Osteoporosis- Nutritional overview

Nutritional Factors
in Osteoporosis





The incidence of osteoporosis increases with age, and is
develops at an earlier age in woman than in men. About 55 % of Americans, women
more so than men, are at risk of developing osteoporosis. This disease is
characterized by a demineralization of the bones, which become porous and
fragile, this causing a higher susceptibility to fractures.5


Background to Medical Intervention


Bone is largely calcium in nature, and if demineralization
were the issue than common sense would dictate that increasing dietary intake
of calcium would arrest, reverse or at least minimize the ravages of this
illness. For years, physicians recommended increase in dietary calcium as the
principal intervention in this illness.3 It is only now becoming
more obvious that calcium intake is but one of many nutritional concerns that
must be addressed in order to effectively treat ostoporosis. Many factors,
including age, menopausal status, total calcium, vitamin K2 and vitamin D
intake,7 as well as consumption  of cigarettes, saturated fats,
alcohol, and cola proved to be linked to a lower bone mineral density.

FACT #1: The human adult
requires approximately 200 mg of elemental calcium per day, and if absorption
is between 20% and 40%, the nutritional allowance is approximately 1,000 mg per
day. Too much calcium causes more immediate problems involving muscle and
nerve. These regulatory mechanisms modulate the absorption of calcium. That
is, calcium in excess of 1,200 mg or so will cause the body to reduce the
percentage absorbed. While this would appear to be ‘wasteful’ of an
inexpensive nutrient, the real cost is that the excess calcium competes with
absorption of other micronutrients, resulting in poor absorption of these.


Too much of a good thing is, in fact, a
very bad thing. Calcium ingestion in excess of the requisite  amount
reduces rates of absorption of calcium thereby limiting the calcium burden in
the vascular system, but dietary cations, including calcium compete for
absorption. That is, increasing dietary calcium past a fairly modest level
actually inhibits the absorption of other cations, including magnesium and
strontium, both essential for development and maintenance of bone.1


FACT #2: Taking a properly balanced
mineral supplement minimizes the danger of ‘overdoing it.’


FACT #3: Most commercially
available vitamin/mineral supplements are worthless because they present the
minerals in a poorly absorbed, inorganic form. This is done so that the
manufacturer can provide a ‘1-tablet solution’ to all of your needs. It is
better that you should keep your money in your pocket than to purchase this




Vitamin D-3


Insufficient ingestion and/or absorption of vitamin D-3
(cholecalciferol) can lead to the development of osteoporosis and damage to the
joints. Cholecalciferol is necessary for the absorption of calcium from the gut
as well as for deposition of calcium in the bone.  Adequate Vitamin D-3 is
necessary to ensure that the bones remain strong and are less prone to being
brittle or fractured. Vitamin D-3  can also delay the effects of arthritis
and reduce back pain.


Vitamin D-3 deficiency leads to Osteoporosis. In so far as
Cholecalciferol is absorbed in the small intestine, disease states that
involve  the liver, intestines and gall bladder can hamper the proper
absorption and result in Vitamin D-3 and other vitamin/nutrient deficiencies.


Vitamin D-3 is
unlike any other vitamin. In fact, it really is not a vitamin, at all, but it
is a hormone. Its metabolic product, calcitriol, is a secosteroid hormone that has genetic receptors
in over 200 genes in the human body. Research studies have  implicated
vitamin D deficiency as a major factor in the pathology of at least 17
varieties of cancer as well as heart disease, stroke, hypertension, autoimmune
diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis,
muscle weakness, muscle wasting, birth defects, and periodontal disease.


In addition to
Vitamin D-3 being important for bone metabolism, sufficient supplementary
cholecalciferol has been demonstrated to reduce the risk of breast cancer,
prostate and colon cancers as well as reduce the risk of developing multiple
sclerosis (MS).12, 13




Strontium is an element necessary for the maintenance of
calcium matrix. It has been assessed in patients with post-menopausal
osteoporosis where it was demonstrated to decrease the risk of vertebral
fractures, by 41% over 3 yrs, and by 49% within the first year of treatment.
Further, this risk of non-vertebral fractures is decreased by 16% and, in
patients at high risk for such a fracture, the risk of hip fracture is
decreased by 36% over 3 yrs.10, 11



Dietary Phosphoric Acid Accelerates Osteoporosis

Dietary influences that increases bone demineralization are
becoming more and more problematic. Intake of phosphoric acid, as an example,
can dramatically accelerate the development of osteoporosis. Cola beverages are
the greatest risk in this regard. Phosphoric acid is present in high
concentration in cola beverages, and with intake of these soft-drinks,
excretion of the phosphate moiety takes place in the form of calcium phosphate.
With intake of excessive amounts of phosphoric acid, drinking cola beverages
may hasten the development of osteoporosis by  worsening  calcium
deficiency in the bone itself, which in turn causes weakening of the  teeth
and weak bone density (osteoporosis).2


FACT: Phosphoric acid intake, in the form
of carbonated soft-drinks can hasten the development of osteoporosis. 


Vitamin K-2


Vitamin K is a lesser known vitamin group, composed of
three major chemicals, structurally
similar, fat-soluble, 2-methyl-l,4-naphthoquinones, including phylloquinone
(K1), menaquinones (


and menadione (K3).
Vitamin K2 (menaquinone), stimulates bone formation
by way of hormone-regulation. This is thought to consist of gamma-carboxylation
of osteocalcin and/or steroid and xenobiotic receptors (SXRs). This modulation
reduces the incidence of vertebral fractures, despite having only modest direct
effects on the bone mineral density (BMD).4


The most common
form of vitamin K2 in animals is menaquinone 4 (menatetrenone; MK-4), produced
by the processing of exogenous and bacterial naphthoquinones
K is a coenzyme for glutamate carboxylase, an enzyme which mediates the
conversion of the amino acid glutamate to gamma-carboxyglutamate (Gla). The
gamma-carboxylation of the these proteins is essential for the proteins to
attract calcium, and to incorporate calcium into the hydroxyapatite crystals
that form bone.6

Vitamin K-2 is found in certain vegetables, but it is
absorbed best if injested simultaneously with butter. Further, the production
of Vitamin K-2 is accomplished through ‘normal’ gastro-intestinal bacteria.


NOTE WELL: Supplementation of vitamin K-2 can prevent
the development of osteoporosis and reduce the risk of lumbar compression
fractures from osteoporosis.8


FACT #1: Marjorine is not butter,
and marjorine is consumed in far greater amounts than butter, thereby reducing
available Vitamin K2 in our diet.


FACT #2: Gastrointestinal flora are
important to the production of Vitamin K2. Anti-biotics kill off the ‘good
bacteria’ right along with the pathogenic bacteria. Patients demand
anti-biotics for all manners of problems that would best be treated without
anti-biotics. By altering gastrointestinal bactial flora, we are crippling our
ability to get K-2, thereby worsening our skeletal strength.


FACT #3: Taking the wrong form or
formulation of Vitamin K, or Vitamin K-2 is worthless in therapeutic benefit.
You’ve got to know your chemistry, here.

Other Important Nutrients


there are several other vitamins and minerals needed for metabolic processes
related to bone, including manganese, copper, boron, iron, zinc, vitamin
A, vitamin C, and the B vitamins.9 The diet must be
sufficient in balanced protein as well as balanced with the appropriate fats
and oils.



Nutritional Intervention


As the complexity of a treatment regimen increases, the
likelihood of patient compliance decreases. This is nothing new, certainly
not a dramatic revelation. Unfortunately, there is no uncomplicated way to
accomplish the task of disease prevention. The American diet, as it is
true in most of the developed world, has become increasingly deficient in basic
nutrient assay. As a result of soil depletion of micronutrients,
deficiencies in micronutrients is becoming commonplace. Deficiencies in
zinc, magnesium, manganese, strontium, vanadium and chromium, result in many
disease states ranging from obesity and diabetes to Alzheimer’s Disease and


To this end, I find it easiest to start my patients on a
balanced mineral supplement, separate and distinct from the vitamin and
hormonal supplement requirements. This permits adjustment for age, gender,
and disease state. To this, I add Strontium Citrate, Vitamin D-3 and
Vitamin K-2. The dosage requirement of strontium increases with advancing
age, while the dosage of Vitamin D-3 and Vitamin K-2 remains relatively
static. Administering the B-complex separately permits for upward
adjustment for the peculiar needs of diabetics. Administering Vitamin E
separately permits adjustment of other nutrients without increasing risks of
Vitamin E overdose and treatment induced pathology.


Patients that suffer from gastro-intestinal disorders
require higher dosages of the chelated minerals, due to hampered
absorption. Patients with a family history of breast or prostate cancer
receive higher doses of Vitamin D-3.


If these products were presented in one capsule or packet
formulation, customization would be difficult if not impossible.




Bone is a dynamic organ system. As the sand on the
beach is forever changing, so is the matrix of bone. Physiologic forces
promote bone deposition and production, while others promote resorption and
destruction. Nutritional influences are extremely important, both in positive
and negative terms. It takes a wide variety of essential substances, mineral,
vitamin, protein, and hormonal to maintain the health and integrity of each and
every organ system, including the musculoskeletal system.


It is important to realize that there is no simple, easy
way to ensure adequate nutritional support of bone. There is no simple or
single product that provides all of the nutritional needs of bone. It
takes a combination of products, tailored to the unique medical condition, age
and gender of an individual to properly provide for basic metabolic need,
disease prevention and improved performance.


Unfortunately, few medical practitioners understand the
complexity of bone metabolism, and this leads to reflex-prescription writing to
slow the progression of this illness, when nutritional prevention is
cost-effective and easily implemented.


WELL: The most important nutrient in the treatment or prevention of any
disease state is the one that is missing from the diet




1. Hendrix JZ , Alcock NW, and
Archibald RM: Competition Between Calcium,
Strontium, and Magnesium for Absorption in
the Isolated Rat Intestine . Clin Chem: 9: 734-744, 1963.

2. Tucker KL, Morita K, et al: Colas,
but not other carbonated beverages, are associated with low bone mineral
density in older women: The Framingham Osteoporosis Study. Amer J Clin Nutr:
84(4), 936-942, 2006.

  3. Suzuki Y, Whiting SJ, et
al: Total calcium intake is associated with cortical bone mineral density
in a cohort of postmenopausal women not taking estrogen. J Nutr Health Aging:
7(5):296-9, 2003.

  4. Iwamoto J, Takeda T & Sato
Y: Role of vitamin K2 in the treatment of postmenopausal osteoporosis. Curr Drug Saf:1(1):87-97, 2006.

  5. Lanham-New SA: Importance of
calcium, vitamin D and vitamin K for osteoporosis prevention and
treatment. Proc Nutr Soc 67(2): 163-176, 2008.

  6. Bugel S: Vitamin K and bone health
in adult humans. Vitam Horm: 78:393-416, 2008.

  7. Yaegashi Y, Onado T et
al: Association of hip fracture incidence and intake of calcium,
magnesium, vitamin D, and vitamin K. Eur J Epidemol. 23(3):219-225, 2008.

  8. Shiraki M, Shiraki Y, et al: Vitamin
K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone
mineral density in osteoporosis. J Bone Miner Res:16(4):794-5, 2001.

  9. Palacios C: the role of nutrients
in bone health, from A to Z. Crit Rev Food Sci Nutr 46(8):621-8, 2006.

 10. Roux C: Strontium ranelate: short- and long-term benefits
for post-menopausal women with osteoporosis. Rheumatology (Oxford
). Jul;47
Suppl 4:iv20-22, 2008.

 11. Roux C, Reginster JY, et
al: Vertebral fracture risk reduction with strontium ranelate in women
with postmenopausal osteoporosis is independent of baseline risk factors. J
Bone Miner Res 21(4):536-42, 2006.

 12. Geller JL & Adams
JS: Vitamin D therapy. Curr osteoporos Rep. Mar;6(11):5-11, 2008.

 13. Gigante A, Torcianti M, et
al: Vitamin K and D association stimulates in vitro osteoblast
differentiation of fracture site derived human mesenchymal stem cells. J Biol
Regul Homeost Agents. Jan-Mar;22(1):35-44, 2008.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.