1) Division of Bodily Remedy, Faculty of Well being Science,
Eulji College, Republic of Korea
2) Division of Meals and Vitamin, Faculty of Bionano
Expertise, Gachon College: 1342 Seongnam-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do
461-701, Republic of Korea
Summary
INTRODUCTION
Osteoporosis is a power, asymptomatic, and osteometabolic illness characterised by
decreased bone mass and microarchitectural alterations of bone tissue1, 2). It’s thought-about a
complicated well being drawback as a result of it’s related to poor bone high quality and elevated facture
risk2). Specifically, fractures within the
aged related to osteoporosis can induce musculoskeletal issues, power ache, and
impairment of actions of day by day dwelling, resulting in deterioration in high quality of life and
socioeconomic status3). Osteoporosis is
thought to have an effect on greater than 200 million individuals within the world4). In Korea, an estimated 200,000 individuals had been affected by this illness
in 2010 in response to the Korean Group Well being Survey5).
The pathogenic mechanisms of bone mineral density loss in osteoporosis are associated to
growing older. It’s well-known that a very powerful issue for osteoporosis in ladies is the
menopause, as a result of the lower in estrogen attributable to lack of ovarian perform interrupts
the steadiness between bone resorption and formation6,
7). In males, growing older additionally decreases bone
mineral density as a result of discount in testosterone8). Subsequently, these intercourse hormones are thought to be a essential indicator
for the prediction and prevention of osteoporosis-related fractures within the elderly6, 8).
Many pharmacological and non-pharmacological methods can utilized to stop osteoporosis
and its associated issues, together with adequate dietary consumption of calcium and nutritional vitamins,
bodily exercise, and varied interventions to stop bone loss1). Calcium and vitamin D are thought to be particularly vital
components in anti-osteoporotic medications9).
Current research have reported that vitamin C supplementation additionally performs a key function within the
prevention of osteoporosis in humans10).
Vitamin C capabilities as a major antioxidant to take away reactive oxygen and nitrogen species,
lowering oxidative stress, which is expounded to osteoporosis11).
Bodily exercise can be broadly often called an efficient issue to cut back bone mass loss in
the aged. Nevertheless, bodily exercise would possibly improve the manufacturing of reactive oxygen and
nitrogen species by the contraction processes of skeletal muscle tissue. This phenomenon
limits the bodily activity-induced constructive effect11). Thus, the mix of bodily exercise and vitamin C
supplementation within the aged could also be vital to stop osteoporosis, as a result of the aged
have further difficulties in neutralizing reactive species as a result of growing older. Nevertheless, present
proof on the results of bodily exercise and vitamin C supplementation on osteoporosis
isn’t adequate. Subsequently, the aim of the current examine was to analyze the
affiliation between vitamin C consumption and osteoporosis prevalence amongst Korean women and men
aged 50 years and over. As well as, this affiliation was examined in subgroups by stage of
bodily exercise.
SUBJECTS AND METHODS
This examine was based mostly on the bone mineral density measurement information from the 2008, 2009,
2010, and 2011 Korean Nationwide Well being and Dietary Examination Survey (KNHANES), which
was supplied by the Korea Facilities for Illness Management and Prevention (KCDC). Bone mineral
density was measured from July 2008 to June 2009 for topics aged 19 and over and from July
2009 to Could 2011 for topics aged 10 and over. We used the “dx_ost” variable to outline
osteoporosis, which was supplied within the dataset. The variable of dx_ost was used for the
standards and grouping of osteoporosis for these of their fifties and over. Within the case of
ladies, solely menopausal ladies had been included within the evaluation. Total, 2,078 topics had been
categorized as having osteoporosis (T-score ≤ −2.5), 4,076 as having osteopenia (−2.5 <
T-score < −1.0), and the remaining 2,272 as regular (T-score ≥ −1.0), as proven within the
2008–2011 KNHANES dataset. We excluded those that had been recognized with or had been receiving
therapy for osteoporosis on the time of the survey with a view to scale back any causal
relationship. We additionally excluded these with osteopenia with a view to consider the affiliation
between osteoporosis and vitamin C consumption. The variety of topics who participated within the
well being examination was 1,523 for the osteoporosis group and a couple of,131 for the conventional group.
Amongst them, the individuals who reported excessive day by day whole power consumption ranges (<
500 kcal or ≥ 6,000 kcal per day) (n = 3,286) had been excluded. We additional excluded topics
with lacking data relating to earnings, training stage, postmenopausal hormone use,
bodily exercise, and vitamin D ranges. Total, 3,047 topics had been included within the ultimate
evaluation. The examine was carried out in accordance with the Moral Rules for Medical
Analysis Involving Human Topics, as outlined by the Declaration of Helsinki. All examine
topics had been supplied with written knowledgeable consent for the survey. Figuring out data
was faraway from all information used within the examine.
RESULTS
The fundamental traits in response to prevalence of osteoporosis are offered in Desk 1. Among the many 3,047 topics, the numbers of topics within the regular (T-score ≥
−1.0) and the osteoporosis teams (T-score ≤ −2.5) had been 1,835 and 1,212, respectively. There
had been vital variations in most variables together with age (regular group, 60.2 ± 0.2 vs.
osteoporosis group, 69.0 ± 0.3 years), BMI (25.0 ± 0.1 vs. 22.9 ± 0.1 kg/m2),
dietary power consumption (2,093.8 ± 18.2 vs. 1,547.9 ± 16.7 kcal/day), vitamin C (113.1 ± 2.0
vs. 81.0 ± 2.1 mg/day) and calcium intakes (567.8 ± 8.8 vs. 378.9 ± 8.1 mg/day), and serum
vitamin D ranges (21.0 ± 0.2 vs. 18.8 ± 0.2 ng/ml) between the conventional and the osteoporosis
teams (p < 0.0001). The proportion of topics who had been male (75.3 vs. 20.1%) or who
had been ladies with postmenopausal hormone use (24.1 vs. 6.2%), had been considerably totally different
between the 2 teams (p < 0.0001). Furthermore, there have been vital variations in
phrases of earnings, training stage, smoking, and bodily exercise between the 2 teams (p
< 0.0001); however, there was no difference with respect to alcohol drinking frequency (p
> 0.05).
Within the non-physical exercise and common bodily exercise teams, vitamin C intakes had been
categorized into quartiles for every group. Desk
2 reveals the affiliation between vitamin C consumption and osteoporosis prevalence in
all topics and within the subgroups by the presence of bodily exercise. Among the many 1,212
topics within the osteoporosis group, 578 carried out day by day common bodily exercise, while
634 didn’t.
Vitamin C consumption was analyzed in response to consumption quartile. Within the general cohort, the
first quartile outlined as dietary vitamin C consumption < 45.0 mg/day (median, 28.3), the
second as ≥ 45.0 and < 77.6 mg/day (median 61.7), the third as ≥ 77.6 and <
128.0 mg/day (median 99.9), and the fourth as ≥ 801.5 mg/day (median 187.5). The general
prevalence of osteoporosis was 452, 308, 250, and 202 in every quartile respectively. Within the
non-physical exercise group, the primary quartile was outlined as having a dietary vitamin C
consumption of < 42.0 mg/day (median, 25.9), the second as ≥ 42.1 and < 75.0 mg/day (median
57.4), the third as ≥ 75.0 and < 121.2 mg/day (median 93.1), and the fourth as ≥
684.7 mg/day (median 174.8). The prevalence of osteoporosis was 236, 155, 136, and 107 in
every quartile respectively for the non-physical exercise group. Within the common bodily
exercise group, the primary quartile was outlined as having a dietary vitamin C consumption <
48.0 mg/day (median, 30.7), the second as ≥ 48.0 and < 81.0 mg/day (median 64.3), the
third as ≥ 81.0 and < 134.4 mg/day (median 104.7), and the fourth as ≥ 801.5 mg/day
(median 198.2). The prevalence of osteoporosis was 215, 142, 120, and 101 in every quartile
respectively for the bodily exercise group.
Of the entire topics with osteoporosis, in comparison with the primary quartile, the second, third
and the best quartiles confirmed a decrease chance of growing osteoporosis with odds
ratios of 0.66 (95% Wald’s confidence intervals (CI), 0.50–0.88), 0.55 (95% CI, 0.42–0.74),
and 0.46 (95% CI, 0.34–0.61) respectively after adjusting for age and gender. Within the
topics with no bodily exercise, in comparison with the primary quartile, the remainder of the
quartiles displayed a decrease chance of growing osteoporosis with odds ratios of 0.53
(95% CI, 0.34–0.81), 0.49 (95% CI, 0.32–0.75), and 0.40 (95% CI, 0.26–0.62) respectively
after adjusting for age and gender. Within the topics with bodily exercise, in comparison with the
first quartile, the remainder of the quartiles confirmed a decrease chance of growing
osteoporosis, with odds ratios of 0.75 (95% CI, 0.53–1.10), 0.63 (95% CI, 0.43–0.92), and
0.54 (95% CI, 0.36–0.80) after adjusting for age and gender.
All the p values for developments had been vital within the age and gender-adjusted fashions as
seen above. Within the multi-variate mannequin, larger intakes of vitamin C had been considerably
related to a decreased prevalence of osteoporosis for all topics (OR = 83; 95% CI:
0.60–1.14 for the second quartile, OR = 0.77; 95% CI: 0.55–1.09) for the third quartile, OR
= 0.67; 95% CI: 0.47–0.97 for the best quartile, p for development = 0.0371). The percentages ratio
and 95% confidence intervals for the chance of growing osteoporosis within the
non-physical exercise group decreased to 0.66 (95% CI, 0.41–1.08), 0.57 (95% CI, 0.34–0.95),
and 0.46 (95% CI, 0.27–0.79) in response to vitamin C consumption stage. This development was vital
within the non-physical exercise group (p for development = 0.0046). Nevertheless, there was no such
vital affiliation within the bodily exercise group (OR = 0.98; 95% CI: 0.63–1.52 for the
second quartile, OR = 1.00; 95% CI: 0.63–1.62 for the third quartile, OR = 0.97; 95% CI:
0.58–1.64 for the best quartile, p for development = 0.9418) in comparison with the bottom quartile.
The significances for all of the fashions had been vital (p < 0.0001) and the c statistic as
the reason of the facility of the mannequin was between 0.83 and 0.91.
DISCUSSION – “vitamin c calcium”
Osteoporosis is a fancy well being drawback as a result of it’s related to poor bone high quality
and elevated facture danger. It’s associated to growing older and intercourse hormones together with estrogen are
thought to be essential indicators to manage bone density loss and to develop methods to
forestall osteoporotic fractures within the aged. Furthermore, the connection between bodily
exercise and vitamin C supplementation within the aged is vital within the prevention and
prevalence of osteoporosis. Nevertheless, reviews concerning the results of bodily exercise and
vitamin C supplementation on osteoporosis usually are not adequate. Subsequently, the aim of the
current examine was to analyze the affiliation between vitamin C consumption and osteoporosis
prevalence amongst Korean women and men aged 50 and over, and additional to analyze this
affiliation in subgroups categorized by the presence of bodily exercise.
The pathological mechanism of osteoporosis entails age, hormonal, dietary,
environmental, and genetic and life model components, amongst others9). The outcomes of the current examine confirmed that vital
variations between the conventional and osteoporosis teams had been current in environmental and
life model components together with month-to-month family earnings, training stage, and smoking.
Furthermore, there have been vital variations had been current between the conventional and
osteoporosis teams in consumption of dietary calcium and serum vitamin D. Earlier research
confirmed that lack of free 25 (OH) vitamin D is concerned in bone loss. Calcium is vital to
forestall bone loss, and calcium absorption is affected by vitamin D8, 13). Accordingly,
these two components affect osteoporosis, which was proven in our outcomes.
The outcomes of the current examine confirmed that vital variations between the conventional and
osteoporosis teams had been current in age and gender ratio. Age-related bone loss is expounded
to decreased ranges of intercourse hormones and lots of research have reported the results of the
menopause on osteoporosis in women8). The
lower of estrogen in postmenopausal ladies induces a rise in bone turnover, which is
related to a discount in bone formation on the mobile stage. The imbalance between
bone formation and resorption results in osteoporosis14). This phenomenon may happen as a result of a decline in estrogen, which
acts as pure antioxidant. Oxidative stress influences bone loss throughout growing older in each
ladies and men6, 15). Subsequently, the dietary consumption of antioxidants is taken into account
to profit osteoporosis in women and men with estrogen deficiency as a result of they assist to
lower oxidative stress inside the body7).
On this respect, vitamin C consumption could play an vital function within the prevention of
osteoporosis within the elderly16). Our
outcomes confirmed that the prevalence of osteoporosis was diminished with rising vitamin C
consumption ranges. Arslan et al.17) advised
that vitamin C supplementation could present alterations relating to enchancment in oxidative
stress and bone mineral density values. As well as, it was reported that vitamin C promotes
the formation of collagen and the rise of calcium absorption10). The mechanical molecule signaling of vitamin C on bone
density has not but been investigated correctly; nonetheless, vitamin C may need a essential
function in prevention of bone loss by osteoclasts and within the stimulation of bone formation by
osteoblasts11). Its inhibitory results
on bone loss are associated to suppression of the receptor activator of nuclear issue κ-B
ligand (RANKL), Runx2 promoter that has a key function in osteoclast differentiation, and
peroxisome proliferator activated receptor gamma (PPARγ) which induces the transition of
osteoblasts to adipocyte6, 18, 19). Furthermore,
vitamin C additionally inhibits the nuclear issue kappa-light-chain enhancer of activated B cell
(NF-κB) proteins for osteoclastogenesis, that are activated oxidative stress6).
Within the current outcomes, the prevalence of osteoporosis in bodily lively people was
diminished by rising vitamin C consumption; nonetheless, there weren’t vital within the worth
to regulate for age, gender, earnings, training, smoking behavior, alcohol consuming frequency,
postmenopausal hormone use, power and calcium intakes, and blood vitamin D stage. Bodily
exercise has preventive results on age-related bone mass loss1, 20). Moreover, bodily
exercise helps bone formation and enhances the bone density21). Nevertheless, these helpful results could possibly be restricted by bodily
activity-induced oxidative stress within the aged. Train produces oxidative stress throughout
contraction of skeletal muscle22).
Though the results of oxidative stress throughout train are lowered by adaptive responses
in younger individuals, these adaptive responses diminish with aging23). Therefore, antioxidant vitamins are required in exercising aged
topics for his or her helpful impact on bone mineral density24). Nevertheless, it was reported that this associative impact was not
noticed when combining resistance coaching with antioxidant dietary supplements corresponding to calcium,
vitamin D, vitamin E, and vitamin C23),
which has similarities to our outcomes. These details indicate that the mix of bodily exercise
and vitamin C consumption doesn’t essentially induce constructive results on osteoporosis in
sufferers aged 50 years and over.
The goal of the current examine was to verify that the prevalence of osteoporosis was
diminished with rising ranges of vitamin C consumption. Nevertheless, combining vitamin C consumption
with bodily exercise didn’t considerably lower the prevalence of osteoporosis in
Korean women and men aged 50 years and over. For the advance and prevention of
osteoporosis, extra research are wanted into acceptable nutritional vitamins and bodily exercise for
the aged.
Acknowledgments
REFERENCES