Fullscript Protocols

Structural Health – Bone Support

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Protocols Fullscript Protocols
Structural Health – Bone Support

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

A
Systematic review or meta-analysis of human trials
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

Structural Health – Bone Support

Description:
Fragility fractures, a marker of weakened bone structure, result in an increased risk of future fractures1 and are a risk factor for disability, morbidity, and mortality.2,3 Fracture rates increase when there is a disparity between bone formation by osteoblasts and bone resorption by osteoclasts, leading to decreases in bone mineral density (BMD) and increased bone fragility.4,5
The risk of fracture increases with age, with an approximate rate of bone loss of 0.5 to 1% yearly, after reaching peak bone mass.5 These effects are seen particularly after the age of 50 and in postmenopausal women.2,6 Further evidence shows that elderly individuals are especially vulnerable to hip fractures, which affect approximately 30% of women and 15% of men by the age of 90.3

Vitamin D

400-2,000 IU, total per day, minimum 1 year3,7,8,9,10,11

  • Provides 70% better probability in the prevention of non-vertebral fractures, hip fractures, and non-vertebral, non-hip fractures than placebo in postmenopausal women7
    Reduces relative risk of hip fracture by 18-30% and non-vertebral fracture by 14-23% in patients older than 65, compared with calcium alone or placebo3,8,9,11
  • Lower range doses may be more effective for reducing bone loss than higher range doses, though higher range doses may be more effective in preventing osteoporotic fracture12
  • Combination therapy with calcium reduces the incidence of any fracture by 5-19%, non-vertebral fractures by 32%, non-vertebral-non-hip fractures by 36%, and hip fractures by 16-33%, compared with calcium mono-therapy or placebo7,10,12,13,14
Vitamin D in the Fullscript catalog

Calcium

500-1,200 mg, as calcium carbonate, calcium citrate, or calcium microcrystalline hydroxyapatite, total per day, minimum 1 year6,14,15,16,17,18,19,20

  • Increases bone mineral density by 0.7-1.8%, which is predicted to reduce risk of fracture by 5-10%, regardless of dose, but protocol adherence of 80% or more may be required to reduce fracture rate17,20
  • Reduces bone resorption (serum C-telopeptide) and bone turnover (procollagen type-I N-terminal propeptide), and raises serum total and ionized calcium concentrations to increase bone mineral density (BMD) or prevent bone loss15,16,18
  • Reduces serum alkaline phosphatase in postmenopausal women but increases its activity in osteoporotic men18,19
  • Combination therapy with vitamin D reduces the incidence of any fracture by 5-19%, non-vertebral fractures by 32%, non-vertebral-non-hip fractures by 36%, or hip fractures by 16-33%, compared with calcium mono-therapy or placebo6,7,10,12,13,14
Calcium in the Fullscript catalog

Vitamin K

Vitamin K2: 45-90 mg per day as menatetrenone (MK-4), or 100-300 µg per day as MK-7 for 6-48 months21,22,23,24,25

  • Improves vertebral bone mineral density or reduces bone loss21,22,23,25,26
  • Reduces relative risk of fracture by 50%, and the incidence of any clinical fracture by 28%, vertebral fracture by 60%, hip fractures by 77%, and non-vertebral fractures by 81%21,23,27
  • Reduces uncarboxylated osteocalcin and osteocalcin increment in as early as 2 weeks, with doses of MK-4 as low as 1.5 mg per day23,24,25,26
  • Vitamin K is often paired as an adjunct therapy to vitamin D and calcium, with equivalent efficacy to bisphosphonate therapy for BMD and fewer adverse effects21,22,23,25,28
Vitamin K in the Fullscript catalog

Collagen

5-10 g as collagen peptides or hydrolysate, total per day, minimum 6-12 months29,30,31

  • Increases femoral neck and spine bone mineral densitys31
  • Increases amino-terminal propeptide of type I collagen and bone-specific alkaline phosphatase/TRAP5b ratio (measures of bone formation)30,31
  • Prevents rises in C-telopeptide of type I collagen, and reduces sclerostin and tartrate-resistant acid phosphatase isoform 5b (measures of bone resorption)30,31
  • Reduces excretion of pyridinoline and deoxypyridinoline (markers of bone collagen breakdown)29
  • Concurrent administration with vitamin D and/or calcium may improve efficacy29,30
Collagen in the Fullscript catalog

Magnesium

300-365 mg elemental magnesium total per day as Magnesium oxide, Magnesium citrate, or Magnesium carbonate, minimum 1-12 months32,33,34

  • Increases the accumulation of hip bone mineral content in healthy adolescent girls33
  • Reduces serum ionized Mg+, intact parathyroid hormone, as well as indicators of bone formation (C-terminus of type I procollagen peptide and osteocalcin) and resorption (type I collagen telopeptide) in young, healthy males, providing an indication of bone turnover attenuation34
  • Reduces serum intact parathyroid hormone and urinary deoxypyridinoline, and increases osteocalcin levels in postmenopausal women providing an indication of bone turnover attenuation32
Magnesium in the Fullscript catalog

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

1
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/15258724/
2
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/27594735/
3
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/15886381/
4
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/26205648/
5
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/26670451/
6
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/26510847/
7
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/20302551/
8
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/19307517/
9
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/22762317/
10
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/17264183/
11
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/17349055/
12
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/21432375/
13
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/31676406/
14
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/31860103/
20
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/26420598/
21
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/16801507/
22
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/21674202/
23
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/25516361/
25
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/30734066/
27
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/31076817/
28
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/28698808/