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  • David S Klein, MD

Nutritional Factors in Osteoporosis

Introduction

The incidence of osteoporosis increases with age, and 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 junk.

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

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 (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). (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 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.(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

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.(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 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.

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

Summary

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.

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

References

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.

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