Preventive and Curative Effect of Omega-3 Supplementation on Bone Mineral Density in People Aged 60 Years and Older: A Review Article
Osteoporosis and osteopenia are common worldwide problems leading to potentially life-threatening consequences. Omega-3 supplementation for treating osteoporosis is less studied and less valued by physicians. We aimed to ascertain the appropriate dosage of omega- 3 supplementation to prevent osteoporosis. Google scholar database was searched in May 2017 using the keywords: n-3 fatty acids, omega-3 polyunsaturated fatty acids, essential fatty acids, eicosapentaenoic fatty acids, docosahexaenoic acid, docosapentaenoic acid, alpha-linolenic acid, linoleic acid, osteopenia, osteoporosis, bone density, and fracture. We reviewed English language reports of randomized controlled trials with intake of omega-3 polyunsaturated fatty acids, in which subjects were over 60 years and supplemented with a quantified dosage of omega-3; and outcome was indicated by bone mineral densitometry medical record of fractures and radiological imaging, and serum biomarker to evaluate bone metabolism. We reviewed 110 papers, which only eight articles met our conclusion criteria and concluded with curative effects. Three articles came up with no prophylactic or curative effect of omega-3 supplementation, three articles suggested a dosage of omega-3 supplement that non significantly increased bone mineral densitometry or decreased absorption, and thus, had prophylactic effects. One article just concluded the positive effects, not defining the exact results. It is suggested that a dosage of 4.5 to 6 g/d of eicosapentaenoic acid and docosahexaenoic acid can have curative effects, while 900-1000 mg/d can have prophylactic outcomes. N-3 fatty acids have positive effects on bone density, but to confine definitive dosage and formulation of omega-3 supplementation for reducing the risk of osteoporosis, further investigations are required.
Kasper D, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrisons manual of medicine: McGraw-Hill Medical Publishing Division, 2016.
Gullberg B, Johnell O, Kanis J. World-wide projections for hip fracture. Osteoporos Int. 1997,7:407-413.
Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. Jama. 2009,301:513-521.
Society NAM. Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause (New York, NY). 2006,13:340.
Glaser DL, Kaplan FS. Osteoporosis: definition and clinical presentation. Spine. 1997, 22:12S-16S.
Lindsay R, Cosman F, Lobo RA, Walsh BW, Harris ST, Reagan JE, et al. Addition of alendronate to ongoing hormone replacement therapy in the treatment of osteoporosis: a randomized, controlled clinical trial. J Clin Endocrinol Metab. 1999, 84:3076-3081.
Prentice A. Diet, nutrition and the prevention of osteoporosis. Public Health Nutr . 2004,7:227-243.
Orchard TS, Pan X, Cheek F, Ing SW, Jackson RD. A systematic review of omega-3 fatty acids and osteoporosis. Br J Nutr. 2012,107:S253-S260.
Sharif PS, Asalforoush M, Ameri F, Larijani B, Abdollahi M. The effect of n-3 fatty acids on bone biomarkers in Iranian postmenopausal osteoporotic women: a randomized clinical trial. Age. 2010, 32:179-186.
Tartibian B, Hajizadeh Maleki B, Kanaley J, Sadeghi K. Long-term aerobic exercise and omega-3 supplementation modulate osteoporosis through inflammatory mechanisms in post-menopausal women: a randomized, repeated measures study. Nutr Metab. 2011,8:71.
Terano T. Effect of ω3 polyunsaturated fatty acid ingestion on bone metabolism and osteoporosis. Fatty Acids and Lipids-New Findings. 88: Karger Publishers p. 2001, 141-147.
Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007, 6:2.
Watkins BA, Li Y, Seifert MF. Dietary ratio of n-6/n-3 PUFAs and docosahexaenoic acid: actions on bone mineral and serum biomarkers in ovariectomized rats. J Nutr Biochem. 2006,17:282-289.
Shen C-L, Yeh JK, Rasty J, Li Y, Watkins BA. Protective effect of dietary long-chain n-3 polyunsaturated fatty acids on bone loss in gonad-intact middle-aged male rats. Br J Nutr. 2006, 95:462-468.
Calder PC. n− 3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006, 83:1505S-1519S.
Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008, 233:674-688.
Lin P-Y, Su K-P. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007, 68:1056-1061.
Ubeda N, Achón M, Varela-Moreiras G. Omega 3 fatty acids in the elderly. Br J Nutr. 2012, 107:S137-S151.
Kini U, Nandeesh B. Physiology of bone formation, remodeling, and metabolism. Radionuclide and hybrid bone imaging: Springer p, 2012, 29-57.
McLean RR. Proinflammatory cytokines and osteoporosis. Curr Osteoporos Rep. 2009,7:134-139.
Jimi E, Akiyama S, Tsurukai T, Okahashi N, Kobayashi K, Udagawa N, et al. Osteoclast differentiation factor acts as a multifunctional regulator in murine osteoclast differentiation and function. J Immunol. 1999,163: 434–442
Abdollahi M, Larijani B. Role of oxidative stress in osteoporosis. Therapy. 2005, 2:787-796.
Dawczynski C, Schubert R, Hein G, Müller A, Eidner T, Vogelsang H, et al. Long-term moderate intervention with n-3 long- chain PUFA-supplemented dairy products: effects on pathophysiological biomarkers in patients with rheumatoid arthritis. Br J Nutr. 2009, 101: 1517–1526
Macdonald HM, New SA, Golden MH, Campbell MK, Reid DM. Nutritional associations with bone loss during the menopausal transition: evidence of a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids. Am J Clin Nutr. 2004, 79:155-165.
Kruger M, Coetzer H, De Winter R, Gericke G, Van Papendorp D. Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging Clin Exp Res. 1998,10: 385-394.
Riggs BL, Khosla S, Melton III LJ. Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev. 2002, 23:279-302.
Díaz-Castro J, Kajarabille N, Pulido-Morán M, Moreno-Fernández J, López-Frías M, Ochoa JJ. Influence of Omega-3 Fatty Acids on Bone Turnover." Omega-3 Fatty Acids. Springer International Publishing, 2016, 285-291.
Maggio M, Artoni A, Lauretani F, Borghi L, Nouvenne A, Valenti G, et al. The impact of omega-3 fatty acids on osteoporosis. Curr Pharm Des. 2009, 15: 4157-4164.
Watkins BA, Li Y, Lippman HE, Feng S. Modulatory effect of omega-3 polyunsaturated fatty acids on osteoblast function and bone metabolism. Prostaglandins, leukotrienes and essential fatty acids. 2003, 68: 387-398.
Vanek C, Connor WE. Do n− 3 fatty acids prevent osteoporosis? Oxford University Press, 2007.
Calder PC. Omega‐3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology? Br Journal Clin Pharm. 2013, 75:645-662.
Orchard TS, Cauley JA, Frank GC, Neuhouser ML, Robinson JG, Snetselaar L, et al. Fatty acid consumption and risk of fracture in the Women’s Health Initiative. Am J Clin Nutr. 2010, 92: 1452–1460.
Virtanen JK, Mozaffarian D, Cauley JA, Mukamal KJ, Robbins J, Siscovick DS. Fish consumption, bone mineral density, and risk of hip fracture among older adults: the cardiovascular health study. J Bone Miner Res. 2010, 25:1972-1979.
Dong H, Hutchins-Wiese H, Kleppinger A, Annis K, Liva E, Lammi-Keefe C, et al. Effects of omega-3 polyunsaturated fatty acid supplementation on bone turnover in older women. Int J Vitam Nutr Res. 2014, 84:124-32.
Vanlint SJ, Ried K. Efficacy and tolerability of calcium, vitamin D and a plant-based omega-3 oil for osteopenia: A pilot RCT. Maturitas. 2012,71:44-48.
Appleton K, Fraser W, Rogers P, Ness A, Tobias J. Supplementation with a low–moderate dose of n-3 long-chain PUFA has no short-term effect on bone resorption in human adults. Br J Nutr. 2011,105:1145-1149.
Chen JS, Hill CL, Lester S, Ruediger CD, Battersby R, Jones G, et al. Supplementation with omega-3 fish oil has no effect on bone mineral density in adults with knee osteoarthritis: a 2-year randomized controlled trial. Osteoporos Int. 2016, 27:1897-1905.
LeBoff MS, Yue AY, Copeland T, Cook NR, Buring JE, Manson JE. VITAL-Bone Health: rationale and design of two ancillary studies evaluating the effects of vitamin D and/or omega-3 fatty acid supplements on incident fractures and bone health outcomes in the VITamin D and OmegA-3 TriaL (VITAL). Contemp Clin Trials. 2015, 41:259-268.
Sims NA, Martin TJ. Coupling the activities of bone formation and resorption: a multitude of signals within the basic multicellular unit. Bonekey Rep. 2014,3:481.
Allaire J, Couture P, Charest A, Leclerc M, Marin J, Lépine MC, et al. DHA is more potent than EPA in attenuating cardiometabolic risk in men and women: a randomized double-blind, placebo-controlled crossover trial. FASEB J 2016,130 (Supp 1).
Allaire J, Couture P, Leclerc M, Charest A, Marin J, Lépine MC, et al. A randomized, crossover, head-to-head comparison of eicosapentaenoic acid and docosahexaenoic acid supplementation to reduce inflammation markers in men and women: the Comparing EPA to DHA (ComparED) Study–3. American J Clin Nutr. 2016, 104:280-287.
Vors C, Allaire J, Marin J, Lépine M-C, Charest A, Tchernof A, et al. Supplementation With Epa and With Dha Induces Similar Inflammatory Gene Expression Profiles in Human Whole Blood Cells: The Compared Study. Am Heart Assoc. 2016,134:A14381434.
This work is licensed under a Creative Commons Attribution 4.0 International License.