Category Archives: Supplements

Review: Exercise Only Beneficial with Calcium > 1000mg per Day

Abstract

Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density.

Results of trials on the effects of physical activity on bone mineral density (BMD) are conflicting. The current hypothesis was that calcium intake modifies the bone response to physical activity. Published trials on physical activity and bone density were reviewed, and the results of 17 trials are summarized. Physical activity has beneficial effects on BMD at high calcium intakes, with no effect at mean calcium intakes less than a mean of 1000 mg/day. The modifying effect of calcium intake on BMD among exercise groups is more pronounced in the lumbar spine than in the radius. This analysis may explain conflicting results of trials on physical activity and calcium effects on bone. Controlled trials designed to test adequately this hypothesis are needed.

Specker BL
J. Bone Miner. Res. Oct 1996
PMID: 8889855

Ferulic Acid Increases Bone Formation in Ovariectomized Rats

Abstract

Preventive effect of ferulic acid on bone loss in ovariectomized rats.

An extract from corn germ induced a positive response in the pigeon crop sack test, used for the detection of prolactin-like substances. One of the substances extracted was identified as ferulic acid, which was reported to affect serum gonadotropin levels in ovariectomized male rats. To evaluate the effects of ferulic acid on bone loss, ovariectomized female rats of the Sprague-Dawley strain at age 35 weeks were given ferulic acid and/or 17a-ethynylestradiol daily for 8 weeks, and serum hormone levels and tibial bone mineral density were measured. In metaphysis of the tibia, which was abundant in cancellous bone and more reflective of BMD than whole tibia, the BMD was markedly reduced by ovariectomy and enhanced by the treatment with estrogen or ferulic acid in the ovariectomized rats. The treatment slightly increased the serum levels of estrogen and progesterone and alkaline phosphatase activity, which was reduced by estrogentreatment, i.e. the mechanism of bone formation by ferulic acid was suggested to be different from that by estrogens. These results indicate that ferulic acid promotes bone remodeling, leading to a predominantly osteoblastic phase, besides bone resorption by osteoclasts.

Sassa S, Kikuchi T, Shinoda H, Suzuki S…
In Vivo May 2003
PMID: 12929580

Vitamin K2 (MK-4) Shows Similar Effectiveness to Alfacalcidol

Abstract

Menatetrenone versus alfacalcidol in the treatment of Chinese postmenopausal women with osteoporosis: a multicenter, randomized, double-blinded, double-dummy, positive drug-controlled clinical trial.

To evaluate whether the efficacy and safety of menatetrenone for the treatment of osteoporosis is noninferior to alfacalcidol in Chinese postmenopausal women.
This multicenter, randomized, double-blinded, double-dummy, noninferiority, positive drug-controlled clinical trial was conducted in five Chinese sites. Eligible Chinese women with postmenopausal osteoporosis (N=236) were randomized to Group M or Group A and received menatetrenone 45 mg/day or alfacalcidol 0.5 μg/day, respectively, for 1 year. Additionally, all patients received calcium 500 mg/day. Posttreatment bone mineral density (BMD), new fracture onsets, and serum osteocalcin (OC) and undercarboxylated OC (ucOC) levels were compared with the baseline value in patients of both groups.
A total of 213 patients (90.3%) completed the study. After 1 year of treatment, BMD among patients in Group M significantly increased from baseline by 1.2% and 2.7% at the lumbar spine and trochanter, respectively (P<0.001); and the percentage increase of BMD in Group A was 2.2% and 1.8%, respectively (P<0.001). No difference was observed between groups. There were no changes in femoral neck BMD in both groups. Two patients (1.9%, 2/108) in Group M and four patients (3.8%, 4/105) in Group A had new fracture onsets (P>0.05). In Group M, OC and ucOC decreased from baseline by 38.7% and 82.3%, respectively (P<0.001). In Group A, OC and ucOC decreased by 25.8% and 34.8%, respectively (P<0.001). Decreases in serum OC and ucOC were more obvious in Group M than in Group A (P<0.001). The safety profile of menatetrenone was similar to alfacalcidol.
Menatetrenone is an effective and safe choice in the treatment of postmenopausal osteoporosis in Chinese women.

Jiang Y, Zhang ZL, Zhang ZL, Zhu HM…
Clin Interv Aging 2014
PMID: 24426779 | Free Full Text

Omega-3 Associated with Peak Bone Density in Men

Abstract

n-3 Fatty acids are positively associated with peak bone mineral density and bone accrual in healthy men: the NO2 Study.

Knowledge of the influence of nutritional intake on bone health is limited. Polyunsaturated fatty acids have been suggested to influence bone growth and modeling in humans, although data are sparse.
The objective was to investigate the role of fatty acids in bone accumulation and the attainment of peak bone mass in young men.
The cohort studied consisted of 78 healthy young men with a mean age of 16.7 y at baseline. Bone mineral density (BMD; in g/cm(2)) of total body, hip, and spine was measured at baseline and at 22 and 24 y of age. Fatty acid concentrations were measured in the phospholipid fraction in serum at 22 y of age.
Concentrations of n-3 fatty acids were positively associated with total BMD (r = 0.27, P = 0.02) and spine BMD (r = 0.25, P = 0.02) at 22 y of age. A positive correlation between n-3 fatty acid concentrations and the changes in BMD at the spine (r = 0.26, P = 0.02) was found between 16 and 22 y of age. Concentrations of docosahexaenoic acid (DHA, 22:6n-3) were positively associated with total BMD (r = 0.32, P = 0.004) and BMD at the spine (r = 0.30, P = 0.008) at 22 y of age. A positive correlation was also found between DHA concentrations and the changes in BMD at the spine (r = 0.26, P = 0.02) between 16 and 22 y of age.
The results showed that n-3 fatty acids, especially DHA, are positively associated with bone mineral accrual and, thus, with peak BMD in young men.

Högström M, Nordström P, Nordström A
Am. J. Clin. Nutr. Mar 2007
PMID: 17344503 | Free Full Text

Butyrate Stimulates Bone Formation and Suppresses Osteoclasts In Vitro

Abstract

Sodium butyrate stimulates mineralized nodule formation and osteoprotegerin expression by human osteoblasts.

Butyric acid (sodium butyrate; BA) is a major metabolic by-product of main periodontopathic bacteria present in subgingival plaque. In the present study, we examined the effects of BA on cell proliferation, alkaline phosphatase (ALPase) activity, mineralized nodule formation, extracellular matrix protein expression, macrophage colony-stimulating factor (M-CSF), and osteoprotegerin (OPG) in normal human osteoblasts.
The cells were cultured with 0, 10(-8), 10(-6) or 10(-4)M BA for up to 12 days. Mineralized nodule formation was detected by alizarin red staining, and the calcium content in mineralized nodules was determined using a calcium assay kit. The gene and protein expression levels for type I collagen, bone sialoprotein (BSP), osteopontin (OPN), M-CSF, and OPG were examined using real-time PCR and ELISA, respectively.
Mineralized nodule formation and the calcium content of mineralized nodules were increased by BA in a dose-dependent manner. Cell proliferation and ALPase activity were not affected by the addition of BA. Following the addition of 10(-4)M BA, the expression levels of BSP, OPN, and OPG increased, whereas the expression levels of type I collagen and M-CSF were not markedly affected.
These results suggest that BA stimulates bone formation by increasing the production of BSP and OPN, whereas it suppresses osteoclast differentiation by increasing the production of OPG by human osteoblasts.

Katono T, Kawato T, Tanabe N, Suzuki N…
Arch. Oral Biol. Oct 2008
PMID: 18406397

High Omega-6:Omega-3 Ratios Increase Fracture Risk and Doubles Risk for Ratios > 6

Abstract

The association of red blood cell n-3 and n-6 fatty acids with bone mineral density and hip fracture risk in the women’s health initiative.

Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFA) in red blood cells (RBCs) are an objective indicator of PUFA status and may be related to hip fracture risk. The primary objective of this study was to examine RBC PUFAs as predictors of hip fracture risk in postmenopausal women. A nested case-control study (n = 400 pairs) was completed within the Women’s Health Initiative (WHI) using 201 incident hip fracture cases from the Bone Mineral Density (BMD) cohort, along with 199 additional incident hip fracture cases randomly selected from the WHI Observational Study. Cases were 1:1 matched on age, race, and hormone use with non-hip fracture controls. Stored baseline RBCs were analyzed for fatty acids using gas chromatography. After removing degraded samples, 324 matched pairs were included in statistical analyses. Stratified Cox proportional hazard models were constructed according to case-control pair status; risk of fracture was estimated for tertiles of RBC PUFA. In adjusted hazard models, lower hip fracture risk was associated with higher RBC α-linolenic acid (tertile 3 [T3] hazard ratio [HR]: 0.44; 95% confidence interval [CI], 0.23-0.85; p for linear trend 0.0154), eicosapentaenoic acid (T3 HR: 0.46; 95% CI, 0.24-0.87; p for linear trend 0.0181), and total n-3 PUFAs (T3 HR: 0.55; 95% CI, 0.30-1.01; p for linear trend 0.0492). Conversely, hip fracture nearly doubled with the highest RBC n-6/n-3 ratio (T3 HR: 1.96; 95% CI, 1.03-3.70; p for linear trend 0.0399). RBC PUFAs were not associated with BMD. RBC PUFAs were indicative of dietary intake of marine n-3 PUFAs (Spearman’s rho = 0.45, p < 0.0001), total n-6 PUFAs (rho = 0.17, p < 0.0001) and linoleic acid (rho = 0.09, p < 0.05). These results suggest that higher RBC α-linolenic acid, as well as eicosapentaenoic acid and total n-3 PUFAs, may predict lower hip fracture risk. Contrastingly, a higher RBC n-6/n-3 ratio may predict higher hip fracture risk in postmenopausal women.

Orchard TS, Ing SW, Lu B, Belury MA…
J. Bone Miner. Res. Mar 2013
PMID: 23018646 | Free Full Text

The full text has a nice chart showing the hazard ratios for the various fatty acids they looked at.

The Omega-6:Omega-3 ratios and their respective hazard ratios were:

Omega-6:Omega-3 Ratio 1.48–5.00 5.01–6.07 6.08–10.59
Hazard Ratio 1.00 1.28 (0.71–2.30) 1.96 (1.03–3.70)

[Hazard Ratios] for hip fracture by tertiles of RBC FAs with multivariate adjustment for risk factors per Robbins and colleagues37 are reported in Table 3. No significant associations were found between RBC total SFA, MUFA, or PUFA and risk of hip fracture. However, there was a significant inverse linear association between hip fracture risk and total n-3 FAs in RBCs (p for linear trend 0.0492). When examining individual n-3 FAs, there was a 56% lower relative risk of hip fracture with highest RBC ALA (tertile 3 [T3] hazard ratio [HR]: 0.44; 95% CI, 0.23–0.85; p for linear trend 0.0154), and a 54% lower hip fracture risk with highest EPA levels (T3 HR: 0.46; 95% CI, 0.24–0.87; p for linear trend 0.0181) compared to T1. Neither DHA nor the n-3 index was significantly associated with risk of fracture. In contrast, hip fracture risk nearly doubled in women in the highest tertile of the n-6/n-3 FA ratio (HR T3: 1.96; 95% CI, 1.03–3.70; p for linear trend 0.0399). Because the n-6/n-3 FA ratio in RBCs primarily reflects the ratio of AA to EPA and DHA, we further examined the relation of the AA/EPA + DHA ratio to hip fracture risk. Similar to the n-6/n-3 FA ratio, a higher AA/EPA + DHA ratio produced higher HR for hip fracture, but the association was not significant (T3 HR: 1.69; 95% CI, 0.86–3.31; p for linear trend 0.1242). Although the direction of association between total n-6 FAs, AA, and hip fracture was toward harm, there was no significant relation of either total n-6 FAs or AA with hip fracture. There was an inverse direction of association between LA and hip fracture risk, but again, this was not statistically significant (T3 HR: 0.77; 95% CI, 0.40–1.49; p for linear trend 0.5140). Inclusion of additional potential confounders (alcohol consumption, total energy intake, total calcium intake, total vitamin D intake, and multivitamin use) in the model produced similar results….

Phloretin Reduces Osteoclast Size by Inhibiting Aquaporin 9 In Vitro

Abstract

Involvement of aquaporin 9 in osteoclast differentiation.

Aquaporins (water channels) selectively enhance water permeability of membranes. Since osteoclast differentiation includes a dramatic increase in cell volume, we hypothesize that aquaporin(s) is/are critical for the formation of the multinucleated osteoclast from its mononuclear precursor. Our studies employ two cell models, bone marrow macrophages (BMMs) and the murine macrophage-like cell line, RAW264.7, as osteoclast precursors. Receptor activator of nuclear factor kappaB (NF-kappaB) ligand (RANKL) and macrophage-colony-stimulating factor or RANKL alone were used to induce osteoclast differentiation in BMMs or RAW264.7 cells, respectively. We first used qualitative reverse transcription (RT)-PCR to examine which of the aquaporins are expressed in osteoclasts and in their precursor cells. Out of the 10 aquaporins examined, only aquaporin 9 (AQP9) was expressed in osteoclast-lineage cells. AQP9 has unique aqueous pore properties mediating the passage of a wide variety of non-charged solutes in addition to water. Western analyses using specific antibodies revealed a higher AQP9 level in RANKL-treated than in untreated cells. Quantitative real-time RT-PCR analyses also demonstrated higher AQP9 mRNA levels in RANKL-treated cells. Finally, we examined the effect of phloretin, an AQP9 inhibitor, on RANKL-induced osteoclast differentiation. Cells were incubated with RANKL for 5 days, and phloretin was added for the last 2 days, when most fusion occurs. A dramatic reduction in osteoclast size and in the number of nuclei per osteoclast was observed in cultures containing phloretin. The inhibitor did not have a significant effect on the number and size of mononuclear phagocytes in cultures not treated with RANKL. Our results suggest a role for AQP9 in osteoclast differentiation, specifically in the fusion process.

Aharon R, Bar-Shavit Z
J. Biol. Chem. Jul 2006
PMID: 16698796 | Free Full Text

Naringenin Derivative has Bone Anabolic Effects

Abstract

A naturally occurring naringenin derivative exerts potent bone anabolic effects by mimicking oestrogen action on osteoblasts.

Naringenin and its derivatives have been assessed in bone health for their oestrogen-‘like’ effects but low bioavailability impedes clinical potential. This study was aimed at finding a potent form of naringenin with osteogenic action.
Osteoblast cultures were harvested from mouse calvaria to study differentiation by naringenin, isosakuranetin, poncirin, phloretin and naringenin-6-C-glucoside (NCG). Balb/cByJ ovariectomized (OVx) mice without or with osteopenia were given naringenin, NCG, 17β-oestradiol (E2) or parathyroid hormone (PTH). Efficacy was evaluated by bone microarchitecture using microcomputed tomography and determination of new bone formation by fluorescent labelling of bone. Plasma levels of NCG and naringenin were determined by HPLC.
NCG stimulated osteoblast differentiation more potently than naringenin, while isosakuranetin, poncirin or phloretin had no effect. NCG had better oral bioavailability than naringenin. NCG increased the mRNA levels of oestrogen receptors (ERs) and bone morphogenetic protein (an ER responsive gene) in vivo, more than naringenin. In OVx mice, NCG treatment in a preventive protocol increased bone formation rate (BFR) and improved trabecular microarchitecture more than naringenin or E2. In osteopenic mice, NCG but not naringenin, in a therapeutic protocol, increased BFR and improved trabecular microarchitecture, comparable with effects of PTH treatment. Stimulatory effects of NCG on osteoblasts were abolished by an ER antagonist. NCG transactivated ERβ but not ERα. NCG exhibited no uterine oestrogenicity unlike naringenin.
NCG is a potent derivative of naringenin that has bone anabolic action through the activation of osteoblast ERs and exhibited substantial oral bioavailability.

Swarnkar G, Sharan K, Siddiqui JA, Mishra JS…
Br. J. Pharmacol. Mar 2012
PMID: 21864313 | Free Full Text

Calcium Threonate may Influence Bone Mineralization Through its Action on Vitamin C

Abstract

Pharmacokinetics and safety of calcium L-threonate in healthy volunteers after single and multiple oral administrations.

To evaluate the pharmacokinetics of L-threonate after single or multiple oral administrations and its safety profile in healthy Chinese volunteers. This was an open-label, single- and multiple-dose study. The subjects were assigned to receive a single dose, 675, 2025, or 4050 mg, of calcium L-threonate (n=12) or repeated doses of 2025 mg twice daily for 4 d (n=12). Serial plasma and urine samples were analyzed with HPLC-MS/MS. Pharmacokinetic parameters of L-threonate were calculated using non-compartmental analysis with WinNonlin software.
In the single dose group, C(max) reached at 2.0 h and the mean t(1/2) was approximately 2.5 h. Area under curve (AUC) and C(max) increased with dose escalation, but dose proportionality was not observed over the range of 675 to 4050 mg. AUC and C(max) in the fasted subjects were lower compared with those in the non-fasted subjects. Cumulative urinary excretion of L-threonate over 24 h represented 5.9% of the administered dose with a mean Cl/r of 0.8 L/h. In the multiple-dose study, no accumulation appeared upon repeated doses of 2025 mg twice daily for 4 d. There were no serious adverse events that occurred during this study.
Calcium L-threonate was well tolerated in healthy Chinese subjects, with no pattern of dose-related adverse events. Plasma exposure increased with dose escalation, but linear pharmacokinetics were not observed over the studied doses. L-threonate was absorbed rapidly, and its absorption was enhanced by food intake. No systemic accumulation appeared after repeated administrations.

Wang HY, Hu P, Jiang J
Acta Pharmacol. Sin. Dec 2011
PMID: 21986570 | Free Full Text

The introduction is the most interesting part of the article.

L-Threonic acid is an active metabolite of vitamin C5, 6, 7, 8. It has been reported that L-threonic acid exhibits significant stimulatory action on vitamin C uptake and prolongs the retention of vitamin C in human T-lymphoma cells9, 10. It is also well known that vitamin C is a marker for osteoblast formation and has been shown to stimulate procollagen and enhance collagen synthesis11, 12, 13, 14. Therefore, L-threonic acid may play a role in the mineralization process through its positive action on vitamin C. This hypothesis was confirmed in 1999 by Rowe DJ15. It was reported that in vitro treatment with ascorbate-containing vitamin C metabolites enhanced the formation of the mineralized nodules and collagenous proteins and that L-threonate was one of the metabolites that was found to influence the mineralization process15. Recently, a preclinical study was performed to investigate the effect of L-threonate on bone resorption of rabbit osteoclasts16. This study contained a total of six culture groups, including one control group and five groups treated with drugs (calcium L-threonate, sodium L-threonate, alendronate, 17β-estradiol and calcium gluconate). The levels of type I collagen C-telopeptide (CTx) and bone slice resorptive area were measured. This study found that L-threonate, especially calcium L-threonate, inhibited the bone resorption of osteoclasts in vitro; however, the reductive effects on the CTx level and resorptive area were not as significant as alendronate and 17β-estradiol at the same concentration.

Calcium L-threonate ((2R,3S)-2,3,4-trihydroxy butyric acid calcium) (Figure 1) is a novel drug developed for the treatment of osteoporosis and as a calcium supplement. Phase I clinical trials of calcium L-threonate, including tolerance, pharmacokinetics and calcium absorption evaluation, were performed in Peking Union Medical College Hospital. In this paper, the pharmacokinetics of L-threonate after single or multiple oral administrations and its safety profile in healthy Chinese volunteers are presented.

Glutamine Minimal Benefit for Healing Fractures in Rats

Abstract

A controlled trial of glutamine effects on bone healing.

Glutamine is considered a nonessential amino acid, but it may be conditionally essential in patients with catabolic conditions. For centuries, researchers have looked for ways to promote and accelerate fracture healing. This controlled animal study examines the effects of glutamine on fracture healing. The left tibias of 10 standardized albino rats were broken at the distal third to produce a closed fracture. L-glutamine/L-alanyl solution (2.0 mL/kg) was administered through the tail veins of half the rats for the first 7 d, and physiologic serum alone was given to the control group. On the 21st day, all rats were euthanized and their left legs removed; after histologic observation, the tibias were examined under light microscopy. In the glutamine-injected group, development of primary callus was quicker and more regular than in the control group. The control group produced insufficient fibrous callus, and the glutamine group attained formed cartilaginous callus. Glutamine was noted to have positive effects on healing of traumatically fractured bone through attainment of positive nitrogen balance. This effect was minimal in enhancing the quality of fracture healing under conditions of stress, but some effect was noted on the speed of healing. Further research is needed in this area.

Polat O, Kilicoglu SS, Erdemli E
Adv Ther
PMID: 17526472