Life Extension Magazine®

Doctor looking at an x ray

How To Reduce The Risk of Osteopenia

Aging is almost always accompanied by bone loss. Fractures caused by osteoporosis are a leading cause of disability and mortality. Bill Faloon reports on his diagnosis.

Scientifically reviewed by: Dr. Gary Gonzalez, MD, in August 2023. Written by: William Faloon.

William Faloon
William Faloon

Osteopenia is diagnosed when your bones are weaker than normal, but not so much that they easily fracture.

As I neared age 65, I knew it was time to check my bone density, since aging is almost always accompanied by significant bone loss.

When my results came back as mild osteopenia I was not surprised.

My low-calorie diet contained little calcium and the last supplement I took each day was calcium, so I seldom got to it before the day ended.

I’m grateful to have found out in time to take corrective actions to rebuild skeletal density.

Prevalence of Osteopenia

Bone fractures caused by osteoporosis are a leading cause of disability and mortality in the elderly.1

Yet a surprising number of younger individuals have osteopenia, which can lead to osteoporosis.

A study published in 2019 found more than 25% of men and women between age 35-50 years already had osteopenia (weakened bones).2

As these people age past 50, they are likely to be at risk of more severe bone loss, a condition called osteoporosis, which means fractures become much more likely. With advancing age, adverse outcomes resulting from fractures are common.

Inability to walk following a hip fracture may lead to pneumonia, deadly blood clots, and muscle loss,3 ultimately increasing the risk of premature death.

Osteoporosis Epidemic

One of every five men over age 50 will suffer an osteoporotic fracture.4

One out of every three women over age 50 will suffer a fracture related to osteoporosis .4

Having osteoporosis not only increases the risk of fractures, it is also associated with accelerated aging and with an increased risk of: 5-9

  1. Cancer
  2. Cardiovascular disease
  3. Dementia

Health-conscious individuals take steps to protect against heart disease, cancer, and Alzheimer’s by taking supplements including CoQ10, fish oil, vitamin D, and others. Often overlooked are nutrients needed for comprehensive skeletal support, like vitamin K.

Drugs That Improve Bone Density

A class of drugs called bisphosphonates, (that include Fosamax® and Actonel®) help rebuild bone density.

There are concerns, however, with short- and long-term use of these drugs in many patients.

Side effects include bone, joint, or muscle pain.13

For oral bisphosphonate tablets, side effects may include nausea, difficulty swallowing, heartburn, irritation of the esophagus, and gastric ulcer.13

These drugs reduce osteoporotic fractures involving the hips and spine in older patients, especially women ages 65 to 80 years with osteoporosis.14

The problem with bisphosphonates is that they focus on limiting additional bone loss, rather than building more bone.

Longer-term use of bisphosphonates beyond five years has been linked to increased risk of atypical fractures of the femur and osteonecrosis of the jaw.13 Some trials, but not others, have also reported increased rates of atrial fibrillation.15,16

Better and safer methods of rebuilding bone mass are clearly needed.

High-Dose Vitamin K2 Restores Bone Mass

Bone mineral density chart

The Japanese approved coenzyme Q10 as a heart medication in 1974.

Americans did not gain access to CoQ10 until 1983.

Analogous to CoQ10, the Japanese approved a high-dose vitamin K2 drug in the 1990s to restore bone mass and prevent fractures.

Vitamin K2 supports new bone formation and also protects against excess removal of older, but still structurally important bone.17,18

Japanese doctors took a common form of vitamin K2 called MK4 and studied it at the high dose of 45 mg a day.19,20 This is about 15 times more than what Life Extension® supporters supplement with.

The results from studies dating back decades reveal improvements in bone density and reductions in fracture rates.19-27

Vitamin K2 activates a protein called osteocalcin in bone that binds calcium. If this calcium-binding protein is not activated, then natural bone restoration may not be possible.

Just as important, vitamin K2 activates a protein in arteries and heart valves that shields them from deadly calcification.

Bone Loss Risk Factors

There are many reasons for loss of bone mass.

Many have a false sense of security about their ability to maintain healthy bones, because they avoided some common bone loss risks.

Some of the major controllable or acquired factors that accelerate bone loss include:10-12

  • Smoking cigarettes
  • Excess alcohol ingestion
  • Hormone deficits (estrogen, progesterone, testosterone, DHEA)
  • Lack of weight-bearing exercise
  • Drugs (proton-pump inhibitors, corticosteroids, warfarin, and others)
  • Nutrient deficiencies (magnesium, boron, vitamins D & K, calcium)

Add to the above list risk factors such as ethnicity, small body frame, family history, and certain medical conditions.10-12

With so many pathologies impairing one’s ability to maintain healthy bone strength, it becomes clear why preservation of bone density requires aggressive measures.

I fear most people look at osteoporosis risk factors and think they are avoiding most of them, such as not smoking or taking bone-depleting drugs.

The reality is that virtually all these factors might need to be addressed to protect against osteopenia and osteoporosis.

Remarkable Improvement in Bone Density

Man doing a bicep curl

Vitamin K2 is critical for calcium to bind to bone to provide structural support.

Clinical trials show that a 45 mg dose of vitamin K2 (MK4) can prevent, or in some cases reverse age-associated bone density loss, and reduce fracture risk.19-27

In one clinical study, researchers divided women in their mid to late 60s with osteoporosis into one of two groups:26

150 mg a day of elemental calcium
150 mg of elemental calcium + 45 mg of MK4

As seen in the graph above, lumbar bone mineral density decreased steadily at every time point in the calcium-only group. By the 24-month measurement, the low-dose-calcium-only group lost 3.3% of their bone density!

Impressively, the calcium + vitamin K2 (MK4) group lost little if any bone mass over that same period. 26

This study demonstrated how high-dose vitamin K2 added to a modest-dose (150 mg/day) calcium supplement prevented the loss of lumbar spine mineral density over a period of two years. And these are only two of several nutrients needed to maintain bone mass.

Reduction in Fracture Incidence

Different bone scans laid out on a table

In this same study,26 the group receiving calcium + high-dose K2 saw a reduction in fracture incidence.

The group receiving calcium alone sustained 35 fractures, compared to only 14 fractures in the vitamin K2 + calcium treatment group (see table below.)

As it relates to percentages, patients in the calcium + high-dose K2 group had a significantly lower fracture rate at 15.4% compared to the calcium alone at 35.4%.

This study corroborates the elevated fracture rate observed in women over age 50.

Even more robust results in the calcium + K2 group may have been seen if higher dose calcium, along with vitamin D and other bone nutrients, had been included.

Number of Fractures and Fracture Location

Group Number of patients included in the fracture incidence analysis Vertebral Forearm Femoral
Calcium (150 mg) 99 30 2 2 1
Calcium (150 mg)
Vitamin K2 (45 mg)
91 13 1 0 0

Adapted from: J Bone Miner Res. 2000 Mar;15(3):515-21.

Combining Vitamin D + Vitamin K2

Another study evaluated the effect of vitamin D3 + high-dose K2 in osteoporotic postmenopausal women.27 All the women were encouraged to obtain 1,000 mg of calcium a day plus 400 IU of vitamin D through their food.

After two years, study participants showed the following percent changes in lumbar spine bone mineral density (BMD) compared to baseline:27

Calcium group (calcium lactate 2,000 mg/day)0.79% reduction in BMD

Vitamin D3 group (30 IU/day) 0.38% increase in BMD

Vitamin K2 (45 mg/day) 0.90 % increase in BMD

Vitamin K2 + D3 group 1.35% increase in BMD

These data reveal the benefits of combined bone-building nutrient supplementation.

New Recommendation to Restore Bone Structure

virtual screen of a bone and joint

Most of us have lost more bone than we realize.

Nutrient formulas containing calcium, magnesium, vitamins D and K, proper hormone balance and healthy lifestyle choices are all important in slowing bone loss and partially reversing it.

Most of us over age 50 should now consider a strategy based on three decades of human studies emanating mostly from Japan. This has demonstrated meaningful bone density improvements and marked reduction in fracture incidence.

Consider a supplement that provides approximately:

45 mg of vitamin K2 (MK4)

700 mg of calcium*

1,000 IU of vitamin D3 (plus nutrients like magnesium and boron)

*This dose assumes daily calcium dietary intake of 300-500 milligrams. A man may require less supplemental calcium, but aging men need skeletal-support nutrients that include calcium.

Many readers obtain additional vitamin D3, zinc, boron, and magnesium from their nutrient formulas.

Those who take this new approach to restoring lost bone mass may not require any other vitamin K supplement. That is because this 45 mg potency of vitamin K2 is likely to provide superior protection against calcification of arteries, soft tissues, and heart valves, along with restoration of bone mass.

Note to Warfarin (Coumadin®) Users

Human studies validate the safety of high-dose vitamin K2 (MK4) in people not taking warfarin.20

Warfarin is a powerful anti-coagulant drug that functions as a vitamin K antagonist.

Warfarin users are told to avoid vitamin K foods and supplements. A side effect of warfarin is accelerated bone loss caused by lack of vitamin K.

If you are using warfarin, consider asking your doctor about newer anti-coagulant drugs (Pradaxa®, Eliquis®, Xarelto®) that do not function by antagonizing vitamin K.

Use of these newer anti-coagulant drugs can enable you to benefit with vitamin K and still obtain needed anti-coagulant effects.


The magnitude and prevalence of age-related bone loss is underappreciated.

Osteopenia and osteoporosis are worsened by poor lifestyle choices (like excess alcohol) and drugs like stomach-acid blocking drugs that impede calcium absorption.

If high-dose vitamin K2 is widely adopted in the United States, it could reverse the surging epidemic of bone loss and crippling fractures occurring in men and women over age 50.

This is of even greater importance to people like myself who intentionally reduce their overall calorie intake, and thus ingest less dietary calcium.

In this special edition, you’ll learn how easy it is to boost your vitamin K2 intake.

For longer life,

For Longer Life

William Faloon


  1. Teng GG, Curtis JR, Saag KG. Mortality and osteoporotic fractures: is the link causal, and is it modifiable? Clin Exp Rheumatol. 2008 Sep-Oct;26(5 Suppl 51):S125-37.
  2. Bass MA, Sharma A, Nahar VK, et al. Bone Mineral Density Among Men and Women Aged 35 to 50 Years. J Am Osteopath Assoc. 2019 Jun 1;119(6):357-63.
  3. Available at: Accessed October 7, 2020.
  4. Available at: Accessed July 7, 2020,
  5. Amouzougan A, Lafaie L, Marotte H, et al. High prevalence of dementia in women with osteoporosis. Joint Bone Spine. 2017 Oct;84(5):611-4.
  6. McGlynn KA, Gridley G, Mellemkjaer L, et al. Risks of cancer among a cohort of 23,935 men and women with osteoporosis. Int J Cancer. 2008 Apr 15;122(8):1879-84.
  7. Ji J, Sundquist K, Sundquist J. Cancer risk after hospitalization for osteoporosis in Sweden. Eur J Cancer Prev. 2012 Jul;21(4):395-9.
  8. Lee HF, Wu CE, Lin YS, et al. Low bone mineral density may be associated with long-term risk of cancer in the middle-aged population: A retrospective observational study from a single center. J Formos Med Assoc. 2018 Apr;117(4):339-45.
  9. Yu XY, Li XS, Li Y, et al. Neutrophil-lymphocyte ratio is associated with arterial stiffness in postmenopausal women with osteoporosis. Arch Gerontol Geriatr. 2015 Jul-Aug;61(1):76-80.
  10. Available at: Accessed October 7, 2020.
  11. Available at: Accessed October 7, 2020.
  12. Available at: Accessed October 7, 2020.
  13. Available at: Accessed October 7, 2020.
  14. Curtis JR, Westfall AO, Cheng H, et al. Benefit of adherence with bisphosphonates depends on age and fracture type: results from an analysis of 101,038 new bisphosphonate users. J Bone Miner Res. 2008 Sep;23(9):1435-41.
  15. Heckbert SR, Li G, Cummings SR, et al. Use of alendronate and risk of incident atrial fibrillation in women. Arch Intern Med. 2008 Apr 28;168(8):826-31.
  16. Sorensen HT, Christensen S, Mehnert F, et al. Use of bisphosphonates among women and risk of atrial fibrillation and flutter: population based case-control study. BMJ. 2008 Apr 12;336(7648):813-6.
  17. Myneni VD, Mezey E. Regulation of bone remodeling by vitamin K2. Oral Dis. 2017 Nov;23(8):1021-8.
  18. Akbari S, Rasouli-Ghahroudi AA. Vitamin K and Bone Metabolism: A Review of the Latest Evidence in Preclinical Studies. Biomed Res Int. 2018;2018:4629383.
  19. Sato Y, Honda Y, Kuno H, et al. Menatetrenone ameliorates osteopenia in disuse-affected limbs of vitamin D- and K-deficient stroke patients. Bone. 1998 Sep;23(3):291-6.
  20. Asakura H, Myou S, Ontachi Y, et al. Vitamin K administration to elderly patients with osteoporosis induces no hemostatic activation, even in those with suspected vitamin K deficiency. Osteoporos Int. 2001 Dec;12(12):996-1000.
  21. Binkley N, Harke J, Krueger D, et al. Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density, or geometry in healthy postmenopausal North American women. J Bone Miner Res. 2009 Jun;24(6):983-91.
  22. Iwamoto J, Takeda T, Ichimura S. Effect of menatetrenone on bone mineral density and incidence of vertebral fractures in postmenopausal women with osteoporosis: a comparison with the effect of etidronate. J Orthop Sci. 2001;6(6):487-92.
  23. Purwosunu Y, Muharram, Rachman IA, et al. Vitamin K2 treatment for postmenopausal osteoporosis in Indonesia. J Obstet Gynaecol Res. 2006 Apr;32(2):230-4.
  24. Takahashi M, Naitou K, Ohishi T, et al. Effect of vitamin K and/or D on undercarboxylated and intact osteocalcin in osteoporotic patients with vertebral or hip fractures. Clin Endocrinol (Oxf). 2001 Feb;54(2):219-24.
  25. Ushiroyama T, Ikeda A, Ueki M. Effect of continuous combined therapy with vitamin K(2) and vitamin D(3) on bone mineral density and coagulofibrinolysis function in postmenopausal women. Maturitas . 2002 Mar 25;41(3):211-21.
  26. Shiraki M, Shiraki Y, Aoki C, et al. Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis. J Bone Miner Res. 2000 Mar;15(3):515-21.
  27. Iwamoto J, Takeda T, Ichimura S. Effect of combined administration of vitamin D3 and vitamin K2 on bone mineral density of the lumbar spine in postmenopausal women with osteoporosis. J Orthop Sci. 2000;5(6):546-51.