Vitamins & Minerals
Best Bets for Healthy Bones
No matter what your age, it’s never too late to stop bone loss now for better posture and fewer fractures down the road. According to research or other evidence, the following self-care steps may be helpful*:
*These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist.
Osteoporosis is a condition in which the normal amount of bone mass has decreased. People with osteoporosis have brittle bones, which increases the risk of bone fracture, particularly in the hip, spine, and wrist. Beyond issues of race, age, and gender, incidence varies widely from society to society, suggesting that osteoporosis is largely preventable.
What are the symptoms?
Osteoporosis is a silent disease that may not be noticed until a broken bone occurs. Signs may include diminished height, rounded shoulders, "dowager’s hump," and evidence of bone loss from diagnostic tests. Symptoms may include neck or back pain.
Other dietary considerations
People who consume soft drinks have been reported to have an increased incidence of bone fractures, although short-term consumption of carbonated beverages has not affected markers of bone health. The problem, if one exists, may be linked to phosphoric acid, a substance found in many soft drinks, particularly colas. Although a few studies have not linked soft drinks to bone loss, the preponderance of evidence now suggests that a problem may exist.
The effect of dairy products on the risk of osteoporosis-related fractures is subject to controversy. According to a review of 46 studies, different dairy products appear to have different effects on bone density and fracture rates. Milk, especially nonfat milk, probably does more good than harm because of its relatively lower protein and salt content, as well as its higher level of calcium. Cottage cheese and American cheese, on the other hand, probably do more harm than good. These foods are not recommended as calcium sources for the prevention of osteoporotic fractures. Although there may be better ways of getting calcium, younger women who wish to prevent osteoporosis might consider nonfat milk and nonfat yogurt to be reasonable dietary calcium sources.
More vitamins that may be helpful
Strontium may play a role in bone formation, and also may inhibit bone breakdown. In a three-year double-blind study of postmenopausal women with osteoporosis, supplementing with strontium, in the form of strontium ranelate, significantly increased bone mineral density in the hip and spine, and significantly reduced the risk of vertebral fractures by 41%, compared with a placebo. Increased bone formation and decreased bone pain were also reported in six people with osteoporosis given 600 to 700 mg of strontium per day. Although the amounts of strontium used in these studies was very high, the optimal intake remains unknown. Some doctors recommend only 1 to 6 mg of supplemental strontium per day—less than many people currently consume from their diets. People interested in taking large amounts of strontium should be supervised by a doctor, and should make sure to take adequate amounts of calcium. People taking large amounts of strontium should mention that fact to the radiologist when they are having their bone mineral density measured, so that the results will be interpreted correctly.
While phosphorus is essential for bone formation, most people do not require phosphorus supplementation, because the typical western diet provides ample or even excessive amounts of phosphorus. One study, however, has shown that taking calcium can interfere with the absorption of phosphorus, potentially leading to phosphorus deficiency in elderly people, whose diets may contain less phosphorus. The authors of this study recommend that, for elderly people, at least some of the supplemental calcium be taken in the form of tricalcium phosphate or some other phosphorus-containing preparation.
Ipriflavone is a synthetic flavonoid derived from the soy isoflavone called daidzein. It promotes the incorporation of calcium into bone and inhibits bone breakdown, thus preventing and reversing osteoporosis. Many clinical trials, including numerous double-blind trials, have consistently shown that long-term treatment with 600 mg of ipriflavone per day, along with 1,000 mg supplemental calcium, is both safe and effective in halting bone loss in postmenopausal women or in women who have had their ovaries removed. Ipriflavone has also been found to improve bone density in established cases of osteoporosis in some but not all, clinical trials.
A preliminary trial found that elderly women with osteoporosis who were given 4 grams of fish oil per day for four months had improved calcium absorption and evidence of new bone formation. Fish oil combined with evening primrose oil (EPO) may confer added benefits. In a controlled trial, women received 6 grams of a combination of EPO and fish oil, or a matching placebo, plus 600 mg of calcium per day for three years. The EPO/fish oil group experienced no spinal bone loss in the first 18 months and a significant 3.1% increase in spinal bone mineral density during the last 18 months.
Vitamin K is needed for bone formation. People with osteoporosis have been reported to have low blood levels and low dietary intake of vitamin K. One study found that postmenopausal (though not premenopausal) women may reduce urinary loss of calcium by taking 1 mg of vitamin K per day. People with osteoporosis given large amounts of vitamin K2 (45 mg per day) have shown an increase in bone density after six months and decreased bone loss after one or two years.
Supplemental magnesium has reduced markers of bone loss in men. Supplementing with 250 mg up to 750 mg per day of magnesium arrested bone loss or increased bone mass in 87% of people with osteoporosis in a two-year, preliminary trial. Supplementing with magnesium (150 mg per day for one year) also increased bone mass in pre-adolescent and adolescent girls in a double-blind study. Some doctors recommend that people with osteoporosis supplement with 350 mg of magnesium per day.
Copper is needed for normal bone synthesis. Recently, a two-year, controlled trial reported that 3 mg of copper per day reduced bone loss. When taken over a shorter period of time (six weeks), the same level of copper supplementation had no effect on biochemical markers of bone loss. Some doctors recommend 2 to 3 mg of copper per day, particularly if zinc is also being taken, in order to prevent a deficiency. Supplemental zinc significantly depletes copper stores, so people taking zinc supplements for more than a few weeks generally need to supplement with copper also. All minerals discussed so far—calcium, magnesium, zinc, and copper—are sometimes found at appropriate levels in high-potency multivitamin-mineral supplements.
Folic acid, vitamin B6, and vitamin B12 are known to reduce blood levels of the amino acid homocysteine, and homocystinuria, a condition associated with high homocysteine levels, frequently causes osteoporosis. Therefore, some researchers have suggested that these vitamins might help prevent osteoporosis by lowering homocysteine levels. In a double-blind study of people who had suffered a stroke and had high homocysteine levels, daily supplementation with 5 mg of folic acid and 1,500 mcg of vitamin B12 for two years reduced the incidence of fractures by 78%, compared with a placebo. However, supplementation with these vitamins did not reduce fracture risk in people who had only mildly elevated homocysteine levels and relatively high pretreatment folic acid levels. For the purpose of lowering homocysteine, amounts of folic acid and vitamins B6 and B12 found in high-potency B-complex supplements and multivitamins should be adequate for most people.
Preliminary evidence suggests that progesterone might reduce the risk of osteoporosis. A preliminary trial using topically applied natural progesterone cream in combination with dietary changes, exercise, vitamin and calcium supplementation, and estrogen therapy reported large gains in bone density over a three-year period in a small group of postmenopausal women, but no comparison was made to examine the effect of using the same protocol without progesterone. Other trials have reported that adding natural progesterone to estrogen therapy did not improve the bone-sparing effects of estrogen and that progesterone applied topically every day for a year did not reduce bone loss. In a more recent double-blind study, however, progesterone had a modest bone-sparing effect in post-menopausal women.
In a preliminary trial, bone mineral density increased among healthy elderly women and men who were given 50 mg per day of DHEA as a supplement. Similar results were found in a one-year double-blind trial that used 50 mg of DHEA per day. It is not known if supplementation would have the same effect in people with established osteoporosis. DHEA is a steroid hormone, and should be used only under the supervision of a doctor.
Lifestyle changes that may be helpful
Smoking leads to increased bone loss and exercise is known to help protect against bone loss. The more weight-bearing exercise done by men and postmenopausal women, the greater their bone mass and the lower their risk of osteoporosis. Walking is a perfect weight-bearing exercise.
Excess body mass helps protect against osteoporosis. As a result, researchers have been able to show that people who successfully lose weight have greater bone loss compared with those who do not lose weight. Therefore, people who lose weight need to be particularly vigilant about preventing osteoporotic fractures.