Alan Cook DC
Osteoporosis remains a confusing item for both the public and providers. In its essence, it’s simple. We grow bone as children and young adults. We lose bone at various rates as middle age and older adults. When enough mineral is lost so that the bone can no longer resist the stresses placed upon it, the bone fractures.
In many attempts to understand how to prevent osteoporotic fractures, experiments have been run to test prescription medications, natural compounds, and various exercises. But the reductionist experiments often miss the importance of recognizing bone loss as a multifactorial process.
For example, if we consider five of the elements needed for bone health, there are estimates of daily requirements. For this example, we’ll focus on: protein, calcium, magnesium, vitamin D, and vitamin K:
Several clinical trials have been run that will look at a single nutrient. For this example, we’ll use vitamin K as the experimental intervention. If the researchers provide 100% of the vitamin K needed to promote bone growth, we’d see the following:
But bone is not just dependent on vitamin K. Rather there is a spectrum of nutrients that are needed. If these are supplied in less than optimal amounts, we see:
In this hypothetical scenario, the skeletal health is limited by the low intake of magnesium. Increasing the vitamin K intervention to even higher levels will have no effect. These types of clinical trials add to the confusion. By omitting the important step of not understanding the patients’ deficiencies vs. adequacies, and trying to apply a single intervention, the research design is faulty as are the conclusions.
In order to enhance bone health with natural compounds, the better interventions include multiple nutrients that emphasize the weak links in a patient’s dietary intake. This does not say that any combination will be helpful, but that well-conceived formulas would be a far better test and increase the likelihood of patient benefit.
In the clinical world, many providers prescribe calcium and vitamin D. If DXA tests are ordered, the patient’s bone mineral often progress from normal to osteopenic to osteoporotic will the Ca++/Vit D protocol. Healthy bone embodies some complexity requiring a spectrum of micronutrients, protein, and mechanical forces. The continual focus of the research world on single nutrient studies is a mistake and is inexcusable given our current knowledge of bone physiology.
Fortunately, there are osteoporosis researchers that have looked at exercise(1-4), prunes(5-7), sun exposure(8,9), soy(10,11), and nutrient combinations(12,13). There is some cause for optimism.
Alan Cook DC has been in practice since 1989. He ran the Osteoporosis Diagnostic Center (1996-2019), participated in four clinical trials, and lectured nationally. He is current working with the Open Door Clinic system in a multi-disciplinary setting and is providing video-based continuing education with EasyWebCE.
- Kemmler W, Lauber D, Weineck J, et. al. Benefits of 2 Years of Intense Exercise on Bone Density, Physical Fitness, and Blood Lipids in Early Postmenopausal Osteopenic Women. Arch Intern Med. 2004;164(10):1084-1091.
- Kemmler W, Bebenek M, Kohl M, von Stengel S. Exercise and Fractures in Postmenopausal Women. Final Results of the controlled Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Osteoporosis International 2015; 26, 2491–2499.
- Sakai A, Oshege T, Zenke Y, et. al. Unipedal standing exercise and hip bone mineral density in postmenopausal women: a randomized controlled trial. J Bone Mineral Metab 2009; 28:42.
- Sakamoto K, Nagai T, Murakami J. Does a One-minute Unipedal-standing Balance Exercise with Eyes Open Three Times Daily Increase Bone Mineral Density? A Randomized Controlled Trial. Showa University Journal of Medical Sciences 2010; 22
- Armandi BH, Khalil DA, Lucas EA, et. al. Dried Plums Improve Indices of Bone Formation in Postmenopausal Women. J Women’s Health & Gender-based Medicine 2004; 11: Published Online:7 Jul 2004 https://doi.org/10.1089/152460902753473471
- Hooshmand S, Sheau CC, Saadat RL, et. al. Comparative effects of dried plum and dried apple on bone in postmenopausal women. Br J Nutr 2011; 106:923-930.
- Hooshmand S, Kern M, Metti D, et. al. The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women: a randomized, controlled trial. Osteo Int 2016; 27: 2271-2279.
- Holick M: High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proc 2006, 81:353–373.
- Bandeira F, Griz L, Dreyer P, Eufrazino C, Bandeira C, Freese E. Vitamin D deficiency: a global perspective. Arq Bras Endocrinol Metabol. 2006 Aug;50(4):640-6.
- Chiechi LM, Secreto G, D’Amore M, et. al. Efficacy of a Soy Rich Diet in Preventing Postmenopausal Osteoporosis: the Menfis Randomized Trial.Maturitas 2002;42:295-300.
- Mori M, Aizawa T, Miki T, Yamori Y. Soy Isoflavone Tablets Reduce Osteoporosis Risk Factors and Obesity in Middle-Aged Japanese Women. CEPP 2005;11:on-line.
- Genuis SJ, Bouchard TP. Combination of Micronutrients for Bone (COMB) Study. J Envir Pub Health 2012. Article 354151.
- Maria S, Swanson MH, Enderby LT, et. al. Melatonin-micronutrients Osteopenia Treatment Study (MOTS). Aging 2017;9:256-85.