Bone health is a common topic as we age. Most people are aware of a condition of bone thinning: osteopenia and osteoporosis. Our bones become strong as we grow through childhood and into our early adult years. Peak bone mass is generally thought to be achieved by our late 20’s. From that point, we work to maintain our bones and prevent loss. Women tend to maintain their bone mass until menopause at which time loss accelerates in the first 5 years postmenopausal. Men tend to achieve higher bone mass and lose it more slowly as testosterone levels decline.
There are many factors that go into supporting bone growth. Optimizing nutrition and exercise play a big role. Likewise there are factors that result in bone loss; poor nutrition, inactivity, smoking, and alcohol to name a few. Certain medications can also increase your risk of bone loss; steroid, oral contraceptives, antidepressants, seizure medications and acid blockers.
The concern around bone loss is related to fracture risk. We know as we grow older we have a greater risk of fall and fractures. Current thinking is that if we can maintain bone strength (density), that we will reduce the morbidity and mortality associated with fractures.
There is an article published in the Journal of Internal Medicine: “Osteoporosis: the emperor has no clothes”, which looks at the pathophysiology, screening, and treatment of Osteoporosis. This articles reviews our current standards of care with some scrutiny, which I think you will find interesting.There is a profitable pharmaceutical industry supporting medications to help slow bone loss. Some of these medications are pills, which need to be taken first thing in the morning on an empty stomach. Others are given intravenously on a monthly or yearly basis. The main categories are Bisphosphonates, SERM’s (selective estrogen receptor modulators), Calcitonin, Forteo, Prolia, HRT (hormone replacement therapy). There are significant adverse effects associated with these medications. There is no data to support use of these medications for longer than 5 years.
I have come across several studies in the past few weeks, which I felt were pretty important to share regarding bone health.
The COMB Study was published in 2012 in the Journal of Environmental and Public Health. This is a retrospective study that was done in Canada, it included mostly postmenopausal women (72/77). These women had either refused pharmacologic treatment or had continued bone loss despite bisphosphonates. They were started on a micronutrient regimen, including DHA (Docosahexanoic acid) 250 mg/day, Vitamin D3 2000IU daily, Vitamin K2 (MK7) 100 mcg/day, Strontium Citrate 680 mg/day, Elemental Magnesium 25mg/day, dietary sources of Calcium (brussels sprouts, broccoli), and daily impact exercise (jumping jacks or skipping) was encouraged. Each of these micronutrients has been shown to improve the health of bones in previous studies. Each participant in the study had a baseline BMD (bone mineral density) which repeated after 12 months. There were 37 participants that did not complete the 12 month study. The BMD change over the year was highest in the hip. There is a table in the article that compares the results of the COMB protocol with Strontium Ranelate, Alendronate, and Risedronate. In all measured categories this combination of micronutrients was equal to or more effective than the medications.
The second study I came across recently, was published in Aging 2017, Vol 9, No 1. “Melatonin-micronutrients Osteopenia Treatment Study (MOTS): a translational study assessing melatonin, strontium (citrate), vitamin D and vitamin K2 (MK7) on bone density, bone marker turnover and health related quality of life in postmenopausal osteopenia women following a one-year double-blind RCT and on osteoblast-osteoclast co-cultures”. This is a bit more daunting to read than the previous article. This again was a one year study, postmenopausal osteopenic women (age 49-75) were studied via BMD and hrQOL (health related quality of life). The study used a specific daily MSDK supplement, containing Melatonin 5mg, Strontium (citrate) 450 mg, vitamin D3 2000IU, and vitamin K2 60mcg.
Bone health was measured via DEXA scans and bone marker activity. BMD was increased at the lumbar spine and left femoral neck after 12 months. Bone formations markers increased and bone turnover markers decreased. Compared to the control group, the MSDK group experienced less aches and pains, GI symptoms, improved mood, and sleep quality.
There are several more studies regarding melatonin and bone health published in the Journal of Pineal Res, 2012 and 2015. There are small studies that showed benefit with 3mg of melatonin nightly.
The takeaway that I would like to leave you all with, is that there are many factors in our control when it comes to bone health. Eating a clean plant based diet, appropriate nutritional supplements, limiting alcohol and tobacco, and getting regular (at least 150 min/week) of weight bearing exercise. The addition of resistance or weight training is also very beneficial. Medications in this case have their limits, all aimed at slowing loss and none at “building” bone.
