Jennifer Pun, ND ~ March 13, 2012
The reality of osteoporosis prevention is that it starts much before the postmenopausal period, contrary to common osteoporosis prevention practices. Prevention starts in proper bone mass attainment in adolescence; however, if you’re like me, that was a while ago. A note for parents and the possible child or adolescent who has come across this article (wow, THAT would be a prevention-minded individual!): though 
genetics account for about 80% of attained bone mass, sufficient nutrition (a variety of whole foods), regular physical activity, and overall balance in health will certainly be a good start at this stage of life.
For the rest of us non-adolescents out there, who ARE worried*, what can be done? I’m here to weed through the information on supplementation out there – the controversies, the hidden gems, the question marks – and give you an un-funded, unbiased,and researched view on what we can do.
*When should you be worried? Major osteoporosis risk factors include:
- Age: postmenopausal women are at risk (that means that pre- and peri-menopause is a good time to think about it!)
- Body type: short stature, small bones, very lean
- Family history: someone in your family has had osteopenia (reduction in bone mass, but not to the same degree as osteoporosis) or osteoporosis, Asian or Caucasian background
- Your history: low birth weight, high caffeine intake (especially in growing years!), low calcium intake or absorption (we’ll talk about this later), inactivity/immobilization, certain medical conditions (thyroid, gastric resection, renal disease), certain medications (glucocorticoids, anticonvulsants), smoking, heavy alcohol use
Oh! ‘Dem Bones
Bones and bone metabolism are not as simple as it may seem. I’m not going to go into an anatomy lesson here (that is whatWikipedia is for, right?), but I will list a few important points that are key to understanding bone health and osteoporosis prevention.
- Bone is a living, metabolically active tissue. It is in contact with blood vessels, nerves, and lymph. The cells that make up bone have different vital functions, and all are important.
- The molecular structure of bone, the part that we tend to know most about is actually composed of more than just mineral matrix (inorganic). Yes, this is an important (and VITAL) component to bone, but there is also an organic component to bone consisting of several proteins and type I collagen (the same collagen as in skin, tendon, vascular ligature, and organs).
- As we age, both organic and inorganic components of bone decrease. (Thus, both will be important to support!)
- Bone remodeling occurs throughout our lives. Osteoblasts form bone, while osteoclasts driv bone resorption. BOTH are vital to bone health. It is the balance of replacement and resorption that is important.
- Bone remodeling is dependant on more than just mineral (e.g. calcium) intake. It is controlled and driven by intricate pathways involving hormones (parthyroid hormone, thyroid hormone, sex hormones, growth hormone, Vitamin D (yes, it has hormone activity), calcitonin, insulin, and osteoprotegerin), other minerals (that affect calcium absorption, blood levels, and bone deposition), growth factors, physical stress (the good kind), toxins, and acid-base balance. Hence, there is MORE THAN JUST MINERAL SUPPLEMENTATION TO THINK ABOUT.
That Being Said…
Today, is about supplementation. Please note that the information included in this blog post is not a substitute for individual medical advice and naturopathic consultation. I do not encourage self-prescribing when it comes to natural health supplements, but I also know that when it comes to bone health, most people DO self-prescribe. These are general guidelines, if you are one of these people.
Calcium
We all know about calcium. We have probably all heard of it’s importance in bones (it makes up about 38% of the mineral matrix). Most of us (especially if we’re concerned for bone health) even know how much we should be getting a day, based on our life stage.
However, did you also know that:
- Only 21-26% of calcium carbonate or calcium citrate from your supplements is absorbed. So what’s the best form? The best way to get your calcium is from the foods you eat. But, when we need supplemental calcium, citrate or citrate-malate is the best absorbed (colloidal form is easy on the intestinal lining), but carbonate contains the most elemental calcium. Calcium carbonate is better absorbed if taken with food (but not a good choice if you lack digestive function- e.g. GERD, medication, indigestion). There are other natural forms (MCHC) that are great, as long as they come from a pure and tested source (professional, high quality brands). The bottom line is to ensure that the product lists how much “elemental calcium” you are getting
- You should be taking calcium (except for calcium citrate) with meals for greater absorption… but away from iron (especially supplements)!
- Too much calcium does not increase bone strength, it just makes the kidneys work harder to get rid of the excess. Do not exceed 2,000 mg a day!
- Prospective studies indicate that increasing the intake of calcium to 1500 mg per day may reduce the rate of bone loss in premenopausal women.
- It is best to take calcium at least twice a day because the intestines do not absorb calcium as well when more than 500-600 mg are taken at once.
- A dose of calcium in the evening might help prevent night-time bone loss.
- Take your highest dose of calcium earlier in the day to replace stores.
- You can get calcium from things besides cow’s milk and dairy. In fact, dairy intake is quite controversial. There is someevidence that it may actually be detrimental to bone health (however, this is MUCH debated…).
- There are other just as important (maybe more) vitamins and minerals to be including in your bone health regime.
The Calcium Controversy
One of the most important questions that comes up has to do with a couple of papers (a 2010 meta-analysis, and then a newerre-analysis) that showed an increased risk of heart attack in participants that took calcium supplements. Panic ensues – especially since the second one was an analysis of post-menopausal women – those who are most likely to be on a calcium supplement.
The facts: calcium IS important for bone health, but… Fact Two: data that is derived from studies that aren’t designed to test the factor in question has the risk of being bad science. Fact Three: This particular research isolated calcium from other minerals and nutrients - excluding the (important and vital) relationships between nutrients. Fact Four: High calcium intake can decrease magnesium absorption and levels… which is a cardioprotective nutrient. Fact Five: Magnesium is actually frequently low in our population and is under-estimated in treatment. (And one more point of interest: Silicon, another component of bone, may also be implicated in protecting the heart.)
The final point? Adequate calcium intake IS important and essential for bone health – but should be accompanied by Magnesium (in a 2:1 ratio, Calcium to Magnesium), and possibly by Silicon (2-5 mg per day, in a multimineral formula).
Those Other Vitamins and Minerals
Here are the other important vitamins and minerals that you should be getting, and why. If you are concerned, get a nutritional analysis done to determine if you are getting adequate levels of nutrients. If you are at high risk for osteoporosis, it is likely you’ll need to take some, if not all, of these through supplements. The best way to find out is to ask for individualized advice from your ND.
Vitamin D3 (1000 IU per day): Vitamin D maintains serum calcium and phosphorus concentrations through regulating absorption from the gut and resorption from the bone. The plasma level of Vitamin D has been shown to correlate with fracture risk in men and women over 50 years old.
Vitamin K (1-10 mg per day, depending on blood health): Vitamin K is famous for it’s role in blood coagulation (thus, if you are on anticoagulants or have a bleeding disorder, consult your healthcare practitioner before you start taking this). It is also required for bone metabolism and calcium balance. It is required to form bone proteins. Low serum Vitamin K has been found to be associated with lower bone mineral density (BMD) and increased risk of hip fracture.
Magnesium (500-1000 mg per day): Magnesium balances calcium –it is both integral in converting Vitamin D to it’s active form and mediating PTH (parathyroid hormone) and calcitonin secretion – two hormones that control the constant process of bone remodeling that occurs at all times. Half of our magnesium stores are found in the bone tissue. It helps to stabilize calcium phosphate, and thus prevents bone fragility. Deficiency is associated with postmenopausal osteoporosis. In a two-year study of menopausal women, magnesium therapy prevented fractures and led to increased bone density. All calcium supplements should have at least a ratio of 2:1 Cal:Mag ratio, or be supplemented on top of this. In addition to this, magnesium is cardioprotective.
Phosphorus (don’t usually have to supplement): Phosphorus is vital to the formation of bones and teeth, and healthy bones and soft tissues require the proper balance of calcium and phosphorus levels to grow and develop throughout life. Phosphorus is present in every cell of the body, although 85% of the body’s phosphorus is found in the bones and teeth. Phosphorus balances calcium in the body and strongly influences calcium absorption.
Boron (3-6 mg per day): In the 1980s, boron was discovered to play a role in regulating mineral metabolism (such as calcium, phosphorus and magnesium) and enhancing the vitamin D activation process in humans. It decreases the urinary excretion of these minerals. There is also additional research going into it’s role in hormonal health, especially in peri-menopausal women.
Silicon (yield 2-5 mg per day): Evidence from animal, human, and in vitro studies suggests that silicon is involved in some aspect of collagen synthesis or stabilization and/or extracellular matrix mineralization – that is bone and matrix formation and strengthening. No to mention this, but it may also prevent arteries from injury and prevent the development of atherosclerosis. Though more studies are needed to show it’s clinical implications in bone and heart health (one study showed benefit for cortical bone health in men and premenopausal women), it’s positive effects on collagen are nonetheless significant for the aging population.
Manganese (3-6 mg), Zinc (10-20 mg), Copper (1-2 mg): These are trace minerals – meaning that our recommended daily requirements for these are quite low. However, it doesn’t mean that they are not important. The are used for cofactors for enzymes systemically in our bodies, but especially for bone synthesis and maintenance. During a 2-year trial of post-menopausal women, the effect of these three minerals, alone, or with calcium, on bone density maintenance was significant – there was no decline in BMD compared to a control group with 3.5% bone loss.
Don’t Forget…
Though nutrition is important, I have to mention one more vital piece: exercise. It increases stability and agility, strengthens the structures that support and surround bone, are reduces the risk of falling. Any weight-bearing exercise is ideal, 3-5 times a week for 30 minutes (a minimum of 90 minute in total). Good exercises include: weight training, calisthenics, walking, hiking, bicycling, yoga, dancing, stair climbing. ~ www.drjennpunND.com
Sources • Gaby, Alan. Lecture at OAND Conference 2011 “Controversies in Nutrition”. • Hanna et al. J Bone Miner Res 2000; 15:2504-12. • Institute of Medicine. DRIs for Calcium, Magnesium, Vitamin D, and Fluoride. 1997. • Institute of Medicine. DRIs for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, copper, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. 1997. • Jugdaosingh, E, et al. J Bone Miner Res 2004; 19:297-307. • Kelly, GS. Alt Med Rev 1997; 2(2):116-127. • Natural Standard. www.naturalstandard.com. 2012. • Nieves, JW. Am J Clin Nutr 2005; 81: 1232S-9S. • Northrup, Christiane. Women’s Bodies, Women’s Wisdom. 1998. • Prousky, Jonathan. Naturopathic Clinical Nutrition. 2008. • Shills, ME. Modern Nutrition in Health and Disease. 2006. • Sojka and Weaver. Nutr Rev 1995; 53(3):71-4.
Garlic: There is a reason that whole books have been written about this amazing bulb. Whether you add it to every meal, take it in concentrated form (but check with your health practitioner first!), or eat it straight up, get your garlic. Don’t worry: no one wants to kiss you while you’re sick anyways. Take the chance to stock up on garlic’s anti-bacterial, anti-viral, and anti-oxidant powers. It is stocked with nutrients (especially vitamin B6, C, and manganese) and highly beneficial sulfur-containing compounds such as allicin – which are also found in onions and other similar-looking plants. In addition to being an important soldier to bring on board to fight the bugs, studies also show it to enhance immune function. You might as well keep it in your diet after the sniffles have passed: it’s positive impact on heart health is well-studied.
Lemons: When life gives you lemons… you can do so much more than make lemonade! Add lemons (and garlic) to dressings, sauces, tea, and water. Not only does this citrus fruit give you a good dose of Vitamin C, the vitamin of the season, but it also has antimicrobial effects to help your body get rid of foreign invaders. As with so many “healthy” foods, lemons (and it’s green relative, the lime) have antioxidants to help protect your cells so that they are stronger and more apt to defend. I would recommend against lemonade in this case though… skip icy drinks in the fall and winter and stick with warming ones instead!
Honey: You may have heard that you should be decreasing your sugar intake when you’re sick. It is true: sugar can impede our immune response. However, I’m still including honey in my list. Who hasn’t been soothed before by a cup of hot water, lemon, and honey during a sore throat or cough? There is something about honey. It’s different. Raw (good quality) honey contains propolis, a natural antimicrobial (it will attack everything from viruses, bacteria, and fungus)- as long as you’re getting good quality honey. Some varieties can be a supply of friendly bacteria (think probiotics), which will also enhance your immune system (flower-fed bees in the summer are most likely to produce this type of honey). And the soothing properties? Honey is alsoanti-inflammatory, which is why you’ll find it in a lot of natural cough and throat syrups and lozenges too. Use it with your hot lemon water, add it to herbal tea, or coat your garlic with it (no, I’m not joking) to enhance your body’s fighting capability AND make your remedies more palatable! (Note: Honey is usually restricted for use in children under 1.)
Green Tea: Were you scared that I was going to recommend a bunch of foul-tasting herbal teas that are hard to find, and harder to swallow? Well, ok. Here’s one that we can all get and has so many beneficial properties that it cannot be ignored. Green tea protects our cells with it’s high anti-oxidant value, boosts the immune system with it’s catechin content, and will warm you up when you have the chills. Research shows that it will reduce the severity and duration of cold and flu symptoms. If you don’t want to drink it, I still have good news. An interesting 
Ginger: I love ginger. During flu season, I put it in smoothies, make ginger tea, add it to stir-fries, and pile it in soups (yummmm 
Tune your Immune System
Understanding the Matrix: Bone Health and Supplementation
Jennifer Pun, ND ~ March 13, 2012
The reality of osteoporosis prevention is that it starts much before the postmenopausal period, contrary to common osteoporosis prevention practices. Prevention starts in proper bone mass attainment in adolescence; however, if you’re like me, that was a while ago. A note for parents and the possible child or adolescent who has come across this article (wow, THAT would be a prevention-minded individual!): though
genetics account for about 80% of attained bone mass, sufficient nutrition (a variety of whole foods), regular physical activity, and overall balance in health will certainly be a good start at this stage of life.
For the rest of us non-adolescents out there, who ARE worried*, what can be done? I’m here to weed through the information on supplementation out there – the controversies, the hidden gems, the question marks – and give you an un-funded, unbiased,and researched view on what we can do.
*When should you be worried? Major osteoporosis risk factors include:
Oh! ‘Dem Bones
Bones and bone metabolism are not as simple as it may seem. I’m not going to go into an anatomy lesson here (that is whatWikipedia is for, right?), but I will list a few important points that are key to understanding bone health and osteoporosis prevention.
That Being Said…
Today, is about supplementation. Please note that the information included in this blog post is not a substitute for individual medical advice and naturopathic consultation. I do not encourage self-prescribing when it comes to natural health supplements, but I also know that when it comes to bone health, most people DO self-prescribe. These are general guidelines, if you are one of these people.
Calcium
We all know about calcium. We have probably all heard of it’s importance in bones (it makes up about 38% of the mineral matrix). Most of us (especially if we’re concerned for bone health) even know how much we should be getting a day, based on our life stage.
However, did you also know that:
The Calcium Controversy
One of the most important questions that comes up has to do with a couple of papers (a 2010 meta-analysis, and then a newerre-analysis) that showed an increased risk of heart attack in participants that took calcium supplements. Panic ensues – especially since the second one was an analysis of post-menopausal women – those who are most likely to be on a calcium supplement.
The facts: calcium IS important for bone health, but… Fact Two: data that is derived from studies that aren’t designed to test the factor in question has the risk of being bad science. Fact Three: This particular research isolated calcium from other minerals and nutrients - excluding the (important and vital) relationships between nutrients. Fact Four: High calcium intake can decrease magnesium absorption and levels… which is a cardioprotective nutrient. Fact Five: Magnesium is actually frequently low in our population and is under-estimated in treatment. (And one more point of interest: Silicon, another component of bone, may also be implicated in protecting the heart.)
The final point? Adequate calcium intake IS important and essential for bone health – but should be accompanied by Magnesium (in a 2:1 ratio, Calcium to Magnesium), and possibly by Silicon (2-5 mg per day, in a multimineral formula).
Those Other Vitamins and Minerals
Here are the other important vitamins and minerals that you should be getting, and why. If you are concerned, get a nutritional analysis done to determine if you are getting adequate levels of nutrients. If you are at high risk for osteoporosis, it is likely you’ll need to take some, if not all, of these through supplements. The best way to find out is to ask for individualized advice from your ND.
Vitamin D3 (1000 IU per day): Vitamin D maintains serum calcium and phosphorus concentrations through regulating absorption from the gut and resorption from the bone. The plasma level of Vitamin D has been shown to correlate with fracture risk in men and women over 50 years old.
Vitamin K (1-10 mg per day, depending on blood health): Vitamin K is famous for it’s role in blood coagulation (thus, if you are on anticoagulants or have a bleeding disorder, consult your healthcare practitioner before you start taking this). It is also required for bone metabolism and calcium balance. It is required to form bone proteins. Low serum Vitamin K has been found to be associated with lower bone mineral density (BMD) and increased risk of hip fracture.
Magnesium (500-1000 mg per day): Magnesium balances calcium –it is both integral in converting Vitamin D to it’s active form and mediating PTH (parathyroid hormone) and calcitonin secretion – two hormones that control the constant process of bone remodeling that occurs at all times. Half of our magnesium stores are found in the bone tissue. It helps to stabilize calcium phosphate, and thus prevents bone fragility. Deficiency is associated with postmenopausal osteoporosis. In a two-year study of menopausal women, magnesium therapy prevented fractures and led to increased bone density. All calcium supplements should have at least a ratio of 2:1 Cal:Mag ratio, or be supplemented on top of this. In addition to this, magnesium is cardioprotective.
Phosphorus (don’t usually have to supplement): Phosphorus is vital to the formation of bones and teeth, and healthy bones and soft tissues require the proper balance of calcium and phosphorus levels to grow and develop throughout life. Phosphorus is present in every cell of the body, although 85% of the body’s phosphorus is found in the bones and teeth. Phosphorus balances calcium in the body and strongly influences calcium absorption.
Boron (3-6 mg per day): In the 1980s, boron was discovered to play a role in regulating mineral metabolism (such as calcium, phosphorus and magnesium) and enhancing the vitamin D activation process in humans. It decreases the urinary excretion of these minerals. There is also additional research going into it’s role in hormonal health, especially in peri-menopausal women.
Silicon (yield 2-5 mg per day): Evidence from animal, human, and in vitro studies suggests that silicon is involved in some aspect of collagen synthesis or stabilization and/or extracellular matrix mineralization – that is bone and matrix formation and strengthening. No to mention this, but it may also prevent arteries from injury and prevent the development of atherosclerosis. Though more studies are needed to show it’s clinical implications in bone and heart health (one study showed benefit for cortical bone health in men and premenopausal women), it’s positive effects on collagen are nonetheless significant for the aging population.
Manganese (3-6 mg), Zinc (10-20 mg), Copper (1-2 mg): These are trace minerals – meaning that our recommended daily requirements for these are quite low. However, it doesn’t mean that they are not important. The are used for cofactors for enzymes systemically in our bodies, but especially for bone synthesis and maintenance. During a 2-year trial of post-menopausal women, the effect of these three minerals, alone, or with calcium, on bone density maintenance was significant – there was no decline in BMD compared to a control group with 3.5% bone loss.
Don’t Forget…
Though nutrition is important, I have to mention one more vital piece: exercise. It increases stability and agility, strengthens the structures that support and surround bone, are reduces the risk of falling. Any weight-bearing exercise is ideal, 3-5 times a week for 30 minutes (a minimum of 90 minute in total). Good exercises include: weight training, calisthenics, walking, hiking, bicycling, yoga, dancing, stair climbing. ~ www.drjennpunND.com
Sources • Gaby, Alan. Lecture at OAND Conference 2011 “Controversies in Nutrition”. • Hanna et al. J Bone Miner Res 2000; 15:2504-12. • Institute of Medicine. DRIs for Calcium, Magnesium, Vitamin D, and Fluoride. 1997. • Institute of Medicine. DRIs for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, copper, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. 1997. • Jugdaosingh, E, et al. J Bone Miner Res 2004; 19:297-307. • Kelly, GS. Alt Med Rev 1997; 2(2):116-127. • Natural Standard. www.naturalstandard.com. 2012. • Nieves, JW. Am J Clin Nutr 2005; 81: 1232S-9S. • Northrup, Christiane. Women’s Bodies, Women’s Wisdom. 1998. • Prousky, Jonathan. Naturopathic Clinical Nutrition. 2008. • Shills, ME. Modern Nutrition in Health and Disease. 2006. • Sojka and Weaver. Nutr Rev 1995; 53(3):71-4.