Constructive Interactions among Nutrients and Bone-Active Pharmacologic Agents with Principal Emphasis on Calcium, Phosphorus, Vitamin D and Protein

Abstract

Current and emerging bone active pharmacologic agents are capable of producing substantial gains in bone mass. However, nutrition must be adequate if this potential is to be realized. Calcium and vitamin D supplementation, for example, have both been demonstrated to augment substantially the skeletal response to estrogen therapy in postmenopausal women. The bisphosphonates and selective estrogen receptor modulator (SERMs) have all been tested only in the context of supplemental calcium and vitamin D. Therefore, it cannot be assumed that these bone active agents would be effective in the absence of these nutrients. Adequate protein intake has also been demonstrated to protect bone mass in the elderly and to improve recovery from osteoporotic fractures. Phosphorus intake, less extensively studied, may be more important than currently recognized, particularly in elderly individuals living alone, eating little meat, and receiving anti-osteoporosis treatment agents.

• osteoporosis
• bone mass
• calcium
• vitamin D
• protein
• phosphorus
• bisphosphonates
• SERMs
• fluoride
• parathyroid hormone
• estrogen

Key teaching points:

• Bone gain in response to current and pending bone active agents creates a high requirement for calcium, phosphorus, and protein, which rivals that occurring at the adolescent growth spurt.

• Physiologic adaptability at mid life and thereafter is less than during growth.

• This is the reason for the higher intake requirements for calcium and vitamin D after age 50 to maintain the skeleton.

• Bone building agents impose an intake requirement higher than current DRIs, for at least calcium and possibly for protein and phosphorus as well.

Key teaching points:

• Bone gain in response to current and pending bone active agents creates a high requirement for calcium, phosphorus, and protein, which rivals that occurring at the adolescent growth spurt.

• Physiologic adaptability at mid life and thereafter is less than during growth.

• This is the reason for the higher intake requirements for calcium and vitamin D after age 50 to maintain the skeleton.

• Bone building agents impose an intake requirement higher than current DRIs, for at least calcium and possibly for protein and phosphorus as well.

Notes

Presented in part at Ross Products Research Conference on Medical Issues, “Synergy in Medical and Nutritional Therapy,” November 6–8, 2000, Key Largo, Florida.