Lifetime Veganism: Osteoporosis and Vertebral fracture

1
Lifetime Veganism Osteoporosis and Vertebral
fracture

• 1Thuc Lan Ho-Pham, 2Nguyen ND ,3Thu A. Le, 2Tuan
  V. Nguyen

Coauthors, 1Vu BQ, 3Pham NH, 1Nguyen LP, 1Le
TT, 1Doan AT, and 1Tran N. 1Pham Ngoc Thach
College of Medicine,Ho Chi Minh City, Vietnam,
2Garvan Institute of Medical Research, Sydney,
Australia 3Cho Ray Hospital, Ho Chi Minh City,
Vietnam.
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OSTEOPOROSIS AND FRACTURE

• OSTEOPOROSIS High prevalence
• 20 postmenopausal women1
• 10 men ( gt 50 year-old)1
• Vietnam 23 postmenopausal women2
• OSTEOPOROTIC FRACTURE High lifetime risk3
• Any fracture 50
• Hip fracture 17
• Vertebral fracture 25
• 1 Nguyen DN, Nguyen TV. Osteoporosis 3rd edition
• 2 Nguyen.T.T.Huong, Nguyen TV. New Zealand Bone
  Miner Soci 2006
• 3 Nguyen DN, et al. J Bone Miner Res 2007

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ROLE OF DIET IN OSTEOPOROSIS PREVENTION

• Prevention is preferable to treatment
• Diet and nutrition are important components in
  osteoporosis prevention

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VEGETARIAN AND OMNIVORE DIETS
Semi/demi vegetarian Lacto-ovo
vegetarian Lacto vegetarian Vegan (Asian veg)
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VEGANISM AND BONE HEALTH

• Whether lifelong vegetarian diet has any negative
  effect on bone health, a contentious issue1,2.
• Lack of information about prevalence of
  osteoporosis and vertebral fracture in
  postmenopausal Vietnamese women.
• 1 EMC Lau, et al. JC Nutrition 1998
• 2 Fontana L, et al. Arch In Med 2005

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AIMS

• Examine the association between lifelong
  vegetarian diet and osteoporosis.
• Estimate the prevalence and risk factors of
  vertebral fracture in postmenopausal Vietnamese
  women.

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METHODS AND STUDY DESIGN
A cross-sectional study

• 50 years old
• From 15 monasteries in Ho Chi Minh City
• Random sample

• 50 years old
• From various districts in Ho Chi Minh City
• Random sample

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OUTCOME MEASUREMENTS

• BMD measurement (Hologic QDR 4500).
• Lumbar spine
• Femoral neck
• Total body (eg lean mass and fat mass)
• Vertebral fracture (X-ray, Genants
  semi-quantitative method).

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COVARIATES

• Anthropometric measurements.
• Daily dietary energy and nutrient intakes (24h
  recall questionnaire).
• Lifestyle factors.
• Comorbidity (CVD, diabetes, osteoarthritis, etc).
• A history of fall (past 3 months)
• Prior fracture (after the age of 50).

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Diet and Bone Mineral Density
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Characteristics of participants by diet
Vegetarians Vegetarians Omnivores Omnivores P-value
(n105) (n105) (n105) (n105)
Age (y) 62 (10) 62 (10) 0.95
Weight (kg) 53 (9) 54 (7) 0.59
Height (cm) 148 (6) 149 (6) 0.15
BMI (kg/m2) 24 (4) 24 (3) 0.78
Total body fat (kg) 19 (5) 19 (5) 0.77
Total body lean (kg) 32 (5) 33 (4) 0.47
Highest education (n,) 0.007
Primary 27 (25.7) 28 (26.7)
Secondary 66 (62.9) 48 (45.2)
Tertiary 12 (11.4) 29 (27.6)
Morning exercise (n,) 82 (78.1) 81 (77.1) 0.86
Coffee drinking (n,) 28 (26. 7) 48 (45.2) 0.004
Major comorbidity (n,) 47 (44.8) 52 (49.5) 0.49
Values are mean (SD), unless otherwise specified.
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Daily dietary energy and nutrient intakes
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Bone mineral density in vegetarians and omnivores
Values are mean and 95 CI
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Prevalence of osteoporosis (T-scores lt -2.5) by
diet
Vegans
Omnivores
Osteoporosis BMD T-scores -2.5 at the femoral
neck
No significant difference in prevalence of
osteoporosis between lifetime vegans and
non-vegans
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Association between factors and BMD
(multivariable analysis)
Unit of ?SD of BMD ?SD of BMD ?SD of BMD R-square
change (95 CI) (95 CI) (95 CI)
Femoral neck 0.36
Age (y) 10 -0.5 (0.4, 0.6)
Lean mass (kg) 4 0.3 (0.2, 0.4)
Lumbar spine 0.36
Age (y) 10 -0.5 (0.4, 0.7)
Weight (kg) 8 0.3 (0.1, 0.4)
Animal source protein (g/d) 20 0.2 (0.0, 0.3)
Bayesian averaging method (BMA) was used to
select the best fit model for FNBMD and LSBMD.
All potential explainable factors were included
in selecting independent factor process.
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Morphometric vertebral fracture
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Prevalence of vertebral fracture
n (95 CI) (95 CI)
Any vertebral fracture 48/209 23.0 (17.3, 28.7)
By age group
50-59 18/106 17.0 (9.8, 24.1)
60-69 10/53 18.9 (8.3, 29.4)
70 20/50 40.0 (26.4, 53.6)
By diet
Buddhist vegetarians 23/104 22.1 (14.1, 30.1)
Non-vegetarians 25/105 23.8 (15.7, 32.0)
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Risk factors for vertebral fracture (bivariate
analysis)
Factor Unit change OR (95 CI) (95 CI)
Age (y) 10 1.6 (1.1, 2.2)
Weight (kg) 8 1.1 (0.8, 1.6)
BMI (kg/m2) 3 1.3 (0.9, 1.7)
FNBMD (g/cm2) -0.11 1.3 (0.9, 1.8)
LSBMD (g/cm2) -0.14 1.7 (1.2, 2.5)
Prior fracture yes 1.9 (1.0, 3.8)
Back pain yes 1.2 (0.6, 2.4)
Calcium intake (g/d) -370 1.2 (0.9, 1.6)
Vegan yes 0.9 (0.5, 1.7)
There was no significant association between
vertebral fracture and other factors
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Risk factors for vertebral fracture
(multivariable logistic regression analysis)
Factor Unit change Odds ratio (95 CI) (95 CI)
Age (y) 10 1.2 (1.0, 1.8)
LSBMD (g/cm2) -0.14 1.5 (1.0, 2.2)
Prior fracture yes 1.5 (0.7, 3.1)
LSBMD, lumbar spine bone mineral density
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Veganism osteoporosis and vertebral fracture

• Vegetarians
• much lower dietary energy, protein and calcium
  intakes than omnivores.
• no adverse effect on bone health, in terms of
  osteoporosis and vertebral fracture risk.

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Osteoporosis and vertebral fracture in
postmenopausal Vietnamese women

• Prevalence of vertebral fracture in
  postmenopausal Vietnamese women was as common as
  in Caucasian women.

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Acknowledgements
I express special thanks to Pro.Nguyen van Tuan
for his excellent support this study. I express
deep appreciation to Dr Nguyen Dinh Nguyen and
Miss Ha Hai Chau for their kind helping
me. Thanks also to my students for their
meticulous assistance.
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Thank you!
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Back-up slides
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Prevalence of osteoporosis
Thai
Korean
Chinese
Japanese
Indonesian
Australian
Present study
Nguyen H, 2007
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Daily dietary energy and nutrient intakes
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Association between factors and BMD (univariate
analysis)
Variables Unit of ? FN BMD ? FN BMD ? FN BMD ? LS BMD ? LS BMD ? LS BMD
change (SD, 95 CI) (SD, 95 CI) (SD, 95 CI) (SD, 95 CI) (SD, 95 CI) (SD, 95 CI)
Age (y) -10 0.5 (0.4, 0.7) 0.5 (0.4, 0.7)
Weight (kg) 8 0.4 (0.2, 0.5) 0.3 (0.2, 0.5)
Height (cm) 6 0.3 (0.2, 0.4) 0.4 (0.2, 0.4)
BMI (kg/m2) 3 0.3 (0.1, 0.4) 0.2 (0.1, 0.4)
Fat mass (kg) 5 0.2 (0.1, 0.3) 0.2 (0.1, 0.3)
Lean mass (kg) 4 0.4 (0.2, 0.5) 0.3 (0.2, 0.5)
Daily dietary intake
Energy (Kcal) 450 0.1 (0.0, 0.2) 0.1 (0.0, 0.3)
Animal source Pr (g) 20 0.0 (-0.1, 0.2) 0.2 (0.0, 0.3)
Vegetable source Pr (g) 12 0.1 (-0.1, 0.2) 0.0 (-0.1, 0.2)
Calcium (g) 370 0.1 (0.0, 0.2) 0.0 (-0.1, 0.2)
Veganism Yes -0.2 (-0.5, 0.1) -0.2 (-0.5, 0.1)
FN, femoral neck LS, lumbar spine BMD, bone
mineral density
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Characteristics of participants by fracture
Vertebral fracture Vertebral fracture Vertebral fracture Non-vertebral fracture Non-vertebral fracture Non-vertebral fracture P-value
(n48) (n48) (n48) (n161) (n161) (n161)
Age (y) 65 (11) 61 (9) 0.0065
Weight (kg) 54 (8) 53 (8) 0.4577
Height (cm) 148 (6) 149 (6) 0.2929
BMI (kg/m2) 25 (4) 24 (3) 0.161
Total body fat (kg) 19 (5) 19 (5) 0.4387
Total body lean (kg) 33 (4) 32 (4) 0.3391
FNBMD (g/cm2) 0.61 (0.13) 0.64 (0.11) 0.115
LSBMD (g/cm2) 0.70 (0.14) 0.78 (0.14) 0.0016
Daily dietary intake
Energy (Cal) 1320 (1007, 1538) 1266 (1051, 1547) 0.7566
Animal source protein (g) 24 (9, 33) 31 (18, 41) 0.0955
Non-animal protein (g) 29 (22, 35) 26 (22, 35) 0.6058
Calcium (g) 432 (310, 645) 422 (267, 641) 0.4263
Values are mean(SD), unless otherwise specified
Median (Q1,Q3)
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Characteristics of participants by fracture
(cont.)
Vertebral fracture Vertebral fracture Vertebral fracture Non-vertebral fracture Non-vertebral fracture Non-vertebral fracture P-value
(n48) (n48) (n48) (n161) (n161) (n161)
Education 0.3579
Primary 14 (29.2) 41 (25.6)
Secondary 28 (58.3) 84 (52.5)
Tertiary 6 (12.5) 35 (21.9)
Morning exercise 37 (77.1) 125 (78.1) 0.8788
Hypertension 17 (35.4) 43 (26.9) 0.2519
CVD 1 (2.1) 6 (3.8) 1.000
Diabetes 3 (6.3) 11 (6.9) 0.8795
Arthritis 9 (18.8) 29 (18.1) 0.9217
Back pain 26 (54.2) 73 (45.6) 0.2987
Prior fracture 15 (31.3) 31 (19.3) 0.0790
A history of fall 4 (8.3) 17 (10.7) 0.6439
Values are n ()