Vitamins and minerals affect bone loss

Calcium

Calcium has been known for its ability to positively impact bone formation. Now, evidence suggests it also slows down bone resorption.^32-34 Research indicates a calcium-rich supplement containing Microcrystalline Hydroxyapatite Concentrate has been useful in preventing bone thinning and increasing cortical bone thickness.³⁵ The Bone Resorption Assessment, through its analysis of pyridinium crosslinks, can monitor the effectiveness of a calcium treatment program.

Magnesium

The typical American diet often contains less than two-thirds of the RDA for magnesium. Deficiency is common in women with osteoporosis and appears to be associated with abnormal bone mineral crystal formation. Magnesium is necessary for the absorption of calcium and plays a part in the conversion of vitamin D to its active form. A two-year study found nearly 75% of 31 women taking 250-750 mg of oral magnesium showed bone density increases of 1% to 8%.³⁶

Vitamin K

Vitamin K is a cofactor in the synthesis of osteocalcin, a unique bone protein which attracts calcium to bone tissue. Inadequatevitamin K levels impair normal bone mineralization. Serum vitamin K levels in individuals with osteoporosis were found to be 74% lower compared to a healthy control group.³⁷ Age-related dietary changes, reduced efficiency of absorption, and use of antibiotics that destroy vitamin K-producing intestinal flora may all contribute to vitamin K deficiency.

Boron

Evidence suggests that boron may promote synthesis of compounds related to bone health, including estrogen, testosterone, DHEA, and vitamin D, and play an important role in maintaining bone mass. One study showed that 3 mg of boron per day decreased urinary calcium excretion by 44% and increased levels of estradiol (the most biologically active form of estrogen in the body) to that found in women receiving estrogen replacement therapy.³⁸

Manganese

In a study of 14 women with osteoporosis, blood levels of manganese were 75% lower than those of age-matched controls.³⁹ Manganese deficiency has also been found to produce osteoporosis in animals. Studies suggest that manganese is a necessary mineral for bone mineralization.

Vitamin D

In many patients with osteoporosis there is an impairment in renal conversion of vitamin D to its most active form. This may result from deficiencies in estrogen, magnesium, or boron.

Folic acid

Folate is important in the metabolism of homocysteine, a metabolic intermediate that may affect osteoporosis by interfering with collagen crosslinking, resulting in a defective bone matrix. Increased levels of homocysteine have been found in postmenopausal women. The beneficial effect of folic acid appears to occur even in women who have no apparent deficiency of the vitamin.⁴⁰

Other nutrients

Additional studies suggest that vitamin B6, vitamin C, zinc, copper, silicon, and strontium play roles in maintaining bone mass. Due to poor food choice and processed food, many of these nutrients are lacking in the American diet. A comprehensive nutritional supplement program which provides all of the vitamins and minerals involved in bone health may be valuable in preventing and treating osteoporosis.

Exercise

Exercise plays an important role in prevention and treatment of osteoporosis. Weight-bearing exercise strengthens bones, increases bone mass, and increases a person's reaction time and stability, thus decreasing the likelihood of a bone-breaking fall. Walking, running, tennis, aerobics, and weightlifting are effective at building and maintaining bone mass. Swimming may increase bone density while strengthening the cardiovascular system.

Hormonal therapy

Estrogen

Estrogen replacement therapy inhibits bone resorption and reduces the incidence of osteoporotic fractures. However, ERT also increases the risk of certain forms of cancer. While the increased risk of endometrial cancer is prevented by the concomitant use of a progestogen, there is evidence that ERT may also cause breast cancer.

Moreover, not only estrogen levels, but also estrogen metabolism, can affect bone loss and risk for osteoporosis. Recent studies have found an association between the ratio of 2-hydroxyestrone (2-OHE1) and 16 alpha-hydroxyestrone (16 alpha-OHE1) and risk for osteoporosis. Because an elevated 2-OHE1/16-alpha-OHE1 ratio has been associated with osteoporosis, it has been suggested that dietary interventions to lower the ratio may significantly decrease risk for osteoporosis.⁴¹

Progesterone

Progestogens have been shown to reduce bone loss. Natural progesterone may be significantly safer and more effective than progestogens. One study of postmenopausal women receiving progesterone demonstrated increased bone density in all subjects. Over several years, average bone mass increased by 15.4%. Height loss was stabilized, and no new osteoporotic fractures occurred.⁴²

Testosterone and DHEA

Although testosterone and dehydroepiandrosterone (DHEA) are considered male hormones, they are produced in substantial amounts by the ovaries. Each of these hormones has been shown to enhance new bone formation. Ovariectomized women as well as some women with intact ovaries may develop testosterone deficiency. In such cases, testosterone therapy may be of benefit.

Serum levels of DHEA tend to decline around the time of menopause. A further fall in levels occurs around age 70, as theadrenal gland loses its capacity to produce the hormone. Administration of DHEA may help to prevent or reverse osteoporosis.

Other considerations

The physician should rule out gastrointestinal problems such as hypochlorhydria, dysbiosis, and malabsorption, which can compromise nutritional status, especially of minerals and fat-soluble nutrients such as vitamin K.

Individuals should avoid exposure to toxic metals, especially aluminum, which can bind to phosphorus in the intestine, leading to phosphorus depletion and fecal calcium excretion. Magnesium deficiency enhances the absorption of aluminum.

Certain medications such as glucocorticoids, anticonvulsants, anticoagulants, and some diuretics may result in a loss of bone tissue. Patients using these medications should be monitored for bone loss.

Related Testing

For many patients with elevated markers of bone loss, additional assessment may be clinically useful in uncovering compounding causes of bone resorption.