Positive Health Online

Osteoporosis, according to the World Health Organisation, comes second only to heart disease as a leading health issue. There are 3 million people in the UK with osteoporosis and another 8 million with osteopenia. It is not only women who are affected; a quarter of men over 60 will have an osteoporotic-related fracture in their lifetimes.

It's a common misconception that the skeleton is a dead and inert structure. But this couldn't be further from the truth. It contains living cells and a network of blood vessels and nerves. Bone is active tissue which is constantly being broken down and renewed. If this remodelling process is not working properly, bone density drops below a certain range and bones become excessively brittle and porous, with a corresponding increase in risk of fracture. This is the condition we call osteoporosis.

Like any other living tissue, bone needs to be nourished with the correct nutrients, in order for it to maintain its strength and density. The great news is that osteoporosis can be prevented and treated with nutrition and lifestyle interventions and as practitioners we have the responsibility of educating our patients on how to achieve this.

Optimize Intake of Clinically Researched Bone Nutrients

Most people know that they need calcium to build strong bones. However, calcium supplementation on its own has been proven to be of limited benefit. Magnesium, boron, vitamins D and K are essential in conjunction with calcium.

Magnesium

This mineral rarely features in mainstream advice for bone health, despite its known role in bone building.[1] Magnesium is far more likely to be deficient in the modern day diet than calcium, as it is not found in high amounts in dairy foods which make up a large part of western diets. Also, food processing causes huge magnesium losses. Eighty percent of women currently consume less than the recommended daily amount of magnesium.

Use the Correct Forms of Calcium and Magnesium

The forms of calcium and magnesium used in supplements are of vital importance. The calcium supplement most often prescribed by doctors is calcium carbonate which is essentially a rock, limestone. Calcium carbonate is cheap to produce but it is poorly absorbed. Similarly, magnesium is also often found as carbonate, or oxide, chloride or sulphate all of which have low absorption rates.

Calcium carbonate needs really good levels of stomach acid in order to be broken down. People who have insufficient stomach acid will find calcium carbonate particularly problematic and it causes indigestion. It will consume the acid in the process, further reducing it and causing digestive discomfort and impaired digestion of other foods. Not only may little calcium be absorbed, but the excess may be deposited inappropriately elsewhere in the body where it can cause calcification, for example, in the joints.

Mineral citrates are thought to be amongst the best absorbed forms. Another newer and highly absorbed form of calcium and magnesium is sourced from marine algae. Algal minerals are extremely bio-available to the human body because they are organically bound within the plant. Such minerals have a sponge-like structure with a large surface area which increases exposure to stomach acid, enabling the minerals to be fully broken down. A chemical analysis simulating identical conditions to those found in the stomach revealed that 97% of algal calcium is dissolved, making it available for absorption.

Further Bone Building Nutrients

Calcium is most effective when taken with vitamin D. Vitamin D deficiency amongst the general population is now known to be a major modern day health concern.[2] Vitamin D reduces bone loss and fracture incidence, and it is suggested that postmenopausal women should consume 400 to 800iu of vitamin D per day to minimize bone loss.[3]

Boron has only relatively recently been found to be a necessary nutrient mineral, and it plays an important role in preventing bone loss. It is needed for converting vitamin D to its active form, and has a crucial effect on the metabolism of calcium and magnesium.[4] Food sources of boron are fruit, leafy vegetables, nuts and legumes. The average diet however, is unlikely to supply the amount needed for bone strengthening, which is 3mg daily.

Vitamin K, The New Bone Nutrient

This vitamin has a vitally important role in bone formation, which has only recently been researched. It is needed to make a protein in bone called osteocalcin, which hardens calcium and strengthens bone.
 
A study published by the International Osteoporosis Foundation in 2007 found that vitamin K supplementation helped maintain bone strength in the hips of a group of 325 post menopausal women aged 55-75.[5] Bone loss is known to accelerate after the menopause. However, at the end of this three year study, the hip bones of the women who received the vitamin K supplements were not only found to have greater mineral content, but also the width of the narrow 'neck' at the top of the hip bone increased.
 
Vitamin K is not a single vitamin, but a group of related compounds.Vitamin K1 (phylloquinone) was the first compound to be discovered and is the most abundant in western diets, found in foods such as broccoli, cauliflower, Brussels sprouts, olive oil, cheese and soya beans. However, recent research has concentrated on vitamin K2 (menaquinone), which is found in bone and other tissue. K2 is much less common in the Western diet because the principal source is fermented soya beans, which are more prevalent in Eastern foods.

Vitamin K2 exists in different forms which include MK-4 and MK-7. The most effective formulations now use the MK-7 form, which remains in the blood circulation for 3 days. The MK-7 form is much more efficient at maintaining good levels of vitamin K in the blood and tissues at a relatively low dose.
 
The best natural source of the MK-7 form of vitamin K2 is a special Japanese fermented soya bean food called Natto. Very few supplements currently contain vitamin K2. This is partly because the benefits of vitamin K are not widely known.
 
A 3-year study on 944 healthy Japanese women aged 20-79 concluded that Natto can help postmenopausal bone loss.[6] Hip bone density in the post menopausal women increased with an increased habitual consumption of natto, as distinct from other soya foods.

In the aforementioned Osteoporosis Foundation study, large doses of vitamin K2 daily were given without any adverse effects. For optimal bone health, most people will need to supplement. Vitamin K is very safe, but due to its effect on blood clotting, people taking blood thinning drugs such as warfarin should not take it except on the advice of a qualified health practitioner.

 In Part Two of this article, I will look at treating osteoporosis with strontium, describe the simple bone turnover test for measuring whether a natural or drug treatment programme is working effectively and discuss dietary measures to prevent osteoporosis.

References

1. Sojka JE. Magnesium Supplementation and Osteoporosis. Nutrition Reviews 53: 71-80. 1995.
2. Vieth R, Bischoff-Ferrari H, Boucher BJ, Bess Dawson-Hughes. American Journal of Clinical Nutrition 85 (3): 649-650. 2007.
3. Dawson-Hughes B. Calcium and Vitamin D Nutritional Needs of Elderly Women. Journal of Nutrition 126 (4): 1165-1167. 1996.
4. Neilson FH et al. Effect of Dietary Boron on Mineral, Oestrogen and Testosterone Metabolism in Postmenopausal Women. FASEB J 1: 394-7. 1987.
5. Knapen MHJ, Schurgers LJ, Vermeer C. Vitamin K2 Supplementation improves Hip Bone Geometry and Bone Strength Indices in Post Menopausal Women. Osteoporosis Int. 2007.
6. Ikeda Y et al. Japanese population based osteoporosis study. J Nutri  136: 1323-1328. 2006.