Bone and Joint Health: The Second Component to Healthy Aging

by Chris D. Meletis, ND 

Osteoporosis in Men

Although osteoporosis in women has received substantial attention, its impact in men is also significant and noteworthy. In particular, men who are treated for prostate cancer with androgen deprivation therapy (ADT) may be at an especially high risk for osteoporosis.^1 2 Males with diabetes also have an increased osteoporosis risk.³ Furthermore, millions of men suffer from andropause, which also contributes to osteoporosis (see my article on Andropause and Menopause in this edition of Vitamin Research News).

The good news is that the approaches used to strengthen bones in women may be equally useful in men.⁴ 

Factors Affecting Bone Health 

Our ability to maintain proper bone density is dependent upon a state of balance. Under normal conditions, an increase or decrease in bone resorption is coupled to a compensatory increase or decrease in bone formation. This creates a homeostasis between the bone-destroying cells known as osteoclasts and the bone-building osteoblast cells. This balance protects against net bone loss.

The dramatic drop in estrogen, progesterone and androgens that occurs after menopause may be in part responsible for disrupting this bone-building homeostasis. Estrogen replacement has been the mainstay for osteoporosis prevention and treatment in this estrogen-deficient population. However, long-term compliance with estrogen therapy generally is poor, and there are numerous concerns regarding its safety.⁵ Due to these concerns, bioidentical hormone replacement, which avoids some of the potential pitfalls of synthetic prescriptions, has become a clinically popular way to restore hormone balance. Dr. John Lee wrote extensively on the importance of using natural progesterone cream to enhance bone strength, an approach that can be used in both women and men.

The foods we eat also play an instrumental role in determining whether or not our bodies’ bone-building mechanisms are knocked out of homeostasis. For example, calcium is known to affect one of the most important bone metabolism regulators, parathyroid hormone (PTH). Phosphorus also is an essential mineral for bone health. However, to protect against osteoporosis, the human body must maintain a balance between calcium and phosphorus. Excess phosphorus intake is common in people consuming the typical Western diet. Excessively high amounts of phosphorus are found in soft drinks and processed foods and meats. Too high a phosphorus intake is known to increase PTH secretion and lower calcium absorption, which could trigger bone destruction. When calcium intake is low, phosphorus also decreases bone formation markers and increases bone resorption markers.⁶ 

Caffeine intake can have an equally damaging effect on bones. Researchers recently reported that women with caffeine intakes greater than 300 mg per day had higher bone loss than women consuming less caffeine. The scientists determined that caffeine may exert these damaging effects through its ability to influence the way vitamin D is metabolized by the body.⁷ Coffee also can raise homocysteine levels, which further contributes to osteoporosis risk.^8 9 This indicates that vitamins B12 and B6 and folic acid, which lower homocysteine levels, may provide further bone-building support.

Other dietary factors that play a role in bone density are the widespread deficiency of nutrients important to bone health, such as vitamin D3 and vitamin K. Studies have shown that vitamin K intake from a normal diet is not enough to counteract the effects of a protein called osteocalcin that is involved in bone destruction. Supplementation with vitamin K reduces osteocalcin activity.¹⁰ 

Vitamin K has been especially effective at improving bone health when combined with vitamin D. Vitamin K enhances the function of bone-building cells known as osteoblasts and inhibits the function of bone-destroying cells known as osteoclasts. The evidence has steadily accumulated that Vitamin D3 supplementation, through its ability to enhance calcium availability, prevents bone loss in elderly women.^11 12 The anti-osteoporosis evidence in support of vitamin D3 is so extensive that the FDA is now allowing claims that this vitamin is important for bone health.

When vitamin K is combined with vitamin D, there appears to be an even greater effect. Vitamin K2 improved bone mass in patients with high vitamin D3 serum levels more than in patients with low vitamin D3 serum ^levels.¹³ Other researchers reported that vitamin K2 enhanced mineralization caused by the bone-building osteoblast cells, but these effects differed in the presence or absence of vitamin D3 levels.¹⁴ 

One group of researchers found that vitamin D3, when added to vitamin K2, promotes bone coupling and restores balance between osteocalcin and osteoblast faster than in untreated subjects or subjects taking only vitamin K2 or only vitamin D3.¹⁵ 

According to the researchers, “Vitamin K2, especially when combined with vitamin D3, can partially prevent bone loss caused by estrogen deficiency.”

Equally Important Nutrients

Vitamin K and Vitamin D3 can be particularly effective when adding two other substances into the bone-building mix: ipriflavone and strontium.

Ipriflavone, a synthetic isoflavone, has proved supportive in bone health in estrogen deficient women. Italian researchers assessed the effects of ipriflavone administration in the prevention of the rapid bone loss that follows ovariectomy in women. Ten to 30 days after an ovariectomy, 16 patients consumed calcium supplements alone and another 16 patients received ipriflavone 600 mg per day plus calcium for 12 months. In calcium-treated subjects bone loss markers increased and radial bone density significantly decreased 6 months after surgery. However, in the group taking ipriflavone and calcium, the patterns of biochemical markers indicated that ipriflavone can restrain the bone destroying processes. In addition, compared to the calcium-only group, where bone density decreased, radial bone density in the ipriflavone-plus-calcium group showed no significant modification.¹⁶ 

According to the researchers, “These results demonstrate that ipriflavone administration prevents the rapid bone loss that follows ovariectomy. Thus, ipriflavone can represent an attractive alternative for the prevention of osteoporosis in postmenopausal women who present contraindications to the estrogen replacement therapy.”

Strontium is another natural agent known for improving bone health. Strontium ranelate is the most studied form of this mineral. It is unique in its mode of action as it both decreases bone resorption and increases bone formation. Two clinical studies have demonstrated over three years that strontium ranelate can reduce vertebral and non-vertebral fractures including those of the hip. These same studies showed that strontium has an excellent safety profile. The only reported side effect in a small number of patients was they developed diarrhea when they consumed more than 2 grams per day. Furthermore, according to a January 2007 report in the medical literature, an analysis of a sub-group of patients aged 80 years and over demonstrated that, currently, strontium ranelate is the only anti-osteoporotic agent to reduce vertebral and non-vertebral fractures in this age group.¹⁷ 

A study published in 2002 included 353 osteoporotic women with at least one previous vertebral fracture and low scores of lumbar bone density. Patients received placebo or strontium ranelate in doses of 170, 340 or 680 mg per day for two years. The results indicated that in the strontium group lumbar bone mineral density increased in a dose-dependent manner (Fig. 1). Also, there was a significant reduction in the number of patients with new vertebral fractures in the second year in the group receiving the 680 mg per day dose. In this same group, a significant positive change in markers of bone metabolism occurred. The authors concluded that strontium ranelate therapy increased vertebral bone mineral density and reduced vertebral fracture incidence.¹⁸ 

Although more recent studies use strontium ranelate, earlier studies showing similar results used other strontium salts, including strontium carbonate, strontium lactate, and strontium gluconate. Therefore, it appears that the active ingredient is strontium.

Conclusion

The high prevalence of osteoporosis and related morbidity and mortality herald an enormous public health burden for the coming decades. Supplementing the diet with vitamin D3, vitamin K, ipriflavone and strontium—along with a good multimineral formula containing bone-building minerals such as boron—can ensure that our structural support systems stay healthy and strong.

Dr. Chris D. Meletis , Executive Director, The Institute for Healthy Aging, article reprint via an educational grant from Complementary Prescriptions  

References: 

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2. Lycette JL, Bland LB, Garzotto M, Beer TM. Parenteral estrogens for prostate cancer: can a new route of administration overcome old toxicities? Clin Genitourin Cancer. 2006 Dec;5(3):198-205.
3. Xu L, Cheng M, Liu X, Shan P, Gao H. Bone mineral density and its related factors in elderly male Chinese patients with type 2 diabetes. Arch Med Res. 2007 Feb;38(2):259-64.
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