Skip to main content

Advertisement

SpringerLink
Log in

Effects of dietary improvement on bone metabolism in elderly underweight women with osteoporosis: a randomised controlled trial

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Malnutrition in elderly people contributes to osteoporosis and fracture. The aim of the study was to investigate the effects of nutritional improvement on bone metabolism in elderly community-dwelling women. A 12-month randomized controlled trial of 71 ambulant women aged ≥70 years with BMI ≤21 kg/m2 and osteoporosis at the hip was undertaken. They received either calcium (1 g) and vitamin D (800 units of cholecalciferol) only (group 1: n=35) or calcium/vitamin D and one or two cartons of a nutritional supplement drink which provided 300 Kcal, 12 g protein, 11.6 g fat and 36.8 g carbohydrate per carton(group 2: n=36). Body composition and bone mineral density (BMD) were assessed at baseline and 12 months. Biochemical markers of bone turnover were measured at baseline and at 1, 3, 6, 9 and 12 months. Group 2 gained significantly more weight [mean (SD) group 1: 0.15 (2.45), group 2:2.66 (2.8) kg P<0.001] and fat mass [group 1: −0.26 (1.8), group 2:1.9 (1.7) kg P<0.001]. BMD at the spine, femoral neck and total hip did not change significantly, although there was a positive trend at the total hip in group 2 [group 1: −0.5 (5.2), group 2:1.25 (3.3)%, P=0.13]. In a subgroup analysis, irrespective of their treatment group, there was a significant difference in changes in BMD at the lumbar spine and total hip in those who lost body weight (A) compared to those who had maintained or increased their weight (B), [mean (SD) % change in BMD lumbar spine; A: −1.64 (3.75), B: 0.96 (2.75) P=0.013, total hip A: −2.09 (6.0), B: 1.04 (3.3), P=0.05)] A significant reduction in serum CTX, a marker of bone resorption, was seen in group 2 [% decrease at 3 months, group 1: 1 (8.7), Group 2: 32 (5.8), P<0.01]. Serum osteoprotegerin (OPG) increased significantly in group 2 with a maximal increase (27%) observed at 6 (P<0.01) and 9 months (P<0.05). A small increase in bone-specific alkaline phosphatase was seen at 12 months in group 2 [% increase group 1:5 (5), group 2: 17 (6), P=0.05]. Serum osteocalcin increased at 12 months in group 2 (P=0.01). Dietary improvement in elderly women with low BMI is associated with a reduction in bone resorption with a small but "net" positive effect on bone formation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Bonjour J-P, Schurch M-A, Rizzoli R (1996) Nutritional aspects of hip fractures. Bone 18:1395–1445

    Google Scholar 

  2. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676

    Google Scholar 

  3. Geinoz G, Rapin CH, Rizzoli R, Kraemer R, Buchs B, Slosman D, Michel J.P, Bonjour J-P (1993) Relationship between bone mineral density and dietary intakes in the elderly. Osteoporos Int 3:242–248

    CAS  PubMed  Google Scholar 

  4. Nguyen TV, Sambrook PN, Eisman JA (1998) Bone loss, physical activity and weight change in elderly women: the Dubbo osteoporosis epidemiology study. J Bone Miner Res 13:1458–1467

    CAS  PubMed  Google Scholar 

  5. Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP (2000) Effect of dietary protein on bone loss in elderly men and women: the Framingham osteoporosis study. J Bone Miner Res 15:2504–2512

    CAS  PubMed  Google Scholar 

  6. Schurch M-A, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour J-P (1998) Protein supplements increase serum insulin-like growth factor-1 levels and attenuate proximal femur bone loss in patients with recent hip fracture. Ann Int Med 128:801–809

    CAS  Google Scholar 

  7. Kanis JA, Melton LJ 111, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    CAS  PubMed  Google Scholar 

  8. Hodkinson HM (1972) Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1:233–238

    CAS  PubMed  Google Scholar 

  9. Looker AC, Johnston CC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Lindsay RL (1995) Prevalence of low femoral bone density in older US women from NHANES 111. J Bone Miner Res 10:796–802

    CAS  PubMed  Google Scholar 

  10. Grimby G (1986) Physical activity and muscle training in the elderly. Acta Med Scand Suppl 711:233–237

    CAS  PubMed  Google Scholar 

  11. Lehmann A, Bassey EJ, Morgan K, Dalloso HM (1991) Normal values for weight, height, skeletal size and body mass indices in 890 men and women aged over 65 y. Clin Nutr 10:18–22

    Google Scholar 

  12. Department of Health and Social Security Committee on Medical Aspects of Food Policy (1979) Nutrition and Health in old age: the cross-sectional analysis of the findings of a survey made in 1972/3 of elderly people. Department of Health (Report on Health and Social Subjects; no 16), HMSO, London

    Google Scholar 

  13. Lipschitz DA (1995) Nutritional assessment and interventions in the elderly. In: Burkhardt P, Heaney RP (eds) Nutritional aspects of osteoporosis '94. Challenges of modern medicine, vol 7. Rome: Ares-Serono Symposia Publications, Rome, pp 77–191

  14. Calvert C, Cade J, Barrett JH, Woodhouse A and UKWCS Steering Group (1997) Using cross-check questions to address the problem of mis-reporting of specific food groups on food frequency questionnaires. Eur J Clin Nutr 51:708–712

    Article  CAS  PubMed  Google Scholar 

  15. Schott AM, Cormier C, Hans D, Favier F, Hausherr E, Dargent-Molina P, Delmas PD, Ribot C, Serbert JL, Breart G, Meunier PJ (1998) How hip and whole-body mineral density predict hip fracture in elderly women: the EPIDOS prospective study. Osteoporos Int 8:247–254

    Article  CAS  PubMed  Google Scholar 

  16. Reid IR, Ames RW, Evans MC, Sharpe SJ, Gamble GD (1994) Determinants of the rate of bone loss in normal postmenopausal women. J Clin Endocrinol Metab 79:950–954

    Google Scholar 

  17. Chestnut CH, Bell NH, Clark GS, Drinkwater BL, English SC, Johnson CC et al. (1997) Hormone replacement therapy in post-menopaual women: urinary N-telopeptide of type 1 collagen monitors therapeutic effect and predicts response of bone mineral density. Am J Med 102:29–37

    Article  PubMed  Google Scholar 

  18. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud K, Avioli LV, Lips P, Cummings SR (1999) Reduction in vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3 year randomized clinical trial. JAMA 282:637–645

    CAS  PubMed  Google Scholar 

  19. Sarkar S, Mitlak BH, Wong M, Stock JL, Black DM, Harper KD (2002) Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res 17:1–10

    CAS  PubMed  Google Scholar 

  20. Garnero P, Dargent-Molina P, Hans D, Schott AM, Breart G, Meunier PJ, Delmas PD (1998) Do markers of bone resorption add to bone mineral density and ultrasonographic heel measurement for the prediction of hip fracture in elderly women? The EPIDOS Prospective stugy. Osteoporos Int 8:563–569

    Article  CAS  PubMed  Google Scholar 

  21. Chapurlat RD, Garnero P, Breart G, Meunier PJ, Delmas PD (2000) Serum type I Collagen breakdown product (serum CTX) predicts hip fracture risk in elderly women: the EPIDOS study. Bone 27:283–286

    Article  CAS  PubMed  Google Scholar 

  22. Garnero P, Hausherr E, Chapuy MC, Marcelli C, Grandjean H, Muller C, Cormier C, Breart G, Meunier PJ, Delmas PD (1996) Markers of bone resorption predict hip fracture in elderly women. The EPIDOS prospective study. J Bone Miner Res 11:1531–1538

    CAS  PubMed  Google Scholar 

  23. Vergnaud P, Garnero P, Meunier PJ, Breart G, Kamihagi K, Delmas PD (1997) Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS study. J Clin Endocrinol Metab 82:719–724

    Google Scholar 

  24. Van Daele PL, Seibel MJ, Burger H, Hoffman A, Grobbee DE, Van Leeuwen JPTM, Birkenhager JC, Pols HAP (1996) Case control analysis of bone resorption markers, disability and hip fracture risk: the Rotterdam study. BMJ 3123:482–483

    Google Scholar 

  25. Akesson K, Ljunghall S, Jonsson B, Sernbo I, Johnell O, Gardsell P, Obrant KJ (1995) Assessment of biochemical markers of bone metabolism in relation to the occurrence of fracture: a retrospective and prospective population based study in women. J Bone Miner Res 10:1823–1829

    CAS  PubMed  Google Scholar 

  26. Ndiaye B, Lemonnier D, Sall MG, Prudhon C, Diaham B, Zeghoud F, Guillozo H, leite N, Wade S (1995) Serum osteocalcin regulation in protein-energy malnourished children. Pediatr Res 37:606–610

    CAS  PubMed  Google Scholar 

  27. Hofbauer LC, Khosla S, Dunstan CR, Lacey DL, Boyle WJ, Riggs BL (2000) The roles of osteoprotegerin and osteoprotegerin ligand in the paracrine regulation of bone resorption. J Bone Miner Res 15:2–12

    CAS  PubMed  Google Scholar 

  28. Hofbauer LC, Khosla S, Dunstan CR, Lacey DL, Spelsberg TC, Riggs BL (1999) Estrogen stimulates gene expression and protein production of osteoprotegerin in human osteoblastic cells. Endocrinology 140:4367–4370

    CAS  PubMed  Google Scholar 

  29. Khosla S, Atkinson EJ, Dunstan CR, O'Fallon WM (2002) Effect of estrogen versus testosterone on circulating osteoprotegerin and other cytokine levels in normal elderly men. J Clin Endocrinol Metab 87:1550–1554

    Google Scholar 

  30. Fiatarone MA, O'Neill EF, Doyle-Ryan N, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330:1769–1775

    Google Scholar 

Download references

Acknowledgements

We are indebted to the medical charity Action Research for funding the study. We would also like to thank Nutricia Clinical Care, Nutricia Ltd and Shire Pharmaceuticals Ltd for providing the nutritional and calcium/vitamin D supplements, respectively, free of charge.

Author information

Authors and Affiliations

  1. Department of Chemical Pathology, 5th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK

    Geeta Hampson, Sashie Vaja, Suki Sankaralingam & Joseph Cheung

  2. Elderly Care Unit, St Thomas' Hospital, London, SE1 7EH, UK

    Finbarr C. Martin

  3. Department of Dietetics, St Thomas' Hospital, London, SE1 7EH, UK

    Kate Moffat

  4. Nuclear Medicine, Guy's Hospital, London, UK

    Glen M. Blake & Ignac Fogelman

Authors
  1. Geeta Hampson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Finbarr C. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kate Moffat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sashie Vaja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suki Sankaralingam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Glen M. Blake
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ignac Fogelman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geeta Hampson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hampson, G., Martin, F.C., Moffat, K. et al. Effects of dietary improvement on bone metabolism in elderly underweight women with osteoporosis: a randomised controlled trial. Osteoporos Int 14, 750–756 (2003). https://doi.org/10.1007/s00198-003-1440-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-003-1440-1

Keywords

Search

Navigation