Osteoporosis is a major health problem in half of all women, and 1 in 4 men over age 50 will have an osteoporosis- related fracture in their lifetime.1 Fortunately, there are supplements that pharmacists can recommend that can strengthen bones and help prevent osteoporotic fractures.
Data from the Third National Health and Nutrition Examination Survey shockingly revealed that 75% of men and 87% of women did not meet the recommended daily calcium intake of 1000 mg per day.2 Deficiencies in other nutrients are now being recognized as probable contributing factors, however. Health care professionals do women a great injustice by recommending only calcium for the prevention of osteoporosis. In 2 studies, when calcium was administered with a broad spectrum of vitamins and minerals, women demonstrated greater bone improvement than in any studies with calcium alone or calcium with hormones.3,4
Magnesium, which is a critical mineral for bone health, is involved in calcium metabolism, the synthesis of vitamin D, and the formation of bone. Magnesium deficiency was shown to be associated with abnormal calcification of bone in 1 study of osteoporotic women.5 In another trial, postmenopausal women who took a high-magnesium supplement along with hormones achieved an 11% increase in bone mass, whereas women taking only hormones showed a 0.7% increase. The supplement included a range of other nutrients known to be important in bone health. This study is significant because it documents the greater effectiveness of treating osteoporosis with a broad range of nutrients rather than with just calcium.6 A supplemental magnesium dosage of 600 to 800 mg per day generally is recognized as being safe and effective.
Vitamin K is required for the production of osteocalcin, the key calcium- binding matrix protein, which attracts calcium to crystallization sites. Studies now indicate that vitamin K deficiency is a factor contributing to osteoporosis and that supplementation may prevent or reverse bone loss. A study of osteoporotic patients showed that they had 74% less vitamin K than controls.7
In postmenopausal women, low levels of vitamin K reduced the capacity of osteocalcin to attract calcium into the bone matrix by 50%. This capacity was normalized after women were given vitamin K supplementation.8 The primary dietary source of vitamin K is dark green leafy vegetables. Patients taking anticoagulant medications should be monitored closely when supplementing with vitamin K, however.
Manganese is essential for mucopolysaccharide biosynthesis, which provides a structure on which calcification takes place.9 A recent study showed that women with osteoporosis had blood levels of this trace element 75% lower than women of the same age without osteoporosis.10 Supplemental manganese doses range from 5 to 25 mg per day.
Boron is a trace mineral that influences the metabolism of calcium, magnesium,11 vitamin D, estrogen, and testosterone.12 Boron supplementation significantly reduced urinary excretion of calcium and increased levels of estrogen and testosterone in a group of postmenopausal women.12 The results of another study suggest that boron supplementation may be helpful in preventing osteoporosis in postmenopausal women not taking estrogen. Boron raised serum calcium to levels comparable with those of a control group of women receiving estrogen replacement.13 Boron dosages range from 1 to 3 mg per day.
Vitamin D is one of the primary regulators of calcium absorption. Deficiencies are frequently found in postmenopausal women with osteoporosis.14 Inadequate sunlight and deficient dietary intake are largely responsible for reduced vitamin D levels. A daily intake of 800 international units is frequently recommended.
Progesterone is a hormone that stimulates osteoblasts to build new bone. In a now-famous study, John Lee, MD, instructed 100 postmenopausal women (average age 65.2 years) to apply OTC natural progesterone transdermal cream. After 3 years, instead of having an expected 4.5% increased bone loss, bone density examinations confirmed that these women had an average increase in bone density of 15.4%.15
Pharmacists can provide a great service by counseling patients about the use of these natural agents to build strong bones and to help prevent or delay the onset of osteoporosis.
Dr. Pelton is director of education at Integrative Health Resources Inc.
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