Inhibition of markers of bone resorption by consumption of vitamin D and calcium-fortified soft plain cheese by institutionalised elderly women

Acceleration of bone remodelling increases the risk of fragility fractures. The objective of the present study was to explore in elderly women whether a vitamin D and Ca-forlified dairy product providing about 17-25% of the recommended intakes in vitamin D, Ca and proteins would reduce secondary hyperparathyroidism and bone remodelling in a way that may attenuate age-related bone loss in the long term. Thirty-seven institutionalised women, aged 84-8 (SD 8-1) years, with low serum 25-hydroxyvitamin D (5-5 (SD 1-7) ng/ml) were enrolled into a multicentre open trial to consume during I month two servings of soft plain cheese made of semi-skimmed milk providing daily 686 kJ (164 kcal), 2.5 mu g vitamin D, 302 mg Ca and 14.2 g proteins. The primary endpoint was the change in serum carboxy terminal cross-linked telopeptide of type I collagen (CTX), selected as a marker of bone resorption. Thirty-five subjects remained compliant. Mean serum changes were: 25-hydroyvitamin D, + 14.5% (P=0.0051); parathyroid hormone (PTH), - 12.3% (P=0.0011); CTX, -7.5% (P 0-01); tartrate-resistant acid phosphatase isoform 5b (TRAP 5b), -9.9% (P<0-0001); albumin, +6.2% (P<0.0001); insulin-like growth factor-I (IGF-I), + 16.9% (P<0.0001); osteocalcin, +8.3 % (P=0.0166); amino-terminal propeptide of type I procollagen (PINP), + 19.3% (P=0.0031). The present open trial suggests that fortified soft plain cheese consumed by elderly women with vitamin D insufficiency can reduce bone resorption markers by positively influencing Ca and protein economy, as expressed by decreased PTH and increased IGF-I, respectively. The rise in the bone formation marker PINP could be explained by a protein-mediated increase in IGF-I. Thus, such a dietary intervention might uncouple, at least transiently, bone resorption from bone formation and thereby attenuate age-related bone loss.