Supplements?

NotVeryBrave

Hey everyone - This is probably opening a can of worms since there seems to be so much conflicting information out there, but ... I've been taking a few supplements and my MO is so totally against me taking anything that it makes me question his position. He constantly makes reference to practicing "evidence based medicine" and has concerns that using supplements may mask symptoms or blood work that would be important to know about.

Anything that I've taken has been on the order of "100% RDA" so it's not like I'm filling my body with many times what it needs. I just feel like perhaps some of these things would help if I'm not taking in enough through diet. And I've read the research that says that in most cases people are just creating expensive pee (!), but I've also read about great responses. What to believe?

I was/am taking -

Centrum multivitamin once a day

B complex once a day

Calcium 600 mg twice a day

Magnesium 500 mg once a day

I was taking an Iron supplement three times a week but quit since my RBC is now normal. I've considered taking DIM but am afraid to.

I'm just wondering what to take. I don't really want to see a naturopath and be out on a ton of things. Everything is expensive, too. Just want to do what's best. Proven would be great as well.

Thoughts?

CBK

NotVeryBrave

That sounds a bit militant doesn’t it? I mean you are not taking anything excessive or radical here that I see.

Exactly what vitamins are potentially affecting your blood work? I know it’s said biotin can do so, I hang off it a week before CBC and chem screens. Wow I’m interested in knowing in more detail what MO said about that and hearing more from community on this thread!!

Keep me posted!!

Georgia1

None of those supplements seems excessive to me. My MO thinks those particular supplements are harmless, and she knows I take a multivitamin, magnesium, vitamin D, turmeric and taurine (the taurine is to help reduce the tinnitus that runs in my family). In fact, she recommended turmeric and vitamin D to me given my age, and believes there is good science behind those two.

vampeyes

My Naturalopath has said to stop iron, vitamin D and B vitamins 3 days before any blood work as they will affect the test. He has me on probiotics, tumeric, magnesium, vitamin D, Iodine, and hydrolyzyme (helps me absorb nutrients). My MO has a list of everything I take and has no problem with it.

Edited to add that I am anemic, that's why I have a few extras in there.

ctmbsikia

My MO seemed OK with my supplements and encouraged calcium.  I also did a interaction list on the internet and nothing came up that would concern me.  Presently taking:

Vit C 1000mg daily (have always done this)  also has 110mg calcium in it

Glucosamine (straight no other stuff in it)  1500mg daily

Caltrate + D3 800 IUs  Calcium = 600mg 1 daily.  Recommendation is 1200mg however I am on Rosatavassin 10mg for cholesterol and it says I should not take calcium within 2 hrs -reason I'm just taking the 1.  I refuse to take meds 3x's in a day.  I take supplements in the am and the scripts in the evening.  Should note that I am also prescribed Vit D 50000 IU's once per week.  It is actually a D2 I believe so I don't think I'm overdoing the D.

NotVeryBrave

Interesting that all of you are taking Vitamin D. I was on the prescription one (50,000 IU per week) before my diagnosis. I read a study that showed that low Vitamin D is often seen in breast cancer.

So, yeah. I don't think the few things I'm taking could possibly be any sort of problem. I really think that my MO is just a control freak.

JoE777

To protect against bone loss, Vitamin D is given to aide calcium absorption

Walden1

During chemo and radiation my doctors advised not to take any supplements apart from a multivitamin. Once that treatment was over and it was just hormonal therapy I was advised to take vitamin D, and calcium. I've never asked about other “supplements".

One word of caution. I had a misunderstanding with my doctor once because I asked her if antioxidants in tea make radiation less effective. She assumed I was asking about a “supplement" ie. a tea product with highly concentrated antioxidants. I went 5 weeks avoiding regular black tea (my favourite drink), and only discovered black tea was perfectly fine at my last follow up appointment. Black tea is fine, “supplement tea" is not! Perhaps your doctor has also misunderstood what you are taking or the quantities?

JaBoo

NotVeryBrave, thank you for starting this thread!

I am in Europe and the doctors here usually say "nothing with chemo!". But I've asked my MO specifically about some supplements, mostly those I've read about here in the forum.

I've asked about multivitamin and magnezium (which I've been taking on and off for years due to leg cramps). she approved to take this. now to prevevent neuropathy I've asked about B-vitamins and my MO and also another MO suggested a supplemement for general neuropathy and said I can take it during Taxol. It has B-vitamins, gingo biloba, selenium and alpha-lipoic acid. So I'm taking it along with Mg. Sometimes I take fish oil capsules, but not 2 days around chemo. I haven't asked about it, but I thought it just the same as if I ate a fish. I take the multivitamin only when I remember to.

Walden1, thank you about the info reg. black tea. It's my most beloved drink, I take it with a bit of milk. I never asked about it, but thought it should be OK... glad to hear that.

reaading the thread, I think I will ask about vit. D and Calcium, since I'm on Zoladex.

Edited to add, that I sked abou calcium and vit D. (I've been waiting to see my MO when writing the previous post) She said Ok to take it and even gave me a prescription for a carcium suplement. So I will start right away.

NotVeryBrave

My doctor knows exactly what I've been taking because I typed up a list of everything prescription and OTC for medications and supplements along with the dosages. He even said that he didn't think that the Calcium would actually do much to help my bones (I have Osteopenia), but he was "okay" with me continuing to take it!

I just find it very frustrating because it seems that there are many people taking various supplements with good results. I can understand if something was contraindicated or truly bad for me, but to just discount all supplements as "not proven" - seems his time could be better spent.

vampeyes

NotVeryBrave - My old GP was like your MO. He didn't believe in supplements, chiropractors, etc. He was old school only believed in what he was taught even though times had changed since the sixties or seventies! haha Sometimes people have a mental block that won't allow them to see outside of their beliefs or what they have learned.

xxx

bluepearl

Without adequate magnesium, taking calcium supplements can be harmful...to useless. Why? Think of magnesium as the conductor in an orchestra, telling where the rest of the minerals go. Without adequate amounts, calcium will be deposited along the lining of your arteries rather than in your bones. Amazing, isn't it. Multivitamins have been basically proven to be useless. BTW, you cannot get magnesium levels from blood tests...it requires a specific test, but usually 350 to 600 mg per day will do the trick. Get the kind that says "absorbable" or you are throwing your money away...or more like pooping it away. There are several kinds of magnesiums, some make you sit on the toilet and some don't.

NotVeryBrave

Yes - I'm sticking with both the Calcium with Vitamin D and the Magnesium. My understanding is that Calcium is needed for muscle contraction and Magnesium is needed for muscle relaxation. Since I'm prone to muscle spasms already - I think it's important to take both of them.

Palesa2018

Hi, I'm taking the following supplements and have found my energy levels quite good: Magnesium, Calcium Glucorate, Vit D2 50000UI weekly, Curcumin, I3C/DIM, Omega 3. My MO has agreed to all of them. Only thing she was against that i stopped is medicinal mushrooms.

CBK

NotVeryBrave

Yes I had a low vitamin D level and I continue to take 2000iu vitamin D3 day and my MO monitors it. D level is important for breast cancer patients and survivors, at least I have always been told and seems to be research to support so.

As well as calcium particularly for us on al inhibitors:

I also take calcium supplement with magnesium K2 and Boron 1000mg plant based. (I was placed in surgical menopause)

B6andB12 (for cipn) and Biotin (ok I’m vain and want my hair back)

Turmeric from curcumin source with black pepper ( joint and muscle aches from cipn/ooph/anastrozole)

Nordic fish oil

My MO and GP know I’m on all of these and I have never been given any problems about it.

ctmbsikia

I just gave up on the Caltrate +D3.  It's giving me either too much calcium or too much D as I already have a weekly script for Vit D.  Yesterday I finally figured out that it was the culprit causing my headache and sometimes dizziness.  Skipped my meds last night and no supplements this morning.  If I feel much better in another day or so I'll be 100% certain it was the cause.  I do feel better this morning, no headache.

Not sure if this helps anyone, but I was just too quick to add something that I thought would HELP me and was recommended by the MO so when I started feeling bad I was blaming it on the Anastrozole.  I know, I'm not the sharpest tack in the box! Just be careful with your regiments/combinations of supplements.  Lesson learned for me.  Have a blessed day.

LoveFromPhilly

just a gals two cents here...I am a licensed acupuncturist/Chinese herbalist and nutritionist - specialized in oncology support. I took many many classes in understanding supplementation and while it’s not rocket science - I was amazed at how much there was to learn. Having a clear and evidence based knowledge of supplements is really important because supplements and herbs DO have an effect on the body just like pharmaceutical medicines do. And they do interact with chemo and other medications.


ALso, we are not a one size fits all! We each have our own individual needs, body types, chemistries, and possibly other health issues going along with a cancer diagnosis.


A lot of nutritional deficiencies can be tested in labs like vitamin d and iron for example. And I never put a patient on a supplement unless I know for certain (through labs) that they have a deficiency of that nutrient. And a lot of herbs and supplements are also what we call “chemoprotective” meaning that they enhance the effect of chemotherapy on cancer cells - this has been shown through research. Also, the way we administer the supplements makes a great difference (IV, sublingual, oral, etc).


I ALWAYS make my patients show me the list of supplements they are taking when we start working together and then we tweak it so that they are on what is absolutely necessary for their individual needs.


I say, why the heck not go to 1 naturopathic doctor appointment and have someone who is trained in this realm help you? It is money well spent to get you on a realistic plan. If you are skeptical of the ND, then ask for a free 15 minute consultation or phone talk before making the appointment.

However - not all NDs are trained in oncology care. They should be what is called FABNO certified - which means they have received extra training in oncology and are specialized and focused in oncology. Oncology is a specialized area of medicine so why go to someone who isn’t specializing in it?

http://fabno.org/index.html

I would never send an oncology patient to an ND that wasn’t FABNO certified because I know what the cerification entails for their training.

Anyway - just a gals two cents! Thanks for listening (steps down from soapbox)

Hugs to all!

NotVeryBrave

LoveFromPhilly - Thanks. A lot of what you wrote makes sense. I'm trying to walk that line between what might be good for me and what's probably useless.

I've been put off to see a ND because I guess I just envision them as pushing a bunch of expensive supplements that I'll need to get through them. I'm sure that's an unfair assumption, but there don't seem to be many around here and insurance doesn't cover visits. And I'm kind of so over meeting any more providers.

My background is in science and medicine so I do have a bias for proven treatments. But I also understand that there are things that "work" that have not been exhaustively studied.

Thank you for your explanation and recommendations.

macb04

I don't know if you read the 2 big studies in 2016 and 2017 that show Calcium supplements increase risks of Heart Attacks and Strokes. Food intake of Calcium is great, no risks, but supplementation should be avoided unless there is no other Calcium rich foods in the diet, like even leafy greens.

Got to remember Ladies, that in Asia women are not having much Dairy, yet despite that they have very low rates of Osteoporosis. Vitamin K2 ( Menaquinones like MK- 4, MK-7) works with Vitamin D3 and Magnesium to escort Calcium into bones and out of soft tissue spaces, thus lowering risks of Heart Disease and Osteoporosi

Are calcium supplements helping or harming your health?

ADRIANA BARTONHEALTH

PUBLISHED MARCH 30, 2018UPDATED MARCH 29, 2018

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SASIMOTO/ISTOCK

Calcium is Canada's go-to strategy for preventing bone loss and osteoporosis. It's in dairy products, canned fish, beans, broccoli and kale. It's pumped into soy beverages, mixed into multivitamins and added to orange juice, breakfast cereals and energy bars. Then there are the calcium supplements that many of us take, often on doctors' orders, just to be safe. The more, the better, right?

Not quite. The safety of calcium supplements has become the subject of heated debate over the past 10 years, as researchers have produced evidence of side effects ranging from kidney stones to cardiovascular disease. Earlier this month, a study linking calcium supplements to precancerous colon growths added another potential health risk to the list. And while at least 40 per cent of Americans take calcium supplements, clinical trials have cast doubt on the effectiveness of these chalky tablets in preventing bone fractures.

So should Canadians ditch their calcium pills? No one disputes the importance of calcium for healthy bones. But the pros and cons of supplementary calcium may depend on your health status, the amount of supplementation – and which scientists you choose to believe.

Dr. Mark Bolland, associate professor of medicine at the University of Auckland, was among the first to sound the alarm about calcium supplements, in a 2010 BMJ report linking them to an increased risk of heart attack.

Various studies have confirmed his findings, but others, including a 2016 review in the Annals of Internal Medicine, have shown no increased cardiovascular risk. According to Bolland, these reassuring reports have either chosen to measure different cardiovascular outcomes, or "did not include all the data from all the studies." One explanation for this, he wrote in an email, involves "tight links between industry, academics and special societies in this area."

Dr. Erin Michos, a cardiologist at Johns Hopkins Medicine, agrees. Michos and colleagues scanned the coronary arteries of 5,448 adults from different ethnic backgrounds to confirm they had no calcium deposits, in a study published in 2016 in Journal of the American Heart Association. Ten years later, those who took calcium supplements had a 22-per-cent increased risk of developing calcification in their heart arteries, compared to non-supplement users. "We didn't see this with dietary calcium," she said, adding that supplements are "a billion-dollar industry."

Earlier this month, other researchers linked calcium supplements to serrated polyps, a less common type of colon growth that can become cancerous. In a study published in the journal Gut, patients with a history of these polyps who took calcium supplements, with or without vitamin D, had a twofold increased risk of developing more of these growths within six to 10 years, compared to those who took no calcium supplements, or vitamin D alone.

The adverse effects of calcium supplements remain controversial, but so are the potential benefits.

In a 2006 study in the New England Journal of Medicine, women aged 50 to 79 who took a 1,000-mg calcium supplement with vitamin D had about the same hip fracture risk after seven years as those who took a placebo. Supplement users in this large clinical trial, involving 36,282 American women, showed just a 1-per-cent increase in hip-bone density – and more kidney stones.

On the flip side, a 2016 review in Osteoporosis International found that calcium supplementation plus vitamin D lowered the risk of total fractures by 15 per cent and hip fractures by 30 per cent. This study came from the U.S. National Osteoporosis Foundation, one of the organizations Bolland has described as "compromised" by the influence of companies that market supplements and nutrition-related laboratory test

Calcium has made headlines since 1984, when the U.S. National Institutes of Health declared osteoporosis "a major public health problem." Newspapers warned about osteoporosis, and the supplement industry stepped in to solve the nation's "calcium deficiency."

The theory that porous bones signalled a need for more calcium made sense, since calcium is the major mineral in bone, said Aileen Burford-Mason, a Toronto-based immunologist, cell biologist and author of Eat Well, Age Better. But, she added, "that story was wrong." Calcium is just part of the picture, since it is poorly absorbed without vitamin D, and requires vitamin K2 to help bind it to bone. Magnesium, too, plays a crucial role in bone health. In fact, "there is no essential nutrient that isn't involved in keeping bones strong."

In 2010, Health Canada lowered its recommended dietary allowance of calcium to 1,000 mg a day for adults under age 51, 1,200 mg for men over 51 and 1,200 for all adults over 70. The agency recommends vitamin D supplementation, and cautions that long-term intakes of calcium above 2,500 mg a day for adults under 51, and 2,000 mg for those over 51, "increase the risk of adverse health effects, such as kidney stones."

Nevertheless, many physicians may be unaware of the current guidelines, said Dr. Angela Cheung, former chair of Osteoporosis Canada's scientific advisory council and professor of medicine at the University of Toronto. Back in 2001, when guidelines recommended a daily calcium intake of 1,000 to 1,500 mg for older adults, "a lot of physicians interpreted that as three [tablets] of 500 mg [per day]," she said, without considering the calcium patients were getting from food.

Since Canadian adults tend to be low on calcium, Cheung encourages people to increase their intake from dietary sources, if possible. Adults can start by tracking their current dietary intake using Osteoporosis Canada's calcium calculator.

Calcium supplements can be useful for patients with specific health conditions, she added, but "for most people, I don't think they need a supplement.".

Here's an article about this from MEDSCAPE.

_______________________________________________________________________________________________________________

Vitamin K in the Treatment and Prevention of Osteoporosis and Arterial Calcification

Jamie Adams; Joseph Pepping

DISCLOSURES

Am J Health Syst Pharm. 2005;62(15):1574-1581.

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IN THIS ARTICLE

Vitamin K for Osteoporosis: Clinical Studies

The relationship between dietary vitamin K intake and bone status has been investigated in several epidemiologic ( Table 1 ) and intervention studies ( Table 2 ). These studies suggest that vitamin K deficiency causes reductions in BMD and increases the risk of fractures, resulting from the undercarboxylation of osteocalcin. Low intakes of vitamin K have been associated with an increased risk of hip fractures. In a study of 72,327 women, vitamin K intakes (assessed through the use of a food-frequency questionnaire) were inversely related to the risk of hip fracture.^[38] The adjusted relative risk (RR = 0.70; 95% confidence interval [CI], 0.53-0.93) of hip fracture was 30% less in the women from the top four quintiles of vitamin K intake (>109 µg daily) compared with women from the lowest quintile (<109 µg daily). This finding is supported by a study of 888 men and women from the Framingham Heart Study.^[39] Patients with the highest quartile of vitamin K intake (median, 254 µg daily) had a 65% lower adjusted RR (RR = 0.35; 95% CI, 0.13-0.94) of hip fracture than did those in the lowest quartile of intake (median, 56 µg daily).

Undercarboxylated Osteocalcin and Bone Health

Numerous studies have shown that an association exists among undercarboxylated serum osteocalcin, BMD, and fracture rate.^{[40,41,42,43,44]} In a study of 359 independently-living women, increased levels of undercarboxylated osteocalcin were associated with increased risk of hip fracture, with an odds ratio of 1.9 (95% CI, 1.2-3.0).^[40] In a series of reports involving institutionalized elderly women, a strong correlation was found between undercarboxylated serum osteocalcin levels and the subsequent risk of hip fracture.^[41] Women with abnormally high undercarboxylated osteocalcin concentrations (>1.65 ng/mL) had a RR between 3.1 (99.9% CI, 1.7-6.0; p < 0.001)^[42]and 5.9 (99.9% CI, 1.5-22.7; p < 0.001) times higher than those with normal undercarboxylated osteocalcin levels (<1.65 ng/mL). Knapen et al.^[43]conducted a cross-sectional study of 212 women and found a strong inverse correlation (adjusted RR = 0.5-0.7) between serum undercarboxylated osteocalcin levels and BMD in postmenopausal women. In a trial of 141 postmenopausal women, the percentage of carboxylated osteocalcin to total osteocalcin was measured.^[44] The value of that variable was positively correlated with BMD of the lumbar spine (r = 0.32, p < 0.005) and femoral neck (r = 0.25, p < 0.005).

Hodges et al.^[45] demonstrated that depressed serum levels of phylloquinone and menaquinone (for the latter, most notably MK-7 and MK-8) are found in patients with osteoporotic fractures and suggested that serum levels of phylloquinone and menaquinone can serve as markers for osteoporotic fracture risk.

Vitamin K, Osteocalcin Carboxylation, and Bone Health

A number of clinical studies have been conducted investigating the effect of vitamin K administration on the carboxylation of osteocalcin, BMD, and fracture rates.^{[29,36,46,47]}Various dosages of both phylloquinone and menaquinone have been used in clinical trials; however, in all studies, undercarboxylated osteocalcin levels declined significantly with vitamin K supplementation. In a study to determine the prevalence of suboptimal carboxylation of osteocalcin in healthy North American adults, Binkley et al.^[29] conducted a single-blind, placebo-controlled trial with 219 healthy young and elderly adults. The treatment group received 1 mg of phytonadione daily for two weeks. At the end of the study, patients receiving phytonadione had a significant decrease in the mean percentage of undercarboxylated osteocalcin, from 7.6% to 3.4% (p < 0.001), without significant differences when stratified by age or sex. In a randomized, open-label, controlled trial of 241 Japanese postmenopausal osteoporotic women, the treatment group received 45 mg of menaquinone daily for two years.^[46] At the end of the study, the undercarboxylated serum osteocalcin concentrations in the treatment group were significantly lower than in the control group (1.6 ± 0.1 ng/mL and 3.0 ± ng/mL, respectively) (p < 0.0001). In addition, the occurrence of fracture in the treatment group was significantly lower than in the control group (χ² = 10.935, p = 0.0273). In a smaller, randomized, open-label study of Japanese osteoporotic women, Miki et al.^[47] found that undercarboxylated serum osteocalcin levels could be reduced in as little as two weeks. The treatment group received 45 mg of menaquinone (specifically MK-4) plus 200 mg of calcium daily. The control group received only 200 mg of calcium daily. After two weeks, the mean ± S.D. serum undercarboxylated osteocalcin concentrations in the treatment group declined from a baseline value of 2.8 ± 0.9 ng/mL to 1.7 ± 0.5 ng/mL (p < 0.05). No significant changes occurred in the control group over the same period.

Involvement of Vitamin D

It appears that adequate levels of both vitamins D and K may have additive effects in improving bone health. Many studies have investigated the combined effects of vitamins D and K.^{[12,36,44,48,49]} An excellent review on the additive effects of vitamin D₃ and menaquinone was recently published by Iwamoto and colleagues.^[50] 1,25 (OH)₂ D₃ is the most active vitamin D₃metabolite and promotes intestinal absorption of calcium, reduces serum levels of parathyroid hormone, and activates the synthesis of osteocalcin.^{[49,51,52,53]}

In a three-year, randomized, double-blind trial of 155 postmenopausal women, Braam et al.^[36]found that vitamin D and phytonadione had a complementary effect on the attenuation of bone loss. Participants were divided into three groups: (1) placebo, (2) vitamin D and mineral (8 µg of vitamin D, 500 mg of milk-derived calcium, 150 mg of magnesium, and 10 mg of zinc daily), and (3) vitamin D, mineral, and phytonadione (same as vitamin D and mineral group plus 1 mg of phytonadione daily). After three years, patients who received vitamin D, minerals, and phytonadione demonstrated a 1.7% reduction (95% CI, 0.35-3.44%) in bone loss from the femoral neck (absolute bone loss of 3.3%) compared with the placebo group (absolute bone loss of 5.0%) and a 1.3% reduction (95% CI, 0.10-3.41%) compared with those receiving only vitamin D and mineral supplements (absolute bone loss of 4.6%). No significant differences were observed among the three groups with respect to changes in BMD of the lumbar spine.

In a two-week, single-blind study, 20 postmenopausal, osteoporotic women were given either 1 mg of phytonadione daily or 1 mg of phytonadione plus 400 IU of vitamin D₂ daily.^[48] The mean carboxylation level of osteocalcin was corrected to pre-menopausal levels (~72%) in both groups, but the addition of vitamin D₂had no effect on study results. The percentage of carboxylated osteocalcin increased from 57% before treatment to 73% after treatment (p < 0.001). A similar finding was reported in a study conducted by Takahashi et al.^[49] In that open-label trial of 113 osteoporotic women with femoral hip or vertebral fractures and 91 premenopausal and postmenopausal women without fractures or osteoporosis, participants were randomized to receive menaquinone (45 mg daily), vitamin D₃ (1 µg daily), or menaquinone (45 mg daily) plus vitamin D₃ (1 µg daily) for four weeks. Significant decreases occurred in undercarboxylated serum osteocalcin levels in the menaquinone only (p = 0.0001) and the menaquinone plus vitamin D₃ (p= 0.0018) groups but not in women treated with vitamin D₃ only.

In a randomized, double-blind study investigating the effects of vitamin D₃ and phytonadione in postmenopausal women, Schaafsma et al.^[44]found that a daily intake of 80 µg of phytonadione was necessary to reach premenopausal percentages of carboxylated osteocalcin. At the end of the study, improvements in the percentage of carboxylated osteocalcin were seen in both the phytonadione-treated group with normal BMD (p = 0.001) and the phytonadione-treated group with low BMD (p≤ 0.0001), compared with the control group, who received no phytonadione. Surprisingly, the percentage of carboxylated osteocalcin also increased in those receiving vitamin D₃ only (p ≤ 0.006). Another randomized, open-label study supporting the combined effects of vitamin D₃and menaquinone on BMD in osteoporotic women was conducted by Iwamoto et al.^[12]Ninety-two postmenopausal women with osteoporosis were given vitamin D₃ (0.75 µg), menaquinone (45 mg daily), vitamins D₃ (0.75 µg daily) plus menaquinone (45 mg daily), or calcium (2 g daily). After two years, BMD increased significantly in the vitamin D₃- and menaquinone-treated groups, compared with the calcium-treated group (p < 0.05 and p < 0.001, respectively). However, the most significant increase in BMD was seen in the vitamin D₃ plus menaquinone group (p < 0.0001).

Menaquinone was also found to have a synergistic effect when administered with postmenopausal hormone therapy.^[54] Hormone therapy is known to increase BMD for two to three years after menopause and maintain it thereafter. For some women taking hormone therapy, the increase in BMD reaches a plateau and then declines. A combined administration of menaquinone (45 mg of MK-4 daily) and hormone therapy was investigated in 10 women who had declining BMD levels. The mean ± S.D. rate of change in their BMD increased significantly, from -2.4% ± 2.5% to 6.7% ± 2.9% (p< 0.03) after 12 months of combination therapy.

Two recent studies have provided dose-response data on phytonadione that indicate that current dietary intake recommendations may be inadequate. Binkley et al.^[32] conducted a single-blind, placebo-controlled trial to identify the lowest dosage of phytonadione needed to maximally carboxylate osteocalcin. One-hundred healthy adults age 19-36 years were randomly assigned to receive placebo or 250, 375, 500, or 1000 µg of phytonadione daily for two weeks. The percentage of undercarboxylated serum osteocalcin decreased with increasing dosages (p < 0.0001), with the greatest reduction occurring in those who received 1000 µg daily. In an 84-day depletion and repletion study, 21 older women received a phylloquinone-restricted diet (18 µg daily), followed by a stepwise repletion of 86, 200, and 450 µg of phytonadione.^[33] Various markers of vitamin K status were evaluated to measure participants' response. The carboxylation of prothrombin was restored to prestudy levels with an intake of 200 µg daily. However, carboxylated osteocalcin remained below normal levels after supplementation of up to 450 µg of phytonadione daily. The efficacy of phytonadione and menaquinone supplementation in the treatment of osteoporosis is currently under study in the United States.^[55]

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