This Position Stand provides an evaluation of diet as a modifiable risk factor in the prevention of osteoporosis. There is an abundance of scientific evidence, which demonstrates the significance of nutrition in the support of bone capital accumulation and wider skeletal health (Wood et al. , 2013; Rizzoli, 2008; Ilich and Kerstetter, 2000). This text predominantly focuses on Calcium and vitamin D, as they are two of the most heavily revised nutrients within the context of skeletal system, however, the implications of wider nutrients are also considered.
The effect size of diet is evaluated across the whole of the population, as some evidence has suggested that it can be more influential in sub-groups such as children, adolescents, the elderly, and menopausal women (Bianchi, 2007; Hannan et al. , 2000; Neer et al. , 2001). Thus, it was deemed appropriate to provide an individualistic evaluation of society. Findings from the current literature body are varied, consequently, few nutrients have universally accepted reference values. Position Stands are required to assess the clinical effectiveness of set nutrients at a specific point in time.
Curre-ntly, there is enough evidence to make basic recomm-endations for calcium and vitamin D. On the contrary, there is inadequate evidence to make firm recommendations for other nutrients. The implications of wider modifiable risk factors such as physical activity and hormone regulation are also considered within this text. Some evidence has indicated such factors can alter the effects that certain nutrients have on the skeletal system (Winters and Snow, 2001; Turner and Pavalko, 1998). In light of these findings, it could be suggested wider considerations need to be made in the development of future reference values.
Moreover, this text briefly considers a multi-factorial approach to controlling the effects of osteoporosis, as a method of yielding more substantial results. The skeletal system is continuously involved in a remodelling process, which involves the formation and resorption of bone (Courtney et al. , 1994). This process is made possible by multicellular units, which aid in the production and removal of bone tissue (Francis, 2007). Osteoclast cells carry enzymes that penetrate the bone and erode segments of trabecular matter, whilst osteoblast cell aid in the remineralisation and formation of new bone mass (Frost, 1966).
Osteoporosis occurs when regulated bone accretion is compromised and the structural integrity of the bone is reduced (Aaron, 1975). Those who suffer with osteoporosis typically illicit few signs and symptoms, prior to encoun-tering problems such as fragility breaks and fractures (Izaks, 2007). Following problems that occur as a result of osteoporosis, individuals are likely to experience chronic pain and reduced functionality (Kanis, 1994). Across the United Kingdom, it is estimated that 300,000 people suffer with the disease (Kanis et al. , 2012 cited in NHS Annual Reports).
In terms of fracture rates, over 300,000 fragility fractures are recorded in the UK every year, with hip fractures alone accounting for over 1. 3 million hospital bed days (Mitchell, 2009). Emergency hospital admissions for breaks and fractures in the UK, results in more bed days, than heart attack, heart failure, and stroke cases combined (Mitchell, 2009 cited in NHS Annual Reports). Treating osteoporosis is estimated to cost the National Health Service (NHS) ? 2 billion each calendar year, highlighting the scale of the problem (Mitchell, 2009 cited in NHS Annual Reports).
Although heritability contributes extensively in overall bone mass, other factors can have a notable impact on wider skeletal health (Macdonald et al. , 2004). There is evidence that suggests diet can be used as a modifiable risk factor, which can minimise the effects of osteoporosis (Rizzoli, 2008). During adulthood, the main aim of nutritional adjustment should be to maintain existing bone mass (Francis, 2007). It remains unclear whether adults can actively increase bone mass with the adjustment of certain lifestyle factors (Wamoto, 2013).
Meta-analyses have indicated dietary adjustment does not always result in significant developments of skeletal composition. However, diet remains an important factor in the maintenance of healthy bones (Cumming, 1990; Welton, Kemper, and Staveren, 1995). There is significant debate surrounding the value of certain nutrients in the context of skeletal health (Prentice, 2004). Thus, such reviews need to analyse the literature body to assess the clinical effectiveness of certain nutrients.