-IBIS-1.7.0-
tx
musculoskeletal system
osteoporosis
Nutrition
dietary guidelines
eating principles:
Decrease protein consumption, if excessive, down to 1 gm per 3.8 lbs of body weight, especially animal proteins. However, dietary protein is required for the synthesis of bone-matrix proteins. In this regard, some recent research has indicated that protein supplements can help hip fracture patients heal faster. Higher levels of insulin-like growth factors (IGF-1), a key element in maintaining skeletal and muscle strength, were found in patients who consumed 20g of milk protein for six months.
(Schurch MA, et al. Ann Intern Med 1998 May 15;128(10):801-809.)
Further, while vegetarians tend to have stronger bone than do meat-eaters, one study of Chinese Buddhist women found that long-term vegans are more likely to have osteopenia of the femoral neck than were short-term vegans.
(Chiu JF, et al. Calcif Tissue Int 1997 Mar;60(3):245-249.)
Diet high in protein has been shown in controlled studies using protein supplements. The evidence is less strong in mixed diets with a moderately high protein level. Considering that homocystinuria is a risk factor and is much more common than what has previously been thought, higher levels of protein, particularly animal proteins in which there is a lot of methionine which can be metabolized into homocysteine in genetically susceptible individuals
(Johnson, Alcantara, Linkswiler. J Nutr. 100:1425, 1970; Walker and Linkswiler. J Nutr. 102:1297,1972; Anand and Linkswiler. J Nutr104:695, l974; Linkswiler, Joyce and Anand. Trans NY Acad Sci 36:333, 1974.)
Increase pH of blood by increasing fruit and vegetable intake
(Metz, JA, Anderson, JB, Gallagher, PN JR. Am J Clin Nutr 1993;58:537-42; Allen, LH, Oddoye EA, Margen L. Am J Clin Nutr 1979;32:741-749; Spencer HJ, et. al. Am J Nutr 1978;37:453-456.)
Bring calcium/phosphorus 2:1 or 1:1
therapeutic foods:
foods rich in Calcium, B-complex vitamins, Magnesium, Vitamin D
sesame seeds, tahini, kale, millet, celery, barley, okra, almonds, collards, turnip greens, mustard greens, raw goat milk (Jensen B. 61.)
sea vegetables: arame, hijiki, kombu, nori
estrogenic foods: animal products, apples, cherries, olives, plums, carrots, yams, nightshade family, peanuts, soy products, coconut, brown rice, barley, oats, wheat
See: Foods that contain estrogen-like sterols
fresh juices:
carrot (Walker. 133.)
carrot and spinach (Walker. 133.)
carrot, dandelion, and turnip (Walker. 133.)
carrot, lettuce, and spinach (Walker. 133.)
carrot, dandelion, and lettuce (Walker. 133.)
black mission figs, raw goat's milk (Jensen. 61.)
black cherry (Jensen. 61.)
green kale (Jensen. 61.)
celery, parsley (Jensen. 61.)
veal joint broth (Jensen. 61.)
avoid:
Coffee, alcohol, smoking: Caffeine increases urinary calcium excretion. Alcohol and smoking have been shown to decrease bone mass. (Hollingbery PW, et al. Fed Proc. 1985;44:1149; Massey LK, Berg TA. Nutr. Res 1985;5:1281-1284.)
High phosphorus diet
Reduced calcium consumption: average consumption ~500mg/day in the U.S.
Inactivity: Increase physical activity: 1hr. 3x/week. This has been shown to actually increase bone mass in postmenopausal women.
Low gastric pH, e.g., hypochlorhydria and achlorhydria (Hunt JN, Johnson C. Dig Dis Sci 21983;8(5):417-421.)
Aluminum toxicity
soda pop, alcohol, salt, animal proteins such as dairy products, meats, eggs
supplements
Calcium 1.5 gm per day for post menopausal and 1 g premenopausal Calcium supplementation provides the greatest preventive effect when taken years, even decades, before menopause and periods of increased risk. Postmenopausal women on a hormonal support program should take 1,000-1,500 mg per day; those not on hormonal support should take at least 1,500 mg per day. Absorption is usually enhanced if taken with meals. Taking calcium before bedtime can also provide a gentle sedative effect. While there are generally assumed to be no known adverse effects at doses up to 2,500 mg per day, calcium carbonate may cause constipation or digestive distress in many individuals. Some research indicates that calcium citrate or hydroxyapatite may provide superior ability to support bone. (NIH. 799ff.)
Supplement highly absorbable calcium such as calcium-citrate (400 mg-800 mg) or citrate malate. In addition the patient should eat foods rich in Calcium (see Materia Medica) for a total intake of 800-1200 mg. It should be noted that calcium citrate is only about 18% calcium which means that you can only have a limited amount of actual elemental calcium in each capsule or tablet. The percentage of calcium absorbed from the more absorbable calcium forms, even though it may be higher, does not make up for the low percentage of actual elemental calcium. In other words there may be greatest value in using some form of mixed calcium (the more expensive low percent and the cheaper high percent calcium forms). (Marz, p. 336, 1997)
Magnesium: 400-600 mg per day, regulates PTH secretion and tissue sensitivity
(Cohen & Kitzes. Israel J Med. Sci. 17:1123-1125, 1981)
Progesterone: Women who are post-menopausal for bone health:
Choose a calendar day (e.g. first day of the month) as day one
Days 1-25: use 1/4 teaspoon of transdermal progesterone cream (450 mg P/oz) twice a day.
Days 25-30 (or 31): do not use transdermal progesterone cream (450 mg P/oz).
For severe menopausal symptoms: use up to 1/2 teaspoon a day according to the same schedule.
The best areas to apply the transdermal progesterone cream (450 mg P/oz) are the palms, inner arms, inner thighs, abdomen, and chest, rotating the areas applied. Transdermal progesterone cream (450 mg P/oz) is best applied twice daily due to the short half-life of progesterone in the blood.
Research by Jerilyn Prior, M.D. and John Lee, M.D. has demonstrated that progesterone helps the body build new bone by increasing the activity of osteoblasts. Progesterone increases bone building activity, while estrogen primarily slows down bone loss. Lee used natural progesterone in his practice for 15 years for women with osteoporosis. A retrospective study of his patients on natural progesterone revealed that these patients did not just stabilize bone loss, they actually had increased bone density. Lee found that patients with the most severe osteoporosis showed the greatest benefit from natural progesterone supplementation, with some individuals attaining a 30% increase in bone mineral density over three years.
Vitamin K1 (phytonadione): 1 mg per day Vitamin K is involved with the synthesis of osteocalcin, a protein containing gamma carboxyglutamic acid which is involved in the mineralization of bone (formation of hydroxyapatite crystals). Calcium is attracted to and binds with gamma-carboxyglutamic acid. Vitamin K deficiency is quite high in patients with gastrointestinal disorders. (Marz, 336, 1997.)
Test via prothrombin anti-antigen or serum vitamin K assay.
(Hart, JP, et al. J Clin Endocrinol Metab 1985;60:1268-1269; Knapen MHJ, Hamulyak, K, Vermeer C. Annals of Internal Medicine 1989;111:1001-1005; Tomita A. Clin Endocrinol (Japan) 19:731-736,1971)
Vitamin D3 (cholecalciferol): 400-1000 IU per day (Harju, 1985, 408ff); 2000 IU per day (Norden. Am. J. Clin. Nut. 1985;42(3):470-744.)
Vitamin A: 20,000 IU per day, is involved in bone matrix formation by osteoblasts. However, excessive dietary intake of retinol seems to be associated with osteoporosis and an increased risk of hip fractures. (Melhus H, et al. Ann Intern Med 1998 Nov 15;129(10):770-778.)
Folic acid: 5 mg IU per day Folate is a coenzyme in the conversion of homocysteine to methionine
(Brattstriom. Metabolism 1985;34(11):1073-1077.)
Boron: 2 mg IU per day, is involved in the hydroxylation of 17 ß-estradiol and 1,25DH vitamin D.
(Nielsen FH, Hunt CD, Mullen LM, Hunt, JR. FASEBJ 1987:1:394-397.)
Silica: 500-1000 mcg per day, has been found to be important in the matrix of bone.
Manganese: stimulates the production of mucopolysaccharides (bones organic matrix).
Zinc: 20-40 mg IU per day, has been found to be important in the matrix of bone.
Copper: 1-3 mg per day, is involved in lysyl oxidase in cross linking of collagen. (Wilson, 1981, p. 35ff)
Citric acid: promotes GI absorption by opening up epithelial tight junctions, enhancing the paracellular shunt pathway of calcium transport. It also helps inhibit calcium oxalate crystallization and possible renal or urinary calculi due to high dose calcium.
Vitamin B6
DHEA: Low doses of DHEA (usually 5-10 mg/day) may be especially appropriate for postmenopausal women whose serum DHEA-S levels are near or below the lower limit of normal. In some cases, DHEA relieves symptoms such as hot flashes that are usually attributed to estrogen deficiency. A combination of DHEA and identical-to-natural progesterone (usually given as a topical cream may be more effective against hot flashes than either treatment alone. (Gaby AR. Alt Med Rev. 1996;1(2):66.)
The decline in DHEA levels appears to be a factor in age-related bone loss. In one important study, bone mineral density was measured at the lumbar spine, hip, and radius in 105 women, aged 45-69. Fifty women had normal measurements, whereas 55 had low bone density. The average serum DHEA-S level was 60% lower in the women with low bone density than in those with normal bones. Women with low DHEA values were 40 times more likely to have osteoporosis than were women with normal DHEA levels. In contrast, there was no relationship between estrogen levels and bone densitv. (Szathmari, M, et al. Osteoporsis Int 1994:4:84-88) In a group of 29 post-menopausal women. there was a significant positive correlation between bone mineral content of the distal radius and ulna and age-adjusted serum DHEA levels. (Brody S, et al. Maturitas 1987:9:25-32.) A study of Belgian women found significant correlations were found between bone mineral content and DHEA levels (measured as DHEA-S), even after correcting for the effects of age. These studies support the proposed role of DHEA in maintaining bone mass.
There are several mechanisms by which DHEA might prevent osteoporosis.
The partial conversion of DHEA to estrogen and testosterone would be expected to provide additional protection against bone loss. DHEA is converted into both estrogen and testosterone, both of which play a role in prevention of bone loss. In a study of postmenopausal women, administering DHEA increased serum levels of both testosterone and estrogens (estradiol and estrone).
Although DHEA is not converted directly into progesterone, it may, through a feedback mechanism, indirectly increase the production of progesterone. Both DHEA and progesterone are produced from the same precursor hormone, pregnenolone. If DHEA levels are adequate, then pregnenolone will be converted primarily to progesterone, rather than to DHEA.
One of the breakdown products of DHEA, a compound called 5-androstene-3B, 178-diol, is known to bind strongly to estrogen receptors. Therefore, DHEA. like estrogen, might inhibit bone resorption.
Androgens, a class of hormones which includes DHEA and testosterone, stimulate bone formation and calcium absorption. DHEA might.therefore. augment the bone-building effect of progesterone.
DHEA appears to be the only hormone which appears capable of both inhibiting bone resorption and stimulating bone formation.
(Casson PR, et al. Fertil Steril 1995;63:1027-1031; Labrie F, et al. Ann NY Acad Sci 1995;774:16-28; Buster JE, et al. Am J Obstet Gynecol 1992;166:1163-1168; Mortola JF, Yen SS. J Clin Endocrinol Metab 1990;71:696-704; Weinstein RE, et al. J Allerg Clin Immol 1996;97:1-8; Yen SS, et al. Ann N Y Acad Sci 1995;774:128-142.)
Fluoride (Lancet, 1984, p. 547)
» drug interactions:
Vitamin D and colestipol: colestipol (Colestid) interferes with absorption of vitamin D; calcium should also be supplemented due to decreased absorption of vitamin D
Calcium and tetracycline (Achromycin, Tetra-C, Tetracyn, Tetralan, Tetram, Tropicycline): tetracycline increases urinary calcium excretion
Calcium and thyroid medication, such as dessicated thyroid, Synthroid (T4), Cytomel (T3): causes increased urinary excretion of Calcium (Paul, et al, 1988;259:3137-3141; Kung and Pun, 1991;265:2688-2691; Adlin, et al, 1992;128:210-213.)
Calcium and thiazides: thiazides, such as chlorthiazide (Diuril, Aldoril, Diachlor) and hydrochlorthiazide (Hydrodiuril) decrease urinary excretion of Calcium (Riis and Christiansen, 1985; 34 (5): p. 421); consequently, risk of osteoporosis may be reduced in patients on thiazides, likewise Calcium supplementation may be effective at lower doses
Vitamin D and heparin: heparin interferes with renal hydroxylation of Vitamin D. Note: this could lead to osteopenia, check 1,25(OH)2 cholecalciferol levels.
footnotes
Albanese. Effects of Calcium and micronutrients on bone loss of pre-and postmenopausal women. Paper presented at Am. Med. Assoc. meeting, Jan.1981.
Abstract: 12 healthy women, ages 39-65, whose usual daily diets contained 200-425mg of Calcium took a supplement containing 600mg of Calcium and all known micronutrients at RDA levels. 11 healthy women with comparable diets took 700-800mg of Calcium per day without the additional nutrients. Periodic x-ray measurements showed that, within 9-11 months, the rate of bone density increase was 2-3x greater in the women receiving the Calcium plus micronutrients than in those taking the Calcium alone.
Allen LH, Oddoye EA, Margen L. Protein-induced hypercalciuria. AM J Clin Nutr 1979;32:741-9.
Anand and Linkswiler. Effect of protein intake on calcium balance of young men given 500mg of calcium daily. J Nutr1974;104:695.
Brattstriom. Folic acid responsive postmenopausal homocysteinemia. Metabolism 1985;34(11):1073-1077.
Abstract: 5mg folate daily for 4 weeks substantially reduced homocysteine concentrations (p less than 0.01) both before a methionine load and afterwards (despite the fact that subjects had normal levels of serum and RBC folate) in normal men and pre- and postmenopausal women, suggesting that folic acid may have a prophylactic action against postmenopausal osteoporosis if moderate homocysteinemia promotes its development (homocysteine which is increased in postmenopausal women, interferes with collagen cross-linking leading to defective bone matrix and osteoporosis.
Brody S, et al. Adrenal steroids in post-menopausal women: relation to obesity and to bone mineral content. Maturitas 1987:9:25-32.
Buster JE, Casson PR, Straughn AB, et al. Postmenopausal steroid replacement with micronized dehydroepiandrosterone: preliminary oral bioavailability and dose proportionality studies. Am J Obstet Gynecol 1992;166:1163-1168.
Abstract: Eight postmenopausal women randomly received either a placebo or 150 or 300 mg of oral micronized dehydroepiandrosterone in a lipid matrix. Serum dehydroepiandrosterone, dehydroepiandrosterone sulfate, testosterone, and estradiol were measured periodically over the 12 hours after each dose. Mean peak steroid concentrations after 150 mg (300 mg) doses were dehydroepiandrosterone 1617 (2639) ng/dl, 7 (11.5)-fold above placebo; dehydroepiandrosterone S 1185 (1688) micrograms/dl, 14 (20)-fold above placebo; and testosterone 183 (311) ng/dl, 4 (7)-fold above placebo. Estradiol concentrations remained less than 20 pg/ml, but androgen concentrations rose by 1 hour and remained elevated through the twelfth hour. Peak androgen concentrations and areas under the curves exhibited proportionality with both doses. A testosterone radioimmunoassay revealed a 300% overestimation for testosterone. Thus after appropriate readjustment maximum testosterone concentrations were observed consistently within physiologic premenopausal ranges after the 150 mg dose. The study concluded that micronized dehydroepiandrosterone may provide a steroidal postmenopausal replacement that is adjunctive to estrogens and worthy of further investigation.
Casson PR, Faquin LC, Stentz FB, et al. Replacement of dehydroepiandrosterone enhances T-lymphocyte insulin binding in postmenopausal women. Fertil Steril 1995;63:1027-1031.
Abstract: Oral micronized DHEA (50 mg/d) was administered in 3-week treatments to 11 postmenopausal women in a prospective, placebo-controlled, randomized, blinded, crossover trial with an interarm washout. After dose (23 hour) serum DHEA, DHEAS, T, and cortisol levels were measured, as were fasting lipoproteins, oral glucose tolerance tests (OGTT), T-lymphocyte insulin binding and degradation, and urine collagen cross-links. Morphometric changes were determined by hydrostatic weighing. Dehydroepiandrosterone sulfate, DHEA, T, and free T increased up to two times premenopausal levels with treatment. Fasting triglycerides declined; no change in collagen cross-links or morphometric indexes was noted. Oral glucose tolerance test parameters did not change, but both T-lymphocyte insulin binding and degradation increased with DHEA. Fifty milligrams per day of oral DHEA gives suprahysiologic androgen levels; 25 mg/d may be more appropriate. Dehydroepiandrosterone enhanced tissue insulin sensitivity and lowered serum triglycerides. Rationale is provided for postmenopausal replacement therapy with this androgen.
Chiu JF, Lan SJ, Yang CY, Wang PW, Yao WJ, Su LH, Hsieh CC. Long-term vegetarian diet and bone mineral density in postmenopausal Taiwanese women. Calcif Tissue Int 1997 Mar;60(3):245-249.
Abstract: This study examined bone density among postmenopausal Buddhist nuns and female religious followers of Buddhism in southern Taiwan and related the measurements to subjects characteristics including age, body mass, physical activity, nutrient intake, and vegetarian practice. A total of 258 postmenopausal Taiwanese vegetarian women participated in the study. Lumbar spine and femoral neck bone mineral density (BMD) were measured using dual-photon absorptimetry. BMD measurements were analyzed first as quantitative outcomes in multiple regression analyses and next as indicators of osteopenia status in logistic regression analyses. Among the independent variables examined, age inversely and body mass index positively correlated with both the spine and femoral neck BMD measurements. They were also significant predictors of the osteopenia status. Energy intake from protein was a significant correlate of lumbar spine BMD only. Other nutrients, including calcium and energy intake from nonprotein sources, did not correlate significantly with the two bone density parameters. Long-term practitioners of vegan vegetarian were found to be at a higher risk of exceeding lumbar spine fracture threshold (adjusted odds ratio = 2.48, 95% confidence interval = 1.03-5.96) and of being classified as having osteopenia of the femoral neck (3.94, 1.21-12.82). Identification of effective nutrition supplements may be necessary to improve BMD levels and to reduce the risk of osteoporosis among long-term female vegetarians.
Cohen and Kitzes. Infrared spectroscopy and magnesium content of bone mineral in osteoporotic women. Israel J. Med. Sci. 1981;17:1123-1125.
Abstract: 16 of 19 Osteoporotic patients had lower than normal trabecular bone magnesium content (by infrared spectrophotometry) and clinical magnesium deficiency (based on Thorens magnesium load test)
Gaby AR. Dehydroepiandrosterone: Biological Effects and Clinical Significance. Alternative Medicine Review. 1996:1(2);60-69.
Gaby AR. Preventing and Reversing Osteoporosis. Prima Publishing: Rocklin, CA, 1993.
Gaby AR. Research Review. Nutr Healing Jun 1997:8.
Hart JP, Hearer MJ, Klenerrman L, Shearer MJ, Caterall A, et al. Electrochemical detection of depressed circulating levels of vitamin K in osteoporosis. J Clin Endocrinol Metab 1985;60:1268-1269.
Abstract: 16 patients with osteoporosis were found to have mean serum vitamin K concentrations only 35% of aged matched controls.
Harvey JA, Zobitz MM, Pak CYC. Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Min Res 1988;3(3): 253-258.
Abstract: It was found that a 500mg dose of calcium citrate resulted in a greater amount of absorption than a 2000mg load of calcium carbonate. The authors suggest that just prescribing higher amounts of the carbonate form doesn't necessarily increase the total amount of calcium absorbed.
Hollingbery PW, et al. Effect of dietary caffeine and aspirin on urinary calcium and hydroxyproline excretion in pre and postmenopausal women. Fed Proc. 44:1149, 1985.
Abstract: 31 women ingested decaffeinated coffee to which caffeine had been added at different times. 3 hours later, urinary calcium excretion increased significantly, but only in women taking estrogen, suggesting that caffeine ingestion may offset the beneficial effect of estrogen on calcium metabolism.
Hunt JN, Johnson C. Relation between gastric secretion of acid and urinary excretion of calcium after oral supplementation of calcium. Dig Dis Sci 1983;28(5):417-421.
Abstract: 12 subjects were given either 1500mg of calcium carbonate or calcium citrate. Urinary calcium excretion was measured as well as gastric pH. Subjects with normal levels of HCL seemed to absorb both forms of the calcium. Subjects who were achlorhydric absorbed the calcium citrate significantly better.
Johnson, Alcantara, Linkswiler. Effect of level of protein intake on urinary and fecal calcium and calcium retention of young adult males, J. Nutr. 1970;100:1425.
Knapen MHJ, Hamulyak K, Vermeer C. The effect of vitamin K suppl on circulating osteocalcin and urinary calcium excretion. Annals of Internal Medicine 1989;111:1001-1005.
Abstract: In postmenopausal women, osteocalcin levels were 50% that of premenopausal women. Vitamin K induced increased serum immunoreactive osteocalcin concentration; normalization of HAB capacity of serum immunoreactive osteocalcin.
Labrie F, Belanger A, Simard J, et al. DHEA and peripheral androgen and estrogen formation: Intracrinology. Ann NY Acad Sci 1995;774:16-28.
Lee J, Hopkins V. What Your Doctor May Not Tell You About Menopause. Warner Books, NY: 1996.
Linkswiler, Joyce, and Anand. Calcium retention of young adult males as affected by level of protein and of calcium intake, Trans NY Acad Sci 36:333, 1974.
Abstract: In a series of 4 carefully controlled human metabolic studies, the influence of protein intake (47, 95, and 142gms daily) on urinary calcium, calcium retention, and calcium absorption was assessed in 33 men between the ages of 18 and 23 years. Dietary calcium was provided at levels of 500, 800, and 1400mg daily, and in each study protein intake varied while calcium intake remained constant. The studies were 45 to 55 days in length, and the period of observation at any level of protein intake was at least 15 days. Positive calcium balance occurred when 47gms of protein was consumed regardless of the calcium intake. Intakes of 800 & 1400mg Calcium caused no higher retention than an intake of 500mgs. On the other hand, protein intake of 142gms resulted in markedly negative calcium balances at all calcium intake levels.
Massey LK, Berg TA. The effect of dietary caffeine on urinary excretion of Calcium, Magnesium, Phosphorus, Sodium, Potassium, Chloride, and Zinc in healthy males. Nutr. Res 1985;5:1281-1284.
Abstract: 15 males drank decaffeinated coffee to which 0, 150, or 300mg caffeine had been added. Total urinary 3 hour excretion of calcium, magnesium, sodium, and chloride, increased significantly after caffeine intake, while zinc, phosphorus, creatinine, and volume were unchanged.
Melhus H, Michaelsson K, Kindmark A, Bergstrom R, Holmberg L, Mallmin H, Wolk A, Ljunghall S. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Ann Intern Med 1998 Nov 15;129(10):770-778.
Abstract: BACKGROUND: The highest incidence of osteoporotic fractures is found in northern Europe, where dietary intake of vitamin A (retinol) is unusually high. In animals, the most common adverse effect of toxic doses of retinol is spontaneous fracture. OBJECTIVE: To investigate whether excessive dietary intake of vitamin A is associated with decreased bone mineral density and increased risk for hip fracture. DESIGN: A cross-sectional study and a nested case-control study. SETTING: Two counties in central Sweden. PARTICIPANTS: For the cross-sectional study, 175 women 28 to 74 years of age were randomly selected. For the nested case-control study, 247 women who had a first hip fracture within 2 to 64 months after enrollment and 873 age-matched controls were selected from a mammography study cohort of 66,651 women 40 to 76 years of age. MEASUREMENTS: Retinol intake was estimated from dietary records and a food-frequency questionnaire. Bone mineral density was measured with dual-energy x-ray absorptiometry. Hip fracture was identified by using hospital discharge records and was confirmed by record review. RESULTS: In multivariate analysis, retinol intake was negatively associated with bone mineral density. For every 1-mg increase in daily intake of retinol, risk for hip fracture increased by 68% (95% CI, 18% to 140%; P for trend, 0.006). For intake greater than 1.5 mg/d compared with intake less than 0.5 mg/d, bone mineral density was reduced by 10% at the femoral neck (P = 0.05), 14% at the lumbar spine (P = 0.001), and 6% for the total body (P = 0.009) and risk for hip fracture was doubled (odds ratio, 2.1 [CI, 1.1 to 4.0]). CONCLUSION: High dietary intake of retinol seems to be associated with osteoporosis.
Metz JA, Anderson JB, Gallagher PN JR. Intakes of calcium, phosphorus, and protein and physical activity are related to radial bone mass in adult women. AM J Clin Nutr 1993;58:537-542.
Nicar MJ, Pak CYC. Calcium bioavailability from calcium carbonate and calcium citrate. J Clin Enodocrin Met 1985;61:2 391-393.
Abstract: Calcium citrate was found to be better absorbed in all patients including normochlorhydrics.
Nielsen FH, Hunt CD, Mullen LM, Hunt JR. Effect of dietary boron mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEBJ 1987;1:394-397.
Abstract: Postmenopausal women were fed a standard diet for 119 days consisting of 0.25mg boron. Supplementing this diet with 3mg boron reduced urinary calcium excretion by 44% and markedly increased serum concentrations of the estrogenic hormone, 17ß-estradiol. The increased levels of 17ß-estradiol were the same as in women receiving estrogen therapy.
Norden. A prospective trial of the effect of Vitamin D supplementation on metacarpal bone loss in elderly women. Am. J. Clin. Nut. 1985;42(3):470-474.
Abstract: 109 women randomly selected elderly women (ages 65-74) received orally either Vitamin D2 15,000iu weekly or placebo. After 2 years, Vitamin D significantly reduced the rate of cortical bone loss as measured by hand radiographs (p less than 0.01)
Recker R. Calcium absorption and achlorhydria. NEJM 1985;313(2)70-73.
Abstract: 9 normal fasting patients were compared to 11 achlorhydric patients. The normal pH subjects absorption was similar for both forms of calcium. In the achlorhydric patients, calcium citrate was absorbed an average of 10x that of the carbonate form.
Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1998 May 15;128(10):801-809.
Abstract: BACKGROUND: Elderly persons who have osteoporotic hip fracture are often undernourished, particularly with respect to protein. Protein malnutrition may contribute to the occurrence and outcome of hip fracture. OBJECTIVE: To investigate whether oral protein supplements benefit bone metabolism in patients with recent hip fracture. DESIGN: 6-month, randomized, double-blind, placebo-controlled trial with a 6-month post-treatment follow-up. SETTING: University orthopedic ward. PATIENTS: 82 patients (mean age, 80.7 +/- 7.4 years) with recent osteoporotic hip fracture. Patients received calcium supplementation, 550 mg/d, and one dose of vitamin D, 200,000 IU (at baseline). INTERVENTION: Protein supplementation, 20 g/d, or isocaloric placebo (among controls). MEASUREMENTS: Bone mineral density, biochemical markers of bone remodeling, calciotropic hormone levels, biochemically evaluated nutritional and immunologic status, and muscle strength were measured every 6 months. RESULTS: Compared with controls, patients who received protein supplements had significantly greater increases in serum levels of insulin-like growth factor-I (85.6% +/- 14.8% and 34.1% +/- 7.2% at 6 months; difference, 51.5 percentage points [95% CI, 18.6 to 84.4 percentage points]; P = 0.003) and an attenuation of the decrease in proximal femur bone mineral density (-2.29% +/- 0.75% and -4.71% +/- 0.77% at 12 months; difference, 2.42 percentage points [CI, 0.26 to 4.59 percentage points]; P = 0.029). Seven and 13 new vertebral deformities were found among patients who received protein supplements and controls, respectively (P > 0.2). Median stay in rehabilitation wards was shorter for patients who received protein supplements than for controls (33 days [CI, 29 to 56 days] and 54 days [CI, 44 to 62 days]; difference, 21 days [CI, 4 to 25 days]; P = 0.018). CONCLUSION: Protein repletion after hip fracture was associated with increased serum levels of insulin-like growth factor-I, attenuation of proximal femur bone loss, and shorter stay in rehabilitation hospitals.
Schuett S, Knowles J. A comparison of calcium absorption from calcium citrate versus calcium H2(PO4)2 by two methods. Am J Clin Nut 1987;45:4;863.
Spencer HJ, et. al.. Affect of a high protein (meat) intake on calcium metabolism in man. Am J Nutr. 1978;37:453-456.
Tomita, A. Post menopausal osteoporosis calcium study with vitamin K2. Clin Endocrinol (Japan) 1971;19:731-736.
Abstract: Osteoporotic patients treated with vitamin K supplementation reduced urinary Calcium loss by 18-50%.
Walker and Linkswiler. Calcium retention in the adult human male as affected by protein intake, J. Nutr. 1972;102:1297.
Yen, SS, Morales, AJ, and Khorram, O. Replacement of DHEA in aging men and women. Potential remedial effects. Ann N Y Acad Sci 1995;774:128-142.
Abstract: DHEA in appropriate replacement doses appears to have remedial effects with respect to its ability to induce an anabolic growth factor, increase muscle strength and lean body mass, activate immune function, and enhance quality of life in aging men and women, with no significant adverse effects. Further studies are needed to confirm and extend our current results, particularly the gender differences.