Bone Health - Osteoporosis

Osteoporosis Risk: A Harbinger of Overall Health

Nutrient deficiencies that cause osteoporosis may predict your risk for other diseases

Your bones aren’t just a bunch of calcium-rich rocks. They’re living, dynamic tissue—highly mineralized, yes, but also very much dependent on a wide range of nutrients to maintain their strength, density, and flexibility throughout life. And the nutrient deficiencies that predispose a person to osteoporosis can also set the stage for many other health problems, including heart disease, cancer, and muscle spasms, to mention just a few. Osteoporosis, a disease characterized by low bone density and deterioration of bone tissue, may also be a predictor of other serious health issues that may crop up down the road.

The same nutrients that are needed for healthy bones are also needed for an array of other functions in the body. It is important to note that because they are so crucial for bone health, the body will preferentially use many of these nutrients for bone health before they are used for other functions. Therefore, if you don’t have enough of these nutrients for healthy bones, then you most likely don’t have enough for other important functions.

Calcium

Nearly all of the body’s calcium is used to make and maintain bone and teeth. The mineral combines with phosphate (which is abundant in foods) to form hydroxylapatite, the actual mineralized part of bones. Bone and teeth mineralization is an ongoing process, with old cells being replaced by newer cells—assuming the nutritional building blocks are present.

Yellow Alert

Calcium intake may influence your life expectancy. A study conducted at McGill University in Montreal found that women who consumed up to 1,000 mg of calcium daily—regardless of whether it came from foods or supplements—had a 22 percent lower risk of dying from any cause.[1]

Recommendation

Although calcium is essential for normal bone development and maintenance, it should not be taken to the exclusion of magnesium, vitamin D, and other nutrients needed for bone health. Thus, while the RDA for calcium is 1,000 mg daily for most adults, less (500 to 800 mg daily) may be sufficient when other bone nutrients are also consumed. Many different types of calcium supplements are available. Calcium citrate provides a well-absorbed form of the mineral at a reasonable price.

Magnesium

After calcium, magnesium is the second most important mineral for maintaining normal bone density. In a study of 2,000 men and women, people with high intake of magnesium had greater bone-mineral density throughout their bodies. For every 100 mg increase in daily magnesium intake, the subjects had a 2 percent increase in whole-body bone-mineral density. The impact of magnesium was comparable to the effect of calcium on bone-mineral density, wrote Kathryn M. Ryder, MD, in the Journal of the American Geriatrics Society.[2] Another study found that magnesium supplements increase bone-mineral density in teenage girls—the time of life when bones should become their strongest.[3]

Yellow Alert

Low magnesium intake may influence your risk of other serious health problems. The mineral plays roles in more than 300 biochemical reactions in the body, affecting heart rhythm, blood sugar, and cancer risk. Muscle spasms are a common sign of magnesium deficiency. A recent five-year Spanish study found people with the highest magnesium intake were 34 percent less likely to die of any cause, including cardiovascular diseases and cancer, compared with people who consumed relatively little magnesium. The researchers also noted, significantly, that a low-fat diet may significantly reduce a person’s intake of magnesium.[4] Another recent study by Harvard University researchers determined that women who had the highest dietary intake of magnesium were 37 percent less likely to suffer from sudden cardiac death. Meanwhile, those with the highest blood levels of magnesium were 77 percent less likely to experience sudden cardiac death.[5]

Recommendation

Magnesium citrate and magnesium glycinate are both well absorbed, but there are many different types of magnesium supplements available. Take 200 to 400 mg daily. Larger amounts may cause loose stools.

Vitamin D

Vitamin D is necessary for calcium absorption. Not surprisingly then, low vitamin D levels reduce bone development and bone density. In children, the consequence is rickets and in adults it is osteomalacia (soft bones). Numerous studies have shown that a combination of vitamin D and calcium help maintain bone density and reduce the risk of hip fractures (one of the consequences of osteoporosis). In a study conducted at the Fred Hutchinson Cancer Research Center, Seattle, women who took both vitamin D and calcium supplements for at least five years were 38 percent less likely to suffer a hip fracture, compared with women who did not take these supplements.[6] However, the amount of vitamin D is critical. In a Scottish study, researchers found that women taking 1,000 IU of vitamin D daily maintained their bone density, whereas those taking only 400 IU lost bone density over one year.[7] Vitamin D is also needed for muscle development and maintenance, and many osteoporotic falls may be related to weak muscles rather than bone. [8] [9] [10] [11]

Yellow Alert

There are vitamin D receptors in all cells in the body, including the brain cells. Not surprisingly, vitamin D influences almost all aspects of health, including cardiovascular health, brain and nerve health, and immune health, and insufficiencies increase the risk of many diseases. Several studies have found that adequate vitamin D helps maintain normal blood sugar levels, therefore potentially reducing the risk of developing type-2 diabetes.[12] [13] [14] Vitamin D might also provide broad-spectrum protection against multiple types of cancer and neurodegenerative diseases such as multiple sclerosis, Parkinson’s, and Alzheimer’s.[15] [16] [17] [18] [19] [20] [21] [22] [23] [24]

Recommendation

Most experts recommend that adults take between 2,000 and 5,000 IU daily to reach optimal levels of 50 ng/mL—levels associated with lowering disease risk.

Vitamin K

Vitamin K is required for the carboxylation, or activation, of osteocalcin, one of the key proteins in the bone matrix. Without adequate vitamin K, bones cannot develop or remain strong. The vitamin is also needed to make matrix Gla protein (MGP), which helps direct calcium to bones instead of arteries.

Recent studies by Dutch and Japanese researchers found that large supplemental amounts of vitamin K2 can actually reverse osteoporosis.[25] [26] Most of these studies used 45 mg (45,000 mcg) daily of the MK-4 form of vitamin K2, although it is probably not necessary for most people to take that much vitamin K. In one study, researchers asked 325 postmenopausal women to take either 45 mg of vitamin K2 or placebos daily for three years. Bone density improved among women taking vitamin K2, but decreased among those taking placebos. An analysis of seven similar studies, published in the Archives of Internal Medicine, found that high-dose vitamin K2 supplements consistently reduced bone fractures in women by more than 60 percent.[27]

Yellow Alert

Adequate intake of vitamin K may offer protection against diabetes and cancer. Osteocalcin regulates the number of insulin-producing cells in the pancreas, the secretion of insulin, sensitivity to insulin, and the size of fat cells—all of which impact the risk of type-2 diabetes. [28] [29] [30] Several studies have noted that vitamin K supplements appear to reduce the risk of breast and liver cancers.[31] [32] And because vitamin K is necessary to activate MGP, which directs calcium to the bones and away from the arteries, it is thought to play a major role in the prevention of atherosclerosis.

Recommendation

Three different types of vitamin K can make things confusing, so here are some guidelines. Take 10,000 mcg of vitamin K2 (MK-4 form) to reduce the risk of osteoporosis. If you have severe osteoporosis, take 45,000 mcg daily under a doctor’s supervision. For blood sugar control, try 1,000 mcg of vitamin K1. For prevention of coronary calcification, try 150 mcg of vitamin K2 (MK-7 form). If you take the anticoagulant drug Coumadin (warfarin), do not take vitamin K without the explicit guidance of your physician.

Vitamin C

Your body requires this popular vitamin to make collagen, a protein that holds together much of our bodies, including bone. In a study at Tufts University, Boston, researchers tracked almost 1,000 elderly men and women for up to 17 years. Overall, people who consumed more than 300 mg daily of vitamin C had the lowest risk of hip and nonvertebral (nonback) fractures, compared with people with the lowest intake of the vitamin. Most of the benefits were related to vitamin C supplements. People who took an average of 260 mg of vitamin C or more daily were about 69 percent less likely to experience a hip fracture and 42 percent less likely to suffer a nonvertebral fracture.[33]

Yellow Alert

Vitamin C has broad health benefits, and low levels can reduce resistance to infection and contribute to bruising and bleeding gums. And because vitamin C is required in energy production, deficiencies can result in fatigue and irritability.

Recommendation

Adults can benefit from taking 1,000 to 3,000 mg daily in divided doses.

B Vitamins

Low levels of vitamins B12 and folic acid are associated with a greater risk of osteoporosis and bone fractures. A Swedish study published earlier this year including 790 elderly men found that low vitamin B12 levels were associated with a two-thirds greater risk of fractures.[34] Other studies have noted a similar link. Japanese researchers studied people’s risk of fractures after suffering a stroke. “Hip fractures are associated with more deaths, disabilities, and medical costs than all other osteoporosis-related fractures combined,” wrote Yoshihiro Sato, MD, of the Keio University School of Medicine, Japan. When Sato and his colleagues supplemented more than 600 stroke patients with either a combination of vitamin B12 and folic acid or placebos, he found that the B vitamins reduced the risk of fracture by 80 percent.[35]

Yellow Alert

Low levels of vitamin B12 and folic acid may influence the risk of other diseases. With inadequate intake of these vitamins, homocysteine levels increase—and homocysteine is strongly related to risk of stroke, atherosclerosis, heart attack, and possibly Alzheimer’s disease. Low levels of these vitamins also lead to DNA damage, which could increase the risk of cancer.

Recommendation

Take a B-complex supplement, a multivitamin (which will contain the B vitamins), or 1,000 mcg of B12 and 400 to 600 mcg of folic acid daily.

Silica, Strontium, and Boron

These three nutrients play small but important roles in bone formation and maintenance. Silicon is involved in the synthesis and stabilization of collagen, and is involved in establishing the matrix that forms bone.[36] Concentrations of the mineral are especially high in cells actively forming new bone. Similarly, strontium plays roles in maintaining and increasing bone formation.[37] Meanwhile, boron aids in the metabolism of calcium, magnesium, and vitamin D—all of which are involved in bone formation and maintenance. Animal studies have found that boron supplementation can increase bone strength.[38]

Yellow Alert

Silicon (also known as silica) may protect against Alzheimer’s disease by reducing aluminum levels in the body and brain. In a 2013 study in the Journal of Alzheimer’s disease, researchers reported that consumption of silicon-rich mineral water for 12 weeks reduced aluminum levels in Alzheimer’s patients. In addition, cognitive function improved significantly in some of the people in the study.[39] [40]

Recommendation

Strontium and boron are typically found in formulas designed to support bone health, rather than standalone supplements. Silicon is available in various forms, including silica and stabilized silicic acid.

Finally…

Because the bone matrix consists of both minerals and protein, it is also important to consume adequate amounts of dietary protein. Higher protein content (more than 68 grams daily, or about 9 ounces of fish or animal protein) is associated with stronger bones.[41] However, consuming a ratio of two-thirds vegetables to one-third protein is crucial for maintaining an alkaline body pH, which will also help preserve both bone and muscle.


References

[1] Langsetmo L, Berger C, Kreiger N, et al. Calcium and Vitamin D Intake and Mortality: Results from the Canadian Multicentre Osteoporosis Study (CaMos). Journal of Clinical Endocrinology & Metabolism, 2013;98:3010-3018.

[2] Ryder KM, Shorr RI, Bush AJ, et al. Magnesium intake from food and supplements is associated with bone mineral density in healthy older white subjects. Journal of the American Geriatrics Society, 2005;53:1875-1880.

[3] Carpenter TO, DeLucia MC, Zhang JH, et al. A Randomized Controlled Study of Effects of Dietary Magnesium Oxide Supplementation on Bone Mineral Content in Healthy Girls. The Journal of Clinical Endocrinology & Metabolism, 2006 Dec;91(12):4866-72.

[4] Guasch-Ferré M, Bullo M, Estruch R, et al. Dietary magnesium intake is inversely associated with mortality in adults at high cardiovascular risk. Journal of Nutrition, 2013: doi 10.3945/jn.113.183012.

[5] Chiuve SE, Korngold EC, Januzzi JL, et al. Plasma and dietary magnesium and risk of sudden cardiac death in women. American Journal of Clinical Nutrition, 2010: doi 3945/ajcn.110.002253.

[6] Prentice RL, Pettinger MB, Jackson RD, et al. Health risks and benefits from calcium and vitamin D supplementation: women’s health initiative clinical trial and cohort study. Osteoporosis International, 2013;24:567-580.

[7] Macdonald HM, Wood AD, Aucott LS, et al. Hip bone loss is attenuated with 1000 IU but not 400 IU daily vitamin D3: a 1-year double-blind RCT in postmenopausal women. Journal of Bone and Mineral Research, 2013; 28:2202-2213.

[8] Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial.  BMJ, 2003;326:469-472.

[9] Venning G. Recent developments in vitamin D deficiency and muscle weakness among elderly people. BMJ, 2005;330:524-526.

[10] Flicker L, MacInnis RJ, Stein MS, et al. Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. Journal of the American Geriatric Society, 2005;53:1881-1888.

[11] Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women. Archives of Internal Medicine, 2006;166:424-430.

[12] Parker J, Hashimi O, Dutton D, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas, 2010;225-236.

[13] Pittas AG, Harris SS, Stark PC, et al. The effects of combined vitamin D and calcium supplementation on glycemia in adults age 65 and older. Presented at the 66th Scientific Sessions of the American Diabetes Association, 2006: Abstract 327-OR.

[14] Pittas AG, Dawson-Hughes B, Li T, et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care, 2006;29:650-656.

[15] Garland CF, Garland FC, Gorham ED, et al. The role of vitamin D in cancer prevention. American Journal of Public Health, 2006;96:252-261.

[16] Vitamin D and prevention of breast cancer: pooled analysis. Journal of Steroid Biochemistry & Molecular Biology, 2007;103: 708-711.

[17] Lin J, Manson JE, Lee IM, et al. Intakes of calcium and vitamin D and breast cancer risk in women. Archives of Internal Medicine, 2007;167: 1050-1059.

[18] Lappe JM Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. American Journal of Clinical Nutrition, 2007;85:1586-1591.

[19] Pilz S, Dobnig H, Winklhofer-Roob B, et al. Low serum levels of 25-hydroxyvitamin D predict fatal cancer in patients referred to coronary angiography. Cancer Epidemiology, Biomarkers and Prevention, 2008;17:1228-1233.

[20] Mohr SB, Gorham ED, Alcaraz JE, et al. Serum 25-hydroxyvitamin D and breast cancer in the military: a case-control study utilizing pre-diagnosis serum. Cancer Causes and Control, 2013: doi 10.1007/s10552-012-0140-6.

[21] Mohr SB, Gorham ED, Alcaraz JE, et al. Does the evidence for an inverse relationship between serum vitamin D status and breast cancer risk satisfy the Hill criteria? Dermato-Endocrinology, 2012;4:152-157.

[22]Annweiler, C. Schott, A. M. Berrut, G. Chauvire, V. Le Gall, D. Inzitari, M. Beauchet, O. Vitamin D and ageing: neurological issues. Neuropsychobiology. 2010 Aug; 62 (3): 139-50.

[23] Evatt, M. L. Delong, M. R. Khazai, N. Rosen, A. Triche, S. Tangpricha, V. Prevalence of vitamin D insufficiency in patients with Parkinson disease and Alzheimer disease. Arch Neurol. 2008 Oct; 65 (10): 1348-52.

[24] Fernandes de Abreu, D. A. Eyles, D. Feron, F. Vitamin D, a neuro-immunomodulator: Implications for neurodegenerative and autoimmune diseases. Psychoneuroendocrinology. 2009 Jun 20s

[25] Knapen MH, Schurgers LJ, Vermeer C. Vitamin K(2) supplementation improves hip bone geometry and bone strength indices in postmenopausal women. Osteoporosis International, 2007; 18:963-972.

[26] Yasui T, Miyatani Y, Tomita J, et al. Effect of vitamin K2 treatment on carboxylation of osteocalcin in earlypostmenopausal women. Gynecological Endocrinology, 2006;22:455-9.

[27] Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Archives of Internal Medicine, 2006;166:1256-1261.

[28] Lee NK, Sowa H, Hinoi E, et al. Endocrine regulation of energy metabolism by the skeleton. Cell, 2007;130:456-469.

[29] Yoshida M, Yoshida M, Booth SL, et al. Phylloquinone intake, insulin sensitivity, and glycemic status in men and women. American Journal of Clinical Nutrition, 2008; 88:210-215

[30] Kassi E, Papavassiliou AG. A possible role of osteocalcin in the regulation of insulin secretion: human in vivo evidence? Journal of Endocrinology, July 21, 2008; epub ahead of print.

[31] Habu D, Shiomi S, Tamori A, et al. Role of vitamin K2 in the development of hepatocellular carcinoma in women with viral cirrhosis of the liver. JAMA, 2004;292:358-361.

[32] Cheung AM, Tile L, Lee Y, et al. Vitamin K supplementation in postmenopausal women with osteopenia (ECKO trial): a randomized controlled trial. PLoS Medicine, 2008;5(10):e196.

[33] Sahni S, Hannan MT, Gagnon D, et al. Protective effect of total and supplemental vitamin C intake on the risk of hip fracture – a 17-year follow-up from the Framingham Osteoporosis Study. Osteoporosis International, 2009;20:1853-1861.

[34] Lewerin C, Nilsson-Ehle H, Jacobsson S, et al. Osteoporosis International, 2014;25:131-140.

[35] Sato Y, Honda Y, Iwamoto J, et al. Effect of folate and mecobalamin on hip fractures in patients with stroke. JAMA, 2005;293:1082-1088.

[36] Carlisle EM. Silicon as an essential trace element in animal nutrition. Ciba Gound Symp, 1986;121:123-139.

[37] Saidak Z, Marie PJ. Strontium signaling: molecular mechanisms and therapeutic implications in osteoporosis. Pharmacol Ther, 2012;136:216-226.

[38] Devirian TA, Volpe SL. The physiological effects of dietary boron. Crit Rev Food Sci Nutr, 2003;43:219-231.

[39] Davenward S, Bentham P, Wright J, et al. Silicon-rich mineral water as a non-invasive test of the ‘aluminum hypothesis’ in Alzheimer’s disease. J Alzheimers Dis, 2013;33:423-430.

[40] Carlisle EM, Curran MJ. Effect of dietary silicon and aluminum on silicon and aluminum levels in rat brain. Alzheimer Dis Assoc Disord, 1987;1:83-89.

[41] Misra D, Berry SD, Broe KE, et al. Does dietary protein reduce hip fracture risk in elders? The Framingham Osteoporosis Study. Osteoporos Int, 2011;22:345-349.