Boning Up on Bone Health
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It takes more than just calcium to build strong bones
Bone health is all too easy to neglect, particularly in the younger years, when – unless one experiences a fracture or break – the body holds together quite well. With the continued process of age and other factors, however, bone strength and integrity will begin to decline for everyone. Whether the decline is fast or slow, mild or severe depends on multiple factors, including sex, nutritional status, medication use, lifestyle factors, and even body size.
Bone health factors
Primary factors that are associated with an increased risk of low bone mineral density (the measurable quantity which is assessed in screenings for osteoporosis) are female gender, postmenopausal status, advancing age, having a low body weight (<127 pounds), long-term use of glucocorticoid therapies (such as prednisone), smoking, and drinking excess alcohol.[1] Having a personal history of a fracture or family history of a hip fracture are also factors that predict future fracture risk.
Hormones play an important role in bone health: the absence of menstrual cycling, decreased estrogen and progesterone levels, and low testosterone can all diminish bone density. Both men and women experience a decrease in hormone levels with age. Nutritional status and nutrient absorption also decline with age, further contributing to osteoporosis. Co-morbidities – such as thyroid disease, celiac disease, Crohn’s disease, and rheumatoid arthritis – may also contribute to a loss of bone strength.
Boosting bone health – more than just vitamin D and calcium!
Most doctors and consumers understand the importance of vitamin D3 and calcium in bone health, yet there are many more vitamins and minerals of importance. Vitamin K plays a role in directing calcium deposition, ensuring that the calcium taken into the body ends up in the bone matrix and not in the soft tissue.[2],[3] Certain forms of vitamin K are more active in the body than others: Menaquinone-7, or MK-7, is a highly bioactive form of vitamin K2.[4] Similarly, vitamin D3 (cholecalciferol) is significantly more effective than vitamin D2 (ergocalciferol) at raising serum vitamin D 25(OH) levels, which are measured with vitamin D screening.[5]
Vitamin K plays a role in directing calcium deposition, ensuring that the calcium taken into the body ends up in the bone matrix and not in the soft tissue.
Magnesium, zinc, copper, boron, manganese, strontium and silica along with other trace minerals are necessary for bone health. [6],[7] Although they are not the primary elements contained in the bone matrix, a deficiency is correlated with reduced bone mass and/or slow healing of fractures. Many of these minerals serve as essential cofactors for enzymes involved in the synthesis of bone.[8],[9] Silicon is involved in bone formation through the synthesis and/or stabilization of collagen.[10] Boron is important for reducing bone breakdown (part of the constant remodeling process in the bones), also supporting blood levels of calcium, magnesium, phosphorus, and vitamin D.[11],[12],[13] Finally, delta and gamma tocotrienols, two forms of vitamin E, also help to improve bone health, increasing the ratio of osteoblast (the cells which produce new bone) to osteoclast (cells which break down old bone) activity.[14]
Improving nutrient absorption from the diet
There is concern that our diets are becoming deficient in trace minerals due to poor soil quality and the overconsumption of processed, nutritionally-void foods. If a bone-supportive nutritional supplement is utilized, it should contain all of these vitamins and minerals, as the sum is greater than the individual parts. In addition to consuming a diverse diet that contains all the nutrients necessary for bone health, adequate digestion of food is important for getting nutrients from the digestive tract into the bones.
In addition to consuming a diverse diet that contains all the nutrients necessary for bone health, adequate digestion of food is important for getting nutrients from the digestive tract into the bones.
Unfortunately, many individuals have compromised production of digestive enzymes, whether due to age, stress, medications such as proton-pump inhibitors, or a variety of chronic diseases.[15],[16],[17],[18],[19] Digestive enzymes that are produced by the pancreas and by the cells lining the digestive tract support the breakdown of food substances and thus the absorption of nutrients, as does stomach acid. A supplemental digestive enzyme and acidic substances like ascorbic acid (vitamin C) may improve the breakdown and absorption of nutrients in foods, as well as supplemental bone-supportive nutrients.
Summary
Many different vitamins and minerals are required for optimal bone health. In addition to vitamin D and calcium, this includes vitamin K, tocotrienols, magnesium, zinc, copper, boron, manganese, strontium and silica, and other trace minerals. The chemical form of vitamins is important: vitamin D3 is significantly more effective than vitamin D2, Menaquinone-7 is the more bioactive form of vitamin K2, and gamma and delta tocotrienols are the form of vitamin E with studies showing their importance for bone health. Supplemental digestive enzymes and acidic substances such as ascorbic acid (vitamin C) may support bone health by improving food breakdown and nutrient absorption.
Click here to see References
[1] Mayo Clinic Staff. Osteoporosis. 2016. http://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/dxc-20207860
[2] Bügel S. Vitamin K and bone health in adult humans. Vitam Horm. 2008;78:393-416.
[3] Inaba N, et al. Low-dose daily intake of vitamin K(2) (Menaquinone-7) Improves Osteocalcin γ-Carboxylation: A Double-Blind, Randomized Controlled Trials. J Nutr Sci Vitaminol (Tokyo). 2015;61(6):471-80.
[4] Schurgers LJ, et al. Vitamin K-containing dietary supplements: comparison of synthetic vitamin K1 and natto-derived menaquinone-7. Blood. 2007 Apr 15;109(8):3279-83.
[5] Houghton LA, Vieth R. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006 Oct;84(4):694-7.
[6] Campbell BJ & Fischer SJ. Calcium, nutrition, and bone health. American Academy of Orthopaedic Surgeons. 2012.
[7] Marie PJ, Ammann P, Boivin G, Rey C. Mechanisms of action and therapeutic potential of strontium in bone. Calcif Tissue Int. 2001 Sep;69(3):121-9.
[8] Saltman PD, Strause LG. The role of trace minerals in osteoporosis. J Am Coll Nutr. 1993 Aug;12(4):384-9.
[9] Devirian TA, Volpe SL. The physiological effects of dietary boron. Crit Rev Food Sci Nutr. 2003;43(2):219-31.
[10] Jugdaohsingh R. Silicon and bone health. J Nutr Health Aging. 2007 Mar-Apr;11(2):99-110.
[11] Nielsen FH. Studies on the relationship between boron and magnesium which possibly affects the formation and maintenance of bones. Magnes Trace Elem. 1990;9(2):61-9.
[12] Nielsen FH, Hunt CD, Mullen LM, Hunt JR. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB J. 1987 Nov;1(5):394-7.
[13] Miljkovic D, Miljkovic N, McCarty MF. Up-regulatory impact of boron on vitamin D function — does it reflect inhibition of 24-hydroxylase? Med Hypotheses. 2004;63(6):1054-6.
[14] Shen CL, et al. Tocotrienol supplementation suppressed bone resorption and oxidative stress in postmenopausal osteopenic women: a 12-week randomized double-blinded placebo-controlled trial. Osteoporos Int. 2018 Jan 12.
[15] Salvatore S, et al. Low fecal elastase: potentially related to transient small bowel damage resulting from enteric pathogens. J Pediatr Gastroenterol Nutr. 2003 Mar;36(3):392-6.
[16] Leeds JS, et al. Is exocrine pancreatic insufficiency in adult coeliac disease a cause of persisting symptoms? Aliment Pharmacol Ther. 2007 Feb 1;25(3):265-71.
[17] Rothenbacher D, et al. Prevalence and determinants of exocrine pancreatic insufficiency among older adults: results of a population-based study. Scand J Gastroenterol. 2005 Jun;40(6):697-704.
[18] Hardt PD, et al. High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatology. 2003;3(5):395-402. Epub 2003 Sep 24.
[19] Ramos LR, et al. Inflammatory bowel disease and pancreatitis: a review. J Crohns Colitis. 2015 Sep 7. pii: jjv153
The information provided is for educational purposes only. Consult your physician or healthcare provider if you have specific questions before instituting any changes in your daily lifestyle including changes in diet, exercise, and supplement use.
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Dr. Carrie Decker
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