Although calcium and vitamin D have been the primary focus of nutritional prevention of osteoporosis, recent research has clarified the importance of several additional nutrients and food constituents. Further, results of calcium and vitamin D supplementation trials have been inconsistent, suggesting that reliance on this intervention may be inadequate. In addition to dairy, fruit and vegetable intake has emerged as an important modifiable protective factor for bone health. Several nutrients, including magnesium, potassium, vitamin C, vitamin K, several B vitamins, and carotenoids, have been shown to be more important than previously realized. Rather than having a negative effect on bone, protein intake appears to benefit bone status, particularly in older adults. Regular intake of cola beverages shows negative effects and moderate alcohol intake shows positive effects on bone, particularly in older women. Current research on diet and bone status supports encouragement of balanced diets with plenty of fruit and vegetables, adequate dairy and other protein foods, and limitation of foods with low nutrient density.
Positive correlation between dietary intake of sodium and balances of calcium and magnesium in young Japanese adults–low sodium intake is a risk factor for loss of calcium and magnesium–.
The content of calcium (Ca) and magnesium (Mg) in sweat during exercise is considerably higher during a relatively low intake of sodium (Na) of 100 mmol/d than with an intake of 170 mmol/d. For this reason and also because Ca and Mg have a negative balance with a Na intake of 100 mmol/d, we analyzed the relationship between Na intake and balances of Ca and Mg in data from 11 balance studies. From 1986 to 2000, 109 volunteers (23 males, 86 females) with an age range of 18 to 28 y took part in mineral balance studies. The balance periods ranged from 5 to 12 d. In a given experiment, the diet of each subject contained the same quantity of food, although this varied between experiments, and was supplied during the balance period without consideration of body weight. In the data of all the studies (n= 109), the balances of Ca and Mg did not correlate positively with Na intake. However, when the data of the highest Na study were excluded, the balances of Ca and Mg correlated positively with Na intake. The mean value for the regression equation between Na intake and Ca and Mg balances when the respective balance was equal to zero were, 63.308 mg Na/kg BW/d (Ca: n=96, r2=0.134) and 60.977 mg Na/kg BW/d (Mg: n=96, r2=0.268), respectively. These values are considerably higher than Na requirements estimated by inevitable Na loss. Low dietary Na may therefore be a risk factor for maintaining positive balances of Ca and Mg.
Nishimuta M, Kodama N, Morikuni E, Yoshioka YH…
J. Nutr. Sci. Vitaminol. Aug 2005 PMID: 16261999
Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet.
Osteoporosis and low bone mineral density affect millions of Americans. The majority of adults in North America have insufficient intake of vitamin D and calcium along with inadequate exercise. Physicians are aware that vitamin D, calcium and exercise are essential for maintenance of bone health. Physicians are less likely to be aware that dietary insufficiencies of magnesium, silicon, Vitamin K, and boron are also widely prevalent, and each of these essential nutrients is an important contributor to bone health. In addition, specific nutritional factors may improve calcium metabolism and bone formation. It is the authors’ opinion that nutritional supplements should attempt to provide ample, but not excessive, amounts of factors that are frequently insufficient in the typical American diet. In contrast to dietary insufficiencies, several nutrients that support bone health are readily available in the average American diet. These include zinc, manganese, and copper which may have adverse effects at higher levels of intake. Some multivitamins and bone support products provide additional quantities of nutrients that may be unnecessary or potentially harmful. The purpose of this paper is to identify specific nutritional components of bone health, the effects on bone, the level of availability in the average American diet, and the implications of supplementation for each nutritional component. A summary of recommended dietary supplementation is included.
Oral intake of 2 gm/day of strontium ranelate have improved bone strength and reduced fracture rates in women with osteoporosis, but there are reports of increased risks of venous blood clots and memory loss [82, 87].
Update on nutrients involved in maintaining healthy bone.
Osteoporosis is a leading cause of morbidity and mortality in the elderly and influences quality of life, as well as life expectancy. Currently, there is a growing interest among the medical scientists in search of specific nutrients and/or bioactive compounds of natural origin for the prevention of disease and maintenance of bone health. Although calcium and vitamin D have been the primary focus of nutritional prevention of osteoporosis, a recent research has clarified the importance of several additional nutrients and food constituents. Based on this review of the literature, supplementation with vitamins B, C, K, and silicon could be recommended for proper maintenance of bone health, although further clinical studies are needed. The results of studies on long-chain polyunsaturated fatty acids, potassium, magnesium, copper, selenium, and strontium are not conclusive, although studies in vitro and in animal models are interesting and promising.
Rondanelli M, Opizzi A, Perna S, Faliva MA
Endocrinol Nutr Apr 2013 PMID: 23273614
Magnesium supplementation through seaweed calcium extract rather than synthetic magnesium oxide improves femur bone mineral density and strength in ovariectomized rats.
Commercially available seaweed calcium extract can supply high amounts of calcium as well as significant amounts of magnesium and other microminerals. The purpose of this study was to investigate the degree to which the high levels of magnesium in seaweed calcium extract affects the calcium balance and the bone status in ovariectomized rats in comparison to rats supplemented with calcium carbonate and magnesium oxide. A total of 40 Sprague-Dawley female rats (7 weeks) were divided into four groups and bred for 12 weeks: sham-operated group (Sham), ovariectomized group (OVX), ovariectomized with inorganic calcium and magnesium supplementation group (OVX-Mg), and ovariectomized with seaweed calcium and magnesium supplementation group (OVX-SCa). All experimental diets contained 0.5% calcium. The magnesium content in the experimental diet was 0.05% of the diet in the Sham and OVX groups and 0.1% of the diet in the OVX-Mg and OVX-SCa groups. In the calcium balance study, the OVX-Mg and OVX-SCa groups were not significantly different in calcium absorption compared to the OVX group. However, the femoral bone mineral density and strength of the OVX-SCa group were higher than those of the OVX-Mg and OVX groups. Seaweed calcium with magnesium supplementation or magnesium supplementation alone did not affect the serum ALP and CTx levels in ovariectomized rats. In summary, consumption of seaweed calcium extract or inorganic calcium carbonate with magnesium oxide demonstrated the same degree of intestinal calcium absorption, but only the consumption of seaweed calcium extract resulted in increased femoral bone mineral density and strength in ovariectomized rats. Our results suggest that seaweed calcium extract is an effective calcium and magnesium source for improving bone health compared to synthetic calcium and magnesium supplementation.
Bae YJ, Bu SY, Kim JY, Yeon JY…
Biol Trace Elem Res Dec 2011 PMID: 21584658
Effect of severe dietary magnesium deficiency on systemic bone density and removal torque of osseointegrated implants.
This study evaluated the effect of severe magnesium (Mg) dietary deficiency on systemic bone density and biomechanical resistance of bone tissue to the removal torque of osseointegrated implants.
The sample consisted of 45 rats; each received a titanium implant in their tibial metaphysis. After 60 days, the animals were divided into three groups (n = 15) according to their dietary Mg: the control group received the recommended content of Mg, group Mg1 received a 75% reduction in dietary Mg content, and group Mg2 was fed a diet with a 90% reduction in Mg content. Animals were sacrificed 150 days after implant placement. Serum concentrations of Mg were measured and the effect of Mg deficiency on systemic bone density was evaluated by densitometry of the lumbar vertebrae and femur. Biomechanical characteristics were measured by resistance of the bone tissue to removal of the implants. Results: Lower Mg serum concentrations were found for the Mg1 and Mg2 groups; however, densitometric analysis and torque evaluations showed a statistically significant difference only in the Mg2 group (P < .05). There was a statistically significant difference in removal torque between the Mg2 group and the control group.
This study showed that a severe deficiency of Mg decreased the systemic bone density and removal torque of osseointegrated implants.
Del Barrio RA, Giro G, Belluci MM, Pereira RM…
Int J Oral Maxillofac Implants PMID: 21197488
Effects of a high-calcium diet on serum insulin-like growth factor-1 levels in magnesium-deficient rats.
In order to clarify the effects of a high-calcium (Ca) diet on bone formation in magnesium (Mg)-deficient rats, this study focused on the effects of a high-Ca diet on serum insulin-like growth factor-1 (IGF-1) levels. Male rats were randomized by weight into four groups, and fed one of four experimental diets containing two different Mg concentrations (0.05% (normal-Mg) or Mg-free (Mg-deficient)), and two different Ca concentrations (0.5% (normal-Ca) or 1.0% (high-Ca)) for 14 days. Serum concentrations of osteocalcin and IGF-1 were significantly lower in rats fed the Mg-deficient diet than in rats fed the normal-Mg diet. On the other hand, dietary Ca concentration had no significant influence on serum concentrations of osteocalcin and IGF-1. This study suggested that: 1) a high-Ca diet has no preventive effects on the decreased bone formation seen in Mg-deficient rats; and 2) a high-Ca diet does not enhance serum IGF-1 levels in Mg-deficient rats. Moreover, unchanged serum IGF-1 concentrations may contribute to the decreased bone formation seen in Mg-deficient rats receiving a high-Ca diet.
Magnesium intake and bone mineral density in young adult women.
The purpose of this study was to determine a possible association between magnesium intake and bone mass in young adult women. Subjects consisted of 106 female university students aged 19-25 years. Calcium and magnesium intakes were evaluated using the duplicate sampling method on three weekdays. Spinal and femoral bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Mean magnesium intake was 139 mg/day (median 127, SD 54). The correlation between magnesium intake and BMD was of borderline significance (r = 0.175, p = 0.073) for the femoral neck, and was insignificant (r = 0.084, p = 0.391) for the lumbar spine. However, the partial correlation between magnesium intake and BMD of the femoral neck (r = -0.027, p = 0.788), adjusted for calcium intake, was not significant. In conclusion, we did not find an association between magnesium intake and bone mass in young women, and calcium intake needs to be included as an important, potential confounding factor when exploring such an association.
Skeletal and hormonal effects of magnesium deficiency.
Magnesium (Mg) is the second most abundant intracellular cation where it plays an important role in enzyme function and trans-membrane ion transport. Mg deficiency has been associated with a number of clinical disorders including osteoporosis. Osteoporosis is common problem accounting for 2 million fractures per year in the United States at a cost of over $17 billion dollars. The average dietary Mg intake in women is 68% of the RDA, indicating that a large proportion of our population has substantial dietary Mg deficits. The objective of this paper is to review the evidence for Mg deficiency-induced osteoporosis and potential reasons why this occurs, including a cumulative review of work in our laboratories and well as a review of other published studies linking Mg deficiency to osteoporosis. Epidemiological studies have linked dietary Mg deficiency to osteoporosis. As diets deficient in Mg are also deficient in other nutrients that may affect bone, studies have been carried out with select dietary Mg depletion in animal models. Severe Mg deficiency in the rat (Mg at <0.0002% of total diet; normal = 0.05%) causes impaired bone growth, osteopenia and skeletal fragility. This degree of Mg deficiency probably does not commonly exist in the human population. We have therefore induced dietary Mg deprivation in the rat at 10%, 25% and 50% of recommended nutrient requirement. We observed bone loss, decrease in osteoblasts, and an increase in osteoclasts by histomorphometry. Such reduced Mg intake levels are present in our population. We also investigated potential mechanisms for bone loss in Mg deficiency. Studies in humans and and our rat model demonstrated low serum parathyroid hormone (PTH) and 1,25(OH)(2)-vitamin D levels, which may contribute to reduced bone formation. It is known that cytokines can increase osteoclastic bone resorption. Mg deficiency in the rat and/or mouse results in increased skeletal substance P, which in turn stimulates production of cytokines. With the use of immunohistocytochemistry, we found that Mg deficiency resulted in an increase in substance P, TNFalpha and IL1beta. Additional studies assessing the relative presence of receptor activator of nuclear factor kB ligand (RANKL) and its decoy receptor, osteoprotegerin (OPG), found a decrease in OPG and an increase in RANKL favoring an increase in bone resorption. These data support the notion at dietary Mg intake at levels not uncommon in humans may perturb bone and mineral metabolism and be a risk factor for osteoporosis.
The frequency of magnesium consumption directly influences its serum concentration and the amount of elutable bone magnesium in rats.
We investigated the influence of Mg feeding frequency on the variation in serum Mg concentration and tissue Mg levels in Mg-deficient rats. Sprague-Dawley rats, which had been fed a Mg-deficient diet for 14 d, were divided into 3 groups that were kept on 3 diets differing in their Mg content. The rats were fed 0.5-fold (Mg250 group), 1-fold (Mg500 group), or 1.5-fold (Mg750 group) the amounts of recommended Mg in their standard AIN-93G diet (Mg: 478 mg/kg diet) during the recovery period (12 d). The Mg500 and Mg750 groups were intermittently fed (Mg500, every 2 d; Mg750, every 3 d) so that their total intake of Mg during the recovery period could equal the Mg intake of the Mg250 group. The serum Mg concentrations increased in the 3 groups after feeding with a Mg-containing diet. However, serum Mg levels were only maintained within the normal range in the Mg250 group. After feeding on the Mg-deficient diet, in the intermittently fed groups, serum Mg concentrations decreased. Urinary Mg excretion was higher and Mg retention was lower in the Mg500 and Mg750 groups than in the Mg250 group. Moreover, bone Mg, especially elutable bone Mg, was lower in the Mg500 and Mg750 groups than in the Mg250 group. The elutable fraction of bone Mg correlated to the coefficient of variation of serum Mg concentration. In conclusion, for the maintenance of serum Mg concentration, it is important to increase the amount of elutable bone Mg by frequent Mg consumption.