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Bone Health and Florida Orange Juice

kids playing on monkey bars on playground

Nutrition is Important

A healthy diet is important to support strong bones and healthy cartilage. Featuring nutrients such as vitamin C, potassium, magnesium, and vitamin D and calcium in fortified varieties, these compounds in 100% orange juice can be part of a healthy diet for healthy bones and connective tissues.

Healthy Bone Nutrients

female doctor holding xray of spine and pelvis
  • Vitamin C: Vitamin C is a factor in the development and maintenance of bones, cartilage, teeth and gums.1
  • Calcium and Vitamin D (fortified orange juice): Calcium is an essential mineral and aids in the formation and maintenance of bones and teeth.1 Vitamin D improves calcium absorption, and helps build strong bones and teeth.1 These nutrients are essential for growing kids to develop strong bones, and for adults to maintain bone health.
  • Potassium: Potassium, found in many fruits and vegetables, is part of a healthy diet.
  • Magnesium: Magnesium is an important mineral for tissue formation and bone development.1
  • Phytonutrients: Many plant compounds, such as carotenoids and flavonoids, may be involved in processes that affect bone structure and formation.2-9

DID YOU KNOW?

A cup (250 mL) of fortified Florida Orange Juice has similar amounts of calcium and vitamin D as a cup of milk.10*

Nutrition Research Corner for Health Professionals

Vitamin C

Vitamin C is essential in collagen production, which is important for maintaining healthy cartilage, bones and other connective tissues.11-14 Citrus juices are reported to be one of the largest contributors of vitamin C in the diet, providing more than 100% of recommended Daily Value for vitamin C in an 8-ounce (1 cup / 250ml) serving.*

Calcium and Vitamin D

Many factors affect bone health, including physical activity.  A healthy diet with adequate calcium and vitamin D, and regular physical activity, help to achieve strong bones and may reduce the risk of osteoporosis.16

Calcium and Vitamin D are critical nutrients necessary for bone health.14 Drinking orange juice fortified with these nutrients may help improve calcium and vitamin D blood levels. Indeed, vitamin D-fortified orange juice was effective in increasing vitamin D blood levels in children, 17 and fortified orange juice (with vitamins D2 or D3) was just as effective as an oral vitamin supplement in maintaining vitamin D status in adults.18 A NHANES analysis reported that consumption of calcium and vitamin D-fortified orange juice was positively associated with femur bone mineral density in children, and femur bone mineral content in both children and adults.19 Furthermore, fortified orange juice has been shown to increase markers of bone formation to a similar extent as milk.20

An 8-ounce glass of fortified orange juice is an excellent source of calcium supplying 30% of the Daily Value.* Orange juice varieties also fortified with vitamin D provide 15% of the Daily Value, and are good sources of vitamin D.*

Potassium and Citrate

The body must keep the amount of acids and bases balanced to keep pH within a safe range. If excess acids are generated, such as when sulfur-containing amino acids in high protein foods are consumed, the body uses buffers like bicarbonate to restore balance.21 Calcium can be lost from the bone when too little bicarbonate is available because bone will demineralize to release buffers for pH neutralization.21

Research suggests higher intake of dietary potassium may be linked to improvements in bone mineral density and lowered risk of osteoporosis.22 Potassium is often found with citrate (as well as other minerals) in fruits and vegetables, including 100% orange juice, which may be one of the reasons for the link between potassium and bone health.21 Citrate is converted in the body to bicarbonate, and consequently may support acid-base balance.21

Thus, disturbance in pH, low intake of potassium from fruits and vegetables, and high sodium intake may lead to a loss of calcium from the bones.21-24 These, as well as other factors, can increase risk for osteoporosis.21,25

100% orange juice is a good source of potassium supplying 10% of the Daily Value in an 8-ounce serving.*

Magnesium

About 50 to 60 percent of the body’s magnesium is stored in the bones. Magnesium plays an important role in bone health mainly by contributing to the structural development of bone (modifies the crystalline size via changes in solubility of hydroxyapatite), but also by affecting the number of osteoblasts, or bone cells that build bones.21 Deficiency experiments in animals have caused negative changes to bone structure and function, including decreased bone mass, reduced osteoblast numbers, and increased inflammation.21

Florida Orange Juice is a source of magnesium. Approximately 6% of the Daily Value for magnesium can be found in an 8-ounce glass of orange juice.*

Phytonutrients

Other components of citrus, like carotenoids and flavonoids, may be involved in supporting bone health through their actions on bone healing and formation. 9,26

Carotenoids

In three separate clinical trials, participants consuming citrus juices rich in the carotenoid beta-cryptoxanthin had positive changes in markers of bone activity.2 Additional clinical trials observed lower markers of bone turnover and less oxidation of protein and lipids in postmenopausal women fed lycopene-rich foods or capsules.5 In elderly men and postmenopausal women, intake and serum levels lycopene were associated with lower hip fracture risk, lower markers of bone turnover and lower protein oxidation.3,4 Additionally, total carotenoids and specific carotenoids (beta-carotene, beta-cryptoxanthin, lutein and zeaxanthin) were positively associated with lower hip fractures in older adults (55 to 80 years old).2,7 Various animal studies investigating carotenoids lycopene and beta-cryptoxanthin have shown positive benefits to bone health, including increased bone formation, bone mineralization and increased bone strength, gene expression of osteoblast growth factors, and inhibition of bone resorption.2,6

Carotenoids, including beta-carotene, beta-cryptoxanthin, lutein, and zeaxanthin, provide the beautiful colors in orange juice. Several of these can also form vitamin A in the body.

Flavonoids

In the United Kingdom Adult Twin Registry study, researchers found higher intakes of flavanones, which are a subclass of flavonoids found primarily in citrus, were positively associated with hip bone and mineral density.7 In healthy menopausal women fed hesperidin, found almost exclusively in oranges and orange juice,28 researchers observed positive changes in markers of bone health.8 Furthermore in animal studies, hesperidin or a combination of hesperidin with naringenin increased bone mineral density.9

Many flavonoids can be found in orange juice; however, hesperidin and naringenin are found in highest amounts.

* Values based on a 2000 calorie diet. Nutrient values may vary based on manufacturer, brand and product types.

BACK TO HEALTH BENEFITS

References

  1. Canadian Food Inspection Agency (2018, May 11): Nutrient Function Claims. Retrieved June 12, 2019 from http://www.inspection.gc.ca/food/general-food-requirements-and-guidance/labelling/for-industry/health-claims/eng/1392834838383/1392834887794?chap=9
  2. Yamaguchi. J Health Sci. 2008; 54(4):356-369.
  3. Rao et al. Pharmacol Res. 2007;55:207-216.
  4. Sahni et al. J Bone Miner Res. 2009;24:1086-1094.
  5. MacKinnon et al. Osteoporos Int. 2011; 22:1091-1101.
  6. Liang et al. Molecules. 2012; 17:7093-7102.
  7. Welch et al. J Bone Miner Res. 2012;27(9):1872-1878.
  8. Habauzit et al. Proc An Meeting Am Society Bone Miner Res. San Diego, CA; Sept 16-29, 2011.
  9. Horcajada et al. J Appl Physiol. 2008; 104:648-654.
  10. USDA National Nutrient Database for Standard Reference, Release 28 (slightly revised). US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory; May 2016. https://ndb.nal.usda.gov/ndb/
  11. Vitamin C. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, D.C.: National Academy Press; 2000:95-185.Vitamin C. Linus Pauling Institute Micronutrient Information Center. Oregon State University. http://lpi.oregonstate.edu/mic/vitamins/vitamin-C).
  12. Lykkesfeldt et al. Adv Nutr 2014; 5:16-18.
  13. Vitamin C. Health Professionals Fact Sheet. Office of Dietary Supplements. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/ .
  14. Dietary Reference Intakes for Calcium and Vitamin D. Food and Nutrition Board. Institute of Medicine; Washington, DC: National Academies Press, 2010.
  15. Chun et al. J Nutr. 2010;140:317-324.
  16. Canadian Food Inspection Agency (Feb 2019): Acceptable Disease Risk Reduction Claims and Therapeutic Claims. Retrieved June 17, 2019 from  http://www.inspection.gc.ca/food/requirements/labelling/industry/health-claims/eng/1392834838383/1392834887794?chap=7 .
  17. Biancuzzo et al. Am J Clin Nutr. 2010;91:1621-1626.
  18. Economos et al. J Acad Nutr Diet. 2014;114:709-717.
  19. Lee et al. J Medicinal Food. 2014;17(10):1142-1150.
  20. Neyestani et al. J Human Nutr Diet. 2014; 27:606-616.
  21. deBaaij et al. Physiol Rev. 2015;95(1):1-46.
  22. Potassium. Linus Pauling Institute Micronutrient Information Center. Oregon State University. http://lpi.oregonstate.edu/mic/minerals/potassium.
  23. Steiner. Urolithiasis. 2016; 44:51-56.
  24. Prezioso et al. Archivo Italiano di Urologia e Andrologia. 2015; 87(2):105-120.
  25. A Food Labeling Guide; Guidance for Industry. FDA Center for Food Safety and Applied Nutrition. January 2013. https://www.fda.gov/downloads/Food/GuidanceRegulation./GuidanceDocumentsRegulatoryInformation/UCM265446.pdf
  26. Sacco et al. Br J Clin Pharmacol. 2013;75:697-707.
  27. Cao et al. Bone. 2018;111:116-122.
  28. Bhagwat S, Haytowitz D. USDA Database for the Flavonoid Content of Selected Foods Release 3.2. In. Beltsville, MD: Unites States Department of Agriculture; 2015.