More than 10 million Americans have the bone-weakening disease osteoporosis—approximately 15 percent of women and 4 percent of men over the age of 50. Another 34 million or so have osteopenia —below-normal bone density that may lead to osteoporosis. And every year, 2 million people with osteoporosis have a so-called osteoporotic fracture, usually of the hip, spine, or wrist.

Measuring the Threat

When osteoporotic fracture occurs
in the hip or spine, the results can
be devastating. Those suffering from hip fracture often tend to become depressed and sedentary. But worse, when Australian researchers in an 18-year study looked at more than 4,000 people age 60 and older, they found that almost any kind of osteoporotic fracture increased mortality risk.

Assessing your risk is the place
to start if osteoporosis seems likely.
A dual energy x-ray absorptiometry (DEXA) test measures bone mineral density (BMD). A score of -1 to -2.5 indicates osteopenia. A score under -2.5 signals osteoporosis. Most people and healthcare providers focus on just changing their bone denstiy test results; however, the most important osteoporosis questions you’re probably not asking is about fracture reduction. A BMD test is not a crystal ball. It predicts only 44% of women who will fracture and only 21% of men, for example.

The BMD test indicates the hardness of bone, imparted by key minerals. That’s why experts suggest supplementing with calcium, magnesium, and trace minerals. But flexibility is also important. The ability to bend a bit and not break is what helps bones resist fracture.

What’s in Your Osteoporosis Supplement?

Bone health supplements contain many different ingredients. Besides calcium and vitamin D (both vital), many include vitamin K, boron, magnesium, and soy isoflavones. Do any of these help build bone and reduce fracture risk? What’s the evidence?

Flexibility is created by the bone’s collagen, its protein-rich infrastructure. To build bone collagen, you need vitamin K. MK4 and MK7 are two types of vitamin K2 that are available in dietary supplements. Of these two, only MK4 (also known as menatetrenone, or menaquinone-4) appears to decrease fracture risk. Multiple clinical trials using 45 milligrams (mg) per day of MK4 show that this dosage may help prevent some fractures. Doctors in England analyzed the data from 13 studies on bone loss and vitamin K. They found that vitamin K helped reduce bone loss, while MK4, in particular, decreased the incidence of hip fractures by 77 percent and spinal fractures by 60 percent. Compare those results to an average 16 percent decrease in fracture risk from taking supplemental calcium and vitamin D (which aids in the absorption of calcium) alone!

MK4 is understood to be safe and useful for promoting bone health when 45 mg are taken daily with calcium and vitamin D. One note of caution, however: If you are taking the anticoagulant warfarin (Coumadin), talk to your doctor before taking any type of supplemental vitamin K, which can block the action of the drug.

Boron, a trace mineral naturally present in the environment, is healthful for humans in small amounts. Studies
have shown that taking 3 mg of boron daily reduces urinary excretion of calcium and magnesium, especially when dietary intake of magnesium is low. Boron supplementation also elevates blood levels of the hormones 17 beta estradiol and testosterone. This evidence suggests that boron may promote bone health. However, no clinical trials have shown that boron specifically improves bone mineral density, decreases bone loss, or decreases frequency of fractures.

Magnesium is used for hundred of biochemical processes in the body. However, magnesium has never been shown to reduce fractures. And the clinical trials showing MK4 (45 mg/day) reduced fractures didn’t use magnesium. Therefore, while magnesium is a great nutrient, it hasn’t been shown to be essential for an osteoporosis supplement.

The term soy isoflavones refers to multiple naturally occurring chemicals called phytoestrogens. As the name implies, these molecules have estrogenic activity. Though estrogen supplementation has been approved by the U.S. Food and Drug Administration as an osteoporosis treatment, the dangerous side effects associated with hormone replacement therapy (HRT) have made many women—and their healthcare providers—reconsider. As a natural alternative, soy isoflavones have been studied for their bone-building effects. However, observational studies and clinical trials have not yet shown consistent evidence that soy isoflavones build stronger bones.

When you’re shopping for an osteoporosis dietary supplement, understanding the research will help you make the best–and most economical–decision. The blog 3 Crucial Questions to Ask Before Buying Osteoporosis Supplements can ensure you’re getting your money’s worth.