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Ergovera's Ergo Savvy Newsletter )

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 We help protect people, your company's most valuable asset July 2003 
In This Issue
Spine Health & Osteoporosis Prevention Part 1
Research: Spine Health & Osteoporosis Part 1
New: Packaged Customized Training Specials
Credits and notices

Published by Ergovera Ergonomic Consulting to help you keep up on ergonomic innovations, so you can protect your employees and increase their productivity. Please pass it on to your colleagues and friends.

Recently, at an Ergonomic Back Training, I was asked "what is good for the spine?" I mentioned calcium, but later realized I would have liked to have given more information when asked that question. Another incident occurred soon afterwards that piqued my interest in spine and bone health even more: I was given an osteoporosis test at an employee health fair and received a rather poor reading that indicated I needed to be concerned about my bones. They told me to take calcium and vitamin D.

As I began to research this topic, one of the first things I found is that for prevention of osteoporosis, calcium is considered substantially less effective than hormone replacement therapy (HRT); and yet women today are trying to avoid taking hormonal therapy due to new research which is rather negative.

Women took HRT readily in the past to counterbalance the decrease in estrogen that occurs during menopause. This decrease has been shown to cause osteoporosis and increased potential for bone fractures. Estrogen replacement therapy has been found to be very effective in preventing postmenopausal bone loss and preventing fractures. However, a long period of treatment is necessary for any significant benefit to the spine.

The long-term effectiveness of estrogen hormone therapy has been questioned since studies have found that in the elderly there is no difference in bone mass with those who received estrogen replacement therapy treatment and those who did not. Cancer, cardiovascular and gall bladder diseases have been linked to estrogen replacement therapy. Many women and their physicians are electing to discontinue their hormone replacement treatment (or not start treatment). Meanwhile, women who stop taking hormone replacement therapy are at high risk for rapid bone loss. Thus researchers need to find alternatives to HRT.

In addition to the nutrients in food such as soy and vegetables which were studied in the research I evaluated, there are non-hormonal medications such as Ibandronate and Alpha-Hydroxycholecalciferol which have been shown to be effective in preventing bone loss in patients who have discontinued hormone replacement therapy. Two of the studies I looked at used soy as a dietary supplement to help prevent bone loss. The study that used a prepared muffin and protein powder had greater compliance than the study that told subjects to add one soy food serving per day to their diet. Over half of this diet group stopped participating due to disliking soy and/or having difficulty in finding and cooking soy products. Both studies found that soy decreased bone loss. The researchers found that:

  • The diet and HRT group showed less bone loss compared to control group.
  • The diet group was found to have increased osteoblasty activity as evidenced by the high concentration of osteocalcin (which enhances bone formation).
  • Overall, the diet group was not as effective as HRT in preventing bone loss.

The third study evaluated the effects of fruit and vegetables on bone health. They found that women with a higher childhood intake of fruit in their diet had higher bone mass density in their femoral neck (upper leg bone) than those who consumed medium to low amounts of fruit as children. They also compared smokers to nonsmokers and were surprised to find no differences in bone mass density. The researchers found that:

  • No similar trends with past intake of milk and milk products (as compared to fruit intake).
  • No significant difference in the variables of bone mass density and bone metabolism between smokers and nonsmokers.
  • Caffeine consumption was not related to bone mass density.
  • Potassium and alcohol intake were positively correlated with total forearm bone mass density.

Two of the studies looked at physical activity and how it related to bone health, and they were surprised to not find any direct correlations. Because this is not consistent with past studies, I think it warrants further investigation, and I plan on looking at exercise and how it benefits bone health next month.

So if you get asked, "what is good for the spine?", hopefully you will now be able to give a more thorough answer than the standard "calcium." You may want to serve fruit juices rather than sodas (which contain phosphorus and take calcium out of bones) at your next function and fruit tart instead of cake (especially during the summer fruit season). As for soy, this may be trickier, since it is not as popular with individuals. Soy milk has come a long way and tofu can be cooked in many delicious ways if you know what you are doing (i.e., disguising it as much as possible!). If you do health fairs, consider having osteoporosis screening if you don't already do that. Talks on back health and nutrition can be a popular brown bag seminar and get people to be more proactive and healthy.

Have a safe day,

Deidre Rogers, RN, MS, CAE

A medium-sized United States study (Alekel et al.) evaluated the effects of soy protein with isoflavones on bone in perimenopausal women. This was a double blind study of 69 women who were divided into three groups: isoflavone-rich soy, isoflavone-poor soy, or whey (control). Smokers were excluded from the study and the medium age of subjects was 50.6.

Diet, physical activity, hormonal levels and bone mineral density were evaluated before and during the 24 week study. All three groups were fed muffins (with the three different ingredients in them and were given powder to mix with food or beverages. They had a high level of subject compliance (the majority of subjects ate most of the muffins) which they evaluated by doing urine analysis. The control group was the only group that showed bone loss. The isoflavone-rich soy had a positive effect on change in bone mineral density.

Weight gain did not confound the results nor did physical activity explain some of the variability in bone loss that was observed. The researchers concluded that soy isoflavones are a benefit to perimenopausal women who can't or don't want to take HRT. The primary limitation of the study was the small sample size.

An Italian study (Chiechi et al.) evaluated the effects of soy rich diet in preventing osteoporosis in postmenopausal women. The study had 187 subjects, ages 39-60 and excluded women who drank alcohol. The 187 diverse subjects were divided into three groups: Diet group, HRT group, and the control group. The diet group was instructed to include one soy food serving per day (e.g., soymilk, miso soup, tofu, tempeh or soybeans).

Compliance in the diet group was assessed by urinary analysis. In addition, the women in the diet group often reported a dislike of soy and difficulty in finding and cooking soy foods. More than half of this group discontinued the study, while only around 80% did in the HRT and control groups.

The control group had bone loss, while both the HRT and the diet groups did not. Overall, diet was not found to be as effective as HRT in preventing bone loss. However, the diet group was found to have high levels of osteocalcin which is an indicator for bone formation. The study was conducted for three months. The researchers concluded that the most troubling outcome of their study was low compliance with their proscribed diet.

A small Scottish study (New et al.) evaluated the effectiveness of a diet rich in fruit and vegetables and bone health. This was a cross-sectional (non-homogeneous group) consisting of 62 healthy women, aged 45-55. Hormonal status was monitored and women were grouped in pre-, post- and perimenopausal groups. Past dietary habits were assessed with the two main groups being: childhood (< 12 y) and early adulthood (20-30y). They were unable to get information from the ages of 12-20y due to the fact that women had a much more difficult time answering questions that pertained to those years. The researchers concluded that this was due to the fact that women have "tremendous change" during that time period. Current physical activity levels were evaluated as well.

Bone mass, markers of bone metabolism and dietary intake were measured within a short time period (< 6 wk). Higher intake of magnesium, potassium and alcohol were associated with higher bone mass. The researchers called the association with alcohol intake and bone mass to be an "intriguing finding." They did not find a significant difference in the variables of bone mineral density and bone metabolism between smokers and nonsmokers, though they found what they called "nutrient differences" between smokers and nonsmokers. The smokers had a higher fat intake than nonsmokers and a lower intake of vitamin C, potassium, and calcium.

The limits of the study include that it was cross-sectional and that the number of subjects studied was relatively small. Thus, the researchers cautioned against making causal relationships and preferred to state that there may be an association between diet and bone health. They concluded that a long-term diet of alkaline-forming foods (including fruits and vegetables) is beneficial.


Alekel, D., St Germain, A., Peterson, C., Hanson, K., Stewert, J., & Toda, T. (2000). Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. American Journal of Clinical Nutrition, 72, (3), 844-852.

Chiechi, L., Secreto, G., D'Amore, M., Fanelli, M., Venturelli, E., Cantatore, F., Valerio, T., Laselva, G., & Loizzi P. (2002) Efficacy of a soy rich diet in preventing postmenopausal osteoporosis: the Menfis randomized trial. Maturitas, 42, (4), 295-300.

New, S., Robins, S., Campbell, M., Martin, J., Garton, M., Bolton-Smith, C., Grubb, D., Lee, S., & Reid, D. (2000). Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? American Journal of Clinical Nutrition, 71, 142-151.

Fun, interactive trainings - from ergonomic back care to ergonomics for specialty departments (e.g., call centers, park maintenance, etc.)

Ergovera will help you:

  • Get high employee buy-in by using such techniques as employee surveying or mini-ergonomic evaluations prior to training.
  • Train employees on behavioral aspects and motivate them to change bad behavior.
  • Give them the message that you care about them.

Call Deidre at 831.335.8448 or send her a message now for more info.

Copyright © 2002, Deidre Rogers and Ergovera Ergonomic Consulting. All rights reserved. Reuse in any form must be requested and granted in writing.

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