Vitamins that may be helpful
Although insufficient when used as the only intervention, calcium supplements help prevent
osteoporosis.42 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 menopausal43 or in men.44
However, after about three years of menopause, calcium supplementation does appear to take on
a protective effect for women.45 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.46 Double-blind research
has found that increasing calcium intake results in greater bone mass in girls.47
An analysis of many trials investigating the effects of calcium supplementation in
premenopausal women has also shown a significant positive effect.48 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.49 . 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.
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 most,50 51
52 53 54 55 56 57 58
59 60 but not all,61 clinical trials. Some studies have shown
that ipriflavone therapy not only stops bone loss, it also actually increases bone density and
significantly reduces the number of vertebral fractures and amount of bone pain.
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.62 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.
Vitamin D increases calcium absorption, and
blood levels of vitamin D are directly related to the strength of bones.63 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.64
In double-blind research, vitamin D supplementation has reduced bone loss in women who consume
insufficient vitamin D from food65 and slowed bone loss in people with
osteoporosis.66 However, the effect of vitamin D supplementation on osteoporosis
risk remains surprisingly unclear,67 68 with some trials reporting
little if any benefit.69 Moreover, trials reporting reduced risk of fracture have
usually combined vitamin D with calcium supplementation,70 making it difficult to
assess how much benefit is caused by supplementation with vitamin D alone.71
Impaired balance and increased body sway are important causes of falls in elderly people
with osteoporosis.72 Vitamin D works with calcium to prevent some musculoskeletal
causes of falls. 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.73
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.
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.74 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.75 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.
Vitamin K is needed for bone formation.
People with osteoporosis have been reported to have low blood levels76
77 and low dietary intake of vitamin K.78 79 One study found that
postmenopausal (though not premenopausal) women may reduce urinary loss of calcium by taking 1
mg of vitamin K per day.80 People with osteoporosis given large amounts of vitamin
K2 (45 mg per day) have shown an increase in bone density after six months81 and
decreased bone loss after one82 or two83 years.
Other preliminary studies have reported that vitamin K supplementation increases bone
formation in some women84 and that higher vitamin K intake correlates with greater
bone mineral density.85 Some doctors recommend 1 mg vitamin K1 to postmenopausal
women as a way to help maintain bone mass, though optimal intake remains unknown.
In a preliminary study, people with osteoporosis were reported to be at high risk for magnesium malabsorption.86 Both
bone87 and blood88 levels of magnesium have been reported to be low in
people with osteoporosis. Supplemental magnesium has reduced markers of bone loss in
men.89 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, controlled
trial.90 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.91 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
Levels of zinc in both blood and bone have
been reported to be low in people with osteoporosis,92 and urinary loss of zinc has
been reported to be high.93 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.94 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.95 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
Copper is needed for normal bone synthesis.
Recently, a two-year, controlled trial reported that 3 mg of copper per day reduced bone
loss.96 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.97 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. All minerals discussed so far—calcium, magnesium, zinc, and
copper—are sometimes found at appropriate levels in high-potency multivitamin-mineral supplements.
Boron supplementation has been reported to
reduce urinary loss of calcium and magnesium in some,98 but not
all,99 preliminary research. However, those who are already supplementing with
magnesium appear to achieve no additional calcium-sparing benefit when boron is
added.100 Finally, in the original report claiming that boron reduced loss of
calcium,101 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
Interest in the effect of manganese and
bone health began when famed basketball player Bill Walton’s repeated fractures were
halted with manganese supplementation.102 A subsequent, unpublished study reported
manganese deficiency in a small group of osteoporotic women.103 Since then, a
combination of minerals including manganese was reported to halt bone loss.104
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.
Silicon is required in trace amounts for
normal bone formation,105 and supplementation with silicon has increased bone
formation in animals.106 In preliminary human research, supplementation with
silicon increased bone mineral density in a small group of people with
osteoporosis.107 Optimal supplemental levels remain unknown, though some
multivitamin-mineral supplements now contain small amounts of this trace mineral.
Strontium may play a role in bone
formation, and also may inhibit bone breakdown.108 Preliminary evidence suggests
that women with osteoporosis may have reduced absorption of strontium.109 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 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.110 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.111 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 stable strontium per day.112
Although the amounts of strontium used in these studies studies was very high, the
optimal intake remains unknown. Some doctors recommend only 1 to 3 mg 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.113 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.114 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.
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.115 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.116 The reduction in
fracture risk appeared to be due to an improvement in bone quality, rather than to a change in
bone mineral density. Whether these vitamins would be beneficial for people with normal
homocysteine levels is not known. 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
Preliminary evidence suggests that
progesterone might reduce the risk of osteoporosis.117 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.118 Other trials have reported that adding natural progesterone to
estrogen therapy did not improve the bone-sparing effects of estrogen when taken
alone119 and that progesterone applied topically every day for a year did not
reduce bone loss.120 In a more recent double-blind study, however, progesterone had
a modest bone-sparing effect in post-menopausal women.121
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.122 It is not known if supplementation would have similar effects in
people with established osteoporosis.
Some whey proteins may reduce bone
loss.123 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.124 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.125
No osteoporosis-related research has been done using complete whey protein mixtures.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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