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Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment: Symposium on ‘Diet and bone health’

  • Susan A. Lanham-New (a1)

Throughout the life cycle the skeleton requires optimum development and maintenance of its integrity to prevent fracture. Bones break because the loads placed on them exceed the ability of the bone to absorb the energy involved. It is now estimated that one in three women and one in twelve men aged >55 years will suffer from osteoporosis in their lifetime and at a cost in the UK of >£1·7×109 per year. The pathogenesis of osteoporosis is multifactorial. Both the development of peak bone mass and the rate of bone loss are determined by key endogenous and exogenous factors. Ca supplements appear to be effective in reducing bone loss in women late post menopause (>5 years post menopause), particularly in those with low habitual Ca intake (<400 mg/d). In women early post menopause (<5 years post menopause) who are not vitamin D deficient, Ca supplementation has little effect on bone mineral density. However, supplementation with vitamin D and Ca has been shown to reduce fracture rates in the institutionalised elderly, but there remains controversy as to whether supplementation is effective in reducing fracture in free-living populations. Re-defining vitamin D requirements in the UK is needed since there is evidence of extensive hypovitaminosis D in the UK. Low vitamin D status is associated with an increased risk of falling and a variety of other health outcomes and is an area that requires urgent attention. The role of other micronutrients on bone remains to be fully defined, although there are promising data in the literature for a clear link between vitamin K nutrition and skeletal integrity, including fracture reduction.

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Corresponding author: Dr Susan Lanham-New, fax +44 1483 686401, email
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4.Consensus Development Conference (1991) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 90, 107110.

5.Consensus Development Conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94, 646650.

6. RP Heaney , S Abrams , B Dawson-Hughes , A Looker , R Marcus , V Matkovic & C Weaver (2000) Peak bone mass. Osteoporos Int 11, 9851009.

7. TP van Staa , EM Dennison , HG Leufkens & C Cooper (2001) Epidemiology of fractures in England and Wales. Bone 29, 517522.

18. A Prentice , I Schoenmakers , MA Laskey , S de Bono , F Ginty & GR Goldberg (2006) Nutrition and bone growth and development. Proc Nutr Soc 65, 348360.

19. SA Abrams (2005) Calcium supplementation during childhood: long-term effects on bone mineralization. Nutr Rev 63, 251255.

20. KA Ward , SA Roberts , JE Adams , SA Lanham-New & MZ Mughal (2007) Calcium supplementation and weight bearing physical activity – do they have a combined effect on the bone density of pre-pubertal children? Bone 41, 496504.

22. E Seeman & J Hopper (1997) Genetic and environmental components of the population variance in bone density. Osteoporos Int 7, S10S16.

23. CB Langman (2005) Genetic regulation of bone mass: from bone density to bone strength. Pediatr Nephrol 20, 352355; Epublication 5 January 2005.

24. M Lorentzon , D Mellstrom & C Ohlsson (2005) Age of attainment of peak bone mass is site specific in Swedish men – The GOOD study. J Bone Miner Res 20, 12231227; Epublication 7 March 2005.

27. JP Bonjour , P Ammann , T Chevalley , S Ferrari & R Rizzoli (2003) Nutritional aspects of bone growth: an overview. In Nutritional Aspects of Bone Health, pp. 111128 [ SA New and JP Bonjour editors]. Cambridge: Royal Society of Chemistry.

28. T Chevalley , R Rizzoli , D Hans , S Ferrari & JP Bonjour (2005) Interaction between calcium intake and menarcheal age on bone mass gain: an eight-year follow-up study from prepuberty to postmenarche. J Clin Endocrinol Metab 90, 4451; Epublication 26 October 2004.

29. SA Abrams , KC Copeland , SK Gunn , CM Gundberg , KO Klein & KJ Ellis (2000) Calcium absorption, bone mass accumulation and kinetics increase during early pubertal development in girls. J Clin Endocrin Metab 85, 18051809.

31. HM Frost (1987) Bone ‘mass’ and the ‘mechanostat’: a proposal. Anat Rec 219, 19.

32. JA Nurmi-Lawton , ADJ Baxter-Jones , R Mirwald , JA Bishop , P Taylor , C Cooper & SA New (2004) Evidence of sustained skeletal benefits from impact-loading exercise in young adolescent females: a 3-year longitudinal study. J Bone Miner Res 19, 314322.

33. RK Fuchs , JJ Bauer & CM Snow (2001) Jumping improves hip and lumbar spine bone mass in prepubescent children: A randomized controlled trial. J Bone Miner Res 16, 148156.

34. O Valdimarsson , C Linden , O Johnell , P Gardsell & M Karlsson (2006) Daily physical education in the school curriculum in prepubertal girls during 1 year is followed by an increase in bone mineral accrual and bone width – Data from the Prospective Controlled Malmo Pediatric Osteoporosis Prevention Study. Calcif Tissue Int 78, 6571.

35. BL Specker (1996) Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res 11, 15391544.

36. B Specker & T Binkley (2003) Randomized trial of physical activity and calcium supplementation on bone mineral content in 3- to 5-year-old children. J Bone Miner Res 18, 885892.

37. SL Bass , G Naughton , L Saxon , S Iuliano-Burns , R Daly , EM Briganti , C Hume & C Nowson (2007) Exercise and calcium combined results in a greater osteogenic effect than either factor alone: A blinded randomized placebo-controlled trial in boys. J Bone Miner Res 22, 458464.

38. B Dawson-Hughes (2004) Calcium and vitamin D for bone health in adults. In Nutrition and Bone Health, pp. 197210 [ MF Holick and B Dawson-Hughes editors]. Totowa, NJ: Humana Press.

40. B Dawson-Hughes , GE Dallal , EA Krall , L Sadowski , N Sahyoun & S Tannenbaum (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 323, 878883.

42. B Shea , G Wells , A Cranney (2002) Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analysis of therapies for post-menopausal osteoporosis. VII Meta-analysis of Ca supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 23, 552559.

43. SC Ho , YM Chen , JL Woo & SS Lam (2004) High habitual calcium intake attenuates bone loss in early post-menopausal Chinese women: an 18-month follow up study. J Clin Endocrinol 89, 21662170.

46. MF Holick (2007) Vitamin D deficiency. N Engl J Med 357, 266281.

56. SA Lanham-New , RL Thompson , J More , K Brooke-Wavell , P Hunking & E Medici (2007) Importance of vitamin D, calcium and exercise to bone health with specific reference to children and adolescents. Nutr Bull 32, 364377.

58. M Ashwell , E Stone , J Mathers (2008) Review of the nutrition and bone health projects funded by the Food Standards Agency – have they helped to inform public health policy? Br J Nutr (In the Press).

60. R Boland (1986) Role of vitamin D in skeletal muscle function. Endocr Rev 7, 434447.

61. RP Heaney , MS Dowell & CA Hale (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22, 142146.

66. G El-Hajj Fuleihan , M Nabulsi , M Choucair , M Salamoun , C Hajj Shahine , A Kizirian & R Tannous (2001) Hypovitaminosis D in healthy schoolchildren. Pediatrics 107, E53.

67. HT Viljakainen , AM Natri , M Karkkainen , MM Huttunen , A Palssa , J Jakobsen , KD Cashman , C Molgaard & C Lamberg-Allardt (2006) A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res 21, 836844.

68. MC Chapuy , ME Arlot , F Duboeuf , J Brun , B Crouzet , S Arnaud , PD Delmas & PJ Meunier (1992) Vitamin D and calcium to prevent hip fractures in elderly women. N Engl J Med 327, 16371642.

69. B Dawson-Hughes , SS Harris , EA Krall & GE Dallal (1997) Effect of Ca and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337, 670676.

70. ER Larsen , L Mosekilde & A Foldspang (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19, 370378.

71. HE Meyer , GB Smedshaug , E Kvaavik , JA Falch , A Tverdal & JI Pedersen (2002) Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 17, 709715.

72. HA Bischoff-Ferrari , WC Willett , JB Wong , E Giovannucci , T Dietrich & B Dawson-Hughes (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomised controlled trials. JAMA 293, 22572264.

73. H Smith , F Anderson , H Raphael , P Maslin , S Crozier & C Cooper (2007) Effect of annual intramuscular vitamin D on fracture risk in elderly men and women – a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology 46, 18521857.

74. DP Trivedi , R Doll & KT Khaw (2003) Effect of four monthly oral vitamin D3 supplementation on fractures and mortality in men and women living in the community: a randomised double blind controlled trial. Br Med J 326, 469474.

75. J Porthouse , S Cockrayne , C King (2005) Randomised controlled trial of calcium supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. Br Med J 330, 10031006.

77. P Sambrook (2005) Vitamin D and fractures: quo vadis? Lancet 365, 15991600.

79. BM Tang , GD Eslick , C Nowson , C Smith & A Bensoussan (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370, 657666.

80. H Dam (1935) The antihaemorrhagic factor of the chick. Biochem J 29, 12731285.

83. S Booth (2003) Dietary vitamin K and bone health. In Nutritional Aspects of Bone Health, pp. 323338 [ SA New and JP Bonjour editors]. Cambridge: Royal Society of Chemistry.

84. P Szulc , M-C Chapuy , PJ Meunier & PD Delmas (1996) Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture: a three year follow up study. Bone 18, 487488.

86. P Weber (2001) Vitamin K and bone health. Nutrition 17, 880887.

87. C Bolton-Smith , ME McMurdo , CR Paterson , PA Mole , JM Harvey , ST Fenton , CJ Prynne , GD Mishra & MJ Shearer (2007). A two-year randomized controlled trial of vitamin K1 (phylloquinone) and vitamin D3 plus calcium on the bone health of older women. J Bone Miner Res 22, 509519.

88. LA Braam , MH Knapen , P Geusens , F Brouns , K Hamulyák , MJ Gerichhausen & C Vermeer (2003) Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age. Calcif Tissue Int 73, 2126.

89. MHJ Knapen , LJ Schurgers & C Vermeer (2007) Vitamin K2 improves hip bone geometry and bone strength indices in postmenopausal women. Osteoporos Int 18, 963972; Epublication 8 February 2007.

90. R Cockrayne , J Adamson , SA Lanham-New , MJ Shearer , S Gilbody & DJ Torgerson (2006) Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 166, 12561261.

92. TLN Jarvinen , H Sievanen , KM Khan , A Heinonen & P Kannus (2008) Shifting the focus in fracture prevention from osteoporosis to falls. Br Med J 336, 124126.

96. N Sasaki , E Kusano , H Takahashi , Y Ando , K Yano , E Tsuda & Y Asano (2005) Vitamin K2 inhibits glucocorticoid-induced bone loss partly by preventing the reduction of osteoprotegerin (OPG). J Bone Miner Metab 23, 4147.

97. M Shiraki , Y Shiraki , C Aoki & M Miura (2000) Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis. J Bone Miner Res 15, 515522.

98. J Iwamoto , T Takeda & S Ichimura (2001) Effect of menatetrenone on bone mineral density and incidence of vertebral fractures in postmenopausal women with osteoporosis: a comparison of with the effect of etidronate. J Orthop Sci 6, 487492.

99. Y Ishida & S Kawai (2004) Comparative efficacy of hormone replacement therapy, etidronate, calcitonin, alfacalcidol and vitamin K in postmenopausal women with osteoporosis: The Yamaguchi Osteoporosis Prevention Study. Am J Med 117, 549555.

100. Y Sato , Y Honda , H Kuno & K Oizumi (1998) Menatetrenone ameliorates osteopenia in disuse-affected limbs of vitamin D and K-deficient stroke patients. Bone 23, 291296.

101. Y Sato , Y Honda , T Asho , K Hosokawa , I Kondo & K Satoh (2002) Amelioration of osteoporosis by menatetrenone in elderly female Parkinson's disease patients with vitamin D deficiency. Bone 31, 114118.

102. Y Sato , T Kanoko , K Satoh & J Iwanmoto (2005) Menatetrenone and vitamin D2 with calcium supplements prevent nonvertebral fractures in elderly women with Alzheimer's disease. Bone 36, 6168.

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