Even though much of the research instils calcium and vitamin D are the most important nutrients in the context of skeletal health, several studies have suggested other vitamins and minerals play a role in bone metabolism, and thus, could impact an individual’s likelihood of suffering with osteoporosis. Nielsen et al. (2011) undertook a 2-year longitudinal (mineral) supplementation study, and found 2mg of copper and 12mg of zinc may have contributed to increases in BMD. However, Nielsen et al.
(2011) concluded such effects were minor and only occurred in individuals with lower than average daily intakes. Furthermore, the study had a sample 50 participants making it hard to draw firm, generalisable recommendations from. Nielsen et al. (2011) suggested although only minor results were observed during this study, not enough emphasis has been placed on wider vitamins and minerals in academic research. Although few studies have reported on the isolated effects of wider vitamins and minerals, some studies have revised the effects of nutrient rich foods such as fruits and vegetables.
Fruits and vegetables are abundant in minerals such as calcium, potassium, and magnesium, each of which have been associated with stimulating osteoclast activity (Tucker et al. 1999). Further-more, fruits and vegetables are rich in vitamin C, Vitamin K, and certain B vitamins, which have also been associated with the maintenance of positive bone synthesis (Boeing et al. , 2012). However, it is difficult to draw specific findings from such studies, as any effects that may have been observed, may have occurred as a result of holistic dietary choices rather than individual nutrients (wider review appendices A).
Thus, this position stand cannot make recommendations for such nutrients. Some evidence has suggested physical activity can affect the degree to which certain nutrients impact skeletal health (Tucker, 2009). Turner and Pavalko (1998) found mineral retention was superior in participants that regularly took part in weight-bearing exercise. Thus, the effect of diet, and furthermore individual nutrients, may be superior when combined with weight-bearing exercise.
Branca and Silvia Vatuena (2004) suggested the anabolic effect of weight bearing exercise that occurs in bones after physical activity, relies heavily on adequate calcium and vitamin D intake. In addition, Prince et al. (1999) found in post-menopausal women, trials that utilised a comb-ination of calcium supplementation and exercise, resulted in superior increases of BMD. Future research should revise the effects of diet when used in conjunction with physical activity. There is relative error associated with the current methods for measuring osteoporosis (Winzen-berg et al., 2003).
From a clinical perspective, this is problematic as it could result in patients not receiving sufficient treatment (Prentice, 2004). From a research perspective, this is problematic as it be difficult accurately follow the implications of risk factors such as diet and physical activity. In addition, there is a significant lack of knowledge on the usability of BMD values within children and adolescents (Gafni and Baron, 2004). Thus, it is difficult to know how valuable recomm-endations which are designed for the adult population are in younger individuals.
In order to develop research on osteoporosis, it seems essential that methods that can identify the disease with a greater efficiency across the whole of the population are developed. In light of more accurate measurement techniques, research could also be developed within the context of nutrition and skeletal health. In conclusion, calcium and vitamin D intake may act as a modifiable risk factor in the prevention of osteoporosis. However, the size of effect gained from these nutrients is debatable.
Wider nutrients such as those identified in the position stand, are yet to be revised with enough focus to draw significant conclusions from. Future research needs to replicate the focus currently provided for calcium and vitamin D, so the isolated effects of other nutrients can be better understood. Bloomfield et al. (2004) suggested that a holistic approach controlling a multitude modifiable risk factors, could work with a greater effect size. Thus, future research could also look at controlling numerous factors such as, diet, physical activity, and hormone regulation simultaneously.