Nutritional Prevention and Treatment of Osteoporosis

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					                   Nutritional Prevention and Treatment of Osteoporosis
                                                By Maureen Williams, ND

The human skeleton’s 206 bones provide the basic structural frame for the rest of the body. The compact or hard bone
includes the mineralized portion of bone. It represents most of the bone mass, and provides the strength the skeleton needs
to support the body. The trabecular or soft bone houses the cells responsible for bone remodeling: osteoclasts resorb bone
by removing minerals and breaking up collagen; osteoblasts build bone by laying down new collagen and mineralizing the
collagen matrix. The balance of osteoclast and osteoblast activities shifts in favor of bone resorption as we age, and
particularly in women after menopause. The result is a reduction in bone mineral density, or osteopenia, which can
eventually lead to osteoporosis and increased risk of fracture.

In women, most bone loss occurs during the first eight to ten years after menopause. During this critical window, a
number of things can be done to slow bone loss, including staying physically active, not smoking, and eating a diet rich in
fruits and vegetables, high in legumes including soy, sufficient in omega-3 fatty acids like those in fish, moderate in
animal protein, and low in sugar, sodium, caffeine, soft drinks, and alcohol. In addition, a number of nutritional
supplements have been found to support bone mineralization through their effects on calcium metabolism.

Calcium - Calcium is the most substantial mineral component of structural bone. In addition to dairy foods, there are
many dietary sources of calcium, including green vegetables, beans, soy foods, nuts and seeds, blackstrap molasses, figs,
sea vegetables, and bony fish. Findings from some studies suggest that getting adequate dietary calcium might prevent
bone loss and fractures, i but there is no conclusive evidence linking dairy foods—the main source of calcium in the
standard American diet—to bone health. ii iii

Calcium supplements have long been recommended as a way to boost calcium intake, which is notoriously low in many
subsets of Americans. Supplementing with calcium and vitamin D has been associated with increased bone mineral
density in peri- and postmenopausal women, iv v shorter healing time in women with osteoporosis-related upper arm
fractures, vi and reduced bone loss in men and women over the age of 60. vii The combination of calcium and vitamin D
was also found to reduce the fracture rate in elderly people living at a Northern latitude, viii and to prevent tooth loss in
people over 65. ix

It is important to note that supplementing with calcium alone does not appear to have a significant fracture-preventing
effect. x xi The most recent report from the ongoing National Health and Nutrition Examination Survey (NHANES)
presented findings showing no clear correlation between calcium intake and fracture risk. xii Even with vitamin D,
supplementation appears to be of little value in women with adequate calcium intake and normal blood levels of vitamin
D. xiii In light of the growing body of evidence that other nutrients influence calcium metabolism and bone cell activity in
critical and complex ways, researchers have begun to question whether the current calcium supplement recommendations
are too high. xiv xv

Calcium from carbonate and citrate are the most common forms of calcium supplements. Calcium carbonate, the most
cost-effective form, is well-absorbed and tolerated in most individuals when taken with a meal (ensures optimal
absorption). Calcium carbonate supplements provide greater amounts of elemental calcium and consequently require
fewer tablets than other forms of calcium. Calcium citrate can be taken with or without food and may be the supplement
of choice for individuals with achlorhydria or who are taking stomach acid blocking drugs (histamine-2 blockers or proton
pump inhibitors). Calcium citrate should be used in individuals with inflammatory bowel disease, or absorption disorders.
xvi xvii

Vitamin D3/Cholecalciferol - Vitamin D3 (cholecalciferol) is produced in sun-exposed skin and activated through a
series of chemical reactions that take place in the liver and kidneys. Once in its active form, calcitriol, it raises calcium
levels by increasing calcium absorption in the intestines and resorption in the kidneys. It also modulates bone remodeling
by osteoclasts and osteoblasts.

Vitamin D2 (ergocalciferol) is not produced by humans, but in some sun-exposed invertrebrates, fungi, and plants. While
vitamin D2 is often used in nutritional supplements and is able to raise blood levels of 25-hydroxyvitamin D (25(OH)D,

the standard measure of vitamin D status), supplementing with vitamin D3 appears to be more effective at improving
vitamin D status. xviii

Supplementing with vitamin D3 plus calcium reduced bone loss and nonvertebral fracture incidence in community
dwelling elders in one study, xix but had no effect on fracture risk in another study. xx An increase in bone mineral density
and reduction in bone loss was observed in people who had experienced an osteoporosis-related hip fracture and
subsequently supplemented with vitamin D3 plus calcium. xxi Researchers conducting a meta-analysis noted a trend
toward a reduced risk of falling in postmenopausal women taking vitamin D3. xxii

Low and deficient vitamin D levels are highly prevalent in people who avoid sun exposure due to health concerns or
cultural traditions, use sunscreen, have dark skin, or live in northern latitudes. In a study involving North American
women with osteoporosis, 52% were found to have suboptimal vitamin D status (<30 ng/ml 25(OH)D). xxiii Because
vitamin D insufficiency has been linked to increased risks of osteoporosis and other chronic diseases including heart
disease, diabetes, and cancer, new recommendations for vitamin D supplementation are being considered. xxiv xxv A routine
recommendation of 1,000 IU per day is considered safe and reasonable, xxvi xxvii and higher amounts are likely indicated for
people with osteoporosis or known vitamin D insufficiency. xxviii

Magnesium - Magnesium, often thought of as the counterpart to calcium, is found in foods such as nuts, seeds, whole
grains, and legumes. It functions primarily intracellularly, and interacts closely with the other cationic minerals, such that
magnesium deficiency can cause hypocalcaemia and hypokalaemia, xxix overly high calcium intake can cause a relative or
absolute magnesium deficiency, xxx and low potassium intake (generally due to lack of fruits and vegetables in the diet)
can lead to increased excretion of calcium and magnesium. xxxi xxxii Women with osteoporosis have been found to have low
intracellular xxxiii and serum xxxiv xxxv magnesium levels, and chronically low magnesium levels have also been associated
with diabetes, hypertension, and coronary artery disease. xxxvi Low magnesium intake is common xxxvii and has been
associated with lower bone mineral density in Caucasians xxxviii and a higher risk of hip fracture in a Japanese community.
       People with high magnesium intake have been found to have higher bone mineral density and less bone loss over time
than people with low intake. xl xli In preliminary trials, increasing dietary magnesium xlii and magnesium supplementation
      have both been found to improve bone mineral density in postmenopausal women with osteoporosis.

Most nutritional guidelines recommend a 2:1 ratio of calcium to magnesium, as it is believed that an excessively high
calcium intake can disrupt the balance between calcium and magnesium, increasing the risk of cardiovascular
consequences such as hypertension and thrombosis. xliv Given magnesium’s important role in thrombus prevention as well
as maintaining healthy blood pressure, regular heart rhythm, and normal cardiac muscle function, xlv an induced relative
magnesium deficiency could explain the increased incidence of cardiovascular disease seen in women using calcium and
calcium plus vitamin D in some xlvi xlvii (though not all xlviii ) studies.

Boron - Humans have a trace requirement for the mineral, boron, which is found in fruits, vegetables, and nuts. Although
its role in the body is not fully understood, boron appears to help regulate the levels of other minerals, including calcium,
magnesium, and phosphorus. A low-boron diet has been linked to increased urinary excretion of both calcium and
magnesium, while supplemental boron seems to limit these mineral losses. xlix l li Boron has also been found to reduce
urinary calcium loss in people with a magnesium-deficient diet. lii The need for boron appears to be enhanced in cases of
magnesium, potassium, and vitamin D deficiencies. liii

Lysine - The essential amino acid, lysine, is a necessary nutrient for the synthesis of biochemical proteins including
muscle tissue, hormones, antibodies, and enzymes. In addition, lysine increases calcium absorption and reduces urinary
calcium excretion, leading to an overall positive impact on calcium balance. liv Research using bone cells derived from
osteopenic rats suggests that lysine stimulates osteoblast proliferation and activity, and might thereby promote bone
building. lv lvi This may partially explain the negative impact of a low-protein diet on bone health. lvii lviii

By increasing calcium absorption and osteoblast activity, lysine might be useful in treating osteoporosis. In two controlled
trials, calcitonin plus a combination of lysine, arginine, and lactose was found to improve bone mineral density and reduce
bone loss more than calcitonin alone in elderly people with osteoporosis. lix lx

Horsetail (Equisetum arvense) - Horsetail is a common weed in many parts of the United States. In traditional herbal
medicine, it is used in the treatment of urinary tract infections, hemorrhage and bleeding, superficial wounds, and benign

prostatic hyperplasia. It is know to be rich in antioxidant phenolic compounds lxi as well as minerals. lxii In particular, the
stems of horsetail contain high levels of silica and silicic acids, lxiii which support bone and collagen formation.

Women and men with high dietary intake of silicon have higher bone density than women with low intake. lxiv
Supplementing with silicon led to improved hip bone density in women with osteoporosis, lxv and augmented the bone-
building effects of calcium plus vitamin D in women with osteopenia. lxvi Horsetail extract, in a preliminary trial, was
more effective at increasing bone density than a calcium/silicon combination taken by women over the course of one year.

Strontium - Strontium is a metal element that occurs naturally in the form of the mineral, strontianite. A compound made
with strontium and ranelic acid (strontium ranelate) has been developed and marketed in Europe and other parts of the
world as a drug for the treatment of osteoporosis. This drug is not available in the US or Canada, but strontium salts, such
as strontium citrate and strontium carbonate, are increasingly common ingredients in bone-building nutritional

In vitro research suggests that strontium becomes incorporated into the bone mineral crystal matrix. lxviii Strontium also
appears to stimulate the production of mature osteoblasts and inhibit osteoclast formation and activity in the trabecular
bone, increasing the capacity of bone to lay down mineralized matrix. lxix lxx

Strontium ranelate has been subjected to a number of clinical trials and has been found to be safe and effective for the
treatment of osteopenia and osteoporosis. lxxi One study identified the minimum effective dose for improving bone mineral
density to be 1 gram per day. lxxii It has also been shown to significantly reduce the incidence of vertebral (approximately
24–40% reduction) and non-vertebral (approximately 15% reduction) fractures over study periods of three to five years,
particularly in women at high risk for fracture and women over 80 years old. lxxiii lxxiv lxxv lxxvi lxxvii In postmenopausal
women with osteoporosis, strontium use has been associated with better physical and emotional functioning, less pain, and
higher overall quality of life. lxxviii Strontium ranelate has also been found to prevent cartilage loss associated with
osteoarthritis, lxxix and reduce back pain in people with spinal osteoarthritis. lxxx
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