Dietary phyto-oestrogens and bone health

The use of dietary phyto-oestrogens as a possible option for the prevention of osteoporosis has raised considerable interest because of the increased concern about the risks associated with the use of hormone-replacement therapy. However, the evidence in support of a bone-sparing effect in post-menopausal women is still not sufficiently convincing. Most studies have been performed on soyabean isoflavones (genistein and daidzein), either in the purified form or as a soyabean-based product or extract. In vitro studies using primary cell cultures or stabilised cell lines indicate that treatment with genistein may lead to a reduction in bone resorption, but effects on bone formation have also been shown. Investigations using animal models have provided convincing evidence of major improvements in bone mass or bone turnover following soyabean feeding. Cross-sectional observations in South-East Asian populations with moderately high intakes of soyabean isoflavones (50 mg/d) have shown that women in the high quartile of intake have higher bone mineral density (BMD) and reduced bone turnover, an effect that has not been shown in populations with low average intakes. Human trials have given an indication of a possible effect on lumbar spine BMD, although they have been either short term (<6 months) or methodologically weak. Unresolved issues are: the optimal dose compatible with safety; the individual differences in response that can be related to diet and genotypes; the duration of exposure. Furthermore, there needs to be an evaluation of the relative biological effects of phyto-oestrogens other than isoflavones (lignans, resorcylic acid lactones, flavanols, coumestans) that are also present in European diets.