Modifiable risk factors for bone health & fragility fractures

Elsevier

Available online 22 June 2022, 101758

Best Practice & Research Clinical RheumatologyAbstract

Osteoporosis is an ageing disorder characterised by poor microstructural architecture of the bone and an increase in the risk of fragility fractures, which often leads to hospitalisation and eventually a loss of mobility and independence. By 2050, it is estimated that more than 30 million people in Europe will be affected by bone diseases, and European hospitalisation alone can approximately cost up to 3.5 billion euros each year [1]. Although inherited variation in bone mineral density (BMD) is pre-determined by up to 85% [2], there is a window of opportunity to optimise BMD and reduce fracture risk through key modifiable lifestyle factors during the life course. An optimal diet rich in micronutrients, such as calcium, vitamin D, and potassium, has long been considered an important modifiable component of bone health, which is attributed to their direct roles within bone metabolism. Recently, there has been emerging evidence to suggest that protein and even an adequate intake of fruit and vegetables may also play an important role in improving BMD [3,4]. Maintaining a physically active lifestyle is not only protective from non-communicable diseases such as cardiovascular disease but it also has been shown to lessen the risk of fractures later in life, thereby making it an imperative modifiable factor for bone health, particularly as it also supports peak bone mass attainment during childhood/adolescence and can facilitate the maintenance of bone mass throughout adulthood [5]. Other key lifestyle factors that could be potentially modified to reduce the risk of osteoporosis or osteoporotic fractures later in life include smoking status, alcohol intake, and body composition [6]. Therefore, the principle aim of this review is to highlight the recent evidence pertaining to modifiable lifestyle factors that contribute to optimal bone health and the prevention of fragility fractures in later life.

Keywords

Bone Health

Fracture risk

Bone nutrition

Modifiable factors

Osteoporosis

Abbreviations1,25(OH)2D

1,25 dihydroxycholecalciferol

25(OH)D

25-hydroxyvitamin D

BHOF

The Bone Health and Osteoporosis Foundation

aBMD

areal Bone Mineral Density

CNR1 & 2

Cannabinoid Receptors Type 1 & 2

CTX

Cross-linked of C-telopeptide of type I collagen

IGF-1

Insulin-Like Growth Factor 1

KHCO3

Potassium Bicarbonate

LRNI

Low Reference Nutrient Intake

NAE

Net Urinary Acid Excretion

NEAP

Non-Endogenous Acid Production

NHS

National Health Service

PRAL

Potential Renal Acid Load

P1NP

Procollagen Type 1 Amino-Terminal Propeptide

RCT

Randomised Controlled Trial

RED-S

Reduced Energy Deficiency in Sport

RNI

Reference Nutrient Intake

© 2022 The Author(s). Published by Elsevier Ltd.

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