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Supplementation with omega-3 fish oil has no effect on bone mineral density in adults with knee osteoarthritis: a 2-year randomized controlled trial

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Abstract

Summary

This study aimed to determine the effect of fish oil on bone mineral density (BMD). There were no differences in the 2-year BMD measures between high and low dose groups after adjusting for baseline BMD. This randomized controlled trial did not demonstrate any efficacy of omega-3 fatty acids on bone loss in adults.

Introduction

The purpose of this study is to investigate whether supplementation with high dose omega-3 fish oil could have an impact on BMD.

Methods

In a multicentre, double-blind randomized controlled trial (RCT) (ACTRN 12607000415404), 202 Australian participants aged ≥40 with knee osteoarthritis (mean age, 61.0 ± 10.0 years; 49 % female) were randomized to receive either high dose (4.5 g eicosapentaenoic acid and docosahexaenoic acid daily) or low dose (0.45 g/day) omega-3 fish oil for 2 years. BMD was assessed at baseline and 2 years by dual energy X-ray absorptiometry.

Results

In subjects with baseline and 2-year assessments, mean standardized BMD at baseline for low or high dose group was 1198 ± 198 and 1157 ± 169 mg/cm2, respectively, for the lumbar spine and was 1035 ± 165 and 1017 ± 174 mg/cm2, respectively, for the femoral neck. There were no differences in the 2-year BMD measures between high and low dose groups after adjusting for baseline BMD in the complete case regression analyses (lumbar spine 3.7, 95 % confidence interval (CI) −7.9 to 15.3 mg/cm2 and femoral neck −5.5, 95 % CI −14.9 to 3.9 mg/cm2). The findings did not change with additional adjustments of age, gender, study centre and uses of bone-related drugs during the study period as well as using the intention-to-treat analysis or limiting to older participants (≥55 years at the baseline) (all P ≥ 0.25). Mild adverse events such as headache and gastrointestinal intolerance were common but did not occur more frequently in either group. There were no serious adverse events related to the intervention.

Conclusion

A 2-year supplementation with high-dose omega-3 fish oil did not alter bone loss among men and women with knee osteoarthritis.

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References

  1. Gahche J, Bailey R, Burt V, Hughes J, Yetley E, Dwyer J, Picciano MF, McDowell M, Sempos C (2011) Dietary supplement use among U.S. adults has increased since NHANES III (1988–1994). NCHS Data Brief 61:1–8

    PubMed  Google Scholar 

  2. Adams J, Sibbritt D, Lui CW, Broom A, Wardle J (2013) {Omega}-3 fatty acid supplement use in the 45 and up study cohort. BMJ Open 3(4):e002292. doi:10.1136/bmjopen-2012-002292

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hill C, Gill TK, Appleton S, Cleland LG, Taylor AW, Adams RJ (2009) The use of fish oil in the community: results of a population-based study. Rheumatology (Oxford) 48(4):441–442. doi:10.1093/rheumatology/ken498

    Article  CAS  Google Scholar 

  4. Heart Foundation (2015) Position statement fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health

  5. Cleland LG, James MJ, Proudman SM (2006) Fish oil: what the prescriber needs to know. Arthritis Res Ther 8(1):202. doi:10.1186/ar1876

    Article  PubMed  PubMed Central  Google Scholar 

  6. Proudman SM, James MJ, Spargo LD, Metcalf RG, Sullivan TR, Rischmueller M, Flabouris K, Wechalekar MD, Lee AT, Cleland LG (2015) Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis 74(1):89–95. doi:10.1136/annrheumdis-2013-204145

    Article  CAS  PubMed  Google Scholar 

  7. Harris WS, Miller M, Tighe AP, Davidson MH, Schaefer EJ (2008) Omega-3 fatty acids and coronary heart disease risk: clinical and mechanistic perspectives. Atherosclerosis 197(1):12–24. doi:10.1016/j.atherosclerosis.2007.11.008

    Article  CAS  PubMed  Google Scholar 

  8. Sun D, Krishnan A, Zaman K, Lawrence R, Bhattacharya A, Fernandes G (2003) Dietary n-3 fatty acids decrease osteoclastogenesis and loss of bone mass in ovariectomized mice. J Bone Miner Res 18(7):1206–1216. doi:10.1359/jbmr.2003.18.7.1206

    Article  CAS  PubMed  Google Scholar 

  9. Bhattacharya A, Rahman M, Sun D, Fernandes G (2007) Effect of fish oil on bone mineral density in aging C57BL/6 female mice. J Nutr Biochem 18(6):372–379. doi:10.1016/j.jnutbio.2006.07.002

    Article  CAS  PubMed  Google Scholar 

  10. Chen YM, Ho SC, Lam SS (2010) Higher sea fish intake is associated with greater bone mass and lower osteoporosis risk in postmenopausal Chinese women. Osteoporos Int 21(6):939–946. doi:10.1007/s00198-009-1029-4

    Article  PubMed  Google Scholar 

  11. Kruger MC, Coetzer H, de Winter R, Gericke G, van Papendorp DH (1998) Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging (Milano) 10(5):385–394

    CAS  Google Scholar 

  12. Virtanen JK, Mozaffarian D, Cauley JA, Mukamal KJ, Robbins J, Siscovick DS (2010) Fish consumption, bone mineral density, and risk of hip fracture among older adults: the cardiovascular health study. J Bone Miner Res 25(9):1972–1979. doi:10.1002/jbmr.87

    Article  PubMed  PubMed Central  Google Scholar 

  13. Meyer BJ, Mann NJ, Lewis JL, Milligan GC, Sinclair AJ, Howe PR (2003) Dietary intakes and food sources of omega-6 and omega-3 polyunsaturated fatty acids. Lipids 38(4):391–398

    Article  CAS  PubMed  Google Scholar 

  14. Mangano K, Kerstetter J, Kenny A, Insogna K, Walsh SJ (2014) An investigation of the association between omega 3 FA and bone mineral density among older adults: results from the national health and nutrition examination survey years 2005–2008. Osteoporos Int 25(3):1033–1041. doi:10.1007/s00198-013-2501-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hill CL, March LM, Aitken D, Lester SE, Battersby R, Hynes K, Fedorova T, Proudman SM, James M, Cleland LG, Jones G (2015) Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. Ann Rheum Dis. doi:10.1136/annrheumdis-2014-207169

    PubMed Central  Google Scholar 

  16. Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 152(11):726–732. doi:10.7326/0003-4819-152-11-201006010-00232

    Article  PubMed  Google Scholar 

  17. Wu CW, Morrell MR, Heinze E, Concoff AL, Wollaston SJ, Arnold EL, Singh R, Charles C, Skovrun ML, FitzGerald JD, Moreland LW, Kalunian KC (2005) Validation of American College of Rheumatology classification criteria for knee osteoarthritis using arthroscopically defined cartilage damage scores. Semin Arthritis Rheum 35(3):197–201. doi:10.1016/j.semarthrit.2005.06.002

    Article  PubMed  Google Scholar 

  18. Genant HK, Grampp S, Gluer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, Van Kuijk C (1994) Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9(10):1503–1514. doi:10.1002/jbmr.5650091002

    Article  CAS  PubMed  Google Scholar 

  19. Rubin DB (1987) Multiple imputation for nonresponse in surveys. John Wiley & Sons, New York

    Book  Google Scholar 

  20. Introduction to SAS. UCLA: Statistical Consulting Group. (accessed November 18, 2013) 2013

  21. The U.S. Food and Drug Administartion (2005) Letter regarding dietary supplement health claim for omega-3 fatty acids and coronary heart disease

  22. Dyerberg J, Bang HO, Stoffersen E, Moncada S, Vane JR (1978) Eicosapentaenoic acid and prevention of thrombosis and atherosclerosis? Lancet 2(8081):117–119

    Article  CAS  PubMed  Google Scholar 

  23. Bang HO, Dyerberg J, Hjoorne N (1976) The composition of food consumed by Greenland Eskimos. Acta Med Scand 200(1–2):69–73

    CAS  PubMed  Google Scholar 

  24. DeCaterina R, Giannessi D, Mazzone A, Bernini W, Lazzerini G, Maffei S, Cerri M, Salvatore L, Weksler B (1990) Vascular prostacyclin is increased in patients ingesting omega-3 polyunsaturated fatty acids before coronary artery bypass graft surgery. Circulation 82(2):428–438

    Article  CAS  PubMed  Google Scholar 

  25. Eritsland J, Arnesen H, Seljeflot I, Kierulf P (1995) Long-term effects of n-3 polyunsaturated fatty acids on haemostatic variables and bleeding episodes in patients with coronary artery disease. Blood Coagul Fibrinolysis 6(1):17–22

    Article  CAS  PubMed  Google Scholar 

  26. Eritsland J (2000) Safety considerations of polyunsaturated fatty acids. Am J Clin Nutr 71(1 Suppl):197S–201S

    CAS  PubMed  Google Scholar 

  27. Watson PD, Joy PS, Nkonde C, Hessen SE, Karalis DG (2009) Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel—versus—aspirin + clopidogrel in patients with cardiovascular disease. Am J Cardiol 104(8):1052–1054. doi:10.1016/j.amjcard.2009.05.055

    Article  CAS  PubMed  Google Scholar 

  28. Eritsland J, Arnesen H, Gronseth K, Fjeld NB, Abdelnoor M (1996) Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol 77(1):31–36

    Article  CAS  PubMed  Google Scholar 

  29. Villani AM, Crotty M, Cleland LG, James MJ, Fraser RJ, Cobiac L, Miller MD (2013) Fish oil administration in older adults: is there potential for adverse events? A systematic review of the literature. BMC Geriatr 13:41. doi:10.1186/1471-2318-13-41

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Zhang Y, Hannan MT, Chaisson CE, McAlindon TE, Evans SR, Aliabadi P, Levy D, Felson DT (2000) Bone mineral density and risk of incident and progressive radiographic knee osteoarthritis in women: the Framingham study. J Rheumatol 27(4):1032–1037

    CAS  PubMed  Google Scholar 

  31. Lee JY, Harvey WF, Price LL, Paulus JK, Dawson-Hughes B, McAlindon TE (2013) Relationship of bone mineral density to progression of knee osteoarthritis. Arthritis Rheum 65(6):1541–1546. doi:10.1002/art.37926

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

JS Chen was supported by the University of Sydney Rolf-Edgar Lake postdoctoral fellowship. He passed away in October 2014.

This study was funded by the Australian National Health and Medical Research Council Project Grant (451900) and a research grant from Arthritis Australia.

Author information

Authors and Affiliations

  1. The University of Sydney Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia

    J. S. Chen & L. M. March

  2. Discipline of Medicine, The University of Adelaide, Adelaide, Australia

    C. L. Hill & C. D. Ruediger

  3. Rheum Unit, The Queen Elizabeth Hospital, Woodville, Australia

    S. Lester

  4. Discipline of Surgery, The University of Adelaide, Adelaide, Australia

    R. Battersby

  5. Menzies Research Institute, Hobart, Australia

    G. Jones

  6. Royal Adelaide Hospital, Adelaide, Australia

    L. G. Cleland

Authors
  1. J. S. Chen
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  2. C. L. Hill
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  3. S. Lester
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  4. C. D. Ruediger
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  5. R. Battersby
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  6. G. Jones
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  7. L. G. Cleland
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  8. L. M. March
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Corresponding author

Correspondence to C. L. Hill.

Ethics declarations

All participants provided written consent. The study was approved by The Queen Elizabeth Hospital, Royal North Shore Hospital and Tasmanian Human Research Ethics Committees. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12607000415404)

Conflicts of interest

None.

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Chen, J.S., Hill, C.L., Lester, S. et al. Supplementation with omega-3 fish oil has no effect on bone mineral density in adults with knee osteoarthritis: a 2-year randomized controlled trial. Osteoporos Int 27, 1897–1905 (2016). https://doi.org/10.1007/s00198-015-3438-x

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  • DOI: https://doi.org/10.1007/s00198-015-3438-x

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