201 Virgin Olive Oil Benefits 17.3. Extra Virgin Olive Oil and Bone Health With ageing, skeletal mass and microarchitecture deteriorate, increasing the risk of osteoporosis and fractures. Global hip fractures reached an estimated 9 million in 2000, exceeding the disability burden of most cancers except lung cancer. As the global population ages -especially in developing nations- osteoporotic fractures pose increasing challenges and healthcare costs Bone remodeling involves osteoblasts (formation), osteoclasts (resorption), and osteocytes (regulation). Osteoporosis arises when resorption surpasses formation. While sex hormone deficiency is a major cause, oxidative stress and inflammation are increasingly recognised contributors. Inflammatory cytokines like IL-1β, IL-6, and Tumour Necrosis Factor alpha (TNF-α) stimulate osteoclastogenesis, increasing bone loss. Oxidative stress also impairs osteoblasts and enhances osteoclast differentiation. Human studies have shown inverse associations between oxidative stress and bone mineral density. Dietary antioxidants, such as tocotrienols, curcumin, and omega-3 fatty acids, have shown protective effects. In the EPIC cohort, adherence to the Mediterranean diet was associated with reduced fracture risk. Among adolescents, it was linked to better calcium retention. In older men, a Mediterranean diet enriched with EVOO improved bone formation markers more than a non-enriched version. Experimental studies corroborate these findings. In pigs, an EVOO-rich diet (19%) increased bone mineral density over 8 weeks. In mice, replacing dietary fats with EVOO improved femur length, volume, and mineral content. Phenolic compounds in EVOO (tyrosol, hydroxytyrosol, oleuropein) are likely responsible for these benefits. In ovariectomised rat models, EVOO (50 g/kg for 80 days) prevented bone mineral density loss and increased femoral strength, especially under inflammatory conditions. However, bone turnover markers (osteocalcin, deoxypyridinoline) were unchanged. Similar benefits were found in Egyptian and Chinese studies using different EVOO dosages and models, sometimes showing comparable efficacy to oestrogen replacement therapy. In the human PREDIMED trial, men aged 55–80 consuming ≥50 mL/day of EVOO showed increased osteocalcin and procollagen type 1 N-propeptide markers over 2 years, compared to those on low-fat or nut-supplemented diets. Still, bone mineral density and fracture data were not collected. Other human studies in China and Italy -despite small sample sizes and lack of placebo controls- also suggest EVOO may help preserve bone mineral density in postmenopausal women, especially when enriched with vitamins K1, D3, and B6.
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