Mar 30, 2022
Disclaimer
Our Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By following this protocol, you understand and accept that the recommendations in the protocol are for initial guidance and need to seek medical professional advise.
Bone Support
Fragility fractures, a marker of weakened bone structure, result in an increased risk of future fractures (14) and are a risk factor for disability, morbidity, and mortality. (4)(31) The risk of fracture increases with age, with an approximate rate of bone loss of 0.5 to 1% yearly, after reaching peak bone mass. (30) These effects are seen particularly after the age of 50 and in postmenopausal women. (28)(31) Further evidence shows that elderly individuals are especially vulnerable to hip fractures, which affect approximately 30% of women and 15% of men by the age of 90. (4)
Fracture rates increase when there is a disparity between bone formation by osteoblasts and bone resorption by osteoclasts, leading to decreases in bone mineral density (BMD) and increased bone fragility. (9)(30) Therefore, improvements in bone mineral density and bone turnover may reduce the risk of frailty and fracture. The protocol presented below includes ingredients and supportive evidence focused on improving bone integrity and decreasing fracture risk.
Vitamin D
400-2,000 IU, total per day, minimum 1 year (2)(3)(4)(5)(6)(18)
Note: Combination therapy with Calcium may improve efficacy. (2)(6)(10)(22)(28)(29)
- Vitamin D is a steroid vitamin, a group of fat-soluble pro-hormones that are best known for the role they play in supporting bone health and aiding in the absorption of calcium and phosphate from the gastrointestinal tract. However, a growing body of research highlights its important role in supporting other body systems, including cardiovascular and blood sugar balance as well as increasing musculoskeletal strength, neurological and immune function enabled by its ability to target over 200 different genes throughout the body. At the same time, deficiency and insufficiency of this important nutrient has reached epidemic proportions around the world, making the achievement of optimal levels extremely important to overall health.
- Known as the sunshine vitamin, one of the key roles of vitamin D is maintaining serum calcium and phosphorous balance. The body makes vitamin D by converting vitamin D2 to D3, or cholecalciferol, when the skin is exposed to sunlight. Vitamin D supplements come in two forms, D2 and D3. Studies have found vitamin D3 is the preferable form, as it has been found to maintain active vitamin D levels for a longer period of time.
- Associated with 70% better probability than placebo for the prevention of non-vertebral fractures, hip fractures, and non-vertebral, non-hip fractures in postmenopausal women (2)
- Systematic review of 19 RCT’s, 9 cohort studies, 19 case-controlled studies, 19 cross-sectional studies, and one meta-analysis found lower range doses (400-700 IU/day) may be more effective for reducing bone loss than higher range doses, though higher range doses (700-800 IU/day) may be more effective in preventing osteoporotic fracture (22)
- Combination therapy with calcium shown to reduce the incidence of any fracture by 5-19%, non-vertebral fractures by 32%, non-vertebral-non-hip fractures by 36%, and hip fractures by 16-33%, compared with calcium mono-therapy or placebo (2)(6)(10)(22)(29)
- Meta-analysis of 11 RDBPC found high dose supplementation (≥ 800 IU per day) resulted in a 30% reduction in risk of hip fraction and 14% reduction in risk of non-vertebral fracture in people 65 or older (3)
- Meta-analysis of 12 randomized double-blind controlled trials and 8 randomized controlled trials found high dose vitamin D supplementation (400 IU/day or more) decreased fracture risk in community-dwelling individuals by 29% and institutionalized older individuals by 15% (5)
Vitamin K
Vitamin K2: 45-90 mg per day as menatetrenone (MK-4), or 100-300 µg per day as MK-7 for 6-48 months (15)(17)(26)
- Emerging research highlights the importance of optimal intake of vitamin K and its critical role in maintaining bone and cardiovascular health. Composed of a group of naturally occurring and structurally similar, fat-soluble vitamins, vitamin K is required for the proper utilization of calcium and helps to bind newly absorbed calcium to the bone matrix. Vitamin K helps maintain bone mineral density by decreasing the activity of osteoclasts, cells which break down bone. It also provides critical cardiovascular protection by activating matrix Gla protein (MGP), a potent inhibitor of circulatory calcification. Current research has found high-concentration supplementation results in improved clinical outcomes compared to lower-dose supplementation.
- Meta-analysis of randomized controlled trials found supplementation with vitamin K to be effective in increasing bone mineral density in the lumbar spine (15)
- Meta-analysis of 19 randomized controlled trials found postmenopausal women with osteoporosis supplemented with vitamin K2 had improved and maintained bone mineral density as well as prevented fractures (17)
- Systematic review and meta-analysis of 18 randomized controlled trials found improvements in lumbar bone mineral density, and decreases in undercarboxylated osteocalcin and osteocalcin (26)
- Serum undercarboxylated osteocalcin decreased and pentosidine as well as maintained bone mineral density when compared to decreased bone mineral density in control group indicating improved bone quality in postmenopausal women (20)
Two important minerals are integral to heart health: magnesium and potassium. Nerve cells use these minerals to fire off messages that keep the heart pumping and muscles contracting. Maintaining magnesium and potassium balance is the key to sustaining healthy cardiovascular function. Potassium and magnesium deficiencies often coexist, so supplementation with extra potassium alone, does not always correct a potassium deficiency. Studies have shown that supplementation with magnesium can assist in regaining potassium balance. Potassium and magnesium are minerals required in tandem for proper functioning of the cells and organs in the body.
Potassium
90 mmol (3,500 mg), total per day, for six months (21)
50-60 mEq, total per day, for one year (16)(19)
- High dose supplementation of 90 mmol/day decreased intact parathyroid hormone, urine calcium, and net excretion as well as improved net calcium balance (21)
- Areal bone mineral density increased and fraction prediction score decreased in healthy elderly people without osteoporosis (19)
- Reduces urinary N-telopeptide and serum amino terminal propeptide of type I procollagen (P1NP), indicating bone turnover and calcium excretion improvements when given weight-adjusted low dose (1 mmol/kg, median dose of 81 mmol/day) (12)
- Reduces urinary N-telopeptide of collagen type 1 (u-NTX) and serum amino-terminal propeptide of type 1 procollagen (P1NP), indicating improved bone turnover (16)
Magnesium
300-365 mg elemental magnesium total per day as magnesium oxide, magnesium citrate, or magnesium carbonate; minimum 1-12 months (1)(8)(13)
- Increases the accumulation of hip bone mineral content in healthy adolescent girls (8)
- Reduces serum ionized Mg+, intact parathyroid hormone, as well as improved indicators of bone formation (C-terminus of type I procollagen peptide and osteocalcin) and resorption (type I collagen telopeptide) in young, healthy males, providing an indication of bone turnover attenuation (13)
- Reduces serum intact parathyroid hormone and urinary deoxypyridinoline, and increases osteocalcin levels in postmenopausal women providing an indication of bone turnover attenuation (1)
Attachments
Support your prescription with these additional resources