Ask Dr. Casey: Bone Health Basics.
Hi Dr. Casey, I am in my menopausal years and have just been told I have osteopenia. Are there any supplements I can take to improve my bone density?
- Laurie K
Hi Laurie,
Yes, osteopenia and osteoporosis can be pretty common new diagnoses in menopausal women. This is in large part because estrogen, which significantly drops after menstruation stops, is no longer stimulating the cells in the bones that help to promote their building process. For any younger folks perchance reading this article, building up bone mineral stores in adolescence and up to thirty years old can really help get ahead of the osteoporotic potential of later years. Laurie, don’t you wish there are so many things you could go back and tell your younger self?!
Time travel aside, there are a number of helpful tactics. One that has gained more acceptance and popularity in recent years is hormone replacement therapy (HRT). Studies have shown estrogen therapy in the early, specifically first three, years after menopause has a significant impact in improving bone mineral density (1). This is a discussion to have with your healthcare provider, as it does require a prescription as well as consideration of risk and benefit based on personal and family history. Estrogen balanced with progesterone for HRT has a safer profile than estrogen alone.
Daily habits of moving and eating patterns can also make a difference for maintenance or decline of bone mineral density (BMD). Daily, weight bearing exercise can induce a positive stress on the bone-building cells, causing them to be more active. I even encourage some of my patients to walk with a lightly weighted backpack to increase the load, especially if they are smaller framed. Plus, if balance can be maintained through daily activity and agility, chances for reduction in fracture are reduced as well. I unfortunately saw this play-out in my 67-year old Aunt. While she had low BMD from a life of inactivity and poor eating, it was poor balance in the end that precipitated a fall, a hip fracture, and her death not too long following. Exercise for agility and balance is just as important as it is for BMD. Eating a whole-foods diet replete with vegetables may sound boring, but research shows its efficacy for maintaining BMD. Oddly enough, consuming five prunes per day has been shown to maintain bone mineral density, too (2).
In terms of supplements, most folks consider just adequate levels of calcium. In fact, there is a bit of a Goldielocks effect with calcium: too much can lead to increased risk for heart attack; too little can lead to increased risk for bone fracture. Total calcium includes that consumed both via food and supplements. Best to tally up daily calcium intake from both sources and calculate a maximum amount of around 1200-1800 mg, depending on the person.
One nutrient that everyone has heard a lot about over the last decade or so has been Vitamin D. This fat soluble vitamin and hormone plays a crucial role in the uptake of calcium from the GI tract as it is necessary for calcium absorption into the body. Recent research has shown that Vitamin D by itself is just not quite enough; Vitamin K is also important to get it from blood to the bones. I think of Vitamin K, and specifically the form K2, as the conductor that helps direct the calcium where to go. Vitamin D3 and K2 really work synergistically together to aid in optimal bone health (3). Even more reason to take the commonly found combination of D and K together is for cardiovascular health and protection of arteries from calcification (4). Any new patient of mine who is just taking Vitamin D, I recommend getting a combo supplement of D3 and K2 for their next bottle. While there are a variety of other essential nutrients I screen postmenopausal patients for adequate intake either via food intake or supplementation, the above synergy is the one I will emphasize as a basic bone health necessity.
And even though you didn’t ask … it’s a common question of if carbonated beverages affect BMD, so let’s address it! In short, no, carbonated beverages have not been shown to decrease BMD in both short and long-term studies. However, soda consumption has. Even though I am not the biggest fan of either as a primary source of liquid intake, in terms of bone health, Pellegrino will be better than caffeinated cola.
Laurie, I wish you well in your bone-building process! There are a lot of helpful tools to pull from, but as always, hitting the determinants of health on a daily basis is a necessary part of the equation.
Sources
1. Bagger YZ, Tankó LB, Alexandersen P, Hansen HB, Møllgaard A, Ravn P, Qvist P, Kanis JA, Christiansen C. Two to three years of hormone replacement treatment in healthy women have long-term preventive effects on bone mass and osteoporotic fractures: the PERF study. Bone. 2004 Apr;34(4):728-35. doi: 10.1016/j.bone.2003.12.021. PMID: 15050905.
2. De Souza MJ, Strock NCA, Williams NI, Lee H, Koltun KJ, Rogers C, Ferruzzi MG, Nakatsu CH, Weaver C. Prunes preserve hip bone mineral density in a 12-month randomized controlled trial in postmenopausal women: the Prune Study. Am J Clin Nutr. 2022 Oct 6;116(4):897-910. doi: 10.1093/ajcn/nqac189. PMID: 35798020.
3. 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. doi: 10.1007/s007760070003. PMID: 11180916.
4. Braam LA, Hoeks AP, Brouns F, Hamulyák K, Gerichhausen MJ, Vermeer C. Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women: a follow-up study. Thromb Haemost. 2004 Feb;91(2):373-80. doi: 10.1160/TH03-07-0423. PMID: 14961167.
