire and by four 1-week dietary records. Dual energy X-ray absorptiometry was performed at five sites: total body, L2–L4 region of the lumbar spine, and three regions of the proximal femur. Serum concentrations of osteocalcin (an osteoblast-specific protein reflecting bone turnover) were measured by a radioimmunoassay. Linear regression models, with adjustment for possible confounding factors, were used for statistical analyses. A weak positive association was found between dietary calcium intake as calculated from the semiquantitative food frequency questionnaire and total body bone mineral density (BMD) among premenopausal women. No association emerged between dietary calcium intake and sitespecific bone mass, i.e., lumbar spine and femoral neck, nor was an association found between dietary calcium intake and serum osteocalcin. BMD at some of the measured sites was positively associated with protein and carbohydrates and negatively associated with dietary fat. In no previous studies of diet and bone mass have dietary habits been ascertained so carefully and the results adjusted for possible confounding factors. Neither of the two methods of dietary assessment used in this study revealed any effect of calcium intake on BMD at fracture-relevant sites among these healthy, mostly middle-aged women. A weak positive association was found between calcium intake estimates based on the food frequency questionnaire and total body BMD. In this study population the preventive effect of high dietary calcium on osteoporosis is probably very weak. The independent significance of protein, carbohydrates, and fat is uncertain.

Key words

Bone density Calcium Diet Osteocalcin 


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  1. 1.
    Reid IR, Ames AW, Evans MC, Gamble GD, Sharpe SJ (1993) Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 328:460–464Google Scholar
  2. 2.
    Aloia JF, Vaswani A, Yeh JK, Ross PL, Flaster E, Dilmanian FA (1994) Calcium supplementation with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Intern Med 120:97–103Google Scholar
  3. 3.
    Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson NK, Harris MM (1991) Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone replacement therapy. N Engl J Med 325: 1189–1195Google Scholar
  4. 4.
    Yano K, Heilbrun LK, Wasnich RD, Hankin JH, Vogel JM (1993) The relationship between diet and bone mineral content of multiple skeletal sites in elderly Japanese-American men and women living in Hawaii. Am J Clin Nutr 42:877–888Google Scholar
  5. 5.
    Hu JF, Zhao XH, Jia JB, Parpia B, Campbell TC (1993) Dietary calcium and bone density among middle-aged and elderly women in China. Am J Clin Nutr 58:219–227Google Scholar
  6. 6.
    Sowers MR, Clark MK, Hollis B, Wallace RB, Jannausch M (1992) Radial bone mineral density in pre- and perimenopausal women: a prospective study of rates and risk factors for loss. J Bone Miner Res 7:647–657Google Scholar
  7. 7.
    Riggs BL, Wahner HW, Melton LJ III, Richelson LS, Judd HL, O'Fallon WM (1987) Dietary calcium intake and rates of bone loss in women. J Clin Invest 80:979–982Google Scholar
  8. 8.
    Stevenson JC, Whitehead MI, Padwick M, Endacott JA, Sutton C, Banks LM, Freemantle R, Spinks TJ, Hesp R (1988) Dietary intake of calcium and postmenopausal bone loss. BMJ 297:15–17Google Scholar
  9. 9.
    Bauer DC, Browner WS, Cauley JA, Orwoll ES, Scott JC, Black DM, Tao JL, Cummings SR, Study of Osteoporotic Fractures Research Group (1993) Factors associated with appendicular bone mass in older women. Ann Intern Med 118:657–665Google Scholar
  10. 10.
    Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P, Vogt TM, Study of Osteoporotic Fractures Research Group (1990) Appendicular bone density and age predict hip fracture in women. JAMA 263:665–668Google Scholar
  11. 11.
    Wasnich RD, Ross PD, Heilbrun LK, Vogel JM (1985) Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol 153:745–751Google Scholar
  12. 12.
    Hui SL, Slemenda CW, Johnston CC Jr (1989) Baseline measurements of bone mass predict fracture in white women. Ann Intern Med 111:355–361Google Scholar
  13. 13.
    Mazess RB, Peppler WW, Chesnut CH, Nelp WB, Cohn SH, Zansi I (1993) Total body mineral and lean body mass by dual photon absorptiometry. Comparison with total body calcium by neutron activation analysis. Calcif Tissue Int 33:361–363Google Scholar
  14. 14.
    Delmas PD (1992) Clinical use of biochemical markers of bone remodeling in osteoporosis. Bone 13:17–21Google Scholar
  15. 15.
    Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologica analyses. Am J Epidemiol 124:17–27Google Scholar
  16. 16.
    Mazess R, Collick B, Trempe J, Barden H, Hanson J (1989) Performance evaluation of a dual-energy x-ray bone densitometer. Calcif Tissue Int 44:228–232Google Scholar
  17. 17.
    Heaney RP (1993) Thinking straight about calcium. N Engl J Med 328:503–505Google Scholar
  18. 18.
    Prince R (1993) The calcium controversy revisited: implications of new data. Med J Aust 159:404–407Google Scholar
  19. 19.
    Block G (1982) A review of validations of dietary assessment methods. Am J Epidemiol 115:492–505Google Scholar
  20. 20.
    Kanis JA, Passmore R (1989) Calcium supplementation of the diet-II. BMJ 298:205–208Google Scholar
  21. 21.
    Mundy GR (1994) Boning up in genes. Nature 367:216–217Google Scholar
  22. 22.
    Wyshak G (1993) Dietary animal fat intake, calcium intake, and bone fractures in women 50 years and older. J Women's Health 2:329–334Google Scholar
  23. 23.
    Heaney RP (1993) Nutritional factors in osteoporosis. Annu Rev Nutr 13:287–316Google Scholar
  24. 24.
    Holbrook TL, Barrett-Connor E (1991) Calcium intake: covariates and confounders. Am J Clin Nutr 53:741–744Google Scholar
  25. 25.
    Lloyd T, Andon MB, Rollings N, Martel JK, Landis JR, Demers LM, Eggli DF, Kieselhorst K, Kulin HE (1993) Calcium supplementation and bone mineral density in adolescent girls. JAMA 270:841–844Google Scholar
  26. 26.
    Tylavsky FA, Anderson JJB, Talmage RV, Taft TN (1993) Are calcium intakes and physical activity patterns during adolescence related to radial bone mass of white college-age females? Osteoporosis Int 2:232–240Google Scholar
  27. 27.
    Matkovic V (1992) Calcium and peak bone mass. J Int Med 231:151–160Google Scholar
  28. 28.
    Kristinsson JÖ, Valdimarsson Ö, Steingrimsdottir L, Sigurdsson G (1994) Relation between calcium intake, grip strength and bone mineral density in the forearms of girls aged 13 and 15. J Int Med 236:385–390Google Scholar

Copyright information

© Springer-Verlag New York Inc 1995

Authors and Affiliations

  • K. Michaëlsson
    • 1
  • L. Holmberg
    • 2
  • H. Mallmin
    • 3
  • A. Wolk
    • 2
  • R. Bergström
    • 4
  • S. Ljunghall
    • 5
  1. 1.Department of OrthopaedicsCentral HospitalVästeråsSweden
  2. 2.Cancer Epidemiology UnitUniversity HospitalUppsalaSweden
  3. 3.Department of OrthopaedicsUniversity HospitalUppsalaSweden
  4. 4.Department of StatisticsUppsala UniversityUppsalaSweden
  5. 5.Department of Internal MedicineUniversity HospitalUppsalaSweden

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