Bone Health: The Other Part of the Equation

An overview of contributing factors to the prevention and treatment of Osteopenia and Osteoporosis, by Stephen Dell-Jones, DOM.

There is a major public health problem facing Americans, one that can result in a complete decline in an individual’s health, as well as hospitalization, need for long term care, and loss of independence.  The problem is osteoporosis and osteopenia.  While everyone has become aware of the meaning of osteoporosis, osteopenia refers to a condition of low bone mineral density, not yet low enough to be labeled osteoporosis.  Both are highly affected by diet, lifestyle, supplements and exercise.  We will review the prevalence of osteoporosis, consequences from the disease, current methods of prevention, and other possibilities that can be employed.

From 2005 to 2006, 49% of women over 50 years old had osteopenia, and 10% had osteoporosis at the neck of the femur bone (Looker,et al., 2010). Thirty percent of men over 50 had osteopenia, and 2% had osteoporosis at the neck of the femur (Looker et al., 2010). It is important to realize that the most common osteoporosis related fracture sites are the vertebrae (compression fracture), hip (femur neck), and wrist (Kotz et al., 2004). The overall lifetime risk for a woman having an osteoporosis related fracture is 39.7% (Kotz et al., 2004). If these numbers are not sobering enough by themselves, consider that a bone fracture in an older person will cause hospitalization, and may possibly require long term care.  Many elderly people never return to an independent life after an event like this.  The time to prepare for this type of problem is not when you are elderly, it is now.  Let us now look at not only current recommendations but also newer research on prevention of bone loss.

When we think of bone health, the first nutrients to come to mind are calcium and vitamin D.  Bones are made with calcium, and we also need vitamin D to help us absorb calcium. These two nutrients have been of primary concern when dealing with bone health.  The National Osteoporosis Foundation recommends 1200 mg of Calcium daily for men over 71 years old and women over 50.  For men under 71 and women under 50 it is 1000 mg per day.  They also recommend 800 IU of vitamin D daily for men and women over 50, and 400-800 IU for men and women under 50.  Two researchers wrote in the Journal of Current Osteoporosis Reports that having good nutritional status, consuming calcium and vitamin D, and avoiding excess alcohol is associated with better bone health (Levis & Lagori, 2012). Avoiding excess sodium is also beneficial  (Miggiano & Gagliard, 2005).  These are the main standard recommendations for prevention and management of osteoporosis.  Certainly when these are not enough, there are medications that are often prescribed.  However, medications commonly have side effects, and osteoporosis drugs are no exception.  Using certain supplements could be a healthier alternative.

One such supplement is menaquinone, or vitamin K2.  Vitamin K2 is found in very small amounts in meats, dairy, and in larger amounts in some fermented foods like natto (fermented soy). Also, our intestinal bacteria produce vitamin K.  According to a research study on vitamin K2, adding it to a dietary program that already included vitamin D and calcium reduced the lifetime probability of a fracture by another 25% (Gajic et al. 2012).  Another study found that adding K2 to a diet already supplemented with calcium and vitamin D added more bone mass density to the lumbar vertebrae compared to subjects who took the same level of calcium and vitamin D alone (Kanellakis et al., 2012).  Remember that one of the major three types of osteoporosis related fractures is compression fractures of the vertebrae.  The study concluded that vitamin K2 created a more favorable bone metabolism (Kanellakis et al., 2012). Likewise, the Journal of Environmental and Public Health included a study with vitamin K2, which found that subjects who were either of normal bone density or already osteoporotic, and took a regimen of vitamin D3, K2, strontium, magnesium, and DHA (omega three fatty acid), had improved bone mineral density.  The interesting fact here is that the results were as good, or better, than taking bisphophonates, a commonly used osteoporosis drug (Genuis & Bouchard, 2012).  Also of note is that the protocol worked well for patients who had previously had poor outcomes with the bisphosphonates.  These findings suggest that Vitamin K2 should be a part of an osteoporosis prevention or treatment plan.  The amounts used were approximately 180 ug (micrograms).  It should be noted that vitamin K contributes to blood clotting, so those on a blood thinner should inform their prescribing physician of any changes in diet and supplements.

Another newer consideration regarding bone health  is how the collagen in bone affects its health, strength and resistance to fracture.  Bones are actually 30% collagen, a very important structural protein in the body.  In bone, the collagen forms a framework for the attachment of calcium and other minerals (Brylka et al., 2010).  The organized arrangement of mineral crystals depends on the collagen, and without adequate collagen, there will be less place for calcium to adhere to, thus lower bone mass overall.  It has always been known that bones are not made of minerals alone, but now the importance of the collagen content and quality is being more closely evaluated.  According to the Journal of Osteoporosis International, bone strength is affected not just by mineral density, but by geometry and shape of bone, microarchitectural factors in the bone, and the collagen (Viquet-Carrin et al., 2006). Another study states that the loss of collagen from the bone is highly correlated with bones being more susceptible to breaking from stresses (Nyman & Makowski , 2012). This would seem to be at least partially because it is the collagen that provides flexibility to the bones.  Bones are not completely hard, rigid structures but instead flex slightly.  Collagen provides both flexibility and frame for mineral  bonding.  Researchers have shown that the collagen molecules not only attract calcium phosphate to them, but also help arrange the calcium into parallel sheets (Brylka et al., 2010) This is how bones form minerals into a specialized lattice for strength.  Clearly, collagen is important  and it would be beneficial to minimize collagen loss. However, collagen loss begins sooner than mineral loss, as early as age 21.  Also, until recently, there was no known way to prevent or reverse this loss because collagen is a protein and merely ingesting it would cause it to be broken down.  What is needed is a method of stimulating our own production of collagen.  There is a naturally occurring molecule that was believed to do just that, orthosilicic acid (OSA). The problem was that it was unstable and would be of no value to us if ingested.  Now, however, OSA can be stabilized by choline, a natural compound needed to build cellular membranes.  Choline-stabilized OSA, or ch-OSA, is showing good results in increasing bone collagen and thereby overall bone mass (Specter et al., 2005; Specter et al. 2008 ).

In conclusion, it is important to maintain our bone health as much as possible, especially for women who are more at risk as shown above. Using calcium and vitamin D is paramount, but the whole picture also involves vitamin K2, a ch-OSA collagen generator, a diet that promotes good nutrition status, regular weight bearing exercise, moderate exposure to sunlight for vitamin D, smoking cessation, and reduction of alcohol, sodium, caffeine and soda drinks.

Thank you very much for your interest in my article.  If you have any questions, by all means feel free to contact me.

Stephen Dell-Jones Dipl. Ac, DOM

Sources:

Gajic-Veljanoski, Bayourni, Tomlinson, Khan, and Cheung  (2012). Vitamin K Supplementation for the primary prevention of osteoporotic fractures: is it cost effective and is future research warranted?  Osteoporosis International, 23(11), 2881-92.

Gennis, Bouchard (2012). Combination of micronutrients for bone study: bone density after micronutrient intervention.  Journal of Environmental and Public Health, 2012:354151.

Kanellakis, Moschonis, Fento, Schaafsma, van den Huevel, Papaioannou, Lyritis, Manios (2012). Changes in Parameters of bone Metabolism in postmenoapusal women following a 12 month intervention period using dairy products enriched with Calcium, Vitamin D, and phylloquinone(K1) or menaquinone-7(K2): the postmenoapusal Health Study II. Calcified Tissue International, 90(4), 251-62.

Krista Kotz, Stephanie Deleger, Richard Cohen, Alisa Kamigaki, John Kurata (2004). Osteoporosis and health related quality of life outcomes in the Alameda county study population. Preventing Chronic Disease. 1(1)

Anne Looker, Joseph Melton, Tamara Harris, Lori Borrund, John Shepherd (2010). Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. Journal of Bone and Mineral Research. 25(1)p. 64-71.

Miggiano and Gagliardi (2005). Diet, Nutrition and Bone Health. Clinica Terapeutica. 156(1-2) p. 47-56.

Nudelman, Dieterse, George, Bomans, Friedrich, Brylka, Hilbers, deWith, Sommerdijk (2010). The role of collagen in bone apatite formation in the presence of hydroxy apatite nucleation inhibitors. Nature Materials, 9,1004-1009.

Nyman, Makowski (2012). The contribution of the extracellular matrix to the fracture resistance of bones. Current Osteoporosis Reports, 10(2) 169-177.

Silvina, Levis, Violet, and Lagori (2012). The role of diet in Osteoporosis Prevention and Management. Current Osteoporosis Reports. 10(4) pg 296-302.

Specter et al. (2005). Effect on bone turnover and bone mineral density of low dose oral silicon as an adjunct to calcium and D3 in a randomized, placebo controlled trial. Journal of Bone and Mineral Research, 20(1).

Specter et al. (2008). Choline stabilized orthosilicic acid supplementation as an adjunct to  calcium and D3 stimulates markers of bone formation in osteopenic females: a randomized, placebo controlled trial. Musculoskeletal Disorders, 9(85)

Viquet-Carrin, Garnero, Delmas (2006). The role of collagen in Bone Strength. Osteoporosis International, 17(3) 319-36.