Cheese positively affects serum osteocalcin levels, bone turnover markers and bone mineral density in cross-country skiers: a dose-response study




Athletes, BMD, BTMs, Jarlsberg cheese, Osteocalcin, Vitamin K2


Background: Vitamin K2-rich Jarlsberg Cheese is demonstrated to increase Osteocalcin and bone turnover markers in fertile women. The impact on endurance-trained young cross-country skiers (XCS) with elevated bone turnover remains unclear. Purpose of study was to estimate the optimal daily efficacy dose of Jarlsberg cheese to increase serum Osteocalcin level in young female and male XCS and estimate the Jarlsberg effect on bone turnover markers (BTMs) and bone mineral density (BMD).

Methods: In a parallel group study consisting of three design levels, 10 female and 10 male XCS were included, using Response Surface Pathway design. Blood samples were taken at each level for measurements of Osteocalcin, vitamin K2, BTMs and other biochemical parameters. Resting metabolic rate (RMR), BMD, VO2max and muscle strength were measured at start and at the end of the study.

Results: The Osteocalcin development with increasing dose of Jarlsberg cheese was almost parallel in both sexes. These variables were reduced significantly from baseline during the first two design levels but increased above baseline by the end of the study. BTMs decreased significantly during the first and second level but increased during the third level. Total and L1-L4 BMD, s-phosphate, s-urea, RMR, muscle strength and Peak VO2 increased significantly while s-calcium and s-magnesium decreased.

Conclusions: Estimated OED of Jarlsberg cheese was 73 and 84 g/day for females and male athletes, respectively. The development in OC, BTMs and BMD suggest an antiresorptive and perhaps anabolic effect of Jarlsberg Cheese on bone tissue. VO2 max, RMR and muscular strength development indicated an anabolic situation.


Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364-76.

Schurgers LJ, Teunissen KJ, Hamulyák K, Knapen MH, Vik H, Vermeer C. Vitamin K-containing dietary supplements: comparison of synthetic vitamin K1 and natto-derived menaquinone-7. Blood. 2007; 109(8):3279-83.

Iwamoto J. Vitamin K₂ therapy for postmenopausal osteoporosis. Nutrients. 2014;6(5):1971-80.

Sato T, Schurgers LJ, Uenishi K. Comparison of menaquinone-4 and menaquinone-7 bioavailability in healthy women. Nutr J. 2012;11:93.

Luo G, Ducy P, McKee MD. Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature. 1997;386(6620):78-81.

De Pergola G, Triggiani V, Bartolomeo N. Independent Relationship of Osteocalcin Circulating Levels with Obesity, Type 2 Diabetes, Hypertension, and HDL Cholesterol. Endocr Metab Immune Disord Drug Targets. 2016;16(4):270-5.

Komori T. Functions of Osteocalcin in Bone, Pancreas, Testis, and Muscle. Int J Mol Sci. 2020; 21(20):513.

Vitale JA, Sansoni V, Faraldi M. Circulating Carboxylated Osteocalcin Correlates With Skeletal Muscle Mass and Risk of Fall in Postmenopausal Osteoporotic Women. Front Endocrinol. 2021;12: 669704.

Geleijnse JM, Vermeer C, Grobbee DE. Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study. J Nutr. 2004;134(11):3100-5.

Manoury E, Jourdon K, Boyaval P, Fourcassié P. Quantitative measurement of vitamin K2 (menaquinones) in various fermented dairy products using a reliable high-performance liquid chromatography method. J Dairy Sci. 2013;96(3): 1335-46.

Hojo K, Watanabe R, Mori T, Taketomo N. Quantitative measurement of tetrahydrom-enaquinone-9 in cheese fermented by propionibacteria. J Dairy Sci. 2007;90(9):4078-83.

Kita K, Yamachika E, Matsubara M. Anti-osteoporosis effects of 1, 4-dihydroxy-2-naphthoic acid in ovariectomized mice with increasing of bone density. J Oral Maxillofac Surg Med Pathol. 2016; 28(1):66-72.

Lundberg HE, Holand T, Holo H, Larsen S. Increased serum osteocalcin levels and vitamin K status by daily cheese intake. J Nutr. 2020.

Lundberg HE, Holo H, Holand T, Fagertun HE, Larsen S. Determination of maintenance Jarlsberg® cheese dose to keep the obtained serum osteocalcin level; a response surface pathway designed de-escalation dose study with individual starting values. J Dairy Sci. 2021.

Lundberg HE, Glasø M, Chhura R. Effect on bone anabolic markers of daily cheese intake with and without vitamin K2: a randomised clinical trial. BMJ Nutr Prevent Health. 2022;5(2):182.

Mountjoy M, Ackerman KE, Bailey DM. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-97.

McKay AKA, Stellingwerff T, Smith ES, et al. Defining Training and Performance Caliber: A Participant Classification Framework. Int J Sports Physiol Perform. 2022;17(2):317-31.

Trond H, Øystein E, Dewi S, Larsen S. Randomized response surface pathway design with skewed starting point and stochastic dose window. Int J Sports Physiol Perform. 2020.

Matvaretabellen. Available at: Accessed on 20 November 2023.

Nana A, Slater GJ, Hopkins WG. Importance of Standardized DXA Protocol for Assessing Physique Changes in Athletes. Int J Sport Nutr Exerc Metab. 2016;26(3):259-67.

Mathisen TF, Engen KM, Sundgot-Borgen J, Stensrud T. Evaluation of a short protocol for indirect calorimetry in females with eating disorders and healthy controls. Clin Nutr ESPEN. 2017;22:28-35.

Losnegard T, Mikkelsen K, Rønnestad BR, Hallén J, Rud B, Raastad T. The effect of heavy strength training on muscle mass and physical performance in elite cross country skiers. Scand J Med Sci Sports. 2011;21(3):389-401.

Edvardsen E, Hem E, Anderssen SA. End criteria for reaching maximal oxygen uptake must be strict and adjusted to sex and age: a cross-sectional study. PLoS One. 2014;9(1):e85276.

Altman D. Practical statistics for medical research. London: CRC; 1991:396;439.

Agresti A. Categorical data analysis. London: John Wiley & Sons; 2012.

Kleinbaum DG, Kupper LL, Nizam A, Rosenberg ES. Applied regression analysis and other multivariable methods. London: John Wiley & Sons; 2013.

van Summeren M, Braam L, Noirt F, Kuis W, Vermeer C. Pronounced elevation of undercarboxylated osteocalcin in healthy children. Pediatr Res. 2007;61(3):366-70.

Kanbur NÖ, Derman O, Şen TA, Kinik E. Osteocalcin. A biochemical marker of bone turnover during puberty. Int J Adolesc Med Health. 2002; 14(3):235-44.

Scheiman J, Luber JM, Chavkin TA. Meta-omics analysis of elite athletes identifies a performance-enhancing microbe that functions via lactate metabolism. Nat Med. 2019;25(7):1104-9.

Kuo TR, Chen CH. Bone biomarker for the clinical assessment of osteoporosis: recent developments and future perspectives. Biomark Res. 2017;5:18.

Shao J, Zhou S-S, Qu Y, Liang B-B, Yu Q-H, Wu J. Correlation between bone turnover and metabolic markers with age and gender: a cross-sectional study of hospital information system data. BMC Musculoskelet Disord. 2020;21:1-10.

Gillett MJ, Vasikaran SD, Inderjeeth CA. The Role of PINP in Diagnosis and Management of Metabolic Bone Disease. Clin Biochem Rev. 2021;42(1):3-10.

Kobayashi T, Seki S, Hwang I. Effects of resistance training on bone mineral density and resting serum hormones in female collegiate distance runners: a randomized controlled pilot trial. J Sports Med Phys Fitness. 2023;63(6):765-72.

Vlachopoulos D, Barker AR, Ubago-Guisado E, Williams CA, Gracia-Marco L. A 9-month jumping intervention to improve bone geometry in adolescent male athletes. J Sports Med Phys Fitness. 2018.

Watson S, Weeks B, Weis L, Harding A, Horan S, Beck B. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2019;34(3):572.

Duplanty AA, Levitt DE, Hill DW, McFarlin BK, DiMarco NM, Vingren JL. Resistance training is associated with higher bone mineral density among young adult male distance runners independent of physiological factors. J Strength Condition Res. 2018; 32(6):1594-600.

Matsubara M, Yamachika E, Tsujigiwa H. Suppressive effects of 1,4-dihydroxy-2-naphthoic acid administration on bone resorption. Osteoporos Int. 2010;21(8):1437-47.

Yamaguchi M, Weitzmann MN. Vitamin K2 stimulates osteoblastogenesis and suppresses osteoclastogenesis by suppressing NF-κB activation. Int J Mol Med. 2011;27(1):3-14.

Sato T, Inaba N, Yamashita T. MK-7 and Its Effects on Bone Quality and Strength. Nutrients. 2020; 12(4):231.

Rabah H, Carmo FLRd, Jan G. Dairy propionibacteria: versatile probiotics. Micro-organisms. 2017;5(2):24.

Kenkre J, Bassett J. The bone remodelling cycle. Ann Clin Biochem. 2018;55(3):308-27.






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