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Supplements

bone-building formula

What Is It?
Health Benefits
Forms
Dosage Information
Guidelines for Use

General Interaction

Possible Side Effects

Cautions

References

Evidence Based Rating Scale
 

What Is It?

This combination product contains at least twenty essential vitamins, minerals and other nutrients that help to strengthen bone, a living tissue that requires constant upkeep. (1) Most important in the combination, is calcium, which ensures that bones stay healthy and strong. Also crucial is Vitamin D, which helps the body absorb calcium from foods and prevents calcium loss in the urine. The Mineral magnesium is essential for assisting bone in creating new calcium crystals. Of course, these and other key nutrients (from vitamin K to trace minerals such as manganese, boron, and zinc) can be taken individually. But, for greater ease, a bone-building formula combining them all can be very convenient.

For more information on the individual vitamins, minerals, and other nutrients found in the combination, see the separate entries in the WholeHealth MD Reference Library.

Health Benefits

Bone is constantly being broken down and rebuilt throughout life to maintain bony integrity and reshape it to accommodate changing mechanical loads. Bone is formed by cells called osteoblasts that produce and mineralize the matrix that becomes bone. Bone resorption is the process where bone cells called osteoclasts break down bone and release calcium into the blood. This process, known as remodeling, is an important function for bone that allows it to become stronger in areas of greater stress, e.g. with changes in activity or posture, and to break down where it is no longer needed. Small, discrete volumes of old bone are replaced with fresh newly-formed bone. Until about age 30, when peak bone mass is typically achieved, the bone forming cells are busier. Sometime between 30 and 40, a shift occurs—new bone is not built as rapidly as old bone is broken down, resulting in a net loss in bone density and an increased risk of fracture. A bone-building formula that includes all of the constituents known to promote bone formation along with stimulation of the bone forming cells through exercise may help to maintain healthy levels of bone mass and prevent problems associated with osteoporosis, as well as diminish hair loss and problems with teeth and nails.

Specifically, a bone-building formula may help to:

Prevent and treat bone loss associated with menopause and aging improve bone mineral density (BMD). Osteoporosis (weak bone) is a progressive condition resulting from gradual loss of bone, flexibility, density, and strength. It was once believed that osteoporosis occurs more rapidly in post-menopausal women solely because of declining levels of estrogen, but it is now attributed to a combination of factors (1) Osteoporosis leads to an increased risk of tooth loss from diminishing bone in the jaw as well as wrist, vertebral and hip fractures that are a leading cause of disability and death in older men and women. (2-3) Taking a daily bone-building formula when bone density typically starts to decline in the years before menopause may prevent loss of bone density and strength and the development of osteoporosis with its associated fractures and height loss.

Calcium is a key factor in building bone mass and in preventing bone loss and osteoporosis. More than 99 percent of the body’s calcium is stored in bones and teeth, helping to keep them strong. (4) Elemental (pure) calcium doesn't exist in nature and may be combined with a variety of other compounds to form a calcium supplement. Calcium citrate is highly absorbable and does not require hydrochloric acid (HCl) in the stomach in order to be absorbed. This form of calcium is a good choice for people with low stomach acid. In contrast, calcium ascorbate and calcium carbonate are not as easily absorbed as the citrate form in people with low stomach HCl but are readily absorbed when taken with food. Generally, absorption rates increase when any form of calcium is taken with food. (1)

Vitamin D helps to strengthen bones, mainly by promoting the absorption and balance of calcium. Multiple clinical studies and meta-analyses have shown that supplementing with calcium plus vitamin D daily is an effective method of preventing osteoporosis. (5-7) Without vitamin D, the body can only absorb about 10-15% of dietary calcium; with vitamin D, calcium absorption increases to 30-40%. Most people do not get enough vitamin D, especially during the winter when there is less sunlight. The National Osteoporosis Foundation recommends adults under age 50 should get at least 400-800 IUs vitamin D3 per day and adults over 50 should get 800-1000 IUs for bone maintenance. (8) More vitamin D may be advised for some of its other functions in the body.

Magnesium plays a number of roles in bone formation and maintenance. Deficiencies have been associated with low levels of parathyroid hormone (PTH) and Vitamin D, which together control calcium absorption. Deficiency also contributes to increases in inflammatory substances that cause increased bone resorption. In animals, magnesium deficiency has been shown to cause an increase in osteoclasts and a decrease in bone strength since bones break down faster than they form. When bone resorption outpaces bone formation, the eventual result is osteoporosis. Decreasing bone resorption slows down bone breakdown and allows bone formation to catch up, thus reducing the risk of osteoporosis. The average dietary intake of magnesium among U.S. women is only 68% of the Recommended Daily Allowance. Animal studies indicate magnesium supplementation improves bone formation, remodeling, and strength. (9-11, 21) 

An efficacious bone-building formula should also contain boron, which seems to enhance the activity of estrogen and testosterone and to decrease the urinary loss of calcium and magnesium. Adults can safely take a supplement of up to 3-5 mg of boron daily for bone health (the average adult diet includes  0.5-3 mg/d). (1) Also, supplementing with a combination of zinc, manganese, and copper has been shown to affect bone health. Thirty percent of the zinc in the body is found in bone and it is essential for bone healing and calcium absorption. (1, 11) In animal studies, manganese supplementation increased bone mineral density and bone formation. It is key in the formation of bone cartilage and collagen. (1, 12) Copper also aids in collagen formation and helps inhibit bone resorption. (1)

Vitamin K is actually the name given to a group of similar vitamins that play a role in calcium binding and in reducing calcium excretion. Vitamin K1 is found in plant-based foods such as green leafy vegetables while the bacteria in fermented foods produce vitamin K2. Both increase bone quality but vitamin K2 is more bioavailable, lasts longer, and provides a greater increase in bone strength than vitamin K1. Vitamin K also helps accelerate the healing of fractures. (1)  A 2010 review of studies indicated supplements of calcium and vitamins C, D, and K should be taken for proper maintenance of bone health. (13)

Vitamin C taken with vitamin E may benefit age-related osteoporosis. In one randomized study of 90 elderly people, the group that received 1000 mg of vitamin C with 400 IU of vitamin E had increased hip-bone mineral density. (14) Vitamin C assists in the formation of collagen, stimulates bone-building cells, and enhances calcium absorption and vitamin D's effect on bone metabolism. Vitamin C also plays a role in the synthesis and function of adrenal steroid hormones, which are vital to bone health. (1)

A formula that includes the Soy isoflavones genistein or daidzin, which are similar to estrogen in their chemical structure but weaker and, presumably, safer, are likely to be beneficial in maintaining healthy BMD. A meta-analysis of randomized, controlled trials found soy isoflavones significantly inhibit bone resorption and stimulate bone formation, even when intake is less than 90 mg a day. The research suggests they may be useful in preventing osteoporosis. (17-18)

Ipriflavone is a synthetic isoflavone (plant based estrogen-like substance) similar to those found in soy. It appears to inhibit osteoclasts and stimulate osteoblasts. Although some studies indicate ipriflavone may benefit bone mineral density, it has not been shown to maintain it in post-menopausal women and should not be recommended for this group. (15-16)

Vitamins B6 and B12 and folic acid are important in the metabolism of Homocysteine, which at high levels can contribute to osteoporosis as well as cardiovascular disease. Deficiencies in these vitamins may be a risk factor in decreased bone health. (19) Vitamin B6 is necessary for HCl production by the stomach while B12 is necessary for the formation of osteoblasts. The most important role of folic acid is the detoxification of homocysteine. (1)

Vitamin A is essential to the formation of osteoblasts and assists in calcium absorption and metabolism. However, it is still unclear if excessive vitamin A will increase the risk of osteoporosis. As a result, supplemental vitamin A should be limited to 5000 IU per day, which is well below the tolerable upper limit of 10,000 IU per day. (1)

The metal strontium also may be effective in building bone mass. Strontium is an alkaline earth element, like calcium, and is physically and chemically similar to calcium. Nearly all of strontium in the body (99 percent) is found in bone. The elemental strontium in strontium ranelate (the form used in clinical trials for osteoporosis) stimulates bone formation and reduces bone resorption by replicating osteoblasts and decreasing osteoclast differentiation. Studies have shown strontium ranelate is one of the first-line agents with proven anti-fracture activity used in the therapy of post-menopausal osteoporosis. (20)

In combination with calcium, the mineral phosphorus makes up 80-90% of the mineral content of bone. Eighty-five percent of the phosphorus found in the body is in the skeleton. Phosphorus combines with calcium—ideally in a 1:1 ratio—to give strength and structure to bones and teeth. However, too much phosphorus can be detrimental to bone health: this is one reason for avoiding many types of soda drinks that have high levels of phosphorus. (1, 11)

Chromium helps to keep insulin activity efficient in the body, which may protect bones by promoting collagen production and moderating bone resorption. Additionally, supplementing with chromium picolinate raises blood levels of DHEA, a hormone that plays a role in preserving bone density in postmenopausal women. (1)

Forms

  • capsule
  • tablet

Dosage Information

Dosages vary according to specific formulas, as amounts of each individual ingredient in bone-building vary among formulas. Follow label instructions.

Generally, the following dosages should be met:

  • Calcium:  800-1200 mg daily divided into two to three doses.
  • Vitamin D: 400-1000 IU daily depending on age.
  • Magnesium: 400-800 mg daily (at least half the calcium dose)
  • Boron: 3-5 mg daily.
  • Manganese: 2-10 mg daily.
  • Zinc: 12-30 mg daily.
  • Copper: 1-3 mg daily
  • Vitamin K1: 250-1000  mcg daily
  • Vitamin K2: 45-187 mcg daily.
  • Vitamin B6: 25-30 mg daily.
  • Vitamin B12: 150-1000 mcg daily.
  • Folic Acid: At least 400-800 mcg daily.
  • Vitamin A: 5000 IU daily
  • Vitamin C: 500-3000 mg daily or 1200 mg in combination with 400 IU vitamin E
  • Soy isoflavones: 80 to 90 mg daily.
  • Strontium: 3-30 mg strontium ranelate daily, providing 680 mg elemental strontium.
  • Phosphorus: 800-1200 mg daily
  • Chromium: 200-1000 mcg daily

Guidelines for Use

Most nutrients in bone-building formulas are best absorbed when taken with food and in divided doses because there is a limit to how much can be absorbed at one time (approximately 600 mgs for calcium). For more information about each nutrient, refer to the specific entries in our WholeHealthMD Reference Library.

General Interaction

For possible interactions with a specific drug or dietary supplement, refer to the separate entries in our WholeHealthMD Reference Library.

Possible Side Effects

Refer to the separate entries (calcium, vitamin D, magnesium, vitamin K, trace minerals) in our WholeHealthMD Reference Library.

Cautions  

People who are prone to kidney stones, or who have had them in the past, should consult a physician before taking supplemental calcium. 

See individual entries in the WholeHealthMD Reference Library for cautions about specific ingredients contained in your bone-building formula. 

References 

1. The Center for Better Bones. Available at http://www.betterbones.com/betterbody/womens-bones-menopause.aspx. Accessed May 7, 2011.
2. Nicopoulou-Karayianni K, Tzoutzoukos P, Mitsea A, Karayiannis A, Tsiklakis K, Jacobs R, Lindh C, van der Stelt P, Allen P, Graham J, Horner K, Devlin H, Pavitt S, Yuan J. Tooth loss and osteoporosis: the OSTEODENT Study. J Clin Periodontol. 2009 Mar;36(3):190-7.
3. Rizzoli R, Bruyere O, Cannata-Andia JB, Devogelaer JP, Lyritis G, Ringe JD, Vellas B, Reginster JY. Management of osteoporosis in the elderly. Curr Med Res Opin. 2009 Oct;25(10):2373-87.
4. Peters BS, Martini LA. Nutritional aspects of the prevention and treatment of osteoporosis. Arq Bras Endocrinol Metabol. 2010 Mar;54(2):179-85.
5. Kärkkäinen M, Tuppurainen M, Salovaara K, Sandini L, Rikkonen T, Sirola J, Honkanen R, Jurvelin J, Alhava E, Kröger H. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: a 3-year randomized population-based trial (OSTPRE-FPS). Osteoporos Int. 2010 Dec;21(12):2047-55.
6. Moschonis G, Katsaroli I, Lyritis GP, Manios Y. The effects of a 30-month dietary intervention on bone mineral density: the Postmenopausal Health Study. Br J Nutr. 2010 Jul;104(1):100-7.
7. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.
8. National Osteoporosis Foundation.  Available at http://www.nof.org/aboutosteoporosis/prevention/vitamind. Accessed May 8, 2011.
9. Matsuzaki H. [Prevention of osteoporosis by foods and dietary supplements. Magnesium and bone metabolism]. Clin Calcium. 2006 Oct;16(10):1655-60.
10. Rude RK, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr. 2009 Apr;28(2):131-41.
11. Heaney RP. Dairy and bone health. J Am Coll Nutr. 2009 Feb;28 Suppl 1:82S-90S.
12. Bae YJ, Kim MH. Manganese supplementation improves mineral density of the spine and femur and serum osteocalcin in rats. Biol Trace Elem Res. 2008 Jul;124(1):28-34.
13. Dennehy C, Tsourounis C. A review of select vitamins and minerals used by postmenopausal women. Maturitas. 2010 Aug;66(4):370-80.
14. Ruiz-Ramos M, Vargas LA, Fortoul Van der Goes TI, Cervantes-Sandoval A, Mendoza-Nunez VM. Supplementation of ascorbic acid and alpha-tocopherol is useful to preventing bone loss linked to oxidative stress in elderly. J Nutr Health Aging. 2010 Jun;14(6):467-72.
15. Zhang X, Li SW, Wu JF, Dong CL, Zheng CX, Zhang YP, Du J. Effects of ipriflavone on postmenopausal syndrome and osteoporosis. Gynecol Endocrinol. 2010 Feb;26(2):76-80.
16. Bawa S. The significance of soy protein and soy bioactive compounds in the prophylaxis and treatment of osteoporosis. J Osteoporos. 2010 Mar 8;2010:891058.
17. Marini H et al. Effects of the phytoestrogen genistein on bone metabolism in osteopenic postmenopausal women: A randomized trial. Ann Intern Med 2007 Jun 19; 146:839-47.
18. Ma DF, Qin LQ, et al. Soy isoflavone intake inhibits bone resorption and stimulates bone formation in menopausal women: meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2008;62(2):155-161.
19. McLean RR, Jacques PF, Selhub J, Fredman L, Tucker KL, Samelson EJ, Kiel DP, Cupples LA, Hannan MT. Plasma B vitamins, homocysteine, and their relation with bone loss and hip fracture in elderly men and women. J Clin Endocrinol Metab. 2008 Jun;93(6):2206-12.
20. Przedlacki J. Strontium ranelate in post-menopausal osteoporosis. Endokrynol Pol. 2011 Jan-Feb;62(1):65-72.
21. All Nurses. Available at http://allnurses.com/nursing-student-assistance/what-difference-between-143143.html. Accessed May 19, 2011.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Boron

   

May enhance estrogen activity and decrease loss of calcium and magnesium. (1)

Calcium (combined with vitamin D3)  
Numerous large studies and meta-analyses have found efficacy in preventing osteoporosis and reducing bone loss and the risk of fractures in the elderly, but only in the presence of adequate vitamin D. (1, 4)
Chromium  
Regulates insulin which may promote collagen production and decrease bone resorption. (1)
Date Published: 04/18/2005
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