Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density

Eur J Clin Nutr. 2003 Apr;57(4):554-65. doi: 10.1038/sj.ejcn.1601577.


Objective: Nutrition is an important factor in the prevention and treatment of osteoporosis. Our goal was to examine the relationship between various nutrients and bone mass of several skeletal sites in elderly women, taking into account possible confounding variables.

Design/methods: A cross-sectional study in 136 healthy Caucasian, postmenopausal women, free of medications known to affect bone was carried out. Bone mineral density (BMD) and body composition (lean and fat tissue) were measured by dual X-ray absorptiometry using specialized software for different skeletal sites. Parathyroid hormone (PTH) and vitamin D, 25(OH)D, as possible confounders, were determined in serum samples. Dietary intake, including all supplements, was assessed by 3-day dietary record and analyzed using Food Processor. Past physical activity and present walking were examined as well and accounted for as potential confounders. Simple and multiple regression models were created to assess the relationships between nutrients and BMD. To examine the co-linear variables and their possible independent association with bone, subgroup analyses were performed.

Results: : Showed independent influence of calcium, energy, and protein, examined separately and in multiple regression models on BMD of several skeletal sites. Magnesium, zinc and vitamin C were significantly related to BMD of several skeletal sites in multiple regression models (controlled for age, fat and lean tissue, physical activity and energy intake), each contributing more than 1% of variance. Serum PTH and 25(OH)D did not show significant association with bone mass.

Conclusions: Despite the cross-sectional nature of our study we were able to show a significant relationship between BMD and several critical nutrients: energy, protein, calcium, magnesium, zinc and vitamin C. The exact involvement of these nutrients and their clinical significance in bone health need to be further elucidated in humans and conclusions about the effects of a single nutrient on bone mass must be given cautiously, taking into account its interaction and co-linearity with others. Understanding relationships among nutrients, not just limited to calcium and vitamin D, but others that have not been investigated to such extent, is an important step toward identifying preventive measures for bone loss and prevention of osteoporosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aging*
  • Ascorbic Acid / administration & dosage
  • Bone Density*
  • Calcium / blood
  • Calcium, Dietary / administration & dosage*
  • Cross-Sectional Studies
  • Dietary Proteins / administration & dosage*
  • Energy Intake*
  • Exercise
  • Female
  • Humans
  • Magnesium / administration & dosage
  • Middle Aged
  • Nutritional Physiological Phenomena*
  • Nutritional Status
  • Osteoporosis, Postmenopausal / prevention & control
  • Parathyroid Hormone / blood
  • Postmenopause
  • Regression Analysis
  • Vitamin D / blood
  • Zinc / administration & dosage


  • Calcium, Dietary
  • Dietary Proteins
  • Parathyroid Hormone
  • Vitamin D
  • Magnesium
  • Zinc
  • Ascorbic Acid
  • Calcium