Pharmaceutical Commentary
Calcium supplementation addresses osteoporosis prevention and treatment. However, this disorder is not principally due to a lack of calcium, but to an imbalance in the bone remodeling action of the osteoclast cells that break down bone, and the osteoblast cells that build up new bone. Remodeling imbalance presents a wider therapeutic issue that mineral supplementation cannot in itself address, however, achieving optimal mineral conditions is a critical step.
Other factors like lifestyle or hormonal therapy will address remodeling imbalance. All calcium deficiencies if uncorrected will lead to bone disorders, especially in growing children, but not all cases of osteoporosis are the direct result of dietary calcium deficiency. Other considerations are important beyond calcium. The North American diet is loaded with potential for causing bone calcium “mobilization” that leads to what amounts to calcium wastage via urine excretion. High phosphate intake via meat and soft drinks, high sugar intake, and high meat intake leading to excess amino acids in the blood calling for calcium buffering, can present significant drains on calcium bone density over time.
Important lifestyle factors that influence the mineral density of bones are exercise and smoking. Many adults who work in sedentary jobs stop exercising in meaningful ways early in life. Yet, daily minimal weight-bearing exercise is able to
drive bone formation, assuming dietary needs are met. Smoking is thought to ultimately lead to the potential for lower
blood pH due to compromised CO2 venting in the lungs, thus allowing higher levels of carbonic acid to accumulate in
the blood. Accordingly, more bone minerals will be mobilized to buffer the blood.
Perhaps no mineral has gained greater recognition and acceptance than that of calcium. We are constantly admonished
to “take calcium”, in order to have strong bones now, and the acquired bone density needed for our latter years to avoid
bone fractures due to osteoporosis. Osteoporosis concerns are well founded in North America, where approximately 1.3
million women suffer fractures each year as a result of osteoporosis. And to add concern, the rate of osteoporosis fractures has been gong up over the past three decades in a manner that cannot be fully explained simply by the increase in
an aging population.
However, part of the problem in curbing the incidence of osteoporosis has been a widespread singular focus on calcium,
with little or no emphasis on magnesium and vitamin D, and often only lip service to other critical mineral factors and
meaningful exercise. Avoiding osteoporosis is much more complex than simply increasing calcium intake, or even relying
on appropriate supplementation alone. It is important to realize that osteoporosis is an infrequent disease in the so
called third world, where calcium supplementation, and milk consumption for that matter, is virtually non-existent and
daily dietary calcium intake is typically below the average intake of North Americans.
As much as 50% of the body’s magnesium is found in the bones, pointing to the importance of magnesium to bone health.
While calcium is the central mineral in bone mineralization or calcification, the quality of the calcium crystals formed is related to magnesium. When too little magnesium is available, the calcium crystals are weaker permitting fractures to occur, even when consistent efforts have been made to consume the recommended daily calcium supplements.
Magnesium also provides a general alkalizing effect on the body’s pH thus helping to avoid the need to sacrifice bone calcium as a buffer.
Vitamin D is important to facilitate calcium absorption from the intestinal tract and renal re-absorption. Those who are regularly exposed to sunlight are generally not regarded as being at risk of developing a vitamin D deficiency.
However, as we grow older and perhaps spend more time inside, especially for those living north of the 49th parallel, a
critical vitamin D deficiency is a very real possibility. Those suffering from diagnosed osteoporosis, should consider 800
international units per day to maximize calcium absorption.9,10 There is a wide margin of safety in vitamin D supplementation,
with a potential for toxicity occurring at a daily dose of 2400 IU or greater.
Thus, a daily amount of 800 IU. per day is safe, especially if the user is an older person for whom optimal direct sunlight is curtailed and absorption of supplemental vitamin D is somewhat inefficient.
Other nutritional factors are known to participate in bone formation and renewal, such as Vitamin K, Manganese, Folic
Acid, Boron, Vitamin B-6, Zinc, Strontium, Copper, Silicon, and Vitamin C. These can be obtained in a diet of fruit and
vegetables and whole grains, as well as supplementing.
Calcium supplementation has also been helpful in cases of salt-sensitive high blood pressure, as well as in pregnancy
induced high blood pressure.
References
1. Murray, Michael T., Encyclopedia of Nutritional Supplementation, Prima Publishing, Rocklin, CA, 1996
2. Whitaker, Julian, "Dr. Whitaker’s Guide to Natural Healing". Prima Publishing, Rocklin, CA, 1995 3. Editorial, Citrate for calcium nephrolithiasis, Lancet, I: 955, 1986
4. Teo, K.K., et al, "Role of Magnesium in Reducing Mortality in Acute Myocardial Infarction: A Review of the Evidence", Drugs, 46: 347-359, 1993
5. Turlapaty, P., et al, "Magnesium Deficiency Produces Spasms of Coronary Arteries: Relationship to Etiology of Sudden Ischemic Heart Disease", Science, 208: 199-200,1980
6. Gaby, Alan R., Preventing and Reversing Osteoporosis, Prima Publishing, Rocklin, CA, 1994
7. Cohen, L., Kitzes, R., "Infrared spectroscopy and magnesium content of bone mineral in osteoporotic women", Israel Journal of Medical Science, 17: 1123-1125, 1981
8. Graedon, Joe, Graedon, Teresa, Deadly Drug Interactions, St Martin’s Griffin, New York, 1995
9. Germano, Carl, The Osteoporosis Solution, Kensington Books, New York, 1999
10. Dawson-Hughes, B., et al, "Rates of bone loss in postmenopausal Women Randomly Assigned to One of Two Dosages of Vitamin D", American Journal of Clinical Nutrition, 61: 1140-1145, 1995
11. Belizan, J.M., et al, "Calcium supplementation to prevent hypertensive disorder of pregnancy", New England Journal of Medicine, 325: 1399-1405,1991
12. Knight, K.B., et al, "Calcium Supplementation on Normotensive and Hypertensive Pregnant Women, American Journal of Clinical Nutrition, 55: 891-895, 1992
13. He, J., Tell, G., Tang, Y., et al, "Effect of dietary electrolytes upon calcium excretion: The Yi People Study", Journal of Hypertension, 10: 671-676, 1992
14. Utiger, Robert D., Editorial, The Need For More Vitamin D, The New England Journal of Medicine, 338(12), March 19, 1998
15. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Institute of Medicine, Dietary Reference Intakes: Calcium, phosphorus, magnesium, vitamin D, and fluoride, Washington, D.C., National Academy Press, 1997
16. Optimal Calcium Intake, NIH Consens Statement Online, 1994, June 6-8; 12(4):1-31 |
