by Andrew W. Saul

You either have to prevent loss of bone mass, or increase it later if you don't.  While estrogen therapy slows bone loss, it does not stop bone loss; it does not prevent bone loss; it does not reverse bone loss. But optimum nutrition can, without estrogen's accompanying risks.

When most people consider nutrient therapy for osteoporosis, they tend to first think of calcium. Actually, the correlation of calcium deficiency with osteoporosis not very good. It is true that most American adults don't get enough calcium each day; the average intake is 600 mg or so. (The DRI/RDA is about 1,000 mg.) But persons in Third World countries get about the same amount. The big difference is that Third World countries have much less osteoporosis than do Western nations.

This is probably because the most important factors are deficiencies of other nutrients. Vitamins and trace minerals affect bone, directly and indirectly. For example:


Vitamin C deficiency weakens bones. I think we need several thousand mg of vitamin C every day, and more during illness.

(Kipp DE, Grey CE, McElvain ME, Kimmel DB, Robinson RG, Lukert BP. Long-term low ascorbic acid intake reduces bone mass in guinea pigs. J Nutr. 1996 Aug;126(8):2044-9. And: Kipp DE, McElvain M, Kimmel DB, Akhter MP, Robinson RG, Lukert BP. Scurvy results in decreased collagen synthesis and bone density in the guinea pig animal model. Bone. 1996 Mar;18(3):281-8. Erratum in: Bone 1996 Oct;19(4):419.)


A lack of magnesium may be one explanation for the low correlation between osteoporosis and calcium. Magnesium regulates active calcium transport, and magnesium supplementation has been shown to increase bone density. (Sojka JE, Weaver CM. Magnesium supplementation and osteoporosis. Nutr Rev. 1995 Mar;53(3):71-4. And: Dimai HP, Porta S, Wirnsberger G, Lindschinger M, Pamperl I, Dobnig H, Wilders-Truschnig M, Lau KH. Daily oral magnesium supplementation suppresses bone turnover in young adult males. J Clin Endocrinol Metab. 1998 Aug;83(8):2742-8.)

The DRI/RDA is around 350-400 mg. I think we need 600 mg/day, taken in divided doses. The most common supplemental form of magnesium is magnesium oxide, which is poorly absorbed. Magnesium citrate, magnesium chloride, or any of several other more expensive forms are absorbed far better. If you are on a budget, select inexpensive magnesium citrate.


The US National Institutes of Health statement on “Vitamin D and Osteoporosis” ( http://ods.od.nih.gov/factsheets/vitamind.asp ) says in part: “While rickets and osteomalacia are extreme examples of vitamin D deficiency, osteoporosis is an example of a long-term effect of vitamin D insufficiency. . .  In a review of women with osteoporosis hospitalized for hip fractures, 50 percent were found to have signs of vitamin D deficiency.” (M. A. Mikati, L. Dib, B. Yamout, R. Sawaya, A. C. Rahi, and G. El-Hajj Fuleihan. Two randomized vitamin D trials in ambulatory patients on anticonvulsants: Impact on bone. Neurology, 2006; 67: 2005-2014. )

Vitamin D increases your body’s absorption of calcium and phosphate. People should have optimum levels of D3, but many do not. (LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA. 1999 Apr 28;281(16):1505-11.)

Vitamin D supplementation (2,000 IU/day preventively; 5,000 IU/day therapeutically) may be a particularly good way to increase bone density provided you also take or eat vitamin K. it will do the most good. 


Vitamin K helps strengthen bone. Adding lots of green leafy vegetables to your diet is the best overall way to get lots of vitamin K. Yes, this will be K1, and many a supplement manufacturer will try to tell you that you need K2. Well, you do . . . and your body will make the conversion.

John Cannell, MD writes:

"It is commonly believed that the body cannot make vitamin K2 from vitamin K1 so you have to take K2 supplements. . . As early as 1994, researchers had discovered that K1 converted into K2 in the body. [Thijssen HH, Drittij-Reijnders MJ. Vitamin K distribution in rat tissues: dietary phylloquinone is a source of tissue menaquinone-4. Br J Nutr. 1994 Sep;72(3):415-25.] In 2006, researchers confirmed this conversion takes place in humans. [Thijssen HH, Vervoort LM, Schurgers LJ, Shearer MJ. Menadione is a metabolite of oral vitamin K. Br J Nutr. 2006 Feb;95(2):260-6.] . . . Recently, the mechanism by which the body turns vitamin K1 into vitamin K2 was clarified. It occurs through an intermediary molecule, vitamin K3, which is made in the intestine from vitamin K1. [Hirota Y, et al. Menadione (vitamin K3) is a catabolic product of oral phylloquinone (vitamin K1) in the intestine and a circulating precursor of tissue menaquinone-4 (vitamin K2) in rats. J Biol Chem. 2013 Sep 30.] I cannot put my hands on it now, but I read a paper that actually showed K2 content in peripheral organs is higher after vitamin K1 ingestion than K2 ingestion. It seems that it could be the case that modern humans are deficient in K2 because they do not eat large quantities of vitamin K1 containing foods. If we look at Paleolithic humans, they probably got high amount of vitamin K2 from eating large quantities of kale and spinach-like foods, very high in K1, which then supplied their tissues with all the vitamin K2 they needed. [A]s far as getting enough vitamin K2, the best thing to do is eat your greens." [https://www.vitamindcouncil.org/dr-cannell-on-vitamin-k2/]


Yes, calcium is still important. Osteoporosis is much more common in women than men. In most females' diets, a "negative calcium balance" (read "deficiency") begins at about age 35 which will become twice as bad by menopause. To help prevent osteoporosis, young and middle aged women should be encouraged to eat calcium. Pretty obvious advice; certainly teenagers are growing like weeds, and they need the minerals. But they need all the minerals, not just calcium. With females especially, the time to pack calcium into bone is before menopause, when hormonal levels are optimal for such a task. 

Can bones be remineralized in old age? The test of this theory is simply to give more calcium, and the vitamin D necessary for its uptake into bone.  It has been done, and it works. Over a period of six months, an average of just under 1,200 mg of calcium daily plus vitamin D improved bone density in osteoporotic women over 70 years of age. (Lee, Lawler and Johnson. "Effects of Supplementation of the Diets with Calcium and
Calcium-rich Foods on Bone Density of Elderly Females with Osteoporosis," American Journal of Clinical Nutrition, 34:819-823, May 1981) 


Estrogen does not make bones stronger. As a matter of fact, "Estrogen administration will cause a marked reduction in bone remodeling rates which may actually increase the risk of fracture." (R. R. Recker, M.D., "Osteoporosis," Contemporary Nutrition, Vol. 8, number 5, May 1983.)  Since estrogen therapy carries a nearly tenfold risk of endometrial cancer (Associated Press, November 26, 1992), nutrient therapy makes a lot of sense.  If you wonder why it is not promoted more enthusiastically, I suggest that it may make a lot of sense but does not make a lot of dollars. The medical and pharmaceutical industries stand to profit rather little from such a cheap cure as vitamin D and minerals. 

But Grandma stands to gain a great deal. Remember that fractures and their complications are a major cause of death in the elderly.  Up to "27% of all hip fracture victims die within six months of their fall, usually of complications following surgery or from infections." (J. M. Mitric, Maturity News Service, November 15, 1992) Probably "90% of all fractures past age 60 are due to osteoporosis." (R. R. Recker, M.D., "Osteoporosis," ibid.) 

Nutritional therapy can save lives as well as bones. 

1.  "High intakes of alcohol, caffeine and protein cause significant negative calcium balance." (R. R. Recker, "Osteoporosis," ibid.) 

Believe it or not, "70% of elderly hospitalizations in 1991 were for alcohol related problems." (Newsletter of the New York State Office of Alcoholism and Substance Abuse Services, 1:1, Sept.- Oct. 1992)  Outside of inadequate diet, alcohol is the most likely silent partner there is in osteoporosis and resulting fractures. 

Caffeine is found in many soft drinks and diet aids as well as in extra-strength pain relievers. There is certainly little food value in coffee. 

Americans consume about 100 grams of protein daily, three times the world average and at least twice as much as we need.  Eat less meat, or none at all, and the risk of osteoporosis declines.  An unprocessed, plant-based diet is a good source of minerals. 

2.  Exercise helps BUILD bone.  Walking is ideal, but whatever exercise program you will actually do regularly is the best for you. 

3.  Boron, a trace mineral, helps strengthen bone.  Even calcium deficient rats "had vertebrae that contained higher calcium content and required more force to break than the vertebrae of rats fed a low boron diet." (Neilsen, F. H. "Ultratrace Minerals," Contemporary Nutrition, Vol. 15, number 7, 1990)  Urinary excretion of calcium and magnesium is higher when either rats or humans are boron deficient.  How much boron do we need to help prevent osteoporosis?  Probably between 0.5 and 3 mg daily, with 1 mg/day commonly suggested. 

4.  A diet of natural, organically grown, mineral-rich food makes stronger bones and speeds healing of broken ones.  Did you ever wonder where all the topsoil went that blew off the Midwest plains during the Dust Bowl?  Apparently it landed in Deaf Smith County, Texas. (L. B. Barnett, M.D. "New Concepts in Bone Healing," Journal of Applied Nutrition, vol. 7, pp 318-323) The average age for a broken hip in Dallas County, Texas is 63 years.  In Deaf Smith County, it is 81 years of age.  The average time for the fracture to heal in Dallas County is 6 to 9 months. In Deaf Smith County, it
is 8 WEEKS!  Not bad for better dirt. 

5.  Cigarette smoking is a known risk factor in osteoporosis. No surprise there. Less than 30% of Americans still smoke, but that is still a lot of osteoporosis waiting to show itself. 

6.  Not only does fluoridation fail to protect bones from fracture, it actually contributes to INCREASED fractures.  A review of the subject entitled "Fluoridation and Osteoporosis" was authored by John R. Lee, M.D., and published in the National Fluoridation News, Volume 32, numbers 1 and 2, 1986-7.  Medical World News ran articles on increased fractures due to fluoride on October 23, 1989 and November 13, 1989.  A lengthy and remarkably unbiased review of the detrimental effects of "Fluoridation of Water" appeared in Chemical and Engineering News, Vol. 66, August
1, 1988, pp 26-42.  Additional confirmation of fluoride's contribution to fractures will be found in the Journal of the American Medical Association, July 25, 1990, June 19, 1991 and July 24, 1991; American Journal of Epidemiology, April 15, 1991; and the American Journal of Public Health, July, 1990. 

It gets even more dramatic: both the National Toxicology Program (January 22, 1990 Fact Sheet) and the National Cancer Institute found a fluoride-related increase in osteosarcoma (a bone cancer) in young males ("Review of Fluoride Benefits and Risks," U.S. Public Health Service, February, 1991.) 

Did you know that the National Parent-Teachers Association withdrew its support for fluoridation on April 17, 1991? 

Unlike water fluoridation, calcium supplementation has shown some pleasing side effects.  A study of over 12,000 adults taking 1,000 mg. of supplemental calcium daily before age 40 showed a 25% reduction in risk of developing high blood pressure (D. Q. Haney, The Associated Press, November 1992).  About 1,200 mg calcium daily may protect against colon cancer, even in persons with a family cancer history, and with a
precancerous colon already.  "Before they took the calcium, the cells of their colon linings were producing new cells, or proliferating, at a relatively high rate.  But after taking the supplements two to three months, their colon linings resembled those following vegetarian diets." (D.Q. Haney, The News Journal - Associated Press, Wilmington, DE, November 28, 1985)  This speaks as well of vegetarianism as it does of calcium. 

There are over 250,000 hip fractures annually among persons over age 65.  It is time to bone up on nutrition. 

Copyright  C  2004, 2003 and prior years Andrew W. Saul. REVISED and copyright 2019.

Andrew Saul is the author of the books FIRE YOUR DOCTOR! How to be Independently Healthy (reader reviews at http://www.doctoryourself.com/review.html ) and DOCTOR YOURSELF: Natural Healing that Works (reviewed at http://www.doctoryourself.com/saulbooks.html ) .


Andrew W. Saul


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