BMJ  2005;331:108 (9 July), doi:10.1136/bmj.331.7508.108

Letter

Calcium and vitamin D in preventing fractures

Vitamin K supplementation has powerful effect

EDITOR—Porthouse et al conducted a good randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D₃) for prevention of fractures in primary care.¹ However, vitamin D and calcium are not enough.

No mention was made of the extensive research from Japan and the Netherlands, which shows that vitamin K supplementation has a powerful effect in decreasing osteoporosis and osteoporosis related fractures. Combining vitamin K, vitamin D, and calcium seems ideal.

Researchers from Osaka Medical College showed that vitamin K and vitamin D together increased bone density much better than vitamin K alone.²

When comparing calcium and vitamin D alone with placebo, researchers at the University of Maastricht found little benefit on bone loss. But those randomised to take vitamin K in addition to calcium and vitamin D had significantly less femoral neck bone loss after three years.³

The Yamaguchi osteoporosis prevention study showed that vitamin K alone reduced vertebral fractures by 56% compared to placebo, comparable to the benefit found from etidronate.⁴

Researchers at Hirosaki University in Japan showed that vitamin K lowered bone fractures in elderly female patients with Parkinson's by 90%.⁵ The same research team showed an 86% decrease in fractures in elderly patients with Alzheimer's treated with a combination of vitamin K, vitamin D, and calcium compared with placebo.^w1

If the medical standard became to first use vitamins D and K with calcium before using bisphosphonates or selective oestrogen receptor modulators, the public would save billions of dollars a year.

705 W Oregon, Urbana, IL 61801, USA c4tf{at}hotmail.com

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Additional reference on bmj.com

Competing interests: None declared.

References

1. Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T, et al. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005;330: 1003. (30 April.)[Abstract/Free Full Text]
2. Ushiroyama T, Ikeda A, Ueki M. Osaka Medical College. Effect of continuous combined therapy with vitamin K(2) and vitamin D(3) on bone mineral density and coagulofibrinolysis function in postmenopausal women. Maturitas 2002;41: 211-21.[CrossRef][Medline]
3. Braam LA, Knapen MH, Geusens P, Brouns F, Hamulyak K, Gerichhausen MJ, et al. Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age. Calcif Tissue Int 2003;73: 21-6.[CrossRef][ISI][Medline]
4. Ishida Y, Kawai S. Comparative efficacy of hormone replacement therapy, etidronate, calcitonin, alfacalcidol, and vitamin K in postmenopausal women with osteoporosis: the Yamaguchi osteoporosis prevention study. Am J Med 2004;117: 549-55.[CrossRef][ISI][Medline]
5. Sato Y, Honda Y, Kaji M, Asoh T, Hosokawa K, Kondo I, et al. Amelioration of osteoporosis by menatetrenone in elderly female Parkinson's disease patients with vitamin D deficiency. Bone 2002;31: 114-8.[Medline]

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Relevant Article

Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D₃) for prevention of fractures in primary care

Jill Porthouse, Sarah Cockayne, Christine King, Lucy Saxon, Elizabeth Steele, Terry Aspray, Mike Baverstock, Yvonne Birks, Jo Dumville, Roger Francis, Cynthia Iglesias, Suezann Puffer, Anne Sutcliffe, Ian Watt, and David J Torgerson
BMJ 2005 330: 1003. [Abstract] [Full Text] [PDF]