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Constructive Interactions among Nutrients and Bone-Active Pharmacologic Agents with Principal Emphasis on Calcium, Phosphorus, Vitamin D and Protein

John A. Creighton University Professor, Creighton University, Omaha, Nebraska

Address correspondence to: Robert P. Heaney, MD, John A. Creighton University Professor, Creighton University, 601 North 30^th Street-Suite 4841, Omaha, NE 68131. E-mail: rheaney{at}creighton.edu.

Current and emerging bone active pharmacologic agents are capable of producing substantial gains in bone mass. However, nutrition must be adequate if this potential is to be realized. Calcium and vitamin D supplementation, for example, have both been demonstrated to augment substantially the skeletal response to estrogen therapy in postmenopausal women. The bisphosphonates and selective estrogen receptor modulator (SERMs) have all been tested only in the context of supplemental calcium and vitamin D. Therefore, it cannot be assumed that these bone active agents would be effective in the absence of these nutrients. Adequate protein intake has also been demonstrated to protect bone mass in the elderly and to improve recovery from osteoporotic fractures. Phosphorus intake, less extensively studied, may be more important than currently recognized, particularly in elderly individuals living alone, eating little meat, and receiving anti-osteoporosis treatment agents.

Key words: osteoporosis, bone mass, calcium, vitamin D, protein, phosphorus, bisphosphonates, SERMs, fluoride, parathyroid hormone, estrogen

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