The Role Of Calcium Citrate and Magnesium
Supplementation in Bone Density
Daniel T. Wagner, R.Ph., Pharm.D., MBA, herbalist
Danielle E. Ladie, BS
Objectives: To assess the effectiveness of dietary calcium citrate, magnesium, and Vitamin D supplementation on T-SCORE and STIFFNESS Index related to Bone Density.
Methods: Using a randomized population of 110 women, their calcaneous bone density was measured with quantitative ultrasound using the LUNAR Achilles-plus Solo Ultrasonometer before and after 16 weeks of supplementation. The recommended daily dose of the study supplement was 1 tablet 3 times a day while remaining on their current medications.
Results: Maintaining the recommended daily dosage had a positive effect on 81.4% (+/-0.2%) of the women after 16 weeks. There were no reported severe adverse drug reactions. Non-digestion of the tablet occurred in less than 2% and was alleviated with a switch to an encapsulated related dosage.
Conclusion: The concern over the increased incidence of osteoporosis in the United States is alarming, but the common perception that bone density cannot be easily increased, regardless of age, may be premature. It appears conclusive in this study that magnesium may be as important, or perhaps more important, than calcium and vitamin D intake for the short-term increase in bone density, even though the importance of calcium and vitamin D (the most common single supplement taken by American women for osteoporosis prevention) is not being challenged in this study. This study does exhibit clearly the advantage of taking the combination of the three minerals, versus one or two, without regard to the drugs or other medicines a woman is taking to prevent osteoporosis or to improve her bone density.
Summary: Calcium citrate, magnesium, and Vitamin D dietary supplementation has a positive effect on the bone density of a high percentage of participants in only a 16 week trial period. This information may be beneficial in long term prevention and treatment of osteopenia and osteoporosis, as low bone mineral density is directly related to fractures in older women. (Albrecht, F. Magnesium-Many Splendored Mineral. Natural Pharmacy March, 1998. Pp 16-18).
Osteoporosis is a degenerative bone disease that results in a decrease in bone density and bone mass. The consequences of osteoporosis include an increased risk of fractures. More than 75 million people worldwide (25 million Americans) have osteoporosis. The disease is responsible for 1 million fractures in the U.S. each year, and more than 50% of American women over seventy years old have some form of osteoporosis (Percival, M. Bone Health and Osteoporosis. Clinical Nutrition Insights. 1998 5(4); 2-3). Women are affected by this disease six times more than men, although the prevalence of osteoporosis among men is steadily increasing.
The increased risks associated with loss of bone density as women age have been well documented. They include: a family history of osteoporosis, early onset of menopause, a small body frame and small bones, low body fat, hyperthyroidism, and nulli party. Women who are Caucasian and Asian also have a higher incidence of osteoporosis than other races. Lifestyle factors also play a major role: lack of exercise, smoking, excessive alcohol consumption, stress and distress (sympathetic hyperactivity), and low exposure to sunlight. Dietary factors that preclude osteoporosis may be a high-fat diet, excessive sugar and/or caffeine intake, high protein and phosphorus intake, and chronic inadequate calcium and vitamin D intake. Finally, risks of osteoporosis increase with chronic use of drugs like steroids, antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDS) (Frackiewicz, EJ, Cutler, NR. Women's Health Care During Perimenopause. Jrl of the American Pharmaceutical Association. Nov-Dec. 2000. 40(6); 800-809).
Four major misconceptions about osteoporosis are prevalent in our society.
The Calcium Issue
The most important element associated with bone mineral is calcium. There is overwhelming evidence that calcium plays an important role in the microstructure of bone. The problem of an increased incidence of osteoporosis in society may have to do more with calcium absorption and not intake. Actually, a significant amount of ingested calcium is concentrated by the kidneys and excreted in the urine. Dietary modifications can be made the help to prevent calcium excretion, thereby increasing the absorption of calcium by the bones.
There has also been scientific research into what form of calcium is best absorbed in the human digestive system. The common forms of calcium include calcium carbonate (oyster shell), calcium citrate, calcium gluconate, and calcium hydroxyapatite. For the purposes of this study calcium citrate was the chosen form of calcium that, based on theory, is best absorbed. Although calcium hydroxyapatite also has a record of a high absorption rate, it was more feasible in this study to incorporate calcium citrate because of cost, availability, and its reputation for having good absorption for the general population (LaValle, JB. Osteoporosis Update. Natural Pharmacy. September 2000. 4(8); 10-11).
Magnesium and Bone Loss
In 1998 the Journal of Clinical Endocrinology and Metabolism printed an article for research done at the University of Graz Medical School in Austria and the Loma Linda University in California suggesting that magnesium may be as important as calcium in promoting the achievement of peak bone mass. The researchers concluded that magnesium supplements (over and above the RDA, which is 300-400 mg per day) may suppress bone turnover and also help to prevent age-related osteoporosis.
Magnesium deficiency is common in osteoporosis. Magnesium promotes and regulates parathyroid hormone, which in turn stimulates osteoclasts (bone cells) to reabsorb calcified bone (Maher, TJ. Magnesium. Nutrition Science News. Dec, 1999. 4(12); Insert). Chronic low levels of magnesium are associated with low secretions of parathyroid hormone, which can result in leg cramps, tetany, back pain and bone pain. All of these symptoms can be reversed and relieved with supplementation of magnesium (Albrecht, F. Magnesium-Many Splendored Mineral. Natural Pharmacy March, 1998. Pp 16-18).
There is little doubt that magnesium plays a balancing role with calcium. If magnesium is not present in sufficient quantities, calcium plays the dominant role. Two-thirds of the magnesium in the body is stored in the bones and the teeth and the other third is in blood and body tissues especially in the brain. The suggested ratio of calcium to magnesium is 2:1 for optimum absorption (Gaby, A. Preventing and Reversing osteoporosis. Health Counselor. 1997. Impakt Communications Inc. p. 2-3).
SUBJECTS AND METHODS
There were mainly two groups of women who were incorporated into this Bone Density Study. The first group were women from a personal care nursing home facility and the second group was from the general public. The women at the nursing facility were chosen by the nurses as being compatible in a few ways. First, they would be willing and physically able to get an Achilles heal test. Secondly, they were capable of swallowing a calcium/magnesium/vitamin D tablet. Last of all, the nurses made determinations as to what patients would be compliant. When the initial Achilles heal tests were taken (July 2000), 34 patients were entered in the test. When the final bone density readings were taken on December 5, 2000, 27 women finished the test. In all cases, the nursing home patients were not charged for the supplements. It was deemed important that they did not resist in taking the supplements at the dosage suggested because of cost.
The second group of women were from the general public that frequented NutriFarmacy to buy their supplements and get consultations on the proper integration of conventional and alternative medicines. Seventy-six women signed up to do the osteoporosis study in August, 2000. These women also had an Achilles bone density screening, but they were charged for the supplement. It was felt that most of these women are already taking a calcium supplement and it would be to their benefit to know if there was an advantage in taking calcium/magnesium/vitamin D over calcium alone. Thirty-four of these women continued to take three tablets daily in order to meet the specifications of the test.
The machine used to do all of the bone density readings was the Achilles-plus Solo Ultrasonometer. Statistically, according to the operator's manual, 68% of the repeat scans fall within 1 SD. All participants were evaluated by measuring their T-SCORE and their STIFFNESS Index. The final statistics were evaluated on T-SCORE increase or decrease versus perspective age of patient.
Calcaneal Bone Mineral Density (BMD) was tested with the LUNAR Achilles-plus Solo (using the protocol provided by the manufacturer) in August of 2000. Recommendations were made as to Calcium/Magnesium/Vit D supplementation. The BMD of the compliant participants was retaken using the same machine after 15 weeks of daily supplementation. Quality assurance phantom scans were performed on a regular basis, and the machine was calibrated before each testing set.
RESULTS AND DISCUSSION
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|In the first set of women (nursing home), 28 of the 33 patients finished the study. Of the 28 women, 57% had an increase in their bone density. Ironically, of the 43% who decreased, 73% were taking a liquid Calcium/Magnesium supplement instead of the 2:1 tablet supplement (Figure 1). The liquid supplementation (containing calcium carbonate) was used to closely parallel the tablet supplementation because of swallowing difficulties.|
|In the second set of women (Nutri-Farmacy customers), of the 42 who finished the study, an astonishing 81.4% of the women increased their bone density (Figure 2).||
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click on image to enlarge
|There were T-Score increases from 0.1 up to an increase of 0.7. The largest percentage (20.9%) of women increased their T-Score by 0.3, with the average T-Score increase being 0.27 (Figure 3).|
Although decreased bone mass is the hallmark of osteoporosis, changes in bone matrix are also present, which could result in fragile or brittle bones that are more susceptible to fracture. There is growing evidence that magnesium may be an important factor in the qualitative changes in bone matrix that determines bone fragility. Since magnesium influences both mineral metabolism and matrix, it is apparent that magnesium depletion affects all stages of skeletal metabolism adversely, causing cessation of bone growth, decreased osteoblastic and osteoclastic activity, osteopenia, and bone fragility (Bauer, D.C., et al. Broadband Ultrasound Attenuation Predicts Fractures Strongly and Independently of Densitometry in Older Women. Archives of Internal Medicine. 1997; 157).
There is also a concern about taking excessive amounts of calcium (in any form) without adequate magnesium. There is evidence that excessive calcium could accelerate both osteoporosis and soft-tissue calcification without magnesium (LaValle, JB. Osteoporosis Update. Natural Pharmacy. September 2000. 4(8); 10-11). This situation would seem desirable if calcium balance is the sole criteria upon which osteoporosis results are based, but there appears to be proof to the contrary. It is interesting to note that human autopsy studies have shown a close correlation between osteoporosis and calcification of the abdominal aorta. Since magnesium deficiency can promote both osteoporosis and aortic calcification, it is possible that magnesium is the prime factor and that calcium is the secondary factor in bone density.
It is advisable to surmise that if one chooses to take large doses of calcium for bone density purposes, then they should consider increasing their magnesium intake as well. The traditional ratio is 2 mg of calcium for every 1 mg of magnesium. Many nutritional supplement programs provide 800 to 1,000 mg of calcium and 400-500 mg of magnesium daily. Surprisingly, there is virtually no research aimed at determining the optimal calcium/magnesium ratio in the diet. The results of this study would seem to substantiate that the 2:1 ratio is adequate.
1. Albrecht, F. Magnesium-Many Splendored Mineral. Natural Pharmacy March, 1998. Pp 16-18.
2. Percival, M. Bone Health and Osteoporosis. Clinical Nutrition Insights. 1998 5(4); 2-3.
3. Frackiewicz, EJ, Cutler, NR. Women's Health Care During Perimenopause. Jrl of the American Pharmaceutical Association. Nov-Dec. 2000. 40(6); 800-809.
4. Gaby, A. Preventing and Reversing osteoporosis. Health Counselor. 1997. Impakt Communications Inc. p. 2-3.
5. LaValle, JB. Osteoporosis Update. Natural Pharmacy. September 2000. 4(8); 10-11.
6. Maher, TJ. Magnesium. Nutrition Science News. Dec, 1999. 4(12); Insert.
7. Bauer, D.C., et al. Broadband Ultrasound Attenuation Predicts Fractures Strongly and Independently of Densitometry in Older Women. Archives of Internal Medicine. 1997; 157.
Dan Wagner is a natural pharmacist and herbalist from Gibsonia. He is owner of NutriFARMACY, Western Pennsylvania's only all natural pharmacy located in the North Hills on Wildwood Road. Dan has done extensive research on botanical medicines in the rainforests of Belize, Costa Rica, the Amazon, and Africa. He is president of The Student Rainforest Fund, a non-profit educational organization that takes college students studying the health sciences to Belize each year. As pharmacy specialist he is a board member of Global Links and The World Health Mission, two international voluntary organizations that send medicine, medical supplies, and equipment to hospital in the Third World. He has volunteered his services in Nigeria, Cuba, Ecuador, and Kenya. In April of 2000 he was awarded the American Pharmaceutical Association "Merit 2000 Award." Their highest award to an American pharmacist working freely on behalf of the profession and the world's needy. Visit Nutri-farmacy's website at www.nutrifarmacy.com for more articles and information, or call toll-free 1-877-289-7478.