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Osteoporosis nutrition beyond calcium: update 2005

Agrawal, Sabina; Krueger, Diane; Binkley, Neil

Current Opinion in Endocrinology & Diabetes: December 2005 - Volume 12 - Issue 6 - p 459-463
doi: 10.1097/
Parathyroids, bone and mineral metabolism

Purpose of review Nutrition is recognized as playing an important role in the pathogenesis and subsequent optimal treatment of osteoporosis. Historically, most research and clinical emphasis have focused on calcium. This review summarizes recent noncalcium osteoporosis-related nutritional studies relevant to the practicing clinician.

Recent findings Vitamin D inadequacy is common and contributes to osteoporosis and fractures. Assessment of vitamin D status requires measurement of circulating 25-hydroxyvitamin D which has been problematic; recent advances in assay methodology have improved this situation. Expert opinion suggests that the optimal 25-hydroxyvitamin D concentration is above 30 ng/ml, which may necessitate a daily intake of approximately 1000 IU D3. Vitamin D3 appears to be more potent than D2 in maintenance of circulating 25-hydroxyvitamin D. Recent studies do not support a major role of vitamin K supplementation in preservation of bone mass, while the role of vitamin A excess in contributing to osteoporosis remains controversial. Although higher dietary protein intake does increase urinary calcium excretion, this may result from enhanced calcium absorption. The prevailing assumption that dietary phosphorus intake is always adequate is being challenged; though data are limited, it may be prudent to consider calcium phosphate supplementation in undernourished osteoporotic patients receiving anabolic therapy. The role of magnesium in osteoporosis remains undefined.

Summary Although osteoporosis is often multifactorial, nutritional assessment is an essential component of osteoporosis care. In addition to the traditional focus upon calcium intake, attention must be paid to vitamin D, protein, and phosphorus status.

Osteoporosis Clinical Center and Research Program, University of Wisconsin - Madison, Madison, Wisconsin, USA

Correspondence to S. Agrawal, University of Wisconsin - Madison, Osteoporosis Clinical Center and Research Program, 2870 University Avenue, Suite 100, Madison, WI 53705, USA

Tel: 608 265 6410; fax: 608 265 6409; e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.