title: Assessment of health claims in the field of bone: a view of the Group for the Respect of Ethics and Excellence in Science (GREES).
abstract: Health claims for food products in Europe are permitted if the nutrient has been shown to have a beneficial nutritional or physiological effect. This paper defines health claims related to bone health and provides guidelines for the design and the methodology of clinical studies to support claims.
  
  
  BACKGROUND
  Regulation (EC) no. 1924/2006 on nutrition and health claims targeting food products was introduced in Europe stating that health claims shall only be permitted if the substance in respect of which the claim is made has been shown to have a beneficial nutritional or physiological effect. The objective of this paper is to define health claims related to bone health and to provide guidelines for the design and the methodology of clinical studies which need to be adopted to assert such health claims.
  
  
  METHODS
  Literature review followed by a consensus discussion during two 1-day meetings organized by the Group for the Respect of Ethics and Excellence in Science (GREES).
  
  
  RESULTS
  The GREES identified six acceptable health claims related to bone health based on the potential of food products to show an effect on either the bioavailability of calcium or osteoclast regulatory proteins or bone turnover markers or bone mineral density or bone structure or fracture incidence. The GREES considers that well-designed human randomized controlled trial on a relevant outcome is the best design to assess health claims. The substantiation of health claim could also be supported by animal studies showing either an improvement in bone strength with the food product or showing the relationship between changes induced by the food product on a surrogate marker and changes in bone strength.
  
  
  CONCLUSIONS
  The consensus reached is that the level of health claim may differ according to the surrogate endpoint used and on additional animal studies provided to support the claim.
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. olivier.bruyere@ulg.ac.be
authors.forename: O
authors.initials: O
authors.lastname: Bruyère
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.forename: V
authors.initials: V
authors.lastname: Coxam
authors.forename: B
authors.initials: B
authors.lastname: Avouac
authors.forename: T
authors.initials: T
authors.lastname: Chevalier
authors.forename: V
authors.initials: V
authors.lastname: Fabien-Soulé
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
authors.forename: J-M
authors.initials: JM
authors.lastname: Kaufman
authors.forename: Y
authors.initials: Y
authors.lastname: Tsouderos
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
mesh_terms: D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism / Q000502:physiology*; D005060:Europe; D019317:Evidence-Based Medicine / Q000379:methods; D019649:Food Industry / Q000331:legislation & jurisprudence; D055951:Functional Food / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D007881:Legislation, Food; D009747:Nutritional Physiological Phenomena / Q000502:physiology*; D012107:Research Design