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    Sutter Medical Center, Sacramento

    Osteoporosis

    Osteoporosis

    Alternative Medicine
    Alternative Medicine
    The following information is specific for alternative and complementary medicine. For additional evidence-based information on diseases, conditions, symptoms, diagnosis, treatment and wellness issues, continue searching the Healthwise Knowledgebase.

    Need to Know
    Osteoporosis
    Stand tall against osteoporosis. 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.
    • Pump it up

      Make weight-bearing exercise a regular habit to increase bone density and prevent osteoporosis

    • Cut the caffeine

      Avoid excessive calcium loss in the urine by switching to healthier beverages

    • Aim for lifelong calcium and vitamin D nutrition

      An extra 800 mg of calcium and 400 to 800 IU of vitamin D a day can help protect the bones, from childhood through adulthood

    • Get your soy

      Make tofu, soy milk, soy protein, and other sources of beneficial isoflavones a regular part of your diet

    • Watch the salt

      Avoid excessive salt intake and high-salt processed and restaurant foods that may contribute to calcium and bone loss

    About

    About This Condition

    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. Osteoporosis is most common in postmenopausal Asian and Caucasian women. Premenopausal women are partially protected against bone loss by the hormone called estrogen. Black women often have slightly greater bone mass than do other women, which helps protect against bone fractures. In men, testosterone partially protects against bone loss even after middle age. Beyond issues of race, age, and gender, incidence varies widely from society to society, suggesting that osteoporosis is largely preventable.

    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.

    Eating Right

    The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

    Recommendation Why
    Choose dairy foods wisely Different dairy products appear to have different effects on bone density and fracture rates. Opt for nonfat milk and yogurt over cottage cheese or American cheese.

    Choose dairy foods wisely

    The effect of dairy products on the risk of osteoporosis-related fractures is subject to controversy. According to a review of 46 studies,1 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. Cottage cheese is high in protein and salt but low in calcium, factors which could contribute to bone loss. American cheese is extremely high in salt and high in protein. 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.

    Cut the caffeine Avoid excessive calcium loss in the urine from by switching to healthier beverages, like herbal teas, juices, and water.

    Cut the caffeine

    Caffeine increases urinary loss of calcium.2 Caffeine intake has been linked to increased risk of hip fractures3 and to a lower bone mass in women who consumed inadequate calcium.4 Many doctors recommend decreasing caffeinated coffee, black tea, and caffeine-containing soft drinks as a way to improve bone mass.

    Curiously, while caffeine-containing tea consumption has been linked to osteoporosis in some studies,5 others have reported that tea drinkers have a lower risk of osteoporosis than do people who do not drink tea.6 , 7 Possibly, the calcium-losing effect of caffeine in tea is overridden by other constituents of tea, such as flavonoids.
    Fine-tune your protein Too much or too little protein in your diet may increase osteoporosis risk.

    Fine-tune your protein

    Studies attempting to uncover the effects of high animal protein intake on the risk of osteoporosis have produced confusing and contradictory results.8 , 9 , 10 , 11 , 12 The same is true of studies attempting to find out whether vegetarians are protected against osteoporosis.13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Moreover, while some studies report that protein supplementation lowers death rates and shortens hospital stays21 or reduces bone loss among people with osteoporosis,22 others have found that such supplementation is of little value.23

    These conflicting findings may occur in part because dietary protein produces opposing effects on bone. On one hand, dietary protein increases the loss of calcium in urine,24 , 25 which should increase the risk of osteoporosis. On the other hand, normal bone formation requires adequate dietary protein, and low dietary protein intake has been associated with low bone mineral density.26 Current research shows that finding the line between too much protein and too little protein remains elusive, though extremes in protein intake—either high or low—might possibly increase the risk of osteoporosis.

    Watch the salt Avoid excessive salt and high-salt processed and restaurant foods that may contribute to loss of calcium and bone.

    Watch the salt

    Short-term increases in dietary salt result in increased urinary calcium loss, which suggests that over time, salt intake may cause bone loss.27 Increasing dietary salt has increased markers of bone loss in postmenopausal (though not premenopausal) women.28 , 29 , 30 Although a definitive link between salt intake and osteoporosis has not yet been proven, many doctors recommend that people wishing to protect themselves against bone loss use less salt and eat fewer processed and restaurant foods, which tend to be highly salted.
    Steer clear of soda People who drink sodas, particularly colas, may be more likely to experience bone loss and bone fractures.

    Steer clear of soda

    People who consume soft drinks have been reported to have an increased incidence of bone fractures,31 although short-term consumption of carbonated beverages has not affected markers of bone health.32 The problem, if one exists, may be linked to phosphoric acid, a substance found in many soft drinks, particularly colas. In one study, children consuming at least six glasses (1.5 liters) per week of soft drinks containing phosphoric acid had more than five times the risk of developing low blood levels of calcium compared with other children.33 In a study in adults, higher consumption of cola beverages was associated with more bone loss in women, but not in men. Consumption of non-cola carbonated drinks, on the other hand, was not associated with bone loss.34 Although a few studies have not linked soft drinks to bone loss,35 the preponderance of evidence now suggests that a problem may exist.

    Supplements

    What Are "Star" Ratings?

    3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

    2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.


    Supplement Amount Why
    Calcium 800 to 1,500 mg daily depending on age and dietary calcium intake 3 stars  Calcium supplements help prevent osteoporosis, especially for girls and premenopausal women. It is often recommended to help people already diagnosed with osteoporosis.

    3 stars  Calcium

    800 to 1,500 mg daily depending on age and dietary calcium intake

    Caution: Calcium supplements should be avoided by prostate cancer patients.

    Although insufficient when used as the only intervention, calcium supplements help prevent osteoporosis.36 Though some of the research remains controversial, the protective effect of calcium on bone mass is one of very few health claims permitted on supplement labels by the U.S. Food and Drug Administration.

    In some studies, higher calcium intake has not correlated with a reduced risk of osteoporosis—for example, in women shortly after becoming menopausal37 or in men.38 However, after about three years of menopause, calcium supplementation does appear to take on a protective effect for women.39 Even the most positive trials using isolated calcium supplementation show only minor effects on bone mass. Nonetheless, a review of the research shows that calcium supplementation plus hormone replacement therapy is much more effective than hormone replacement therapy without calcium.40 Double-blind research has found that increasing calcium intake results in greater bone mass in girls.41 An analysis of many trials investigating the effects of calcium supplementation in premenopausal women has also shown a significant positive effect.42 Most doctors recommend calcium supplementation as a way to partially reduce the risk of osteoporosis and to help people already diagnosed with the condition. In order to achieve the 1,500 mg per day calcium intake many researchers deem optimal, 800 to 1,000 mg of supplemental calcium are generally added to the 500 to 700 mg readily obtainable from the diet.

    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.43. 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.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.44 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Strontium 600 to 700 mg daily under medical supervision 3 stars  Studies indicate that supplementing with strontium may help reduce bone pain, increase bone mineral density, and reduce the risk of some fractures.

    3 stars  Strontium

    600 to 700 mg daily under medical supervision

    Strontium may play a role in bone formation, and also may inhibit bone breakdown.45 Preliminary evidence suggests that women with osteoporosis may have reduced absorption of strontistaum.46 The first medical use of strontium was described in 1884. (Strontium supplements do not contain the radioactive form of strontium that is a component of nuclear fallout.) Years ago in a preliminary trial, people with osteoporosis were given 1.7 grams of strontium per day for a period of time ranging between three months and three years; afterward, they reported a significant reduction in bone pain, and there was evidence suggesting their bone mass had increased.47 More recently, 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.48 The amount of strontium used in that study was 680 mg per day, which is approximately 300 times the amount found in a typical diet. Increased bone formation and decreased bone pain were also reported in six people with osteoporosis given 600 to 700 mg of strontium per day.49  Although the amounts of strontium used in these studies 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, but an amount that has begun to appear in some mineral formulas geared toward bone health. Strontium preparations, providing 200 to 400 mg per day, were used for decades during the first half of the twentieth century without any apparent toxicity.50 No significant side effects were observed in people taking large amounts of strontium; however, animal studies have demonstrated defects in bone mineralization, when strontium was administered in large amounts in combination with a low-calcium diet. People interested in taking large amounts of strontium should be supervised by a doctor, and should make sure to take adequate amounts of calcium. It should be noted that, although supplementing with strontium increases bone mineral density, only part of the increase is real. The rest is a laboratory error that results from the fact that strontium blocks X-rays to a greater extent than does calcium.51 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.
    What Else Is This Supplement Used For?

    Supplement Amount Why
    Vitamin D 400 to 800 IU daily depending on age, sun exposure, and dietary sources 3 stars  Vitamin D increases calcium absorption and helps make bones stronger. Vitamin D supplementation has reduced bone loss in women who don’t get enough of the vitamin from food and slowed bone loss in people with osteoporosis. It also works with calcium to prevent some musculoskeletal causes of falls and subsequent fractures.

    3 stars  Vitamin D

    400 to 800 IU daily depending on age, sun exposure, and dietary sources

    Vitamin D increases calcium absorption, and blood levels of vitamin D are directly related to the strength of bones.52 Mild deficiency of vitamin D is common in the fit, active elderly population and leads to an acceleration of age-related loss of bone mass and an increased risk of fracture.53 In double-blind research, vitamin D supplementation has reduced bone loss in women who consume insufficient vitamin D from food and slowed bone loss in people with osteoporosis.54 , 55 However, the effect of vitamin D supplementation on osteoporosis risk remains surprisingly unclear,56 , 57 with some trials reporting little if any benefit.58 Moreover, trials reporting reduced risk of fracture have usually combined vitamin D with calcium supplementation,59 making it difficult to assess how much benefit is caused by supplementation with vitamin D alone.60

    Impaired balance and increased body sway are important causes of falls in elderly people with osteoporosis.61 Vitamin D works with calcium to prevent some musculoskeletal causes of falls.62 In a double-blind trial, elderly women who were given 800 IU per day of vitamin D and 1,200 mg per day of calcium had a significantly lower rate of falls and subsequent fractures than did women given the same amount of calcium alone.63 Vitamin D in the amount of 800 IU per day effectively prevented falls in a double-blind study of elderly nursing home residents, but lower amounts were ineffective.64

    Despite inconsistency in the research, many doctors recommend 400 to 800 IU per day of supplemental vitamin D, depending upon dietary intake and exposure to sunlight.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.65 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Copper 2 to 3 mg daily 2 stars  Copper is needed for normal bone synthesis, and one trial reported that copper reduced bone loss.

    2 stars  Copper

    2 to 3 mg daily

    Copper is needed for normal bone synthesis. Recently, a two-year, controlled trial reported that 3 mg of copper per day reduced bone loss.66 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.67 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. Calcium, magnesium, zinc, and copper are sometimes found at appropriate levels in high-potency multivitamin-mineral supplements.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.68 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    DHEA Take under medical supervision: 50 mg per day 2 stars  DHEA may be helpful in preventing osteoporosis. In one trial, bone mineral density increased among healthy elderly women and men who were given DHEA.

    2 stars  DHEA

    Take under medical supervision: 50 mg per day

    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.69 Similar results were found in two one-year double-blind trials that used 50 mg of DHEA per day.70 , 71 , 72 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. DHEA is a steroid hormone, and should be used only under the supervision of a doctor.
    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Fish Oil and Evening Primrose Oil 6 grams daily 2 stars  Fish oil combined with evening primrose oil (EPO) may improve calcium absorption and promote bone formation.

    2 stars  Fish Oil and Evening Primrose Oil

    6 grams daily

    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.73 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.74 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.


    Supplement Amount Why
    Folic Acid
    (High Homocysteine)    		 5 mg with 1,500 mcg of vitamin B12 daily 2 stars  Homocystinuria, a condition associated with high homocysteine levels, frequently causes osteoporosis. By lowering homocysteine levels, folic acid may help prevent osteoporosis.

    2 stars  Folic Acid

    5 mg with 1,500 mcg of vitamin B12 daily

    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.75 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.76 The reduction in fracture risk appeared to be due to an improvement in bone quality, rather than to a change in bone mineral density. 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.77 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.
    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Ipriflavone 600 mg daily along with 1,000 mg calcium daily 2 stars  Ipriflavone promotes the incorporation of calcium into bone and inhibits bone breakdown, thus preventing and reversing osteoporosis.

    2 stars  Ipriflavone

    600 mg daily along with 1,000 mg calcium daily

    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,78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 but not all,89 clinical trials.

    However, one double-blind study has failed to confirm the beneficial effect of ipriflavone. In that study, ipriflavone was no more effective than a placebo for preventing bone loss in postmenopausal women with osteoporosis.90 The women in this negative study were older (average age, 63.3 years) than those in most other ipriflavone studies and had relatively severe osteoporosis. It is possible that ipriflavone works only in younger women or in those with less severe osteoporosis.

    What Else Is This Supplement Used For?

    Supplement Amount Why
    Magnesium Adults: 250 mg up to 750 mg daily; for girls: 150 mg daily 2 stars  Supplementing with magnesium has been shown to stop bone loss or increased bone mass in people with osteoporosis.

    2 stars  Magnesium

    Adults: 250 mg up to 750 mg daily; for girls: 150 mg daily

    In a preliminary study, people with osteoporosis were reported to be at high risk for magnesium malabsorption.91 Both bone92 and blood93 levels of magnesium have been reported to be low in people with osteoporosis. Supplemental magnesium has reduced markers of bone loss in men.94 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.95 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.96 Some doctors recommend that people with osteoporosis supplement with 350 mg of magnesium per day.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.97 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Progesterone Consult a qualified healthcare practitioner 2 stars  Preliminary evidence suggests that progesterone might reduce osteoporosis risk by promoting bone density.

    2 stars  Progesterone

    Consult a qualified healthcare practitioner

    Preliminary evidence suggests that progesterone might reduce the risk of osteoporosis.98 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.99 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.100 101 In a more recent double-blind study, however, progesterone had a modest bone-sparing effect in post-menopausal women.102
    What Else Is This Supplement Used For?

    Supplement Amount Why
    Red Clover Take an extract supplying 26 mg of biochanin A, 16 mg of formononetin, 1 mg of genistein, and 0.5 mg of daidzein per day 2 stars  In one study, supplementing with isoflavones from red clover reduced the amount of bone loss from the spine by 45%, compared with a placebo.

    2 stars  Red Clover

    Take an extract supplying 26 mg of biochanin A, 16 mg of formononetin, 1 mg of genistein, and 0.5 mg of daidzein per day

    In a double-blind study, supplementation with isoflavones from red clover for one year reduced the amount of bone loss from the spine by 45%, compared with a placebo.103 The supplement used provided daily 26 mg of biochanin A, 16 mg of formononetin, 1 mg of genistein, and 0.5 mg of daidzein.
    What Else Is This Supplement Used For?

    Supplement Amount Why
    Vitamin B12
    (High Homocysteine)    		 1,500 mcg with 5 mg of folic acid daily 2 stars  Homocystinuria, a condition associated with high homocysteine levels, frequently causes osteoporosis. By lowering homocysteine levels, vitamin B12 may help prevent osteoporosis.

    2 stars  Vitamin B12

    1,500 mcg with 5 mg of folic acid daily

    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.104 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.105 The reduction in fracture risk appeared to be due to an improvement in bone quality, rather than to a change in bone mineral density. 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.106 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.
    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Vitamin K 1,000 mcg daily 2 stars  Vitamin K is needed for bone formation, and supplementing with it may be a way to maintain bone mass.

    2 stars  Vitamin K

    1,000 mcg daily

    Vitamin K is needed for bone formation. People with osteoporosis have been reported to have low blood levels107 , 108 and low dietary intake of vitamin K.109 , 110 One study found that postmenopausal (though not premenopausal) women may reduce urinary loss of calcium by taking 1 mg of vitamin K per day.111 People with osteoporosis given large amounts of vitamin K2 (45 mg per day) have shown an increase in bone density after six months112 and decreased bone loss after one113 or two114 years.

    Other preliminary studies have reported that vitamin K supplementation increases bone formation in some women115 and that higher vitamin K intake correlates with greater bone mineral density.116 However, a double-blind study found that supplementing with 500 mcg of vitamin K1 per day for three years had no effect on bone mineral density, when compared with a placebo.117 Some doctors recommend 1 mg vitamin K1 to postmenopausal women as a way to help maintain bone mass, though optimal intake remains unknown.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Black Cohosh Refer to label instructions 1 star  Black cohosh has been shown to improve bone mineral density in animals fed a low-calcium diet.

    1 star  Black Cohosh

    Black cohosh has been shown to improve bone mineral density in animals fed a low calcium diet,118 but it has not been studied for this purpose in humans.

    What Else Is This Supplement Used For?

    Supplement Amount Why
    Boron Refer to label instructions 1 star  Supplementing with boron has been reported to reduce urinary loss of calcium and magnesium. However, those already supplementing with magnesium appear to achieve no additional calcium-sparing benefit when boron is added. Therefore, people with osteoporosis should supplement with magnesium or boron, not both.

    1 star  Boron

    Boron supplementation has been reported to reduce urinary loss of calcium and magnesium in some,119 but not all,120 preliminary research. However, those who are already supplementing with magnesium appear to achieve no additional calcium-sparing benefit when boron is added.121 Finally, in the original report claiming that boron reduced loss of calcium,122 the effect was achieved by significantly increasing estrogen and testosterone levels, hormones that have been linked to cancer risks. Therefore, it makes sense for people with osteoporosis to supplement with magnesium instead of, rather than in addition to, boron.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.123 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?

    Supplement Amount Why
    Calcium and Vitamin D
    (Amenorrhea)    		 Refer to label instructions 1 star  Despite the lack of evidence that calcium and vitamin D supplements alone are helpful to amenorrheic women, they are still generally recommended to prevent the added burden of calcium and vitamin D deficiency from further contributing to bone loss.

    1 star  Calcium and Vitamin D

    A preliminary trial showed that bone loss occurred over a one-year period in amenorrheic exercising women despite daily supplementation with 1,200 mg of calcium and 400 IU of vitamin D.124 In a controlled study of amenorrheic nursing women, who ordinarily experience brief bone loss that reverses when menstruation returns, bone loss was not prevented by a multivitamin supplement providing 400 IU of vitamin D along with 500 mg twice daily of calcium or placebo.125 Despite the lack of evidence that calcium and vitamin D supplements alone are helpful to amenorrheic women, they are still generally recommended to prevent the added burden of calcium and vitamin D deficiency from further contributing to bone loss.126 Amounts typically recommended are 1,200 to 1,500 mg calcium and 400 to 800 IU vitamin D daily.

    Supplement Amount Why
    Fish Oil Refer to label instructions 1 star  Supplementing with fish oil may improve calcium absorption and promote bone formation.

    1 star  Fish Oil

    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.127 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.128 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.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Horsetail Refer to label instructions 1 star  Horsetail is a rich source of silicon, and preliminary research suggests that this trace mineral may help maintain bone mass.

    1 star  Horsetail

    Horsetail is a rich source of silicon, and preliminary research suggests that this trace mineral may help maintain bone mass. Effects of horsetail supplementation on bone mass have not been studied.
    What Else Is This Supplement Used For?

    Supplement Amount Why
    Manganese Refer to label instructions 1 star  A combination of minerals including manganese was reported to halt bone loss in one study. Some doctors recommend manganese to people concerned with bone mass maintenance.

    1 star  Manganese

    Interest in the effect of manganese and bone health began when famed basketball player Bill Walton’s repeated fractures were halted with manganese supplementation.129 A subsequent, unpublished study reported manganese deficiency in a small group of osteoporotic women.130 Since then, a combination of minerals including manganese was reported to halt bone loss.131 However, no human trial has investigated the effect of manganese supplementation alone on bone mass. Nonetheless, some doctors recommend 10 to 20 mg of manganese per day to people concerned with maintenance of bone mass.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.132 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Silicon Refer to label instructions 1 star  Silicon is required in trace amounts for normal bone formation, and supplementation with silicon has increased bone mineral density in a small group of people with osteoporosis.

    1 star  Silicon

    Silicon is required in trace amounts for normal bone formation,133 and supplementation with silicon has increased bone formation in animals.134 In preliminary human research, supplementation with silicon increased bone mineral density in a small group of people with osteoporosis.135 Optimal supplemental levels remain unknown, though some multivitamin-mineral supplements now contain small amounts of this trace mineral.
    What Else Is This Supplement Used For?

    Supplement Amount Why
    Vitamin B6
    (High Homocysteine)    		 Refer to label instructions 1 star  Homocystinuria, a condition associated with high homocysteine levels, frequently causes osteoporosis. By lowering homocysteine levels, vitamin B6 may help prevent osteoporosis.

    1 star  Vitamin B6

    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.136 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.137 The reduction in fracture risk appeared to be due to an improvement in bone quality, rather than to a change in bone mineral density. 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.138 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.
    What Else Is This Supplement Used For?
    See Drug Interactions

    Supplement Amount Why
    Vitamin B-Complex Refer to label instructions 1 star  In one trial postmenopausal women who combined hormone replacement therapy with B vitamins and other nutrients and dietary changes increased their bone density by a remarkable 11%.

    1 star  Vitamin B-Complex

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.139 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    What Else Is This Supplement Used For?

    Supplement Amount Why
    Whey Protein Refer to label instructions 1 star  Some whey proteins may reduce bone loss. Milk basic protein (MBP) is a mixture of some of the proteins found in whey protein and has been shown to promote bone density

    1 star  Whey Protein

    Some whey proteins may reduce bone loss.140 Milk basic protein (MBP) is a mixture of some of the proteins found in whey protein. A preliminary trial found that 300 mg per day of MBP improved blood measures of bone metabolism in men, suggesting more bone formation was occurring than bone loss.141 A double-blind trial found that women taking 40 mg per day of MBP for six months had greater gains in bone density compared with those taking a placebo.142 No osteoporosis-related research has been done using complete whey protein mixtures.

    What Else Is This Supplement Used For?

    Supplement Amount Why
    Zinc Refer to label instructions 1 star  Supplementing with zinc appears to be helpful in both preventing and treating osteoporosis.

    1 star  Zinc

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.143 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    Levels of zinc in both blood and bone have been reported to be low in people with osteoporosis,144 and urinary loss of zinc has been reported to be high.145 In one trial, men consuming only 10 mg of zinc per day from food had almost twice the risk of osteoporotic fractures compared with those eating significantly higher levels of zinc in their diets.146 Whether zinc supplementation protects against bone loss has not yet been proven, though in one trial, supplementation with several minerals including zinc and calcium was more effective than calcium by itself.147 Many doctors recommend that people with osteoporosis, as well as those trying to protect themselves from this disease, supplement with 10 to 30 mg of zinc per day.

    What Else Is This Supplement Used For?
    See Drug Interactions

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    Last Review: 04-21-2010

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