Prevention of low bone mass to achieve high bone density in Mexico: position of the Mexican Association for Bone and Mineral Metabolism
In Mexico, osteoporosis is a public health problem. In this document, the Mexican Association for Bone and Mineral Metabolism defines its position on calcium, vitamin D supplement use, and physical activity as an effective, safe, and cost-effective initiatives to prevent low bone mass.
In Mexico, osteoporosis is a public health problem that is expected to increase in the decades ahead. Generally, modifiable risk factors for bone health are related with lifestyles, especially nutrition and physical activity.
In this position paper, the Mexican Association for Bone and Mineral Metabolism (AMMOM, by its acronym in Spanish), which is a multidisciplinary group of researchers, dietitians, epidemiologists, nurses, and physicians who study bone and related tissues and communicate the best strategies for diagnosis, treatment, and prevention of bone problems, aims to analyze the association between nutrition and bone health, risk behaviors for low bone mass, and the economic impact that prevention of low bone mass represents for the health care system.
Addressing therapeutic management with pharmacological and non-pharmacological approaches, we emphasize the important role the patient plays in the doctor–patient relationship, both in the consulting room and in daily life. Furthermore, the AMMOM defines its position on calcium and vitamin D supplement use as an effective, safe, and cost-effective initiative to prevent low bone mass.
In summary, most research and clinical practice related to osteoporosis have focused on diagnosis and treatment, but general measures for primary prevention based on addressing modifiable risk factors as a public health priority to delay the onset of loss of bone mass have not been considered by Mexican authorities. Consequently, the AMMOM task force also seeks to provide information on concrete actions to prevent low bone mass.
KeywordsBone density Osteoporosis Prevention Calcium Vitamin D Dietary supplements
All the authors were involved in the conceptual design of the manuscript. RE, PC, EDG, MAAB, MF, PD, SJ, MPPR, FS, PL, and VM prepared a section of the first version of the manuscript. EDG reviewed and edited the first version of the manuscript. All the authors reviewed and approved the final version of the manuscript.
This paper was supported by Pfizer Mexico, SA de CV, which allowed the experts’ meetings. All the authors received an honorarium from Pfizer in connection with the development of this manuscript.
Medical writing support was provided by Dr. Karim Majluf Cruz at ByronMuller and was funded by Pfizer.
Editorial support was provided by Dr. Edgar Denova and was funded by Pfizer.
Compliance with ethical standards
Conflicts of interest
Statement of human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, informed consent is not required.
- 3.Clark P, Cons-Molina F, Deleze M, Ragi S, Haddock L, Zanchetta JR, Jaller JJ, Palermo L, Talavera JO, Messina DO, Morales-Torres J, Salmeron J, Navarrete A, Suarez E, Pérez CM, Cummings SR (2009) The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int 20:275–282CrossRefGoogle Scholar
- 5.Gennari C (2001) Calcium and vitamin D nutrition and bone disease of the elderly. Public Health Nutr 4:547–559Google Scholar
- 7.Food and Agriculture Organization (2013) Dairy production and products. Milk and milk products. www.fao.org/dairy-production-products/products/en/. Accessed 20 Jan 2018)
- 8.Rivera-Dommarco J, López-Olmedo N, Aburto-Soto T et al (2014) Consumo de productos lácteos en población Mexicana. Resultados de la Encuesta Nacional de Salud y Nutrición 2012. Instituto Nacional de Salud Pública, MéxicoGoogle Scholar
- 9.Heaney RP (2008) Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr 88:541S–544SGoogle Scholar
- 12.Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press (US), Washington, DCGoogle Scholar
- 14.Pedroza-Tobías A, Hernández-Barrera L, López-Olmedo N, et al (2016) Usual vitamin intakes by Mexican populations. J Nutr 146:1866S–1873SGoogle Scholar
- 18.Manios Y, Moschonis G, Trovas G, et al (2007) Changes in biochemical indexes of bone metabolism and bone mineral density after a 12-mo dietary intervention program: the Postmenopausal Health Study. Am J Clin Nutr 86:781–789Google Scholar
- 19.Bonjour JP, Benoit V, Pourchaire O, et al (2009) Inhibition of markers of bone resorption by consumption of vitamin D and calcium-fortified soft plain cheese by institutionalised elderly women. Br J Nutr 102:962–966Google Scholar
- 20.Denova-Gutierrez E, Clark P, Tucker KL, et al (2016) Dietary patterns are associated with bone mineral density in an urban Mexican adult population. Osteoporos Int 27:3033–3040Google Scholar
- 21.Winzenberg TM, Shaw K, Fryer J, et al (2006) Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2:CD005119Google Scholar
- 22.Avenell A, Mak JC, O'Connell D (2014) Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 4:CD000227Google Scholar
- 23.Shea B, Wells G, Cranney A, et al (2004) Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 1:CD004526Google Scholar
- 24.Osteoporosis. Clinical guideline for prevention and treatment. Executive Summary. National Osteoporosis Guideline Group (NOGG) on behalf of the Bone Research Society, British Geriatrics Society, British Orthopaedic Association, British Society of Rheumatology, National Osteoporosis Society, Osteoporosis 2000, Osteoporosis Dorset, Primary Care Rheumatology Society, Royal College of Physicians and Society for Endocrinology. 2010Google Scholar
- 25.Wadsworth TG (1990) Colles’ fracture: failure in management may cause permanent disability. BMJ 301:192–194Google Scholar
- 26.Ross PD, He YF, Yates AJ, et al (1994) Body size accounts for most differences in bone density between Asian and Afro-Caribbean women. Clin Sci 87:339–343Google Scholar
- 27.Tobias JH, Cook DG, Chambers TJ, et al. A comparison of bone mineral density between Caucasian, Asian and Afro-Caribbean women. Clin Sci 1994;87(5):587–591Google Scholar
- 28.The DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group (2010) Patient level pooled analysis of 68500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 340:b5463. https://doi.org/10.1136/bmj.b5463
- 29.Wang L, Manson JE, Sesso HD (2012) Calcium Intake and Risk of Cardiovascular Disease: A Review of Prospective Studies and Randomized Clinical Trials. American Journal of Cardiovascular Drugs12:105–116. https://doi.org/10.2165/11595400-000000000-00000
- 30.Chung M, Tang AM, Fu Z, et al (2016) Calcium intake and cardiovascular disease risk. An updated systematic review and meta-analysis. Ann Intern Med 165:856–866Google Scholar
- 31.Margolis KL, Manson JE (2016) Calcium supplements and cardiovascular disease risk: What do clinicians and patients need to know? Ann Intern Med 165:884-885Google Scholar
- 32.Russell-Aulet, Wang J (1993) Bone mineral density and mass in a crossectional study of white and asian women, J Bone Miner Res 8:575–582Google Scholar
- 33.Hodgson SF, Watts NB, Bilezikian JP (2003) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003.Endoc Pract 9:544–564Google Scholar
- 34.Mykkanen HM, Wasserman RH (1983) Enhanced absorption of calcium by casein phosphopeptides in rachitic a normal chick. J Nutr 110:2141–2148Google Scholar
- 35.Recker RR, Bammi A, Barger-Lux MJ, et al (1988) Calcium absorbability from milk products, and imitation milk, and calcium carbonate. Am J Clin Nutr 47:93–95Google Scholar
- 36.Rosado JL (2016) Lactose Intolerance. Gac Med Mex 152(Suppl 1):67-73Google Scholar
- 37.Heine RG, AlRefaee F, Bachina P, et al (2017) Lactose intolerance and gastrointestinal cow's milk allergy in infants and children - common misconceptions revisited.World Allergy Organ J10:41. https://doi.org/10.1186/s40413-017-0173-0
- 38.Shea B, Wells G, Cranney A, et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 23:552–559Google Scholar
- 39.Aguilera-Barreiro MA, Guerrero-Mercado AS, Méndez-Jiménez TE, et al (2005) Efecto del calcio dietético vs el citrato de calcio sobre marcadores bioquímicos convencionales, en mujeres perimenopáusicas. Salud Publica Mex 47:259–267Google Scholar
- 40.Mavroeidi A, Stewart AD, Reid DM, et al (2009) Physical activity and dietary calcium interactions in bone mass in Scottish postmenopausal women. Osteoporos Int 20:409–416Google Scholar
- 41.Yoon SJ, Lee MJ, Lee HM, et al (2016) Effect of low-intensity resistance training with heat stress on the HSP72, anabolic hormones, muscle size, and strength in elderly women.Aging Clin Exp Res 29:977–984Google Scholar
- 42.Pham HM, Nguyen ND, Center JR, et al (2016)Contribution of Quadriceps Weakness to Fragility Fracture: A Prospective Study. J Bone Miner Res 31:208–214Google Scholar
- 43.Lombardi G, Sanchis-Gomar F, Perego S (2016)Implications of exercise-induced adipo-myokines in bone metabolism. Endocrine 54:284–305Google Scholar
- 44.Martyn-St James M, Carroll S(2010)Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. J Bone Miner Metab28:251–267Google Scholar
- 45.Smith EN, Boser A (2013) Yoga, vertebral fractures, and osteoporosis: research and recommendations. Int J Yoga Therap 23:17–23Google Scholar
- 46.Tüzün S, Aktas I, Akarirmak U, et al (2010)Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis.Eur J Phys Rehabil Med 46:69–72Google Scholar
- 47.Fielding RA, Vellas B, Evans WJ, et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and conse- quences. International working group on sarcopenia. J Am Med Dir Assoc 12:249–256Google Scholar
- 48.Espinel-Bermúdez MC, Sánchez-García S, García-Peña C, et al (2018) Associated factors with sarcopenia among Mexican elderly: 2012 National Health and Nutrition Survey. Rev Med Inst Mex Seguro Soc56(Suppl 1):S46–S53Google Scholar
- 49.Olsen CF, Bergland A (2014) The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial.Osteoporos Int 25:2017–2025Google Scholar
- 50.Stalmeier PF (2011) Adherence and decision AIDS: a model and a narrative review. Med Decis Making 31:121–129Google Scholar
- 51.Hill L, Mueller M, Roussos S, et al (2009) Opportunities for the use decision aids in primary care. Fam Med 41:350–355Google Scholar