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Answers to common questions on bone health

Every woman should make bone health a top priority as soon as they possibly can. Why? Just look at these statistics.

The number of women each year in the United States having a hip or spine bone fracture due to osteoporosis exceeds 1,500,000. In comparison, 300,000 women will have heart attacks and less than 200,000 women will be diagnosed with breast cancer.

Bone health is a priority in men too, although much less so than in women. More than 80 percent of cases of osteoporosis occur in women. However, consider this fact, the risk of experiencing a hip or vertebral fracture in men is almost 2.5 times more as likely as developing prostate cancer (27 percent vs 11).

Despite the statistics, what surveys have shown is that there is a disconnect between the reality of the problem and a strong focus on dealing with it. Part of the problem is that many women simply think they can take a drug and that will miraculously build healthy bones. It doesn’t work that way and what the research shows is that long-term use of bisphosphonate drugs, such as Fosamax, Actonel, etc., increase fracture rates. The focus should be on . For good reason, osteoporosis can be prevented through these measures, especially if they are combined.

What factors may lead to a person’s bone loss?

Bone is dynamic living tissue that is constantly remodeling. The breaking down and rebuilding of bone is the result of the actions of two types of bone cells—osteoclasts and osteoblasts. Osteoclasts stimulate the production of acids and enzymes that dissolve minerals and protein in bone and thus promote bone breakdown (resorption). Osteoblasts create a protein matrix primarily of collagen that provides the structural framework upon which mineralization can occur. Bone remodeling is normally a balance of bone resorption and bone formation. An imbalance between bone removal and bone replacement results in bone loss.

In childhood, bone mass rapidly increases and then slows in the late teens, but it continues to increase during the 20s. In women, the bone-building process is nearly complete by age 17. After achieving a peak bone mass, around age 28, women slowly lose an average of 0.4 percent of bone mass in the femoral neck each year. After menopause, the rate of loss is faster, with an average 2 percent loss annually during the first 5 to 10 years. Bone loss continues in older women past age 70 but at a much slower rate.

The major risk factors for bone loss are advanced age, genetics, lifestyle and dietary issues (e.g., lack of exercise, low calcium, low vitamin D intake and smoking), thinness, and menopausal status. The most common risk factors are as follows:

• Age (50-90 years)
• Female
• Thinness
• Small stature
• Parental history of hip fracture
• Current smoker (tobacco)
• Long-term use of glucocorticoids
• Alcohol intake above two units daily
• Low level of vitamin D

What are the best forms of supplemental calcium to take for bone health, and why?

The truth is that in terms of clinical response, there is little (if any) difference between one form of calcium and another. Adequate calcium intake has an established role in maintaining bone health, primarily in very young women and the elderly. However, calcium alone has very little benefit in protecting against bone loss or osteoporosis; it requires vitamin D, vitamin K and other nutrients, as well. In detailed analysis of all controlled trials with calcium supplementation evaluating bone health, supplementation with 500 to 2,000 mg/day of calcium had only a modest benefit on bone density in postmenopausal women: the difference in the amount of bone loss between calcium and placebo was 2.05 percent for the total body, 1.66 percent for the lumbar spine, and 1.64 percent for the hip.

Closer examination of the largest study, the Women’s Health Initiative, which enrolled more than 36,000 postmenopausal women, showed a surprising result. While overall data showed that supplementation with 1,000 mg/day of calcium and 400 IU/day of vitamin D decreased the risk of hip fractures by 12 percent when compared with placebo, when the analysis was restricted to women who actually took the tablets at least 80 percent of the time, calcium plus vitamin D significantly decreased hip fractures by 29 percent compared with placebo. That is a significant amount, especially with vitamin D having been supplemented at levels now known to be less than ideal.

Here are my practical recommendations on calcium supplementation. First, there is no reason to take more than 1,000 mg per day as a supplement. Studies are clear, the benefits seen at 2,000 mg per day are not greater than those seen with 1,000 mg. Taking large dosages of calcium can impair the absorption of magnesium and other minerals. It serves no positive purpose to take higher dosages of calcium.

In regard to forms of calcium, avoid natural oyster-shell calcium, dolomite, and bone meal products because these forms tend to have higher lead levels. Many nutritional experts prefer easily ionized forms of calcium like calcium citrate, but the reality is that if taken with meals, even calcium carbonate is effectively absorbed in most people. Dicalcium or tricalcium phosphate are good choices for the following reasons:

• Clinical studies indicate that consuming calcium with phosphorus in the form of tricalcium phosphate is more effective at building strong bones than consuming calcium alone.

• Calcium cannot be utilized in the absence of phosphorus.

• Approximately 50 percent of North American women are deficient in phosphorus.

• Phosphorus is an essential component of bone, with 85 percent of the phosphorus in your body found in your bones.

• Clinical research indicates that calcium supplements without phosphorus may actually decrease the phosphorus available to the body for bone health, thus contributing to osteoporosis.

While too much phosphorus is not a good thing, especially when it is not accompanied by calcium (as in soft it drinks and animal meats), so too is not enough, especially in regard to the absorption of calcium. What advice should retailers give shoppers who are concerned about taking too much calcium? Could it really be harmful to the cardiovascular system?

There is concern that taking too much calcium may lead to an increased risk of cardiovascular disease. There is sound research to support this link. First, there is absolutely no benefit to be gained by taking more than 1,000 mg of calcium daily to promote bone health. Second, there is little benefit to taking calcium alone. Bone requires much more than calcium. Especially important is magnesium. Taking too much calcium and no magnesium may be the key reason for the link between calcium supplementation and heart disease in some studies. Another factor is vitamin K2, which not only helps build bone (discussed below), it also helps block the deposition of calcium within arteries.

What is vitamin K2 and how does it promote bone health?

Vitamin K2 or menaquinone is produced by bacteria and found in some fermented foods. There are several different forms of K2 based upon the number of molecules known as isoprenoids that are attached to the vitamin K backbone. MK-7 is the most important commercial form of vitamin K2. MK-7 is available as a dietary supplement derived from natto (a fermented soy food popular in Japan). Also, a 3 oz. serving of natto provides 850 mcg of MK7.

Vitamin K2 plays an important role in bone health, as it is responsible for converting the bone protein osteocalcin from its inactive form to its active form. Osteocalcin is the major non-collagen protein found in our bones that anchors calcium into place within the bone. In a landmark major clinical published in the March 23, 2013 issue of Osteoporosis International, 2013 March 23, MK-7 supplementation at relatively low dosage levels (180 mcg per day) produced tremendous effects on improving bone health. In the study, 244 healthy postmenopausal women took either the MK-7 or a placebo for three years. Bone mineral density of lumbar spine, total hip, and femoral neck was measured by DXA; bone strength measures of the femoral neck were also calculated. Vertebral fracture assessment was performed by DXA and used as measure for vertebral fractures. Measurements occurred at baseline and after one, two and three years of treatment.

MK-7 intake significantly improved vitamin K status and active osteocalcin levels, and decreased the age-related decline in bone mineral concentration (BMC) and bone mineral density (BMD) at the lumbar spine and femoral neck. Bone strength was also favorably affected by MK-7—a key determinant of fracture risk. Lastly, MK-7 significantly decreased the loss in vertebral height of the lower thoracic region at the mid-site of the vertebrae. These results highlight the importance of MK-7 supplementation in post-menopausal women.

How does silica help bone density and strength?

During bone growth and the early phases of bone calcification, silicon has an essential role in the formation of cross-links between collagen and the structural components of bone. In animals, silicon-deficient diets have produced abnormal skull development and growth retardation, and supplemental silicon partially prevented bone loss in female rats that had ovaries removed.

A highly bioavailable form of silica (choline stabilized orthosilicic acid, tradename: BioSil) showed impressive clinical results in improving bone health in a double-blind study in postmenopausal women with low bone density. Compared to a control group receiving calcium and vitamin D alone, the addition of BioSil (6 mg per day) was able to increase the collagen content of the bone by 22 percent and increase BMD by 2 percent within the first year of use. The ability to improve the actual collagen matrix as well as BMD indicates that BioSil produced greater bone tensile strength and flexibility, thereby greatly increasing the resistance to fractures. The recommended dosage is 6-10 mg per day.

Final comments

When talking about bone health, it is very important to point out that weight-bearing exercise/physical activity is the major determinant of bone density. One hour of walking at a moderate activity three times a week is critical to prevent bone loss, and has even been shown to improve osteoporosis.

Many general dietary factors have been shown to cause osteoporosis. With the focus on the ketogenic diet and other high protein diets, it must be pointed out that excess protein dramatically increases the excretion of calcium—the same with sugar intake.

My last comment has to do with dispelling the myth that dairy consumption makes for healthy bones. In fact, hip fractures and osteoporosis rates are higher in milk consumers and countries with a high intake of dairy. Keep in mind that calcium is found in high amounts in many green leafy vegetables and other plant foods. Vegans do not consume dairy products, yet they have a lowered risk for osteoporosis. Several factors are probably responsible for this decrease in bone loss observed in vegetarians. Perhaps most important is a reduced intake of protein and sugar, thereby reducing the loss of calcium. But, plant foods are also rich in many bone-building nutrients, including several not discussed above, such as boron and other trace minerals, flavonoids and B vitamins. VR

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