Articles

Vitamins and Supplements for Osteoporosis

By Tiffany Spudich, Pharm.D.

Within five to seven years after menopause, women can lose as much as 20% of their bone mass. After menopause, levels of estrogen and progesterone decline substantially, which are the main contributing factors to bone loss. Estrogen decreases bone destruction by decreasing the activity of osteoclasts, cells that breakdown bone. Progesterone increases bone integrity by helping to promote osteoblasts, cells the promote bone growth. Osteoporosis occurs when bone resorption (osteoclast activity) exceeds bone formation (osteoblast activity). Over time, this results in fragile bones, and an increased risk of fractures, usually of the hip, spine, or wrist.

Osteoporosis is most common in white and Hispanic women, and occurs about twice as frequently in these populations compared to black women. The reason is that black women have about 20% greater bone mass. Other risk factors for osteoporosis include low body weight, low body mass index (BMI), smoking, alcohol abuse, estrogen deficiency, lack of exercise, and a family history of osteoporosis. Due to the larger skeletons of males, bone loss in men often starts later in life and progresses more slowly. Only about 20% of osteoporosis patients are men.

Some common conventional treatments for osteoporosis include Fosamax, Boniva, Actonel, and Evista. However, there are several natural vitamins and supplements that are also important in the prevention and treatment of osteoporosis. Bone loss typically occurs at a rate of 0.5% to 1% per year in pre-menopausal women over 40, with the bone loss being more pronounced if dietary calcium intake is below the recommended amount. Adequate calcium intake is considered the mainstay therapy for both preventing and treating osteoporosis. The majority of studies show that long-term calcium supplementation decreases primary fracture rates by 30% to 35% for vertebral bone and 25% for hip bone fractures.

Calcium is formulated as a variety of salts, including carbonate, citrate, lactate, gluconate, and phosphate salts. Calcium carbonate is better absorbed when taken with food, whereas calcium salts such as calcium citrate can be taken without regards to meals. Calcium supplements should be taken in three or four divided doses daily, as absorption is greatest when each dose does not exceed 500 mg. For most postmenopausal women, the target calcium intake is 1200 to 1500 mg per day, in divided doses.

Vitamin D is also a vital component for preventing and treating osteoporosis, as it has a variety of functions including enhancing intestinal absorption of calcium, maintaining calcium in the blood stream within a normal range, and increasing the mobilization of stem cells to become osteoblasts, which build bone. The two most integral forms of Vitamin D are ergocalciferol, vitamin D2 (primarily from food), and cholecalciferol, vitamin D3 (from the skin via the sun). Both forms are inactive until transformed by the kidney to calcitriol. Normally, vitamin D is produced in the skin following sun exposure. But aging affects this process, and menopausal patients need two or three times the amount of vitamin D because their skin only produces about 25% as much vitamin D as the skin of adults in their 20s or 30s. Adequate vitamin D intake can usually be accomplished with a daily oral intake of 400 to 800 IU per day.

The role of magnesium in osteoporosis is also being studied, as magnesium deficiency is thought to be a possible risk factor for postmenopausal osteoporosis. Some epidemiological evidence links dietary intake of magnesium to increased bone mineral density. Preliminary clinical research suggests that taking magnesium supplements might decrease bone loss in women with postmenopausal osteoporosis.

Manganese and zinc are both minerals that may also have a role in bone integrity. Manganese levels are lower in women with osteoporosis, and it is and essential mineral for the enzymatic activity required for bone formation. Zinc is concentrated in bone and muscle, and a deficiency of this mineral can cause a reduction in osteoblastic activity and in the synthesis of collagen and chondroitin, two essential building blocks of joints and bone. Preliminary evidence suggests that calcium in combination with zinc and manganese may be better at increasing bone mineral density in postmenopausal women then calcium alone.

Strontium is an element that is chemically and physically similar to calcium. About 90% of strontium in the body is found in bone. Strontium appears to increase bone formation, possibly reduce bone resorption, and enhance the replication of preosteoblastic cells. Researchers are studying a specific form of this mineral called strontium ranelate, which appears to reduce the risk of vertebral fractures by potentially 40% in postmenopausal women with osteoporosis.

Vitamin K is responsible for activation of osteocalcin, a protein that helps attract calcium to the bone. There is some evidence that low vitamin K intake is associated with reduced bone mineral density and increased fractures in people with osteoporosis. The best way to get vitamin K is from one’s diet. Food rich in vitamin K include cabbage, cauliflower, spinach, soybean, and most cereals.

The bottom line is that getting adequate calcium and vitamin D is the cornerstone of supplementation necessary for osteoporosis prevention and treatment, as calcium and vitamin D consistently have been shown to decrease fracture rates. Even patients who are on conventional prescriptions for osteoporosis need calcium and vitamin D. Incorporating a multivitamin that contains magnesium, zinc, manganese, and strontium may be beneficial for your bones as well. Note that many herbs such as Dong quai, Panax ginseng, alfalfa, red clover, and licorice are promoted for osteoporosis but there’s not enough consistent clinical evidence at this time to support their use.

Finally, never underestimate the importance of diet and lifestyle for preventing and treating osteoporosis. Lifestyle modification is integral in the prevention and treatment of osteoporosis. Several steps can be taken to reduce the risk of developing osteoporosis and subsequent fractures. High-impact, weight-bearing exercise, such as weight training, can increase bone strength. Avoid excessive alcohol, and instill that New Year's resolution to quit smoking. Also, remember to incorporate those foods into the diet that are high in calcium including milk, cheese, and yogurt.

Food / Portion / Calcium (Milligrams)
Plain, fat-free yogurt / 1 cup / 450
Grilled cheese sandwich / 1 sandwich / 371
American cheese / 2 ounces / 348
Milk (fat free or low fat) / 1 cup / 300
Orange juice with added calcium / 1 cup / 300
Mozzarella cheese, part skim, low moisture / 1 ounce / 207
Tofu (with calcium sulfate on ingredient list) / ½ cup / 204
Macaroni and cheese / ½ cup / 180
Cheese pizza / 1 slice / 111-147
Ice Cream / ½ cup / 84