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Exercise, bone and nutrition

Published online by Cambridge University Press:  15 January 2013

Susan A. New*
Affiliation:
Centre for Nutrition and Food Safety, School of Biomedical and Life Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
*
Corresponding author: Dr Susan New, fax +44 1483 576978, email [email protected]
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Abstract

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Predisposition to poor skeletal health resulting in osteoporotic fracture is a major public health problem, the future economical impact of which is likely to be phenomenal. Two mechanisms principally determine adult bone health: (1) maximum attainment of peak bone mass (PBM); (2) the rate of bone loss with advancing age. Both aspects are regulated by a combination of endogenous and exogenous factors, and although genetic influences are believed to account for up to 75 % of the variation in bone mass, there is still room for modifiable factors to play a vital role. Weight-bearing physical activity is beneficial to the skeleton, but clarification of the exact type, intensity and duration required for optimum bone mass is needed. Excessive levels of exercise, which result in amenorrhoea, are detrimental to skeletal health. The importance of Ca to bone remains controversial. There is evidence that Ca is effective in reducing late post-menopausal bone loss, but more research is required on the long-term benefit of increased Ca intake on PBM attainment. Vitamin D ‘insufficiency’ appears to be widespread amongst population groups and is an area of considerable public health concern. The role of other micronutrients on bone metabolism remains to be fully quantified, but data from a combination of experimental, clinical and observational studies suggest a positive link between alkaline-forming foods and indices of bone health. The influence of nutrient–gene interactions on the skeleton requires further elucidation, but it may be useful in the future to target nutrition advice at those individuals who are genetically susceptible to osteoporosis.

Type
Clinical Metabolism and Nutrition Group Symposium on ‘Nutritional aspects of bone metabolism from molecules to organisms’
Copyright
Copyright © The Nutrition Society 2001

References

Alfredson, H, Nordstrom, P & Lorentzon, R (1997) Bone mass in volleyball players: a comparison of total and regional bone mass in female volleyball players and nonactive females. Calcified Tissue International 60, 338342.CrossRefGoogle ScholarPubMed
American College of Sports Medicine (1997) Position stand on the female athletic triad. Medicine and Science in Sports and Exercise 29, iix.CrossRefGoogle Scholar
Andon, MB, Lloyd, T & Matkovic, V (1994) Supplementation trials with calcium citrate malate: evidence in favour of increasing the calcium RDA during childhood and adolescence. Journal of Nutrition 124, 1412S1417S.Google Scholar
Appel, LJ, Moore, TJ, Obarzanek, E, Vallmer, WM, Svetkey, LP, Sacks, FM, Bray, GA, Vogt, TM & Cutler, JA (1997) A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine 336, 11171124.CrossRefGoogle ScholarPubMed
Barzel, US (editor) (1970) The role of bone in acid-base metabolism. In Osteoporosis, pp. 199206. New York: Grune & Stratton.Google ScholarPubMed
Barzel, US (1995) The skeleton as an ion exchange system: implications for the role of acid-base imbalance in the genesis of osteoporosis. Journal of Bone and Mineral Research 10, 14311436.CrossRefGoogle ScholarPubMed
Bassey, EJ & Ramsdale, SJ (1994) Increase in femoral bone density in young women following high impact exercise. Osteoporosis International 4, 7275.CrossRefGoogle ScholarPubMed
Bassey, EJ, Rothwell, MC, Littlewood, JJ & Pye, DW (1998) Pre and post-menopausal women have different bone mineral density responses to the same impact exercise. Journal of Bone and Mineral Research 13, 18051813.CrossRefGoogle Scholar
Black, DM, for the Joint NOF/ISCD/ASBMR Committee on Simplification of the BMD Reporting (2000) Revision of t-score BMD diagnostic threshold. Osteoporosis International 11, S58.Google Scholar
Bonjour, JP, Carrie, AL, Ferrari, S, Claven, H, Slosman, D, Theintz, G & Rizzoli, R (1997) Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized, double blind, placebo controlled trial. Journal of Clinical Investigations 99, 12871294.Google Scholar
Bonjour, JP, Theintz, G, Buchs, B, Slosman, D & Rizzoli, R (1991) Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. Journal of Clinical Endocrinology and Metabolism 73, 555563.Google Scholar
Bushinsky, DA (1998) Acid-base imbalance and the skeleton. In Nutritional Aspects of Osteoporosis '97. Proceedings of the 3rd International Symposium on Nutritional Aspects of Osteoporosis, Switzerland, 1997, pp. 208217 [Burckhardt, P, Dawson-Hughes, B and Heaney, RP, editors]. Rome, Italy: Ares-Serono Symposia Publications.Google Scholar
Cadogan, J, Eastell, R, Jones, N & Barker, M (1997) Milk intake and bone mineral acquisition in adolescent girls: randomised controlled intervention trial. British Medical Journal 315, 12551260.Google Scholar
Chapuy, MC, Arlot, ME, Duboeuf, F, Brun, J, Crouzet, B, Arnaud, S, Delmas, PD & Meunier, PJ (1992) Vitamin D and calcium to prevent hip fractures in elderly women. New England Journal of Medicine 327, 16371642.Google Scholar
Chapuy, MC, Preziosi, P, Maamer, M & Meunier, P (1997) Prevalence of vitamin D ‘insufficiency’ in an adult population. Osteoporosis International 7, 439443.Google Scholar
Consensus Development Conference (1991) Diagnosis, prophylaxis and treatment of osteoporosis. American Journal of Medicine 90, 107110.CrossRefGoogle Scholar
Consensus Development Conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. American Journal of Medicine 94, 646650.Google Scholar
Cooper, C (1999) Epidemiology of osteoporosis. Osteoporosis International 9, S2S8.Google Scholar
Cooper, C, Barker, DJP & Wickham, C (1988) Physical activity, muscle strength and calcium intake in fracture of the proximal femur in Britain. British Medical Journal 297, 14431446.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B, Dallal, GE, Krall, EA, Sadowski, L, Sahyoun, N & Tannenbaum, SA (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. New England Journal of Medicine 323, 878883.CrossRefGoogle Scholar
Dawson-Hughes, B, Harris, SS & Finneran, S (1995) Calcium absorption on high and low Ca intakes in relation to vitamin D receptor genotype. Journal of Clinical Endocrinology and Metabolism 80, 36573661.Google Scholar
Dawson-Hughes, B, Harris, SS, Krall, EA & Dallal, GE (1997) Effect of Ca and vitamin D supplementation on bone density in men and women 65 years of age or older. New England Journal of Medicine 337, 670676.CrossRefGoogle ScholarPubMed
Department of Health (1992) The Nutrition of Elderly People. Report on Health and Social Subjects no. 41. London: H.M. Stationery Office.Google Scholar
Department of Health (1998) Nutrition and Bone Health: with Particular References to Calcium and Vitamin D. Report on Health and Social Subjects no. 49. London: H.M. Stationery Office.Google Scholar
Dibba, B, Prentice, A, Ceesay, M, Stirling, DM, Cole, TJ & Poskitt, EM (2000) Effect of calcium supplementation on bone mineral accretion in Gambian children accustomed to a low-calcium diet. American Journal of Clinical Nutrition 71, 544549.CrossRefGoogle Scholar
Dodiuk, R, Rozen, GS, Rennert, G, Rennert, HS & Ish-Shalom, S (2001) Sustained effect of short-term Ca supplementation on bone mass in adolescents. In Nutritional Aspects of Osteoporosis 2000 [Burckhardt, P, Dawson-Hughes, B and Heaney, RP, editors]. New York: Springer-Verlag (In the Press).Google Scholar
Eastell, R (1999) Pathogenesis of postmenopausal osteoporosis. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 4th ed., pp. 260262 [American Society for Bone and Mineral Research, editors]. London: Lippincott, Williams & Wilkins.Google Scholar
Eaton-Evans, J, McIlrath, EM, Jackson, WE, Bradley, P & Strain, JJ (1993) Dietary factors and vertebral bone density in perimenopausal women from a general medical practice in Northern Ireland. Proceedings of the Nutrition Society 52, 44A.Google Scholar
El-Hajj-Fuleihan, GA, Nabulsi, M, Shoucair, M, Salamoun, M & Hajj Shahine, C (2000) Hypovitaminosis D in healthy school children. Journal of Bone and Mineral Research 15, S572.Google Scholar
Faulkner, KG, von Stetten, E & Orwoll, E (2000) T-score discrepancies in men at different skeletal sites. Osteoporosis International 11, S121.Google Scholar
Ferrari, SL, Garnero, P, Ahn-Luong, LE, Montgomery, H, Humphries, S & Greenspan, S (2000) A functional polymorphic variant in the IL-6 gene promoter associated with low bone resorption in postmenopausal women. Osteoporosis International 11, S147.Google Scholar
Finch, S, Doyle, W, Lowe, C, Bates, CJ, Prentice, A, Smithers, G & Clarke, PC (1998) National Diet and Nutrition Survey of People Aged 65 Years and Over. London: H.M. Stationery Office.Google Scholar
Food and Nutrition Board of the Institute of Medicine (1997) Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. Washington, DC: National Academy Press.Google Scholar
Francis, RM, Sutcliffe, AM & Scane, AC (1998) Pathogenesis of osteoporosis. In Osteoperosis, pp. 2952 [Stevenson, JC and Lindsay, R, editors]. London: Chapman & Hall Medical.Google Scholar
Frost, HM (1987) The mechanostat: a proposed pathogenic mechanism of osteoporosis and the bone mass effects of mechanical and non-mechanical agents. Bone and Mineral 2, 7385.Google Scholar
Frost, HM (1992) The role of changes in mechanical usage set points in the pathogenesis of osteoporosis. Journal of Bone and Mineral Research 7, 253261.Google Scholar
Gertner, JM (1999) Childhood and Adolescence. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed., pp. 4549 [American Society for Bone and Mineral Research, editors]. London: Lippincott, Williams & Wilkins.Google Scholar
Glastree, C, Braillon, P & David, L (1990) Measurement of bone mineral content of the lumbar spine by dual energy X-ray absorptiometry in normal children: correlations with growth parameters. Journal of Clinical Endocrinology and Metabolism 70, 13301333.Google Scholar
Grant, SF, Reid, DM & Ralston, SH (1996) Reduced bone density and osteoporosis associated with a polymorphic Sp1 binding site in the collagen type I alpha 1 gene. Nature Genetics 14, 203205.Google Scholar
Gregory, J, Lowe, S, Bates, CJ, Prentice, A, Jackson, LV, Smithers, G, Wenlock, R & Farron, M (2000) National Diet and Nutrition Survey of People Aged 4–18 Years, vol. 1. London: H.M. Stationery Office.Google Scholar
Guillemant, J, Allemandou, A, Peres, G & Guillemant, SE (2000) Wintertime vitamin D deficiency in male adolescents: response to vitamin D3 supplements. Journal of Bone and Mineral Research 15, S450.Google Scholar
Halioua, L & Anderson, JJB (1989) Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healthy premenopausal Caucasian women. American Journal of Clinical Nutrition 49, 534541.CrossRefGoogle ScholarPubMed
Heaney, RP (1994) The bone remodeling transient: implications for the interpretation of clinical studies of bone mass change. Journal of Bone and Mineral Research 9, 15151523.Google Scholar
Heaney, RP (2000) There should be a dietary guideline for calcium. American Journal of Clinical Nutrition 71, 658670.Google Scholar
Hennig, TM (2000) Difference between t-score of lumbar spine and hip as an indicator for perimenopausal bone loss. Osteoporosis International 11, S138.Google Scholar
Holick, MF (2000) Microgravity-induced bone loss – will it limit human space exploration? Lancet 355, 15691570.Google Scholar
Johnson, CC, Millar, JZ, Slemenda, CW, Reister, TK, Hui, S, Christian, JC & Peacock, M (1992) Calcium supplementation and increases in bone mineral density in children. New England Journal of Medicine 327, 8287.Google Scholar
Johnson, CC & Slemenda, CW (1998) Pathogenesis of postmenopausal osteoporotic fractures. In Osteoporosis, pp. 5364 [Stevenson, JC and Lindsay, R, editors]. London: Chapman Hall Medical.Google Scholar
Jones, HH, Priest, JD, Hayes, WC, Tichenor, CC & Nagel, DA (1977) Humeral hypertrophy in response to exercise. Journal of Bone and Joint Surgery 59A, 204208.CrossRefGoogle Scholar
Jonsson, B, Ringsberg, K, Josefsson, PO, Johnell, O & Birch-Jensen, M (1992) Effects of physical training on bone mineral content and muscle strength in women: a cross-sectional study. Bone 13, 191195.Google Scholar
Kanis, JA (1994) Calcium nutrition and its implications for osteoporosis. Part I: Children and healthy adults. European Journal of Clinical Nutrition 48, 757e767.Google Scholar
Kanis, JA & Passmore, R (1989 a) Calcium supplementation of the diet I and II. British Medical Journal 298, 137140.Google Scholar
Kanis, JA & Passmore, R (1989 b) Calcium supplementation of the diet I and II. British Medical Journal 298, 205208.CrossRefGoogle Scholar
Keay, N (2000) The modifiable factors affecting bone mineral accumulation in girls: paradoxical effect of exercise on bone. British Nutrition Foundation Nutrition Bulletin 25, 219222.CrossRefGoogle Scholar
Klibanski, A, Biller, BMK & Schoenfeld, DA (1995) The effects of oestrogen administration on trabecular bone loss in young women with anorexia nervosa. Journal of Clinical Endocrinology and Metabolism 80, 898904.Google Scholar
Kobayashi, S, Inoue, S, Hosoi, T, Ouchi, Y, Shiraki, M & Orimo, H (1996) Association of bone mineral density with polymorphism of the estrogen receptor gene. Journal of Bone and Mineral Research 11, 306311.CrossRefGoogle ScholarPubMed
Kohrt, W, Snead, D, Slatopolsky, E & Birge, SJ (1995) Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women. Journal of Bone and Mineral Research 10, 13031311.Google Scholar
Kohrt, W, Ehsani, A & Birge, SJ (1997) Effects of exercise involving predominantly either joint-reaction or ground-reaction forces on bone mineral density in older women. Journal of Bone and Mineral Research 12, 12531261.Google Scholar
Kriska, AM, Sandler, RB, Cauley, JA, LaPorte, RE, Hom, DL & Pambionco, G (1988) The assessment of historical physical activity and its relation to bone parameters. American Journal of Epidemiology 127, 10531061.CrossRefGoogle ScholarPubMed
Lambert, HL, Eastell, R & Barker, ME (2000) Calcium supplementation in teenage girls: effects on bone mineralisation and biochemical markers of bone turnover over 18 months. Journal of Bone and Mineral Research 15, S187.Google Scholar
Lau, E, Donnan, S, Barker, DJP & Cooper, C (1988) Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. British Medical Journal 297, 14411443.CrossRefGoogle ScholarPubMed
Lee, WTK, Leung, SSF, Leung, DMY & Cheung, JCY (1996) A follow-up study on the effects of calcium withdrawal and puberty on bone acquisition of children. American Journal of Clinical Nutrition 64, 7177.CrossRefGoogle Scholar
Lee, WTK, Leung, SSF, Leung, DMY, Wang, S-H, Xu, Y-C, Zeng, WP & Cheung, JCY (1997) Bone mineral acquisition in low calcium intake children following the withdrawal of calcium supplement. Acta Paediatrica 86, 570576.CrossRefGoogle ScholarPubMed
Lee, WTK, Leung, SSF, Wang, SH, Yu, YC, Zeng, WP, Lau, J, Oppenheimer, SJ & Cheung, JCY (1994) Double blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. American Journal of Clinical Nutrition 60, 744750.Google Scholar
Lee, WTK, Leung, SSF, Wang, SH, Zeng, WP, Lau, J & Fairweather-Tait, SJ (1995) Effects of double-blind controlled calcium supplementation on calcium absorption in Chinese children measured with stable isotopes (42 Ca and 44 Ca). British Journal of Nutrition 73, 311321.Google Scholar
Lips, P, Graafmans, WC, Ooms, ME, Bezemer, D & Bouter, LM (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Annals of Internal Medicine 124, 400406.Google Scholar
Lloyd, T, Andon, M, Rollings, N, Andon, MB, Kulin, H, Demers, LM, Eggli, D, Kieselhorst, K & Chinchilli, VML (1993) Calcium supplementation and bone mineral density in adolescent girls. Journal of the American Medical Association 270, 841844.CrossRefGoogle ScholarPubMed
Lohman, T, Going, S, Pamenter, R, Hall, M, Boyden, T, Houtkopper, L, Ritenbaugh, C, Bare, L, Hill, A & Aickin, M (1995) Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomised prospective study. Journal of Bone and Mineral Research 10, 10151024.Google Scholar
Lutz, J & Tesar, R (1990) Mother:daughter pairs: spinal and femoral neck bone densities and dietary intakes. American Journal of Clinical Nutrition 52, 872877.CrossRefGoogle ScholarPubMed
Macdonald, HM, New, SA, McGuigan, FE, Golden, MHN, Ralston, SH, Grubb, DA & Reid, DM (2000 a) Femoral neck bone loss and dietary Ca intake in peri and early postmenopausal women: an association dependent on VDR genotype. Journal of Bone and Mineral Research 15, S202.Google Scholar
Macdonald, HM, New, SA, McGuigan, FE, Golden, MHN, Ralston, SH, Grubb, DA & Reid, DM (2000 b) Modest alcohol intake reduces bone loss in peri and early postmenopausal Scottish women: an effect dependent on estrogen receptor genotype? Bone (In the Press).Google Scholar
McClung, M, Ross, PD, Christiansen, C, Hosking, D, Thompson, D & Yates, J for the EPIC Research Group (2000) Consistency and changes in T-score categories over 4 years among early postmenopausal women. Osteoporosis International 11, S141.Google Scholar
Marcus, R (1999) Physical activity and regulation of bone mass. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 4th ed., pp. 262264 [American Society for Bone and Mineral Research, editors]. London: Lippincott, Williams & Wilkins.Google Scholar
Menke, A, Mazel, S & Redmond, RA (1993) Strength training increases regional bone mineral density and bone remodelling in middle-aged and older men. Journal of Applied Physiology 74, 24782484.Google Scholar
Meyer, HE, Falch, JA, Kvaavik, E, Smedshaug, GB, Tverdal, A & Pedersen, JI (2000) Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomised controlled trial. Osteoporosis International 11, S114.Google Scholar
Michaelsson, K, Holmberg, L, Maumin, H, Wolk, A, Bergstrom, R & Ljunghall, S (1995) Diet, bone mass and osteocalcin; a cross-sectional study. Calcified Tissue International 57, 8693.Google Scholar
Morrison, NA, Qi, JC, Tokita, A, Kelly, L & Eisman, JA (1994) Prediction of bone density in vitamin D receptor alleles. Nature 367, 284287.Google Scholar
Mundy, GR (1999) Bone remodelling. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 4th ed., pp. 3038 [American Society for Bone and Mineral Research, editors]. London: Lippincott, Williams & Wilkins.Google Scholar
National Osteoporosis Society (1996) ‘Fit but Fragile’ – Advice on Bone Health for Young Women Athletes and Dancers, Their Coaches and Teachers. Bath, Avon: National Osteoporosis Society.Google Scholar
National Osteoporosis Society (2000). Facts and Figures on Osteoporosis. Bath, Avon: National Osteoporosis Society.Google Scholar
New, SA (1998) ‘Fit but Fragile’ – are elite sportswomen at an increased risk of osteoporosis? British Nutrition Foundation Nutrition Bulletin 23, 211213.Google Scholar
New, SA (1999) Bone health: the role of micronutrients. British Medical Bulletin 55, 619633.Google Scholar
New, SA (2001 a) Diet and osteoporosis – where are we now? Proceedings of the 1st Nutrition and Health Conference (In the Press).Google Scholar
New, SA (2001 b) Fruit & Vegetable Consumption and Skeletal Health – Is There a Positive Link? British Nutrition Foundation Nutrition Bulletin (In the Press).Google Scholar
New, SA (2001 c) Impact of food clusters on bone. In Nutritional Aspects of Osteoporosis 2000 [Burckhardt, P, Dawson-Hughes, B, and Heaney, RP, editors]. New York: Springer-Verlag (In the Press).Google Scholar
New, SA, Bolton-Smith, C, Grubb, DA & Reid, DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. American Journal of Clinical Nutrition 65, 18311839.Google Scholar
New, SA, Nurmi, JA, Bishop, JA, Carr-Bains, S, Taylor, P & Cooper, C (2000 a) Are British female gymnasts ‘Fit but Fragile’? Osteoporosis International 11, S20.Google Scholar
New, SA, Robins, SP, Campbell, MK, Martin, JC, Garton, MJ, Bolton‐Smith, C, Grubb, DA, Lee, SJ & Reid, DM (2000 b) Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? American Journal of Clinical Nutrition 71, 142151.Google Scholar
New, SA, Smith, R, Foulds, E & Reid, DM (1998) Associations between present dietary intake and bone health in elderly Scottish men and women. In Current Research in Osteoporosis and Bone Mineral Measurement, vol. 5, p. 3 [Ring, EFJ, Elvins, DM and Bhalla, AK, editors]. London: British Institute of Radiology.Google Scholar
Nordin, BEC & Heaney, RP (1990) Calcium supplementation of the diet is justified by present evidence. British Medical Journal 300, 10561060.Google Scholar
Nowson, CA, Green, RM, Hopper, JL, Sherwin, AJ, Young, D, Kaymakci, B, Guest, CS, Smid, M, Larkins, RG & Wark, JD (1997) A co-twin study of the effect of calcium supplementation on bone density during adolescence. Osteoporosis International 7, 219225.Google Scholar
O'Shea, B, Rosen, CJ, Guyatt, G, Cranney, A, Tugwell, P & Black, D for the Osteoporosis Research Advisory Group (2000) A meta‐analysis of Ca supplementation for the prevention of postmenopausal osteoporosis. Osteoporosis International 11, S114.Google Scholar
Pocock, NA, Eisman, JA, Gwinn, TH, Sambrook, PN, Yeates, MG & Freud, J (1989) Mechanical load and the skeleton: the interaction of regional muscle strength, physical fitness and weight with bone mass. Journal of Bone and Mineral Research 4, 441448.Google Scholar
Pocock, NA, Eisman, JA, Hopper, JL, Yeates, MG, Sambrook, PN & Ferri, S (1987) Genetic determinants of bone mass in adults. Journal of Clinical Investigation 80, 706710.CrossRefGoogle ScholarPubMed
Prentice, A (1997) Is nutrition important in osteoporosis? Proceedings of the Nutrition Society 56, 357367.Google Scholar
Puliyel, JM, Agarwal, K, Upadhyay, P, Mawer, EB, Berry, JL & Mughal, Z (2000) The impact of atmospheric pollution related haze on vitamin D status of two-year-olds in Delhi, India. Journal of Bone and Mineral Research 15, S356.Google Scholar
Ralston, SH (1999) The genetics of osteoporosis. Bone 25, 8586.Google Scholar
Recker, RR, Davies, MK, Hinders, SM, Heaney, RP, Stegman, MR & Kimmel, DB (1992) Bone gain in young adult women. Journal of the American Medical Association 268, 24032408.Google Scholar
Robinson, TL, Snow-Harter, C, Taafe, DR, Gillis, D, Shaw, J & Marcus, R (1995) Gymnasts exhibit higher bone mass than runners despite similar prevalence of amenorrhoea and oligoamenorrhoea. Journal of Bone and Mineral Research 10, 2635.CrossRefGoogle Scholar
Shearer, MJ (1997) The roles of vitamins D and K in bone health and osteoporosis prevention. Proceedings of the Nutrition Society 56, 915937.Google Scholar
Slemenda, CW & Johnson, CC (1993) High intensity activities in young women: site specific bone mass effects among female figure skaters. Bone and Mineral 20, 125132.Google Scholar
Slemenda, CW, Miller, JZ, Hui, SL, Reister, TK & Johnson, CC Jr (1991) Role of physical activity in the development of skeletal mass in children. Journal of Bone and Mineral Research 6, 12271233.CrossRefGoogle ScholarPubMed
Slemenda, CW, Reister, TK, Peacock, M & Johnson, CC (1993) Bone growth in children following cessation of Ca supplementation. Journal of Bone and Mineral Research 8, S154.Google Scholar
Snow-Harter, C, Bouxsein, ML, Lewis, BT, Carter, DR & Marcus, R (1992) Effects of resistance and endurance exercise on bone mineral status of young women: a randomized exercise intervention trial. Journal of Bone and Mineral Research 7, 761769.Google Scholar
Specker, BL (2000) Should there be a dietary guideline for calcium intake? No. American Journal of Clinical Nutrition 71, 661664.Google Scholar
Specker, BL, Brazerol, W & Tsang, RC (1987) Bone mineral content in children 1–6 years of age. American Journal of Diseases in Children 141, 343344.Google Scholar
Stear, SJ, Prentice, A, Jones, SC & Cole, TJ (2000 a) Impact of a calcium and exercise intervention on bone mineral status of female adolescents. Osteoporosis International 11, S84.Google Scholar
Stear, SJ, Prentice, A, Jones, SC & Cole, TJ (2000 b) Bone mineral status of female adolescents 14 months after the cessation of a calcium and exercise intervention. Osteoporosis International 11, S84.Google Scholar
Theintz, G, Rizzoli, R & Bonjour, JP (1992) Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of the lumbar spine and femoral neck in female subjects. Journal of Clinical Endocrinology and Metabolism 75, 10601065.Google Scholar
Toba, Y, Takada, Y, Yamamura, J, Tanaka, M, Matsuoka, Y, Kawakami, H, Itabashi, A, Aoe, S & Kumegawa, M (2000) Milk basic protein: a novel protective function of milk against osteoporosis. Bone 27, 403408.Google Scholar
Torgerson, DJ, Iglesias, C & Reid, DM (2000) Economics of osteoporosis. Key Advance Series (In the Press).Google Scholar
Tucker, KL, Hannan, MT, Chen, H, Cupples, A, Wilson, PWF & Kiel, DP (1999) Potassium and fruit & vegetables are associated with greater bone mineral density in elderly men and women. American Journal of Clinical Nutrition 69, 727736.Google Scholar
Tylavsky, FA, Anderson, JJB, Talmage, RV & Taft, TN (1992) Are calcium intakes and physical activity during adolescence related to radial bone mass of white college-age females? Osteoporosis International 2, 232240.Google Scholar
Vico, L, Collet, P, Guignandon, A, Lafage-Proust, MH, Thomas, T, Rehaillia, M & Alexandre, C (2000) Effects of long-term microgravity exposure on cancellous and cortical weight-bearing bones of cosmonauts. Lancet 355, 16071611.Google Scholar
Wachman, A & Bernstein, DS (1968) Diet and osteoporosis. Lancet i, 958959.Google Scholar
Weaver, CM (1999) Nutrition and bone health: the US perspective. British Nutrition Foundation Nutrition Bulletin 24, 122124.Google Scholar
Wolman, RL, Faulman, L, Clark, P, Hesp, R & Harries, MG (1991) Different training patterns and bone mineral density of the femoral shaft in elite female athletes. Annals of the Rheumatic Diseases 50, 487489.Google Scholar
World Health Organization (1994) Study Group on Assessment of Fracture Risk and Its Application to Screening and Postmenopausal Osteoporosis. Report of a WHO Study Group. Technical Report Series no. 84. Geneva: WHO.Google Scholar
Zanker, CL & Swaine, IL (1998) Bone turnover in amenorrhoeic and eumenorrhoeic women distance runners. Scandinavian Journal of Medical Science in Sport 8, 2026.CrossRefGoogle ScholarPubMed
Zumda, J, Cauley, J, Stone, K, Nevitt, M, Ensrud, K, Harris, E, Hochberg, M, Morin, P, Saiz, R, Joslyn, G & Cummings, SR (2000) An interleukin 6 promoter polymorphism is associated with hip bone loss in older women. Osteoporosis International 11, S58.Google Scholar