Osteoporosis, Osteopenia, Calcium, Vitamin D, Vitamin K, etc.

[pjoshea13]

Postmenopausal bone loss has long been recognized as a major problem.

It always amused me that women were told to take calcium when their bones were leaching calcium. When osteopenia or osteoporosis occurs following the menopause shouldn't one suspect a hormonal issue?

A 1988 paper [1] reported that:

"Long-term studies confirm that postmenopausal women who regularly use estrogen have greater bone mass and fewer osteoporotic fractures."

"Timely restoration of E2 levels can prevent estrogen-dependent bone loss and can reduce significantly the risk of fracture."

"High calcium intake without estrogen is not effective in preventing the accelerated loss of bone that occurs in the years immediately after menopause."

I suspect that many women don't want to hear that estradiol [E2] may be the solution, but a low-dose E2 patch is not going to reverse the menopause or promote cancer.

These days, doctors know that calcium may not be effective if the patient is deficient in vitamin D. & so calcium + vitamin D is now the mantra. Most have not yet learned about vitamin K - or any on the other essential nutrients for bone health.

Sometimes one sees a comment that men too can suffer bone loss - but at a much older age, as though it isn't really a serious problem.

The French MINOS study was a "Cross-sectional assessment of age-related bone loss in men". The first of many papers appeared in 2000. In 2001 [2] we discover that:

"Low 17betaE(2) {total estradiol} levels may be an important risk factor for osteoporosis in men."

In 1999, a Swedish study of idiopathic (unknown cause) osteoporosis in men, reported that "The patient group compared with the controls had significantly lower serum levels of estradiol ..." [3]

...

Natto is a good source of vitamin K2. In a 2012 Japanese study [4]:

"Habitual intake of natto was associated with a beneficial effect on bone health in elderly men, and this association is primarily due to vitamin K content of natto ..."

The pathogenesis of osteoporosis is multifactorial, but it isn't really that complicated.

It's amazing that people swallow a gram or two of calcium daily in the hope that osteopenia or worse can be prevented. When one takes a mega-dose of one mineral, it is usually to the detriment of another. The calcium:magnesium ratio is particularly important. From 1990 [5]:

"Prophylactic treatment of postmenopausal osteoporosis with oestrogen and calcium, often in combination, disregards the likelihood that an excess of each agent may increase magnesium requirements and decrease serum Mg levels."

"If the commonly recommended dietary Ca/Mg ratio of 2/1 is exceeded (and it can reach as much as 4/1 in countries with low to marginal Mg intakes), relative or absolute Mg deficiency may result, and this may increase the risk of intravascular coagulation, since blood clotting is enhanced by high Ca/Mg ratios."

We know from the PCa literature that calcium intake is associated with progression. This is likely due to inhibition of the conversion of calcidiol to calcitriol - starving PCa cells of hormonal active vitamin D.

Incidentally, in the recent vitamin D study that was the subject of a thread [6], there was a drop in parathyroid hormone [PTH] in the high-dose D group. It was suggested that D itself caused this. Unmentioned was that the intervention included calcium citrate to a maximum of 600 mg. 76% of participants received supplements.

Vitamin D (cholecalciferol) is converted to inactive calcidiol. Neither cholecalciferol nor calcidiol affect PTH. PTH is produced when serum calcium levels fall. PTH tells the kidneys to convert some calcidiol to calcitriol. Calcitriol causes a number of things to occur. Calcium is taken from bone, there is increased calcium uptake from the gut, & calcium is returned to bone. Supplemental calcium in the blood inhibits PTH.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/317...

[2] ncbi.nlm.nih.gov/pubmed/112...

[3] ncbi.nlm.nih.gov/pubmed/100...

[4] ncbi.nlm.nih.gov/pubmed/213...

[5] ncbi.nlm.nih.gov/pubmed/213...

[jdm3]

Interesting. Thanks. My wife is dealing with osteoporosis now and doing some research. She went and bought some Natto the other day. That stuff is nasty, but hey, if it helps with the K2 and bone health.... gotta do it.

[pjoshea13 in reply to jdm3]

A local Japanese restaurant stands out from the many pseudo-Japanese Chinese-owned restaurants here. It had natto as a special appetizer last time I was there. The waiter said it smelled like unwashed feet. It would have been interesting to try it, but I was there to enjoy sashimi.

With natto, you get vitamin K2 and nattokinase. Some Japanese eat it for breakfast every morning. But it's very much an acquired taste that non-Japanese find difficult to acquire.

I hope that it helps reverse her osteoporosis.

-Patrick

[Shanti1]

Great write up! The evidence is mounting for the importance of vitamin K (especially K2) in artery and bone health. Here is a nice paper on the potential benefits of vitamin K for prostate cancer: Vitamin K and its analogs: Potential avenues for prostate cancer management (2017) ncbi.nlm.nih.gov/pmc/articl...

[pjoshea13 in reply to Shanti1]

Shanti,

Very useful!

-Patrick

[milto27xabc]

BONE HEALTH and PROSTATE CANCER

Men being treated with hormone therapy for prostate cancer suffer a number of side effects. One of the most serious is osteoporosis, which weakens the bones and can result in fractures. The normal advice is to take calcium (in food and/or supplements) plus vitamin D and to exercise using weight bearing exercises. In some cases, bisphosphonates are prescribed. Bone health is measured by a bone mineral density test (BMD) .

However the advice tends to be vague (how much and how often?). There is some evidence that the body doesn’t absorb calcium very efficiently and the suggestions on how much vitamin D to take and in what form (sunlight and/or supplements) are variable.

A clinical study performed at the University of Alberta by Drs Stephen Genuis and Thomas Bouchard in 2012 called Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention, showed some very positive results. hindawi.com/journals/jeph/2...

After 12 months on the micronutrients, the 77 patients, (mostly post menopausal women, 38% of whom had tried bisphosphonates without success) all had improved BMD Z scores. The authors compared the COMB patient Z score improvement with published results for strontium ranelate and bisphosphonates and the COMB scores were considerably better. Since some patients refuse bisphosphonates because of reported side effects, the COMB diet offers an alternate treatment. I have used the diet for 10 years with excellent results

COMB Protocol

1.Vitamin D3:2000IU/day .

2.Vitamin K2 (non-synthetic MK7 form):100 ug/day(same as mcg/day)

3.DHA (Docosahexanoic acid):250 mg/day from purified fish oil

4.Strontium citrate:680 mg/day

5.Elemental magnesium:25mg/day

6.Dietary sources of calcium recommended

7.Daily impact exercising encouraged

I have used this formula for 10 years and my Bone mineral density tests have been excellent--Bracy in 2005--Lympth node in 2007 many years of intermittent lupron,then casodex,then regular lupron (every 3 months) plus caodex for 5 years now ADT plus Zitiga since Oct /16 . PSA and testosterone excellent but I'm tired. I'm 87

[pjoshea13 in reply to milto27xabc]

Milt,

Top of my list would be low-dose estradiol [E2].

Has your E2 ever been measured?

-Patrick

[milto27xabc in reply to pjoshea13]

nope--will look into it

[herb1 in reply to milto27xabc]

milto27xabc: Interesting. I was just going to ask about SrCitrate. It was "hot" some years ago but then there were some legal and maybe medical issues. I used it for several years but stopped--have no idea why! Like you, I'm in my 80s, have survived G6 PCA for 20+ yrs. Arthritis is now becoming a problem, maybe time to go back on Strontium!!!

[PhilipSZacarias in reply to milto27xabc]

Thank you for posting. Should be very useful. Cheers, Phil

[GranPaSmurf]

PJ, I'm trying to follow this. There are too many variables for me to hold in my head. I'm going to have to draw it out on paper.

I'm now faced with figuring out what's lighting up the bone scan that's not cancer. I've dealt with the pain from degerative Spinal Stenosis for years.

There has to be a way to snap all these leggos together in a way that they make sense.

[herb1]

pjoshea13: your comment about a '2/1 Ca/Mg ratio concerned me enough to check my blood work. My ratio is 5-6 to 1 on a mg/DL basis. With acceptable ranges of 8-10 for Ca and ~2 for Mg something is wrong. Are you using molar ratios? With Ca at 40, Mg at 24, that still gives us a 9/40 ratio to 2/24, a molar ratio of ~2.8. Nevertheless, a lot closer to 2/1.

[Hidden]

I mix my natto with apple butter. I eat one heaping tablespoon daily or about 200 mcg of K2?

[pjoshea13]

I just came across this product (natto starter spores):

amazon.com/Japanese-Natto-S...

& here are soybeans for natto:

amazon.com/Signature-Soy-NO...

-Patrick

[PhilipSZacarias]

Excellent post...comprehensive. Cheers, Phil