Nutrition / February 22, 2014

Why Docs Recommend Calcium – Even Though You’re Taking Bone Meds

Don’t bring sand to the beach. It’s wise advice we’ve all heard cautioning against our redundant tendencies. And the debate of what is redundant, or wasteful, overlaps into health issues.

At AlgaeCal we get asked “I’m taking a multi – do I need to take vitamin D as well?”, or
“I eat well, why do I need to supplement with capsules as well? Isn’t that like bringing sand to the beach?”

The answer to both those questions rests simply upon – how much minerals/vitamins are you getting from say, your multi, or from the food you are eating? If you look into it you will likely find that the amounts you get fall below what our bodies need to thrive (as that’s generally what the statistics reveal for many people). If so, then supplement.

Because being mineral/vitamin deficient will cost you a lot more in lost productivity, energy, downtime etc. than the roughly $1.50 per day you might spend on quality supplements. That’s a straightforward question and answer.

However, here’s one we get asked often that’s a bit more involved:

“Should I follow my doctor’s orders and take a calcium supplement – alongside my bone health medication?”

On the surface it sounds like bringing sand to the beach, doesn’t it? Millions of bone health prescription medications, technically known as bisphosphonates, are filled every year in America, because they promise to stave off the osteoporosis epidemic that is gaining more ground every year.

Doctors routinely prescribe bisphosphonates, yet they also advise to supplement with a high quality calcium and vitamin D product.

The confusion about this is justified. Doctors are sending their patients home with a mixed message: if bisphosphonates are effective, why the need for extra calcium?

Bisphosphonates inhibit the loss of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone loss.
Bisphosphonate-based drugs work by coordinating calcium ions. Bisphosphonate molecules “stick” to calcium and bind to it in the bones, which is the largest store of calcium in your body.

Upon initial inspection, bisphosphonates do exactly what is claimed – they increase bone density. So why prescribe calcium supplements on top?

The quality of bone that bisphosphonates produce that seems to be the issue. Many do experience an increase of bone density, as confirmed by DEXA tests, but report that it’s ‘ceramic, brittle’ in nature, due to these medications. It’s taken trial and lots of error – and fractures, to come to the understanding that increased bone density does not necessarily equal increased bone strength.

In fact, there are no shortage of studies that confirm what many patients experience. Consider these shocking statements from separate studies and write ups:

“Bisphosphonate use was associated with an increased risk of subtrochanteric or diaphyseal fractures in elderly women… with a higher risk among long-term bisphosphonate users…Spontaneous fractures were observed…”

“FDA: Possible increased risk of thigh bone fracture with bisphosphonates.”

“In the long-term, there is an increased risk of atypical fractures affecting the subtrochanter and diaphysis of the femur.”

Yet bisphosphonates still continue to be prescribed by doctors due to the good that they do – in certain cases. Said Brett A. Lenart, MD, at the Orthopaedic Trauma Association’s 2009 annual meeting “We’re not advocating that bisphosphonate therapy be stopped. These are extremely useful drugs. Many clinical trials have demonstrated their efficacy in treating osteoporotic fractures of the spine and hip. Our study identifies a small subgroup of patients that may be more susceptible to the effects of prolonged bisphosphonate therapy and require specialized care.”

Knowing that bisphosphonate efficacy is hit and miss, many doctors recommend augmenting with a high quality calcium and vitamin D product simply for insurance; a plan B so to speak. It’s a way to ‘cover your bases’ as supplementing with calcium is thought to only help someone suffering from osteoporosis.

And if bisphosphonates do create a kind of ceramic bone for some people, doctors know that offsetting that brittleness with a calcium is a logical move.

Not All Calciums Are Created Equal

If you are a candidate for a calcium supplement due to bisphosphonate use, do keep in mind that there are as many types of product as there are types of cars.

If you’ve been advised to take bisphosphonates it is because your bones are in a very weakened porous state, so it’s not the time to be casual about taking any old calcium.

Avoid typical rock based (called calcium carbonate) calcium products, as it’s come to light over the last few years that they’re associated with cardiovascular problems and only slow down bone loss.

However, plant based multi mineral calcium supplements are more readily absorbed by your body. Look for ones that contain vitamin D3 and K2 as both vitamins are proven to help minerals get to the bones – while keeping them out of your arteries.