|Cupples, L Adrienne|
Submitted to: Journal of Bone and Mineral Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/29/2008
Publication Date: 1/12/2009
Citation: Gosai, S.S., Hannan, M.T., Blumberg, J., Cupples, L., Kiel, D.P., Tucker, K. 2009. Protective effect of total carotenoid and lycopene intake on the risk of hip fracture: A 17-year follow-up from the Framingham Osteoporosis Study. Journal of Bone and Mineral Research. DOI: 10.1359/jbmr.090102. Interpretive Summary: Osteoporosis is a major public health problem in the aging population. It has been estimated that almost 10 million Americans have osteoporosis, and there are approximately 1.5 million osteoporotic fractures in the United States each year. Among 50-year old non-Hispanic white women, the lifetime risk of hip, spine, or forearm fracture is approximately 40%. Of these fractures, hip fractures are the most serious, as they almost always result in hospitalization, lead to mortality for about 20%, and to permanent disability for about 50%. Studies have consistently shown that higher fruit and vegetable intake has positive effects on bone mineral status. Data from several in vitro and in vivo studies, suggest that further investigation into the relationship between carotenoids and bone health is warranted. To our knowledge, no longitudinal observational study has examined the association between intake of carotenoids (other than beta-carotene) and the risk of hip fracture. Therefore, we evaluated associations between intake of total carotenoids and individual carotenoids (alpha-carotene, total beta-carotene, beta-cryptoxanthin, lycopene, lutein+zeaxanthin) and the risk of hip fracture as well as non-vertebral osteoporotic fracture in the Framingham Osteoporosis Study. We observed a possible protective effect of total carotenoids and lycopene in this population of elderly Caucasian men and women. Beta-carotene and lutein plus zeaxanthin may also be protective against hip fracture. These findings support the hypothesis of a protective association between carotenoid intake and risk of hip fracture as well as non-vertebral osteoporotic fracture in older adults. More studies are needed to examine these associations in other populations. Future research is needed to examine associations between specific foods rich in carotenoids and fracture.
Technical Abstract: In vitro and in vivo studies suggest that carotenoids may inhibit bone resorption; yet no previous study has examined individual carotenoid intake (other than beta-carotene) and the risk of fracture. We evaluated associations of total and individual carotenoid intake (alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein+zeaxanthin) with incident hip fracture and non-vertebral osteoporotic fracture. 366 men and 596 women (mean age 75 +/- 5 y) from the Framingham Osteoporosis Study, a population-based cohort, completed a food frequency questionnaire (FFQ) in 1988-89 and were followed for hip fracture until 2005 and non-vertebral fracture until 2003. Tertiles of carotenoid intake were created from estimates obtained using the Willett FFQ adjusting for total energy (residual method). Hazard ratios (HR) were estimated using Cox-proportional hazards regression, adjusting for sex, age, body mass index, height, total energy intake, physical activity, alcohol, smoking status, total calcium intake and vitamin D intake and multivitamin use. A total of 104 hip fractures occurred over 17-years of follow-up. Subjects in the highest tertile of total carotenoid intake had lower risk of hip fracture (P trend=0.007) and non-vertebral fracture (P trend=0.06) relative to subjects in the first tertile. Subjects in the highest tertile of lycopene intake had lower risk of hip fracture (P trend=0.009), and non-vertebral fracture (P trend=0.01) relative to subjects in the first tertile. A protective trend was observed for total beta-carotene and lutein plus zeaxanthin for hip fracture alone (P trend=0.06) but associations did not reach statistical significance (P<0.05). No significant associations were observed with alpha-carotene or beta-cryptoxanthin. These results suggest a protective role of several carotenoids for bone health in older adults.