Review recommends bone-building nutrients before drugs
A review published in a recent issue of the journal Nutrients concludes that calcium and vitamin D supplements should be tried before resorting to bone building drugs to help maintain normal bone density.
For their review, Karen Plawecki and Karen Chapman-Novakofski of the University of Illinois at Urbana-Champaign selected 62 human studies conducted over the past decade that evaluated the impact on bone health of calcium and vitamin D from food, calcium and vitamin D from supplements, other bone health-related nutrients (including protein, sodium, soy and vitamin K), and portfolio diets, such as the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets, which provide a number of nutrients. The researchers confirmed a benefit for supplements, food-based interventions and educational strategies on bone health. The findings suggest nutrition therapies as first-line treatments for postmenopausal women and others at risk of osteoporosis, particularly in light of the side effects associated with pharmaceutical agents used to treat the condition.
"For many people, prescription bone-building medicines should be a last resort," stated Dr Chapman-Novakofski, who is a professor of nutrition at the University of Illinois. "Bisphosphonates, for instance, disrupt normal bone remodeling by shutting down the osteoclasts—the cells that break down old bone to make new bone. When that happens, new bone is built on top of old bone. Yes, your bone density is higher, but the bone's not always structurally sound . . . Although the test reports that you're fine or doing better, you may still be at risk for a fracture."
"I suspect that many doctors reach for their prescription pads because they believe it's unlikely that people will change their diets," she remarked.
Concerning the effect of nutrients other than calcium and vitamin D were examined in this review, Dr Plawecki observed that "Following a low-sodium diet does seem to have a positive effect on bone density."
"Some people have the habit of adding a generous sprinkle of salt to most foods before eating, but there's more involved here than learning not to do that," she noted. "You have to choose different foods."
Dr Plawecki, who is the director of the University of Illinois' dietetics program, recommends adopting a portfolio diet that provides numerous beneficial nutrients, including high amounts of magnesium and potassium in addition to calcium. Additionally, Drs Plawecki and Chapman-Novakofski stress that increased physical activity is needed to help maintain bone and muscle strength, as well as balance and flexibility.
Hormone deficiencies are clearly associated with bone loss and osteoporosis, beginning as early as the third decade of life. By the time women reach 50, they are at significantly increased risk of an osteoporotic bone fracture. Estrogen deficiency results in increased production of pro-inflammatory cytokines, which cause increased bone breakdown and inflammation (Weitzmann and Pacifici 2006). Combined estrogen and androgen therapy increases bone mineral density (BMD), and has been shown to increase BMD more than estrogen therapy alone (Notelovitz 2002).
Studies have shown that postmenopausal women with a habitually high intake of phytoestrogens have high bone mineral density of the spine and hip (Bawa 2010; Hanna 2004). A number of studies have been conducted on phytoestrogens and bone health, and their conclusions are as follows:
Genistein and daidzein increase bone mineralization (Taku 2010; Clifton-Bligh 2001; Kanno 2004).
Genistein and daidzein decrease bone resorption and inflammatory factors and increase osteogenic (bone-forming) proteins (Ma 2008; Jia 2003; Rassi 2002; Yamaguchi 2000; Zhang 2004).
An isoflavone mixture of daidzein and genistein demonstrated significant increases in bone mineral density after six months of treatment. Women who ingested 57 mg/day of isoflavones had a 4% increase in bone mineral density (Clifton-Bligh 2001).
A phytoestrogen preparation containing daidzein and genistein demonstrated protective effects on the lumbar spine (Atkinson 2004).
Dietary supplementation with 54 mg/day of genistein “may be as effective as hormone replacement therapy in attenuating menopause-related bone loss without causing the associated side effects.” (Cotter 2003)
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