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Guillermou
Jan 2

Great report. Nutrition and physical activity are known to contribute to bone health. Age is one of the main risk factors for primary type 1 (postmenopausal) osteoporosis. Primary osteoporosis type 2 (occurs after age 75) affects women and men in a 2:1 ratio. The effect of diet alone in this context may depend on individual genotype, gene-diet interactions, or the composition and function of the gut microbiota. Insufficient dietary protein intake can lead to muscle atrophy, resulting in unintentional weight loss due to accelerated muscle protein breakdown and reduced synthesis. This is a clinically significant complication of many chronic diseases, including osteoporosis. Lean muscle mass influences not only overall bone mineral density but also key cross-sectional bone parameters related to bone strength. Osteoblast growth and differentiation are partially favored by the stimulation of insulin secretion by alanine, lysine, arginine, leucine, and glutamine. Lysine and arginine have been shown to have a positive effect on nitric oxide production. (NO) and the synthesis of type I collagen, with potential for use in osteoporosis prevention. Dietary lipids can also influence bone health. Higher lipid intake can lead to decreased bone mineral density (BMD) and an increased risk of fractures. A negative relationship has been established between saturated fatty acid (SFA) intake and BMD. Monounsaturated fatty acid (MUFA) intake, derived from olive oil, and omega-3 fatty acids are associated with higher BMD.

It is known that soluble fiber administration leads to greater calcium retention in bone. Many fruits and vegetables contain non-digestible carbohydrates, such as inulin-type fructans. A large increase in calcium absorption was observed in young adults (58% increase) and postmenopausal women with inulin intake.

Obesity, type 2 diabetes mellitus (T2DM), and osteoporosis are serious diseases with an increasing incidence that often coexist, especially in older adults. In older adults, people with obesity and type 2 diabetes have impaired bone quality and a higher risk of fragility fractures, despite having high bone mineral density (BMD).

The most important and studied micronutrients in the prevention and treatment of osteoporosis are calcium (Ca) and vitamin D. However, other minerals and vitamins (e.g., phosphorus [P], magnesium [Mg], zinc, selenium, copper, vitamins C, K, A, and B) also participate in bone formation. In this review, Ca, P, and Mg are characterized, and vitamins D, C, and K are described in greater detail. Oxalic acid and phytic acid interfere with calcium absorption, so foods containing them are considered a poor source of this mineral. Excessive sodium (Na) intake can also increase urinary calcium excretion, as calcium and sodium compete for reabsorption in the renal tubules. Conversely, phosphorus (P) and vitamin D are effective in increasing calcium intake. The calcium:phosphorus (Ca:P) ratio is important for proper bone formation. Maintaining a Ca:P molar ratio of 1-2:1 is common practice. Studies have demonstrated the beneficial effects of co-administering eggshell calcium with vitamins D3 and K2. Magnesium deficiency can have a detrimental effect on bone health both directly (by increasing osteoclast activity and reducing osteoblast activity, thus decreasing bone rigidity) and indirectly (by interfering with vitamin D and PTH, promoting inflammation and subsequent bone loss).

Hypercalcemia can cause kidney stones and cardiac arrhythmias, as well as soft tissue calcification, while excessive iron accumulation can lead to oxidative stress and organ and tissue damage. Maintaining adequate mineral levels through a balanced diet, appropriate supplementation, and monitoring of at-risk populations is essential for good health and for preventing disorders related to deficiencies and toxicities.

Vitamin D can influence bone health both directly and indirectly. It has the ability to regulate intestinal calcium absorption, bone and renal calcium resorption, as well as PTH synthesis. Vitamin D also plays an important role in maintaining optimal serum calcium and phosphorus levels and in bone mineralization. Furthermore, vitamin D supplementation has a profound effect on bone and muscle strength, reducing the risk of falls and subsequent fractures.

Vitamin C deficiency manifests as osteolysis, osteonecrosis, decreased bone mineral density, bone pain, impaired wound healing, and pathological fractures. Vitamin C deficiency is associated with inadequate collagen synthesis, inappropriate osteoid formation, and increased bone resorption.

Vitamin K2 is recognized as safe and effective in the treatment of age-related bone loss and osteoporosis. It participates in the modulation of the RANK/RANKL signaling pathway by inhibiting RANKL and reducing osteoclastogenesis. In addition, vitamin K2 enhances osteoblastogenesis through the steroid and xenobiotic receptor, a specific nuclear receptor for osteoblasts, which promotes collagen accumulation.

Optimal levels of vitamin D and vitamin K are beneficial for bone and cardiovascular health, as supported by genetic, molecular, cellular, and some human studies. However, vitamin D and calcium supplementation, along with vitamin K deficiency, may also induce long-term soft tissue calcification and cardiovascular disease (CVD), particularly in users of vitamin K antagonists and other high-risk populations.

Potassium plays a vital role in maintaining acid-base balance in the body. It acts as an alkaline buffer by neutralizing excess acid produced during metabolic processes. This acid-base balance is closely linked to bone health.

Studies in middle-aged men and women have shown that boron can induce an increase in serum levels of 25(OH) vitamin D. Numerous studies have demonstrated that a diet rich in polyphenols contributes to delaying aging and reducing the incidence of chronic diseases, such as cardiovascular disorders, arteriosclerosis, cancer, type 2 diabetes mellitus, cataracts, cognitive decline, neurological diseases, and even osteoporosis. Polyphenols, such as quercetin, resveratrol, curcumin, isoflavones, and epigallocatechin gallate, modulate bone metabolism and prevent or mitigate osteoporosis. Polyphenols enhance osteoblastogenesis, inhibit osteoclast differentiation, and activate osteogenic pathways. Furthermore, their estrogenic activity and their ability to modulate the gut microbiota offer even greater therapeutic potential. Specifically, quercetin, luteolin, kaempferol, naringin, rutin, resveratrol, curcumin, isoflavones, and epigallocatechin gallate, to modulate bone metabolism and prevent or mitigate osteoporosis.

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