Dietary vitamin C intake and the risk of hip fracture: a dose-response meta-analysis
The meta-analysis suggested that dietary vitamin C was statistically inversely associated with the risk of hip fracture (overall OR = 0.73, 95% CI = 0.55–0.97, I2 = 69.1%) and with the increase of 50 mg/day vitamin C intake, the risk of hip fracture will reduce by 5% (OR = 0.95, 95% CI 0.91–1.00, P = 0.05).
Previous studies had inconsistent findings regarding the association between vitamin C intake and the risk of hip fracture. Therefore, we conducted a meta-analysis to evaluate the association of dietary vitamin C intake and the risk of hip fracture.
Relevant studies were identified by searching PubMed, Embase, and Web of Science up to December 2016. Additional articles were identified from reviewing the reference lists of relevant articles. The summary relative risks (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by random effects model. Funnel plot and Egger’s test were used to test publication bias.
The total six articles containing 7908 controls and 2899 cases of hip fracture were included in this meta-analysis. By comparing the highest versus the lowest categories of vitamin C intake, we found that dietary vitamin C was statistically correlated with the risk of hip fracture [overall OR = 0.73, 95% CI = 0.55–0.97, I2 = 69.1%]. A linear dose-response association showed that the increase with vitamin C intake of 50 mg/day statistically reduced by 5% (OR = 0.95, 95% CI 0.91–1.00, P = 0.05) the risk of hip fracture.
In conclusion, the results of current meta-analysis strongly support that increasing dietary vitamin C intake can decrease the risk of hip fracture. In order to verify the association of vitamin C intake and hip fracture risk, further well-designed largely randomized controlled trials (RCTs) are needed.
KeywordsAntioxidant Dietary vitamin C Dose-response Hip fracture Meta-analysis
- 8.Benetou V, Orfanos P, Pettersson-Kymmer U, Bergstrom U, Svensson O, Johansson I, Berrino F, Tumino R, Borch KB, Lund E, Peeters PH, Grote V, Li K, Altzibar JM, Key T, Boeing H, von Ruesten A, Norat T, Wark PA, Riboli E, Trichopoulou A (2013) Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24(5):1587–1598. https://doi.org/10.1007/s00198-012-2187-3 CrossRefPubMedGoogle Scholar
- 11.Park JK, Lee EM, Kim AY, Lee EJ, Min CW, Kang KK, Lee MM, Jeong KS (2012) Vitamin C deficiency accelerates bone loss inducing an increase in PPAR-gamma expression in SMP30 knockout mice. Int J Exp Pathol 93(5):332–340. https://doi.org/10.1111/j.1365-2613.2012.00820.x CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL (2009) Protective effect of total and supplemental vitamin C intake on the risk of hip fracture—a 17-year follow-up from the Framingham Osteoporosis Study. Osteoporosis Int 20(11):1853–1861. https://doi.org/10.1007/s00198-009-0897-y CrossRefGoogle Scholar
- 18.Kim YA, Kim KM, Lim S, Choi SH, Moon JH, Kim JH, Kim SW, Jang HC, Shin CS (2015) Favorable effect of dietary vitamin C on bone mineral density in postmenopausal women (KNHANES IV, 2009): discrepancies regarding skeletal sites, age, and vitamin D status. Osteoporos Int 26(9):2329–2337. https://doi.org/10.1007/s00198-015-3138-6 CrossRefPubMedGoogle Scholar
- 19.Kim DE, Cho SH, Park HM, Chang YK (2016) Relationship between bone mineral density and dietary intake of beta-carotene, vitamin C, zinc and vegetables in postmenopausal Korean women: a cross-sectional study. J Int Med Res 44(5):1103–1114. https://doi.org/10.1177/0300060516662402 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Kaptoge S, Welch A, McTaggart A, Mulligan A, Dalzell N, Day NE, Bingham S, Khaw KT, Reeve J (2003) Effects of dietary nutrients and food groups on bone loss from the proximal femur in men and women in the 7th and 8th decades of age. Osteoporos Int 14(5):418–428. https://doi.org/10.1007/s00198-003-1391-6 CrossRefPubMedGoogle Scholar
- 23.Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012CrossRefPubMedGoogle Scholar
- 24.Finck H, Hart AR, Lentjes MAH, Jennings A, Luben RN, Khaw KT, Welch AA (2015) Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort. Am J Clin Nutr 102(6):1416–1424. https://doi.org/10.3945/ajcn.115.111971 CrossRefPubMedGoogle Scholar
- 27.Sun LL, Li BL, Xie HL, Fan F, Yu WZ, Wu BH, Xue WQ, Chen YM (2014) Associations between the dietary intake of antioxidant nutrients and the risk of hip fracture in elderly Chinese: a case-control study. Br J Nutr 112(10):1706–1714. https://doi.org/10.1017/S0007114514002773 CrossRefPubMedGoogle Scholar
- 39.Carpenter TO, DeLucia MC, Zhang JH, Bejnerowicz G, Tartamella L, Dziura J, Petersen KF, Befroy D, Cohen D (2006) A randomized controlled study of effects of dietary magnesium oxide supplementation on bone mineral content in healthy girls. J Clin Endocrinol Metab 91(12):4866–4872. https://doi.org/10.1210/jc.2006-1391 CrossRefPubMedPubMedCentralGoogle Scholar