The main focus of bone loss and Osteoporosis (OP) research has been limited almost
entirely to women, but OP has become increasingly common in older men and the impact of
hip fracture on mortality may actually be greater in men. OP is a major cause of morbidity
and mortality in developed countries, at a cost that currently exceeds $10 billion per year in
the United States (US) alone. Osteoporotic fractures affect 50 % of women and 20-30% of
white men and 4% of black men over the age of 50 years. These statistics may even
increase because of increasing life expectancy. Few studies focusing on Blacks have been
published to date and very little is known regarding the bone health and the aetiology and
prevalence of OP and fractures among older South African blacks. From the above
information it is clear that OP is of considerable clinical and economic importance. Without
information on the patterns and determinants of bone loss, the formulation of rational
prevention and treatment strategies in these groups is not possible.
The aim of the study described in this thesis was to investigate the influence of the dietary
factors (iron, vitamin C, and protein) and lifestyle factors (alcohol and tobacco smoking) on
osteoporotic fractures and bone mineral density in older South African black men using a
case-control study design. Sixteen black male patients with fractures of the proximal femur,
the proximal humerus or the distal radius and who conformed to the inclusion and exclusion
criteria were included in the study. An equal amount of age-matched (K? years), apparently
healthy black men with no previous fracture (of the proximal femur and humerus and distal
radius), were recruited as a control group. Dual energy X-ray absorptiometry (DEXA) was
used for the measurement of the lumbar vertebrae and the proximal femur (hip).
Questionnaires were used to gather demographic and medical information, data on physical
activity and dietary intakes. Anthropometric measurements and blood samples were taken.
Appropriate biochemical analyses were done with standard methods.
Both the cases and controls were osteoporotic according to the mean lumbar spine BMD
determined in both groups. The BMD was only marginally lower in the cases than in the
controls and therefore not statistically significant. The mean tobacco pack years of the cases
(13.29) [95% CI: 4.44; 22.141 were almost double that of the controls (7.43) [1.83; 13.031 but
it was not statistically significant (p=0.55). Tobacco pack years were negatively associated
with BMD of the lumbar spine (p=0.008) even after controlling for possible confounding
SUMMARY
factors (p=0.001). Malnutrition, as indicated by the low dietary intakes of energy, protein,
vitamin C, iron and low BMI, could play a role in the lower bone mineral density (BMD)
observed in the cases. The mean protein intakes of the cases (56.1 19) [46.49; 65.741 were
very low compared to the recommended 639 per day. This low protein intake was also
significantly less compared to the controls (739) [58.28; 88.311. lron intake tended to be
lower in the cases compared to the controls (p=0.09). lron intake was not associated with
BMD, however, in the stepwise regression analysis; iron intake came out as a possible
predictor of BMD of both the lumbar spine and hip, although it was not statistically significant.
The BMI was c 19 kg/m2 in 50% of the cases and the controls. S-GGT, a marker of alcohol
intake, was significantly increased in the cases with a mean value of 65.88ulL opposed to the
36.33UIL in the control group. S-GGT was the most important predictor of BMD in both the
hip and the lumbar spine. There was a significant statistical correlation between lumbar spine
BMD (p=0.04); hip BMD (p=0.02) and s-GGT.
In conclusion it can be said that malnutrition played a vital role in the low BMD aggravated by
the use of tobacco from a young age and alcohol in excessive amounts over weekends.
From the results of this study it can be recommended that any intervention programme
should focus on alcohol abuse, tobacco smoking and improvement in nutritional status.
Children should be encouraged not to smoke and be educated on the detrimental effects of
alcohol. It is important to address dietary risk factors associated with OP, namely to increase
the overall nutrition of the South African black male with low cost protein and calcium
products. Vitamin C enhances iron absorption and may be beneficial for bone collagen. The
increased intake thereof by using seasonal fruit can therefore be recommended. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2004.
| Identifer | oai:union.ndltd.org:NWUBOLOKA1/oai:dspace.nwu.ac.za:10394/272 |
| Date | January 2003 |
| Creators | Leach, Martha Ettrusia |
| Publisher | North-West University |
| Source Sets | North-West University |
| Detected Language | English |
| Type | Thesis |
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