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Bone Health in Premenopausal Women with Coeliac Disease: An Observational Study.
(MDPI (Basel, Switzerland), 2024-07-09) Schraders K; Coad J; Kruger M; Iacone R
Low bone mineral density (BMD) is common in adults with coeliac disease (CD), even in individuals adhering to a gluten-free diet (GFD). Women are more likely to have low BMD and have an increased risk of osteoporosis, so women with pre-existing low BMD related to CD are at an even higher risk. BMD assessed by dual X-ray absorptiometry (DXA) and bone quality assessed through quantitative ultrasound (QUS) were investigated in 31 premenopausal women with CD consuming a GFD, and 39 matched healthy controls from the Lower North Island, New Zealand. In addition, bone metabolism and nutrient status were assessed, and four-day diet diaries were used to estimate nutrient intake. No statistically significant differences were found in BMD assessed by DXA between the two groups at the hip, lumbar spine or forearm. However, the parameters measured by the QUS were significantly lower in CD participants. Dietary data indicated significantly lower intakes of energy, dietary fibre, magnesium and phosphorus in women with CD, likely as a result of a reduced intake of wholegrain foods, and suggested that both groups had inadequate intake of calcium. No significant differences were demonstrated in biochemical parameters. BMD and bone biomarkers indicated no differences between coeliac and healthy women in New Zealand. However, these findings suggest that QUS may be more sensitive for the coeliac population, due to the disease's affect on the trabecular bone, and warrant further research.
Understanding the Barriers and Enablers to Sporting Activity in Relation to Bone Health: A Qualitative Narrative Study among Adolescents and Young Adults in New Zealand
(Longdom Publishing, 2020-07-29) Patel H; Denison H; Teesdale-Spittle P; Dennison E
Background: Sports participation may be considered a method of reducing the risk of fragility fracture in later life by maximizing Peak Bone Mass (PBM) in the growing years. However, sports participation typically declines during late adolescence and adulthood. This qualitative study aims to identify barriers and facilitators to engaging with regular weight bearing sporting activity in adolescents and young adults in New Zealand. Methods: 44 adolescents and young adults aged 17 to 33 participated in nine focus groups. The study was conducted using a semi-structured approach with open-ended questions and prompts. Transcripts were thematically coded using an inductive content analysis approach. Results: The three main barriers to sports participation that emerged were a) structural (disorientation in a new living environment, facilities, access to healthcare), b) social (financial and time constraints) and c) personal (social pressures and lack of an understanding of why sporting activity matters for bone health) while enablers of sports participation included a) supportive environments, b) access to health checks including support to avoid injury and c) education to better understand benefits of recreational sporting activity. Conclusions: Current awareness of osteoporosis and lifestyle factors that impact PBM is limited. Educational interventions are now warranted and urgently required.
Non-polar lipid from greenshell mussel (Perna canaliculus) inhibits osteoclast differentiation
(Elsevier Inc, 2021-12) Siriarchavatana P; Kruger MC; Miller MR; Tian HS; Wolber FM
The osteoclast-dependent bone resorption process is a crucial part of the bone regulatory system. The excessive function of osteoclasts can cause diseases of bone, joint, and other tissues such as osteoporosis and osteoarthritis. Greenshell mussel oil (GSM), a good source of long chain omega-3 polyunsaturated fatty acids (LCn-3PUFAs), was fractionated into total lipid, polar lipid, and non-polar lipid components and their anti-osteoclastogenic activity tested in RAW 264.7 cell cultures. Osteoclast differentiation process was achieved after 5 days of incubation with RANKL in 24-well culture plates. Introducing the non-polar lipid fraction into the culture caused a lack of cell differentiation, and a reduction in tartrate-resistant acid phosphatase (TRAP) activity and TRAP cell numbers in a dose-dependent manner (50% reduction at the concentration of 20 μg/mL, p < 0.001). Moreover, actin ring formation was significantly diminished by non-polar lipids at 10-20 μg/mL. The bone digestive enzymes released by osteoclasts into the pit formation were also compromised by downregulating gene expression of cathepsin K, carbonic anhydrase II (CA II), matrix metalloproteinase 9 (MMP-9), and nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1). This study revealed that the non-polar lipid fraction of GSM oil contains bioactive substances which possess potent anti-osteoclastogenic activity.
B vitamins and homocysteine as determinants of bone health: A literature review of human studies
(John Wiley and Sons Ltd on behalf of British Dietetic Association, 2023-06) Ilesanmi-Oyelere BL; Kruger MC
Although there are several factors related to bone diseases such as physical activity, gender (oestrogen), race/ethnicity, smoking and alcohol habits, nutrition is a modifiable risk factor that could be employed to prevent or manage the onset of bone health diseases such as osteoporosis in humans. Aside from calcium and vitamin D, B vitamins are a group of water-soluble vitamins that play a vital role in cell metabolism. In this review, current evidence on B vitamins and bone health is assessed. Clinical trials (interventions) indicate that treatment with B vitamins impact the concentrations of total plasma/serum homocysteine concentrations (tHcy); however, most studies have reported the lack of an effect of low homocysteine concentrations on bone turnover markers, bone mineral density or fracture risks. Current studies have been inconsistent in their reports on the role of B vitamins and homocysteine in bone health. More data are therefore required to show the mechanism and effect of tHcy and B vitamins on bone mineral density, bone metabolism and fracture risk.
Comparative benefits of orange heirloom tomatoes over red tomatoes for bone health : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science at Massey University, Manawatū, New Zealand
(Massey University, 2022) Walallawita Kankanamge, Umani Shanika Walallawita
Bone loss, common in women after menopause, is characterized by reduced bone mineral density with disruption of bone microarchitecture, leading to higher fracture risk and osteoporosis. There are few treatments, and most have adverse side effects. Intervention studies have shown protective effects of lycopene against bone loss in animal models. Lycopene is a lipid-soluble carotenoid found mainly in tomatoes. The molecule exists in all-trans- and a variety of cis- configurations; and cis- lycopene isomers have been reported to be more bioavailable than all-trans-. ‘Moonglow’, an orange heirloom tomato, contains >90% of its lycopene in cis- isomeric form and thus may be a better source of naturally bioavailable lycopene than red tomato, which contains all-trans- lycopene. We hypothesised that consumption of moderate daily doses of whole ‘Moonglow’ tomato would reduce bone loss more effectively than red tomato in rat and cell models of osteoporosis. In vivo, ‘Moonglow’ tomato supplementation delivered physiologically relevant plasma lycopene concentrations within four days of feeding. The post-ovariectomy rat model was successful in accelerating bone loss. ‘Moonglow’ tomatoes delivered a higher plasma lycopene concentration than red tomatoes and were beneficial in reducing a bone turnover marker compared to red tomatoes, even when fed after initiation of bone loss, but did not improve bone mineral density. Ovariectomy reduced gut bacteria abundance; compared to red, ‘Moonglow’ tomato feeding restored the numbers of Lactobacillus, Enterococcus, Bacteroides and E. coli. In vitro cell culture studies showed that both red and ‘Moonglow’ tomato hexane extracts induced a significant decrease in the number of bone-resorbing TRAP-positive osteoclasts at 10 µmol/L lycopene concentration. In conclusion, there were slight differences in bone measurements between red or 'Moonglow' tomato feeding, except for the significant reduction of one bone turnover marker. This suggests that a higher dose and longer intervention period may be needed to provide clinically important improvement against bone loss. However, significantly higher plasma lycopene followed ‘Moonglow’ feeding compared to red tomatoes, indicating its better bioavailability and demonstrating value for future research on health benefits from ‘Moonglow’ tomatoes. In addition, findings from this study provide support for the importance of exploring the potential prebiotic-like effect of tomatoes and the mechanisms associated with changes in gut bacteria.
The impact of selenium-rich green and black tea water extracts on bone health in vitro, and in an animal model of osteoporosis : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Health Sciences at Massey University, Palmerston North, New Zealand
(Massey University, 2017) Nordin, Noor Hazarina
The consumption of tea, as a source of dietary antioxidants, is a natural nonpharmacotherapy approach that could provide beneficial effects on bone health and represent an alternative strategy for the prevention and management of osteoporosis throughout one’s life. While the benefits of tea and its bioactive chemical compounds on bone health have been increasingly investigated and reviewed, studies concerning the effects of tea with high selenium content have not yet been conducted. The purpose of the series of studies presented in this thesis was to test the hypotheses that green and black teas with high selenium content would be more effective in preventing postmenopausal bone loss than regular green and black teas, and that the positive effect of these teas on bone (if any), could be due their antioxidant and/or prebiotic-like properties. These hypotheses were investigated through a series of studies involving a variety of cellular assays, a young growing rat model, and an ovariectomy-induced bone loss rat model of postmenopausal osteoporosis. Four different teas derived from Camellia sinensis were assessed for their total phenolic content (TPC), antioxidant properties and prebiotic-like potential, which included a selenium-rich green tea (Se-GTE), a selenium-rich black tea (Se-BTE), a regular green tea (R-GTE) and a regular black tea (R-BTE). Aqueous tea extracts were prepared using different extraction temperatures and times to quantify the extraction efficiencies for TPC and antioxidant properties. TPC was measured using the Folin-Ciocalteu method, antioxidant activity was measured using the ferric-reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays, and the prebiotic-like effect on two beneficial bacteria (Lactobacillus acidophilus and L. rhamnosus) was determined using the plate agar dilution method. Irrespective of tea selenium content, the results obtained for TPC, antioxidant properties and prebiotic-like potential of the investigated teas were highly variable dependent on the different types of tea. In addition, the optimal time and temperature of tea infusion for maximising TPC was determined to be 90 °C for 5 min (Chapter 4), which was then used as the standard method of preparation for aqueous tea extracts for the subsequent in vitro and in vivo work. Further, the freeze-dried aqueous tea extracts (0.001 to 10 μg/mL) were investigated for their osteogenic effects on murine pre-osteoblastic MC3T3-E1 (Subclone 4) cells, as assessed by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT), alkaline phosphatase (ALP) activity, and Alizarin Red S (ARS) staining assays. The osteoprotective effect of the freeze-dried aqueous tea extracts against H2O2-induced oxidative stress during osteoblast differentiation was also evaluated. At low concentrations, all tea extracts showed an anabolic effect by enhancing matrix mineralisation in MC3T3-E1 cells. Moreover, the teas were capable of protecting and restoring the differentiated osteoblasts against the dysfunctional effects of H2O2-induced oxidative stress. These in vitro activities were irrespective of the selenium content, and were in a time- and concentration-dependent manner (Chapter 5). Next, their anti-osteoclastogenic effects were assessed by measuring tartrate-resistant acid phosphatase (TRAP) activity in receptor activator of nuclear factor kappa beta ligand (RANKL)-treated RAW 264.7 cells, while the numbers of TRAP-positive osteoclasts (TRAP+ OCLs) with five or more nuclei were quantified. All tea extracts (0.001 to 10 μg/mL), independent of selenium content, suppressed RANKL-induced osteoclastogenesis in a concentration-dependent manner, i.e. mostly significant at the higher concentrations (Chapter 6). In the first animal trial (Chapter 7), the effect consuming tea (1%, w/v) for four weeks on bone mass and strength were examined in young growing male Sprague-Dawley rats. No osteo-stimulative effects on bone parameters (i.e. serum bone resorption biomarker, bone mineral density and bone biomechanics) were observed in the rats during the rapid growth phase following tea consumption. Only Se-GTE showed prebiotic-like potential evaluated by changes in caecal parameters (i.e. decrease in caecal pH, decrease in numbers of Clostridium spp. (perfringens/histolyticum subgroup) and enhanced bacterial β-glucosidase enzyme activity). In the next animal trial (Chapter 8), the effects of eight-week consumption of tea (1%, w/v) on bone loss were assessed in ovariectomised mature adult female Sprague-Dawley rats. Only R-BTE significantly suppressed the serum bone resorption biomarker. Moreover, only Se-GTE and R-BTE demonstrated prebiotic-like potential in modulating intestinal microbiota composition, as seen by a marked decrease in caecal pH and enhanced activity of the bacterial β-glucosidase enzyme. Additionally, serum antioxidant capacity levels of the teas evaluated by FRAP assay in both animal trials showed mixed results. Based on the study findings, it is suggested that tea may exert stimulating effects on bone metabolism part-mediated through its prebiotic influence on gut microbiota, and not via a direct antioxidant mechanism. However, the exact mechanism underlying this effect remains unclear and needs to be investigated further. Taken together, these studies provide new insights into the potential antioxidant and prebiotic roles of teas with different levels of selenium, and their possible impact on bone health.
An investigation into the effects of Omega-3 fatty acids on bone resorption in the female ovariectomised rat : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutritional Science at Massey University
(Massey University, 2004) Poulsen, Raewyn Carol
Estrogen deficiency results in disruption of the normal bone remodeling cyclc leading to a loss of bone mineral and, in many cases, the development of osteoporosis. Various studies have demonstrated a beneficial effect of essential fatty acids (EFAs) in reducing the loss of bone density as a consequence of estrogen deficiency. The aim of the present study was to examine the specific effects of the n-3 EFA, eicosopentaenoic acid (EPA) on bone density and strength in ovariectomised female rats. 60 Sprague-Dawley rats were randomized into four groups and either ovariectomised (n=45) or sham operated (n=15). Ovariectomised animals were fed calcium adequate diets containing either corn oil (OVX control, n=15), corn oil + 0.1g/kg body weight EPA (low dose, n=15) or corn oil + 1.0g/kg body weight EPA (high dose, n= 15) for a period of nine weeks. Sham rats were fed the corn oil diet as per the OVX control group. Urinary calcium and phosphate excretion, serum type 1 collagen c-telopeptide concentration, bone density, bone ash and bone breaking strength were measured. Plasma fatty acid composition and serum concentrations of 25 hydroxyvitamin D3 were also determined. Femur bone density was significantly lower in the high dose group compared to sham, OVX control and low dose EPA groups (p<0.001, p=0.0096 and p=0.0047 respectively). Low dose EPA supplementation had no significant effect on bone density. No significant differences in urinary calcium or phosphate concentrations, serum concentrations of type-1 collagen c-telopeptide or bone breaking strength were evident with either dose of EPA compared to unsupplemented, ovariectomised controls. EPA supplementation resulted in significant decreases in the levels of n-6 EFAs and increases in the levels of n-3 EFAs except docosahexaenoic acid in plasma lipids. Both low and high dose EPA supplementation led to significant increases in serum concentration of25(OH) vitamin D3. In conclusion 1.0g EPA/kg body weight had a detrimental effect on bone density in ovariectomised rats. It is proposed that high intake of the highly unsaturated EPA resulted in significant lipid peroxidation. This in turn disrupted membrane structure and inhibited intestinal calcium absorption thereby stimulating PTH-mediated bone resorption. potential role for n-3 EFAs in the regulation of vitamin D activity is also outlined.
The impact of diet and lifestyle on bone health in the elderly : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutritional Science at Massey University
(Massey University, 2001) Stanley, Caroline Morva
Osteoporosis is a multi-factorial disorder in which nutrition and lifestyle play an important role. There were two main reasons for doing this study. The purpose of the first part of the study was to determine the prevalence of nutritional and lifestyle factors related to bone health in a group of senior citizens from the Manawatu who were over the age of 70 years. This was followed by an intervention trial in which the purpose was to assess the impact of a single serve of a high-calcium milk on bone resorption using two ingestion strategies. Calcium, magnesium and zinc intakes were below currently recommended levels in many of the study participants. Some of the participants and particularly those in rest homes received very little sunlight exposure and low dietary vitamin D. Participants spent an average of around 3.5 hours/day in physical activity. Weight-bearing activities such as walking, gardening and certain sports were common in this group. Institutionalised women were most compromised by nutrition and lifestyle. Dietary supplementation may therefore benefit many in this group. Of the 52 participants in the diet and lifestyle study, a group of 28 women and 14 men volunteered to take part in an intervention trial, which was approved by the Massey University Human Ethics Committee. The mean calcium intake of trial participants was only 70% of the current US recommended adequate intake (AI). Each person consumed a supplementary serve of 250mls of high calcium milk (640mg Ca), every evening for two weeks. Half consumed a whole dose one hour before bedtime (single serve group), whilst the rest consumed the milk in three divided doses of 80mls every hour before bedtime (divided dose group). Free deoxypyridinoline (Dpd), a biochemical marker of bone resorption, was measured in urine that was collected overnight on two consecutive days before and after two weeks of milk intervention. In the single serve group Dpd was 4.15 ± 1.99 at the start and 3.94 ± 2.15 mmol/mmol creatinine after two weeks (NS). In the divided dose group Dpd was 4.25 ± 2.21 at the start and 4.79 ± 2.27 mmol/mmol creatinine after two weeks (NS). In conclusion, a supplementary serve of milk in this group of elderly people did not produce significant changes in urinary Dpd, whether the milk was consumed as the whole amount or in divided doses.
Effect of goat milk on bone mass, morphology and biomechanics : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Anatomy and Physiology at Massey University, Palmerston North, New Zealand
(Massey University, 2012) McKinnon, Hilary
Milk is a major source of dietary calcium which is essential for bone growth and maintenance, and is seen as a beneficial resource in the prevention and alleviation of osteoporotic bone loss. The objectives of this thesis were to investigate the effects of a bioactive component of goat milk, Casein phosphopeptide (CPP), and its ability to increase calcium solubility for improved calcium absorption and retention. To investigate the effect of a formulated goat milk diet as a nutritional supplement on bone growth and mineral accretion; and to investigate the effect of the long term consumption of goat milk as a nutritional supplement with or without a drug therapy (Sodium Alendronate) to determine any complementary effects on ovariectomy induced osteoporosis in the female rat. The effect of CPP on calcium bioavailability was investigated in growing rats during a period of rapid bone growth. The diets that contained 80% and 57% of goat milk protein as casein delivered increased calcium absorption compared to the diet containing 17% casein, suggesting a minimum level of casein is needed to optimise calcium absorption from goat milk. However, increased calcium absorption did not result in increased mineral retention in the femur or lumbar spine. The next trial had two animal experiments with a total of 200 rats involved (Chapter 4 and 5); in the first experiment all 200 rats were fed either a non-milk diet, a formulated cow’s milk diet, or a formulated goat milk diet from 3 weeks of age until 5 months of age. At its conclusion 60 rats were euthanized and ex vivo samples taken for analysis. The second experiment saw the remaining mature rats either ovariectomized or sham operated then grown until 10 months. The consumption of the goat milk diet increased mineral accretion during the phase of rapid bone growth beyond ‘Peak bone mass’ at approximately 12 weeks of age until maturity at 5 months of age. Mineral retention in the femoral shaft showed that the rats fed the goats milk diet had significantly greater quantities of mineral (p<0.001) compared to the not-milk group. Investigation of the marrow cavity showed that bone formation at the two cross sections examined at the femoral mid-shaft were more significant for the rats fed the goat milk diet compared to the rats fed the non-milk diet (p<0.034 and p<0.007) respectively. Ovariectomy surgery at 5½ months caused osteoporotic like conditions in bone to develop resulting in the rapid loss of bone mass in the ovariectomized rats. This saw both periosteal and endosteal expansion resulting in larger overall marrow cavities (p<0.0001) in the femoral shaft and larger overall cross sectional area (p<0.002). Ovariectomy was also found to have an uneven effect on bone loss within the femoral shaft of ovariectomized rats (OVX), where bone at the endosteal surface had a tendency to be lost at a greater rate than the distal region compared to sham operated rats (SHAM) (p<0.061). This regional change showed that the SHAM rats had relatively larger bone areas in the proximal region, whereas, OVX rats had relatively larger bone areas in the distal region (p<0.0005). Dual energy x-ray absorptiometry (DEXA) measurements of the lumbar spine and femur did not show any significant differences between OVX and ovariectomized alendronate groups (OVX ALD) fed either of the milk diets (Chapter 5). However, there was a potentially differing, almost opposite effect within each of the two milk diets in the bone area of the femoral shaft. The GOAT OVX rats showed a trend for larger overall mean bone areas than the GOAT OVX ALD rats (p<0.063), yet in contrast to this the COW OVX rats showed a trend for smaller overall mean bone areas than the COW OVX ALD rats in the femoral shaft although not significant. The rats fed a long term diet of formulated goat milk and dosed with alendronate had a tendency to have tougher bone material per unit of bone (J/mm2) than rats fed cow’s milk and dosed with alendronate (p<0.073) in the femoral mid-shaft. Whereas, in the proximal femoral shaft the rats fed either of the milk diets and dosed with alendronate had tougher bone material per unit of bone (J/mm2) than the rats fed either of the milk diets and dosed with the placebo (p<0.05). Analysis of the trabecular structure of the proximal tibia showed that the rats fed goats milk and dosed with alendronate increased the prevalence of rod shaped trabeculae (p<0.048), increased surface volume to bone ratio (p<0.001), reduced the connectivity between trabeculae struts within the structure (p<0.004), decreased the fractal dimensions of the trabecular structure (p<0.018), and had thinner trabeculae (p<0.006) compared to the rats fed the Goat milk diet and dosed with the placebo. In conclusion, this thesis has found that the long-term consumption of goat milk may provide some protection against ovariectomy bone loss in rats. This may be in part due to increased mineral accretion during the phase of rapid bone growth. The co-administration of goat milk and alendronate had a significant effect on the toughness of the bone material per unit area of bone in the proximal and mid-shaft of the femur, however, potentially weakened the trabecular structure of the proximal tibia.
The lived experience of osteoporosis in the male body : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Health Psychology at Massey University, Palmerston North, New Zealand
(Massey University, 2010) Kawakami, Sachiko
Introduction: Osteoporosis has been medicalised as primarily a women‟s disease, despite the fact that men are also at risk. Although more attention has been paid to men‟s health in recent years, we know little about men‟s experiences regarding being diagnosed with, and living with, osteoporosis. This study was undertaken to address this gap in knowledge and attempted to explore what osteoporosis might mean for masculine identity and ageing. The male body was theorised as the phenomenological body, embodied masculinity integrated with Simone de Beauvoir‟s critique of gender and framed in her theory of old age. Methods: In-depth individual interviews were undertaken with four voluntary male participants aged between 42 and 86 years old (mean age = 62), diagnosed with osteoporosis 2-6 years previously. Interviews explored their perspectives regarding their body after diagnosis, and how that relates to other aspects of embodied life, including body image, past views, relationships with others and everyday living. Data were analysed using an existential-phenomenological approach, drawing upon Beauvoir‟s philosophy. Three main themes emerged: body image, body sensation, and body action, all of which together represent embodiment. Results: The medical diagnosis and bone density scan image served for the male participants to reconstruct their body images as fragile (how easy it is to break bones). The men attributed their chronic back pain to osteoporosis after the diagnosis. This led to the restriction of physical activities that they thought of as risky for fractures, which in turn encouraged them to engage in regular exercise. Meanings ascribed to osteoporosis (femininity, fragility, ageing) challenged their masculine identities. Although the participants recognised their bodies as ageing, they worked to retain their unchanging age-less self identities which were linked to masculinity. Conclusions: Men, like women, reconstructed their body images as fragile after the diagnosis of osteoporosis. However, men endeavoured to sustain dominant versions of masculinity by actively engaging in regular exercise and gendered roles. Findings have implications for health practitioners. Younger men may experience stigma with the construction of a feminised and aged disease. Gender sensitive health promotion and health services can be achieved by understanding the psychological consequences men experience following the diagnosis of osteoporosis.

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