BACKGROUND: The role of total calcium intake in the prevention of hip fracture risk has not been well established. OBJECTIVE: The objective of the study was to assess the relation of calcium intake to the risk of hip fracture on the basis of meta-analyses of cohort studies and clinical trials. RESULTS: In women (7 prospective cohort studies, 170,991 women, 2,954 hip fractures), there was no association between total calcium intake and hip fracture risk [pooled risk ratio (RR) per 300 mg total Ca/d = 1.01; 95% CI: 0.97, 1.05]. In men (5 prospective cohort studies, 68,606 men, 214 hip fractures), the pooled RR per 300 mg total Ca/d was 0.92 (95% CI: 0.82, 1.03). On the basis of 5 clinical trials (n = 5666 women, primarily postmenopausal, plus 1074 men) with 814 nonvertebral fractures, the pooled RR for nonvertebral fractures between calcium supplementation (800-1600 mg/d) and placebo was 0.92 (95% CI: 0.81, 1.05). On the basis of 4 clinical trials with separate results for hip fracture (6,504 subjects with 139 hip fractures), the pooled RR between calcium and placebo was 1.64 (95% CI:1.02, 2.64). Sensitivity analyses including 2 additional small trials with <100 participants or per-protocol results did not substantially alter results. CONCLUSIONS: Pooled results from prospective cohort studies suggest that calcium intake is not significantly associated with hip fracture risk in women or men. Pooled results from randomized controlled trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible. For any nonvertebral fractures, there was a neutral effect in the randomized trials.

BACKGROUND AND AIMS: Loss of balance is a major risk factor for falls in the elderly, and physical exercise may improve balance in both elderly and middle-aged people. We propose a clinical trial to test the efficacy of an exercise program based on dance in improving balance in adult and young old subjects.

METHODS: We carried out a mono-institutional, randomized, controlled clinical trial. 40 subjects (aged 58 to 68 yr) were randomly allocated in two separate groups: the exercise group (n = 20) followed a 3-month exercise program; the control group (n = 20) did not engage in physical activities. Differences in balance between the end of the training period and the baseline were assessed using four different balance tests: Tinetti, Romberg, improved Romberg, Sit up and go.

RESULTS: Results showed a significant improvement in balance in the exercise group at the end of the exercise program, whereas the control group did not show any significant changes. The comparison between exercise and control group variations in balance test scores showed a highly significant difference. 17 out of 20 subjects in the exercise group reported great or moderate satisfaction with the dance activity.

CONCLUSIONS: Results suggest that physical activity based on dance may improve balance and hence be a useful tool in reducing the risk of falling in the elderly. The exercise program also revealed interesting psychosocial benefits.

The serum concentration of ascorbic acid was measured in 40 elderly patients with a recent hip fracture and compared to values measured in 102 home-living elderly. The concentrations were 37 +/- 22 mumol l-1 vs 50 +/- 29 mumol l-1 (p<0.01). Among the patients admitted from home-living conditions and controls, 20 pairs could be matched with respect to age, sex and season for the test. Serum ascorbic acid concentration was significantly lower in the hip fracture patients (34 +/- 19 mumol l-1 vs 54 +/- 30 mumol l-1, p<0.01). In the matched pairs, a seasonal variation in serum ascorbic acid concentration was found in the controls, but not in the hip fracture patients. As previous studies have found decreased concentrations of several nutritional factors in hip fracture patients, our findings might indicate that a reduced serum concentration of ascorbic acid could be a part of a general nutritional insufficiency in several patients with hip fracture.

A Mediterranean diet, known to have beneficial effects on cardiovascular health, may also influence the risk of hip fracture although previous studies present discrepant results. We therefore aimed to determine whether the rate of hip fracture was associated with degree of adherence to a Mediterranean diet. We combined two Swedish cohort studies consisting of 37,903 men and 33,403 women (total n = 71,333, mean age 60 years) free of previous cardiovascular disease and cancer who answered a medical and a food-frequency questionnaire in 1997. A modified Mediterranean diet score (mMED; range 0-8 points) was created based on high consumption of fruits and vegetables, legumes and nuts, wholegrains, fermented dairy products, fish, and olive/rapeseed oil, moderate intake of alcohol, and low intake of red and processed meat. Incident hip fractures between 1 January 1998 and 31 December 2012 were retrieved from the National Patient Register. Hazard ratios (HR) and 95% confidence intervals(CI) adjusted for potential confounders were calculated using Cox proportional hazards regression. Differences in age at hip fracture were calculated using multivariable Laplace regression. During follow-up, 3,175 hip fractures occurred at a median age of 73.3 years. One unit increase in the mMED was associated with 6% lower hip fracture rate (adjusted HR = 0.94; 95% CI 0.92-0.96) and with a three months higher median age at hip fracture (50(th) percentile difference = 2.8 months; 95% CI 1.4-4.2). Comparing the highest quintile of adherence to the mMED (6-8 points) with the lowest (0-2 points) conferred an adjusted HR of hip fracture of 0.78 (95% CI 0.69-0.89) and a 12 months higher median age of hip fracture (50(th) percentile difference = 11.6 months; 95% CI 4.2-19.0). Results were similar in men and women. We conclude that higher adherence to a Mediterranean-like diet isassociated with lower risk of future hip fracture. This article is protected by copyright. All rights reserved.

:The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk.

INTRODUCTION:Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults.

METHODS:A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis.

RESULTS:A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, p = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence.

CONCLUSIONS:In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

OBJECTIVES: This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of osteoporotic fractures. METHODS: This was a 12-year prospective study among 77761 women, aged 34 through 59 years in 1980, who had never used calcium supplements. Dietary intake was assessed with a food-frequency questionnaire in 1980, 1984, and 1986. Fractures of the proximal femur (n = 133) and distal radius (n = 1046) from low or moderate trauma were self-reported on biennial questionnaires. RESULTS: We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence. Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture (95% confidence interval [CI] = 0.87, 2.43) and 1.05 for forearm fracture (95% CI = 0.88, 1.25) when compared with women consuming one glass or less per week. Likewise, higher intakes of total dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture. CONCLUSIONS: These data do not support the hypothesis that higher consumption of milk or other food sources of calcium by adult women protects against hip or forearm fractures.

We aimed to systematically review available data on the association between vitamin C intake and bone mineral density (BMD), as well as risk of fractures and osteoporosis, and to summarise this information through a meta-analysis. Previous studies on vitamin C intake in relation to BMD and risk of fracture and osteoporosis were selected through searching PubMed, Scopus, ISI Web of Science and Google Scholar databases before February 2017, using MeSH and text words. To pool data, either a fixed-effects model or a random-effects model was used, and for assessing heterogeneity, Cochran's Q and I 2 tests were used. Subgroup analysis was applied to define possible sources of heterogeneity. Greater dietary vitamin C intake was positively associated with BMD at femoral neck (pooled r 0·18; 0·06, 0·30) and lumbar spine (pooled r 0·14; 95 % CI 0·06, 0·22); however, significant between-study heterogeneity was found at femoral neck: I 2=87·6 %, P heterogeneity<0·001. In addition, we found a non-significant association between dietary vitamin C intake and the risk of hip fracture (overall relative risk=0·74; 95 % CI 0·51, 1·08). Significant between-study heterogeneity was found (I 2=79·1 %, P heterogeneity<0·001), and subgroup analysis indicated that study design, sex and age were the main sources of heterogeneity. Greater dietary vitamin C intake was associated with a 33 % lower risk of osteoporosis (overall relative risk=0·67; 95 % CI 0·47, 0·94). Greater dietary vitamin C intake was associated with a lower risk of hip fracture and osteoporosis, as well as higher BMD, at femoral neck and lumbar spine.