Life Extension Magazine January 2005
By Richard P. Huemer, MD
One treatment that can be considered both hormonal and nutritional is vitamin D. In its active, hormonal form, vitamin D enhances absorption of calcium from the small intestine. Its deficiency results in inadequate skeletal mineralization (rickets in children) or mineral depletion (osteomalacia in adults). When vitamin D is lacking, the parathyroid gland’s output increases to compensate for low calcium in the body, and the unfortunate result is more bone resorption—the hallmark of osteoporosis. Although 400-600 IU is the recommended daily dose of vitamin D for adults over the age of 50, the National Osteoporosis Found-ation recommends 800 IU for those at risk of deficiency. The safe upper dose is at least 2000 IU per day.28
Along with vitamin D, doctors routinely prescribe calcium for their osteoporotic patients and others at risk. One standard reference suggests a baseline preventive dietary intake of at least 1000 mg of calcium a day, unless osteoporosis risk factors or the disease itself is present, in which case the recommendation is 1000-1500 mg from calcium supplements.2 Because a daily dietary intake of 600 mg a day of calcium is about par for most Americans,3 calcium supplements clearly need to be used for preventing osteoporosis as well as treating it.
Although everyone with osteoporosis can probably benefit from calcium, it is especially important for those on bisphosphonate drugs to receive adequate daily calcium and vitamin D. In fact, low blood calcium is a contraindication to the drugs.29
Many forms of supplemental calcium are available on the market. In one study, calcium in the form of its citrate and malate salts (calcium citrate malate) was absorbed better than milk calcium and calcium carbonate.30 In another study, calcium citrate malate was most absorbable, followed by milk calcium, calcium carbonate, and calcium phosphate.31 Calcium citrate decreases biochemical bone resorption markers unaffected by calcium carbonate.32 As for much-touted coral calcium, it outperformed only calcium carbonate in the sole comparison contained in the peer-reviewed literature.33
Calcium has many health benefits beyond maintaining bone strength. It helps regulate the heartbeat, transmits nerve impulses, assists blood clotting, activates enzymes, and stimulates hormone output. Calcium even protects against colon polyps, especially the kind most likely to turn cancerous.34
The Bone-Building Team
Calcium may excel at building bone, but it cannot work alone.35 Calcium’s bone-building team has many players. The most important are the mineral elements magnesium, manganese, boron, silicon, zinc, and copper, as well as vitamin D3, the natural form of vitamin D. Vitamins C and K also play key roles.
The teamwork effect is nicely illustrated in a study by Strause and colleagues,36 who gave calcium citrate malate—either with or without the trace minerals zinc, manganese, and copper—to healthy postmenopausal women over a two-year period. The researchers evaluated spinal bone loss. The most loss occurred in women receiving placebo (with no calcium). At the end of the study, the group that had received both calcium citrate malate and the trace minerals was clearly better off than the placebo group, whereas other between-group comparisons were not significant.
Magnesium is an important team player, with a role in regulating active calcium transport. Some studies have associated its dietary intake with increased bone mineral density. A two-year study of postmenopausal women supplemented with magnesium showed significant protection from osteoporosis and greater bone mineral density.37 Many doctors favor maintaining a magnesium intake that is approximately half your calcium intake as measured in milligrams.
Herbalists have long used a silicon-rich plant called horsetail to heal bones. In animals, silicon deficiency causes bone defects. Dietary silicon is absorbed as orthosilicic acid, which has recently been shown to stimulate the synthesis of collagen type 1 (the kind found in bone matrix) and to induce characteristic osteoblast enzymes in osteoblast-like cells.38 In a small retrospective study, women who received silica had significantly increased bone mineral density in the femur.39
Boron may mimic the action of estrogen, a hormone that protects bone health. In one report, postmenopausal women lost calcium and magnesium from their bodies when they were made boron deficient, and retained those minerals on a boron-supplemented diet; they also manufactured more estrogen and testosterone when on boron supplementation. In another study, vitamin D status improved in boron-deficient women after they received boron.40
Vitamin D acts as the “gatekeeper” of calcium by facilitating its absorption in the intestine. Natural vitamin D3 comes from sunshine and animal sources. A plant-derived form, vitamin D2 or ergocalciferol, is a common additive to dairy products. Vitamin D3, whether ingested or created naturally by the action of sunlight on the skin, is carried to internal organs that convert it into a potent, hormonal form. Only a few minutes of full sun exposure will create thousands of units of vitamin D3.41,42
If vitamin D is calcium’s gatekeeper in the body, vitamin K is its shepherd. Vitamin K ensures that calcium goes into the bones where it belongs, and stays out of parts of the body such as the arteries where it does not belong. It accomplishes this by helping an enzyme that activates special Gla-proteins that control calcium deposition.43 Using vitamin K does not require a physician’s supervision; however, because vitamin K is involved in blood clotting and may interact with certain medications, it should not be used by those taking anti-coagulant drugs like Coumadin®.
Finally, vitamin C helps to create the collagen-rich bone matrix. One component of collagen (connective tissue) is hydroxyproline, an amino acid formed when proline becomes hydroxylated, a step that requires vitamin C. That is why bones break so easily and tissues are so weak in people with scurvy, which is the overt form of vitamin C deficiency. Although scurvy is rare, scientists like Linus Pauling and Irwin Stone long ago pointed out that most of us exist in a state of chronic subclinical scurvy due to near-universal insufficiency of vitamin C in our diet.44
Osteoporosis Prevention Guidelines
The National Osteoporosis Foundation, which provides educational material to the public and health professionals, has posted on its website (www.nof.org) the following guidelines for preventing osteoporosis:
To these well-conceived rules, the Life Extension Foundation adds four more:
While a certain amount of bone loss may occur with aging, developing osteoporosis is certainly not inevitable. Regardless of genetic risks, most of us can maintain strong, fracture-resistant bones throughout our lifetimes by avoiding dietary and lifestyle habits that lead to bone loss, exercising regularly, receiving preventive health check-ups, and nourishing our bone-building cells with bioavailable calcium and other supportive nutrients.
1. Available at: http://www.nof.org/advocacy/ prevalence. Accessed August 21, 2004.
2. Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:469-73.
3. Available at:.http://www.nof.org. Accessed August 21, 2004.
4. Seeman E. Osteoporosis in men. Baillieres Clin Rheumatol. 1997 Aug;11(3):613-29.
5. Baldock PA, Eisman JA. Genetic determinants of bone mass. Curr Opin Rheumatol. 2004 Jul;16(4):450-6.
6. Available at: http://www.gsdl.com. Accessed August 22, 2004.
7. Sandyk R, Anastasiadis PG, Anninos PA, Tsagas N. Is postmenopausal osteoporosis related to pineal gland functions? Int J Neurosci. 1992 Feb;62(3-4):215-25.
8. Elliott ME, Binkley N. Evaluation and mea- surement of bone mass. Epilepsy Behav. 2004 Feb;5 Suppl 2:S16-S23.
9. Available at: http://www.nof.org/physguide/diagnosis.htm. Accessed August 27, 2004.
10. Whiting SJ, Lemke B. Excess retinol intake may explain the high incidence of osteo- porosis in northern Europe. Nutr Rev. June 1999;57:192-5.
11. Drevon CA, Henriksen HB, Sanderud M, Gundersen TE, Blomhoff R. Biological effects of vitamin K and concentration of vitamin K in Norwegian food. Tidsskr Nor Laegeforen. 2004 Jun 17;124(12):1650-4.
12. Available at: http://www.nof.org/prevention/calcium.htm. Accessed August 26, 2004.
13. Lloyd T, Andon MB, Rollings N, et al. Calcium supplementation and bone mineral density in adolescent girls. JAMA. 1993 Aug 18;270(7):841-4.
14. Lloyd T, Martel JK, Rollings N, et al. The effect of calcium supplementation and Tanner stage on bone density, content and area in teenage women. Osteoporos Int. 1996;6(4):276-83.
15. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium sup- plementation on bone density in postmenopausal women. N Engl J Med. 1990 Sep 27;323(13):878-83.
16. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997 Sep 4;337(10):670-6.
17. Available at: www.aeron.com. Accessed August 26, 2004.
18. Kirk D, Fish SA. Medical management of osteoporosis. Am J Manag Care. 2004 Jul;10(7 Pt 1):445-55.
19. Chen YM, Ho SC, Lam SS, Ho SS, Woo JL. Soy isoflavones have a favorable effect on bone loss in Chinese postmenopausal women with lower bone mass: a double-blind, randomized, controlled trial. J Clin Endocrinol Metab. 2003 Oct;88(10):4740-7.
20. Laszlo A. Postmenopausal osteoporosis. Orv Hetil. 2004 Jan;145(1):3-13.
21. Staren ED, Omer S. Hormone replacement therapy in postmenopausal women. Am J Surg. 2004 Aug;188(2):136-49.
22. Leifke E, Korner HC, Link TM, Berhre HM, Peters PE, Nieschlag E. Effects of testosterone replacement therapy on corti- cal and trabecular bone mineral density, vertebral body area, and paraspinal muscle area in hypogonadal men. Eur J Endocrinol. 1998 Jan;138(1):51-8.
23. Davis SR, McCloud P, Strauss BJ, Burger H. Testosterone enhances estradiol’s effects on postmenopausal bone density and sexu- ality. Maturitas. 1995 Apr;21(3):227-36.
24. Lee JR. Is natural progesterone the missing link in osteoporosis prevention and treatment? Med Hypotheses. 1991 Aug;35(4):316-8.
25. Whitfield JF, Morley P. Small bone-building fragments of parathyroid hormone: new therapeutic agents for osteoporosis. Trends Pharmacol Sci. 1995 Nov;16(11):382-6.
26. Frolik CA, Black EC, Cain RL, et al. Anabolic and catabolic bone effects of human parathyroid hormone (1-34) are predicted by duration of hormone exposure. Bone. 2003 Sep;33(3):372-9.
27. Quattrocchi E, Kourlas H. Teriparatide: a review. Clin Ther. 2004 Jun;26(6):841-54.
28. Lane NE. Parathyroid hormone: evolving therapeutic concepts. Curr Opin Rheumatol. 2004 Jul;16(4):457-63.
29. Slovik DM, Rosenthal DI, Doppelt SH, et al. Restoration of spinal bone in osteoporot- ic men by treatment with human parathyroid hormone (1-34) and 1,25-dihydroxyvita- min D. J Bone Miner Res. 1986 Aug;1(4):377-81.
30. Doggrell SA. Does the combination of alendronate and parathyroid hormone give a greater benefit than either agent alone in osteoporosis? Expert Opin Pharmacother. 2004 Apr;5(4):955-8.
31. Available at: http://www.nof.org/physguide/ univeral_recommendations.htm#adequate. Accessed August 27, 2004.
32. PDR, 58th ed. Montvale, NJ: Thomson PDR; 2004:1989, 2827-8.
33. Smith KT, Heaney RP, Flora L, Hinders SM. Calcium absorption from a new calcium delivery system (CCM). Calcif Tissue Int. 1987 Dec;41(6):351-2.
34. Cited in: PDR for Nutritional Supplements, 1st ed. Montvale, NJ: Medical Economics Co.; 2001:75.
35. Kenny AM, Prestwood KM, Biskup B, et al. Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women. Osteoporos Int. 2004 Apr;15(4):290- 4.
36. Ishitani K, Itakura E, Goto S, Esashi T. Calcium absorption from the ingestion of coral-derived calcium by humans. J Nutr Sci Vitaminol (Tokyo). 1999 Oct;45(5):509-17.
37. Wallace K, Baron JA, Cole BF, et al. Effect of calcium supplementation on the risk of large bowel polyps. J Natl Cancer Inst. 2004 Jun 16;96(12):921-5.
38. Tucker KL. Dietary intake and bone status with aging. Curr Pharm Des. 2003;9(32):2687-704.
39. Strause L, Saltman P, Smith KT, Bracker M, Andon MB. Spinal bone loss in post- menopausal women supplemented with calcium and trace minerals. J Nutr. 1994 Jul;124(7):1060-4.
40. PDR for Nutritional Supplements, 1st ed. Montvale, NJ: Medical Economics Co.; 2001:288-95.
41. Reffitt DM, Ogston N, Jugdaohsingh R, et al. Orthosilicic acid stimulates collagen type 1 synthesis and osteoblastic differentiation in human osteoblast-like cells in vitro. Bone. 2003 Feb;32(2):127-35.
42. Eisinger J, Clairet D. Effects of silicon, fluoride, etidronate and magnesium on bone mineral density: a retrospective study. Magnes Res. 1993 Sep;6(3):247-9.
43. PDR for Nutritional Supplements, 1st ed. Montvale, NJ: Medical Economics Co.; 2001:60-3.
44. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995 Mar;61(3 Suppl):638S-45S.
45. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May;69(5):842-56.
46. Shearer MJ. Role of vitamin K and Gla proteins in the pathophysiology of osteoporosis and vascular calcification. Curr Opin Clin Nutr Metab Care. 2000 Nov;3(6):433-8.
47. Stone I. Scurvy, the cosmic connection: an ancient supernova and the practice of medicine in the twentieth century. In: Huemer RP, ed. The Roots of Molecular Medicine: A Tribute to Linus Pauling. New York: W. H. Freeman; 1986:48-56.