Données nouvelles sur la prévention nutritionnelle de l’ostéoporose New advances in osteoporosis nutritional prevention

Résumé

En raison de l’augmentation de la longévité, l’ostéoporose est devenue un véritable problème de santé publique. À la suite des études montrant notamment l’augmentation du risque relatif de cancer du sein chez les femmes sous hormonothérapie substitutive, ce traitement, classiquement prescrit, ne doit plus être considéré en première intention dans la prévention de l’ostéoporose. Les professionnels de la santé et les responsables politiques recommandent donc de proposer des stratégies alternatives validées. Les recherches dans le domaine de la nutrition et de l’épidémiologie nutritionnelle ont permis de montrer l’effet protecteur de certains aliments sur la santé, en particulier sur l’acquisition du capital osseux et sa préservation. Si la contribution majeure de l’apport calcique n’est plus à démontrer, il est probable que d’autres facteurs (vitamines, polyphénols, phyto-oestrogènes, oligo-éléments, minéraux) jouent également un rôle déterminant.

Summary

With the human race experiencing a progressive increase in life expectancy, we are facing a growing prevalence of chronic age-related conditions, among which osteoporosis is a generalised condition of bone, whose hallmark is increased bone fragility. Based on the overwhelming body of evidence emphasising that gonadal failure at the time of menopause causes osteopenia and the administration of estrogens in postmenopausal women prevents this loss, hormone replacement therapy (HRT) has been widely recommended. However HRT should be limited due to its potential adverse effects. In this light, an effort should be made to integrate alternative therapies of proven values to provide new options for women in midlife. Research in nutrition over the past 30 years has led to exciting and significant progress. Although the primary role of diet is to provide sufficient nutrients to fulfill the metabolic requirements of an individual, there is an emerging rationale to support the hypothesis that, by modulating specific target functions in the body, diet can help to achieve optimal health and also play an important role in reducing the risk of disease. Specifically, it has been recognized that human diet contains, in addition to essential macro- and micronutrients, a complex array of naturally occurring bioactive molecules, the phytochemicals, that may confer significant long-term health benefits. Indeed, besides calcium, micronutrients such as vitamins, polyphenols, phytoestrogens, trace elements or minerals remain a source for putative new and innovative dietary health intervention in the nutritional prevention of osteoporosis.