An osteoporosis pain treatment menu

A diet, supplement and exercise model for osteoporosis pain treatment and patient health

Osteoporosis is the most common bone disease worldwide. If undetected and untreated, it causes millions of fractures and mortality.¹ Many factors influence bone health by promoting, directly or indirectly, the formation or loss of bone mineral. Just as a house needs a strong foundation and sound framing, healthy bone requires multiple raw materials to build a structure that can withstand inevitable stresses without a failure.  In the human skeleton, this begins with diet for osteoporosis pain treatment.

Balanced diet and exercise

Bone, as living tissue, needs adequate nutrition. Poor diet is a risk factor for osteoporosis.

General dietary guidelines for prevention include eating whole foods (vs. processed), adequate protein, dark green leafy vegetables, and avoiding excess sugar and alcohol.^2-4

These are important for the maintenance of all body systems and osteoporosis pain treatment. Many western diets are deficient in several of the elements and compounds necessary to build and retain a healthy skeleton.

In regard to exercise and injury, the strongest single risk factor for hip fracture is falling.^5,6 Any exercise that improves balance and/or muscle strength will reduce fall risk.

In addition, high-impact and strength training exercise places a load on bone, causing it to increase strength, density and mass.⁷ This is stated in Wolff’s law, where bone will form in response to mechanical stress.^8-10

Calcium underconsumption and overconsumption

The relationship of calcium consumption to bone health is often overstated, oversimplified and controversial.

For example, the U.S. RDA for calcium for adults is 800-1,200 mg/day. Some European researchers dispute this, suggesting a practical allowance of 400-500 mg/day.¹¹ Other researchers state that less than 300 mg/day are needed.^12,13

Increasing calcium intake is important if there is deficiency.^14,15 Overconsumption of calcium does not add measurable gains. There is mixed data on the correlation between calcium or dairy consumption and bone health.^16-22

Osteoporosis pain treatment and minerals and vitamins

Several minerals and vitamins are needed for the skeleton, either directly as a building block, or to enhance a chemical reaction necessary for bone formation or repair.

Bone is active, living tissue that constantly renews itself in a process called remodeling. Osteoclasts remove old cells from bone tissue, transferring them into the bloodstream, creating small holes. Osteoblasts fill the holes with a “mortar” of calcium, minerals and collagen proteins to aid with osteoporosis pain treatment.

Vitamins D and K

Vitamin D facilitates the absorption of calcium in the gut and calcium reabsorption in the kidneys. Vitamin D deficiency is a global problem, with approximately 42% of the U.S. population deficient.

Sunshine (specifically ultraviolet B) striking exposed skin is the main source of vitamin D. Skin pigment (melanin) inhibits its synthesis. Therefore, darker-skinned people have an increased incidence of vitamin D deficiency. African Americans have the highest levels of vitamin D deficiency at 82%, followed by Hispanics at 70%.²³

Obesity adds to these rates, as vitamin D is oil-soluble and is incorporated into body fat. Patients with a Body Mass Index of more than 30 need 2-3 times more vitamin D, from whatever source, as compared with people at optimum body weight.²⁴

Vitamin K has been demonstrated to have a synergistic effect with vitamin D in the synthesis of osteocalcin, an essential bone protein.^25,26 Studies using vitamin K1 (phylloquinone) have had both positive and negative results. However, vitamin K2 (menaquinone), especially the isoforms K2M4 (MK-4) and K2M7 (MK-7), have consistently demonstrated positive effects on bone quality and the prevention of fractures.²⁷

Other minerals and vitamins

Magnesium induces osteoblast proliferation and is a co-factor needed for the activation of vitamin D²⁵. Its deficiency is associated with reduced bone formation.^29,30

In spite of its importance, up to 68% of American adults don’t meet the recommended daily allowances for magnesium of 310-360 mg (for women) and 400-420 mg (for men).³¹ Approximately 50–60% of the total body magnesium content is accumulated in bone. To date, no randomized studies have evaluated the effect of magnesium, in isolation, on bone.^32,33 

Several trials demonstrate the benefits of trace minerals including manganese, zinc, boron and strontium for osteoporosis pain treatment.^28,34-39 Given the known interdependence of nutrients, combination therapies, by design, enhance the likelihood of successful prevention and treatment.

Vitamins other than D and K needed for bone health include: folate, B6, B12 and vitamin C.^40-42  The need for a spectrum of raw materials to build healthy bone is intuitively obvious and has been demonstrated in numerous studies.^43,44

The roles of vitamin C are a good example of the varied effects of nutrients. It is an antioxidant, suppresses osteoclast activity, acts as a co-factor for osteoblast differentiation, and is needed for collagen formation.⁴⁵ Vitamin C intake is positively associated with higher bone mineral density⁴⁶ and lower rates of hip fracture.⁴⁷

Fish oil, melatonin, protein and bone health

The consumption of wild fish and their polyunsaturated fatty acids such as EPA and DHA have been suggested to influence bone health through several mechanisms, including: opposing effects on inflammatory cytokines, modulation of prostaglandin E₂ (PGE₂) production, enhancement of calcium transport, and reducing urinary calcium excretion.⁴⁸

Aside from the well-known influence on sleep, melatonin appears to both enhance anabolic effects and have antiresorptive benefits. Melatonin improves bone formation by promoting the differentiation of mesenchymal cells into osteoblasts. Bone resorption is diminished by reducing the synthesis of RANKL, a compound known to accelerate skeletal losses.^49,50

Dietary protein is essential for bone health. Approximately 50% of bone volume or 33% of bone mass is composed of proteins.⁵¹ Collagen and osteocalcin are structural proteins. Other proteins are functional, involved in secretion of hormones, calcitriol synthesis, and influence intestinal absorption. The recommended protein intake is 1.0-1.2g/kg per body weight/day.⁵²

Prunes and additional compounds

No single food has as wide a spectrum of skeletal benefit as prunes.

Several studies have demonstrated the mechanisms of action that enhance bone health. Prunes increase bone formation,^53,54 increase trabecular microstructure,⁵⁵ decrease osteoclastogenesis,⁵⁵ and decrease RANKL.⁵⁶ Each of these traits leads to a decrease in fracture risk.⁵⁷

Several other compounds could be considered, above and beyond those mentioned. These include: soy isoflavones, ipriflavone, dehydroepiandrosterone (DHEA), and Cissus quadrangularis. Sex steroid hormones are also bone protective, as the declines of testosterone and estrogen, associated with aging, can be a major influence on skeletal health and fracture risk.⁵⁸

Supporting the skeleton

The living skeleton is highly vascularized, metabolically active and constantly responding to its environment. Bone consists of organic compounds (mostly collagen type 1 protein) and inorganic calcium hydroxyapatite (Ca₁₀ (PO₄)₆ (OH)₂), plus other minerals.⁵⁹ A robust skeleton depends upon not only the protein matrix and hydroxyapatite for structural materials, but several vitamins to signal and augment the processes needed for bone formation and retention.

A daily balanced diet

Below is a composite of lifestyle and supplements shown to enhance bone health:

Protein ― 1.0-1.2 g/kg of body weight (meat, legumes, dairy, nuts)

Calcium ― RDA is 800-1,200 mg/day (dairy, broccoli family, calcium-fortified foods)

Minerals ― dark green leafy and colored vegetables, organ meat

Exercise ― High impact and balance (running, jumping, volleyball, Tai Chi, unipedal standing, dance, yoga)

Vitamin D3 ― exposure to noontime sunshine or 1,000-5,000 IU/day (blood level should be > 45 ng/ml, supplements best taken in morning)

Vitamin K2 ― 100-500 mcg/day (contraindicated if patient is taking a vitamin K-antagonist

anticoagulant)

Magnesium ― 250 mg/day (best in chelated form, e.g., citrate, aspartate…)

Melatonin ― 5 mg (take at bedtime)

Strontium ― 500-800 mg/day

Wild fish oil ― 250 mg/day (eicosapentanoic acid (EPA) and docosahexanoic acid (DHA))

Dried plums (prunes) ― 11 prunes/day (bowel tolerance increases if unsulfured)

Vitamin C ― 500-1,000 mg/ day

Boron ― 2 mg/day

Manganese ― 10-20 mg/day

Zinc ― 10-20 mg/day

Provide the body the necessary compounds for osteoporosis pain treatment

All prevention strategies and treatments are designed to target osteoclasts or osteoblasts, either directly or indirectly, or to provide the compounds necessary to support the renewal of the protein and mineral matrix and to address osteoporosis pain treatment.

Prescribing dietary/supplement/exercise/lifestyle interventions that are customized to individual patient’s needs requires more provider effort, but in the end will yield more positive outcomes.

ALAN COOK, DC, has been in practice since 1989. He ran the Osteoporosis Diagnostic Center (1996-2019), participated in four clinical trials, and has lectured nationally. He is current working with the Open Door Clinic system in a multi-disciplinary setting and is providing video-based continuing education with EasyWebCE. To see more of his work, go to EasyWebCE.com.

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