Role of food fortification with vitamin D and calcium in the bone remodeling process in postmenopausal women: a systematic review of randomized controlled trials.

Abstract

CONTEXT\nFoods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover.\n\n\nOBJECTIVE\nTo discuss effects of the intake of vitamin D-fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women.\n\n\nDATA SOURCES\nPubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as grey literature . Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used.\n\n\nDATA EXTRACTION\nInformation was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations.\n\n\nDATA ANALYSIS\nFive randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9\u2009years. Daily consumption of soft plain cheese fortified with 2.5\u2009µg of vitamin D3 and 302\u2009mg of calcium for 4 weeks resulted in a mean increase of 0.8\u2009ng/mL in 25(OH)D and 15.9\u2009ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (-0.64\u2009U/L). Yogurt fortified with 10\u2009µg of vitamin D3 and 800\u2009mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286\u2009ng/mL and 1.06\u2009U/L in PTH and TRAP5b, respectively. After 12\u2009weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8\u2009ng/mL and PTH levels decreased in by a mean of 0.0167\u2009ng/mL.\n\n\nCONCLUSIONS\nThe interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women.\n\n\nPROSPERO REGISTRATION NUMBER\nCRD42019131976.