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  • Writer's pictureDavid S Klein, MD

Updated: Dec 14, 2023

David S. Klein, MD, FACA, FACPM

Osteoporosis is not just a condition of the elderly, or a disease that only hits 'old ladies.' Bone is not a simple tissue, but a complex living structure that is continuously building and redefining itself. As we get older, we become less efficient in absorbing the necessary nutrients from the gut, we produce less and less estradiol (essential to both men and women in maintaining bone density), and we acquire disease states that worsen the health of our bones.

You do not need an intense background in chemistry to appreciate what we have presented here. It might help, but you do not need to understand everything discussed. What is important is knowing that there is easily reference science behind what is being presented.


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.

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. 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 osteoporosis. This is the principal reason why teenagers eat poorly, yet they grow, and now that you are a mature adult, eating well, your bone is melting away.

Many factors, including age, menopausal status, total calcium, vitamin K2 and vitamin D intake, as well as consumption of cigarettes, saturated fats, alcohol, and cola proved to be linked to a lower bone mineral density. It is far more complex than a simple fix with 'go get some calcium tablets!'


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. 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.

My preferred calcium salt is a chelated form, calcium hydroxyapetite. This is a calcium-phosphorus compound, essentially identical to what is found in your bone.

This product contains a chelated of calcium and phosphorus, as well as a small amount of vitamin D.

My instructions to patients iare: "one tablet to prevent, two tablets for mild osteoporosis, three for moderate osteoporosis and four capsules for severe osteoporosis. "


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 junk.

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).

FACT #4 : 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 (K2), 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).

The most common form of vitamin K2 in animals is menaquinone (menatetrenone; MK-4), produced by the processing of exogenous and bacterial naphthoquinones Vitamin 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.

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

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


FACT #1: 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 bacterial flora, we are crippling our ability to get K-2, thereby worsening our skeletal strength.

FACT #2: 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.


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, Calcitrol is a secosteroid 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).



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.

Instructions to patients is usually "one capsule daily if you are 40 to 60 years of age, 2 capsules daily if you are 60 to 70 and three per day if you are blessed to be over 70 years of age."


Other Important Nutrients

However, 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. The diet must be sufficient in balanced protein as well as balanced with the appropriate fats and oils.

Two good choices are demonstrated, below:

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 cancer.

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.


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.

Estradiol supplementation is often necessary, particularly in post-menopausal women. This is best done using carefully controlled bio-identical estradiol, followed with intemittent blood level determination to try to keep it between 20 and 80. Further blogs will be posted on this topic.

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.

The most important nutrient in the treatment or prevention of any disease state is the nutrient(s) that is(are) missing from the diet.

David S. Klein, MD, FACA, FACPM

copyright 2023 Stages of Life Medical Institute

Into each life some rain must fall?

As we get older, perhaps a bit less flexible and certainly more brittle, the risk of falling increases. In fact, it is one of the greatest risk to life as we enter advanced age. Changes in balance, weakness of muscle, joint stiffness contribute to instability, diabetes with associated small nerve damage results in easy stumbling, sleep problems lead to mental fatigue. The net result is an increased risk of injury due to fall.

So it went with my family. My wife slipped and fell, twisting her ankle in such a way that it resulted in ankle fracture, a minimally displaced fracture of the fibula. Unfortunately, it happened while we on vacation in Portugal, and getting her back home had its’ own challenges. No weight bearing under the circumstance resulted in a 'leave no soldier behind' variant to the potato sack race through Lisbon International Airport. Wheelchairs were not to be had, and we had a plane to catch.

We made it home, safe and sound, but in the process of working our way through this, my lovely wife did her own research as to what supplies, durable medical equipment/goods and combinations of the above would work well for the person recently advised to “NOT BEAR WEIGHT ON THE FOOT.” This was much easier said than done.

Note this well: The most expensive place to get these products and supplies can be the DME store or the medical practices. The hospital is even more expensive, most of the time. The reason is not necessarily what you might believe it to be. In the medical world, dispensing anything along these lines most frequently requires them to have a HCPS Code, limiting the selection that your doctor can peruse, it is expensive for the manufacturers to obtain the HCPS Code, and the ‘savings’ is passed right on to you.


Knee scooter: We tried several and found that the cheapest ones were entirely inadequate, unstable and may result in an even more catastrophic fall. After several efforts, she found the one that we will illustrate.


Next she bought the essential cup holder. Here in Florida, you should always have something to drink available.


Ambulation: It takes many weeks for the bones to heal, assuming the bones are properly lined-up and immobilized. The first thing we did was get an ‘orthopedic boot.’ There are many choices, some good, many not so great, but none of them were terribly expensive if you buy them on Amazon. If you go to the DME store, thinking that you’re going to get it cheaper with your insurance, you may be unpleasantly surprised that it is 3 times more expensive for the same item, you may be hit with co-payments, deductibles and the unfortunate “Not covered” letter. Let us start with the basics.

Stability of the joint: You will need a Support boot for the joint. These are often dispensed at the Emergency Room, Orthopedic Surgeon’s office or Podiatrists practice. This works most of the time, but you are going to want to have more than one for a few important reasons.

They need to air out, frequently. They start to smell badly if not aired out and cleaned , having a second boot is a luxury, not a necessity. Your call. The process of cleaning implies that they need to dry out more. The need to rotate your boots will soon become evident.

We went through a few of these boots, after the initial, ER dispensed device was used. It got us home from Portugal, but now it sits in a bag in the closet, in case one of the better ones breaks. We found one that was easier to use, more comfortable and less bulky. They come with a few different options, it is an individual choice but I've used AirCast products for years and they have been highly reliable and of the highest quality.

This boot has air pads that are adjustable, allowing a 'custom fit,' as it were. It was quite inexpensive and was more comfortable, fit better and is seeing the most use. Not a fashion item, it simply does the job comfortably.


This might seem like a frivolity, but getting a ‘furry pad’ for the scooter will keep you from abrasions and pain in the injured limb. You simply attach the ‘furry pad’ to the scooter seat, and in comfort, you shall go.


Absorbent socks are very, very handy, and will minimize the hygiene hassles that you might encounter. Buy several, or more. They wear out faster than you will believe.


Lastly, most importantly, you must remove carpets from the floors. These are scooter-traps and can put you right back in the ER, if you are not paying attention. Clearly, you do not remove wall to wall carpeting, but throw carpets, designer items and such must be rolled up and put away until you can adequately navigate your home without hazard.

More to come!

The next blog will be on items that you need for creature comforts & hygiene, during your convalescence. Our favorite knee pillow, cast covers and more.

Stay in touch.

David S. Klein, M.D., FACA, FACPM, FAACPM (and a few more, but it looks silly)

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  • Writer's pictureDavid S Klein, MD

Updated: Oct 11, 2023

Well, after years of procrastination, delay and denial, I have finally agreed to invest the time and effort into sharing ‘tricks of the trade’ that your doctor may not have shared with you.   In all fairness, your doctor probably did not have all of the data to share with you, or, more likely, you spend your medical visits in the company of the nurse practitioner of physician’s assistant, while the doctor is elsewhere, ‘supervising.’

It was not the doctor’s fault that he or she is forced to practice this way, but the reality is simple:  The government and the insurance industry has forced the medical industry to ‘package to price.’  The same thing happened to the nickel (and dime) candy bar.  As economic pressures pushed the price up, at certain break-points, the candy bar shrunk in size.

  • in the medical industry, the shrinkage first occurred in time spent with patients

  • more patients per hour

  • then, treat several patients at once

  • using physician extenders

  • finally, see the extender, damned the doctor.

As the profession found itself going down the tubes, the quality of the domestic medical school applicant diminished, and now we find ourselves wondering:  “where did all of the good doctors go?”

It is obvious, in most parts of the country, that you are putting your life in your hands when you are admitted to the hospital.  Due to the ever-increasing administrative demands, many of the better doctors have abandoned hospital practice. The hospitals have been forced to hire physicians trained abroad (language barrier is now an interesting challenge) and hospital related deaths/errors/disasters has increased tremendously.

Take home message: “Take preventative health very seriously.  It may be your only defense against medical/hospital incompetence.”

The purpose of this blog will be to share interventions that the public can perform in the effort to get healthy, be healthy, and stay healthy. In a commercial aircraft, you are told: "In case of cabin decompression, put on your mask, first."

Now, more than ever, it is imperative that you take charge of your own health, Lord knows, you can't trust the system to look after your best interests.

About David S. Klein, MD, FACA, FACPM

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. Retired from the Medical-Radio business after 21 years, Dr Klein is currently practicing in Longwood, Florida, entirely in the office setting.

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