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Osteoporosis in Context

with Vitamin D, Vitamin C, Calcium & Magnesium

Written by Dr Arien van der Merwe,

Extract from her book Health & Happiness, available from the online health shop (as hard copy or eBook):


Calcium is best known for its role in strengthening bone for the prevention and treatment of osteoporosis. Apart from calcium intake, other factors are also involved in bone density and the ability of bone to retain calcium. These factors include the growth rate of children at certain stages of their development (for example during the teenager years, where young girls especially tend to cut down on dairy products for fear of putting on weight), hormone status (lower oestrogen levels after menopause result in less calcium being stored in bone), exercise (low impact exercise such as walking improves bone density), genetic heredity (osteoporosis tends to occur in families) and other factors to do with lifestyle (high alcohol intake and smoking accelerate the onset of osteoporosis). Long-term stress leads to increased cortisol levels, which in turn lead to an increased risk for developing osteoporosis.

Osteoporosis is a slow developing, insidious disease where bone density diminishes and the bones become increasingly brittle and crumble easily. The average loss of bone density in women over 35 is 0.5-1.0 per cent a year. Although all people develop osteoporosis, its severity differs among individuals and between men and women. Women develop osteoporosis earlier than men because the oestrogen that promotes calcium deposits in the bone, decreases markedly around menopause. In men testosterone levels decline more gradually; therefore osteoporosis in men develops more slowly. Not all women get osteoporosis to the same extent: a genetic tendency to serious osteoporosis occurs in families. Smoking, low calcium intake, excessive alcohol intake and lack of exercise over a lifetime can play an important role. Slight women often have a fine bone structure with a low calcium content and are therefore more prone to develop osteoporosis.

A major problem in osteoporosis is that bones break easily, especially the vertebrae (causing the collapse of the spine, compression of the discs between the vertebrae, severe pain and nerve symptoms) and the head of the femur in the hip joint. If the bone breaks, it is so thin that it takes a long time to knit. Osteoporosis can therefore be the cause of an elderly person with an active, healthy, purposeful lifestyle ending up permanently in a wheelchair or bedridden, totally dependent on the support of others for even the most basic functions. This often leads to severe depression and unhappiness.

Osteoporosis can be prevented by taking calcium and magnesium supplements from an early age. It is never too late to start taking calcium. Calcium is needed for so many physical functions in the body, and if the body does not have enough for its needs, it simply takes calcium from the bone. Calcium supplements therefore prevent the osteoporosis from becoming worse. Research has also shown that, even if oestrogen and testosterone levels are low, the calcium is still deposited in the bone. In such a case the osteoporosis may even improve with the use of supplemental calcium.

Calcium (and magnesium) is needed for nearly every function in the body. If there isn’t enough calcium for its needs, it simply takes calcium from the bone, hence osteoporosis!

Calcium and magnesium

The Institute of Medicine of the Food and Drug Administration (FDA) in the United States has reconsidered the scientific literature on calcium, phosphorus, magnesium, vitamin D and fluoride metabolism in humans and re-analysed it. New guidelines for minimum, adequate and maximum daily requirements were established as long ago as 1997. The report on calcium et al was completed first and this is the only group of micronutrients for which the recommended daily allowance (RDA) is really accurate and up to date as to optimal needs for a healthy body.

The requirement for calcium is between 1 000 mg and 1 300 mg a day. The chief source of calcium is dairy products. Calcium is also found in reasonable quantities in leafy green vegetables, egg yolk, pulses (legumes) and nuts. It is almost impossible to obtain enough calcium for normal daily requirements through food alone. Everyone should take supplements: 600 mg per day for general needs, and menopausal and postmenopausal women should take 900-1 000 mg a day. All those who participate in sport should take at least 600 mg of calcium and 300 mg of magnesium a day. This will improve their endurance and performance (by improving heart and lung function), prevent muscular and bone injuries and ensure that muscles, ligaments and bones that are injured, heal more quickly.

Phosphorus and fluoride

Phosphorus is an important nutrient for the growth and development of bone and soft tissue. It is plentiful in so many types of food that only advanced starvation or a metabolic disorder will result in a lack of phosphorus in the body. It is therefore unnecessary to supplement it.

Fluoride supplementation remains a very controversial topic. Many research papers indicate that fluoride in drinking water and toothpaste leads to an increased risk of developing cancer, hip fractures (osteoporosis), fluorosis (mottling of the teeth) and liver damage – and does not reduce tooth decay at all. After 50 years of fluoride promotion, it now seems to have been an enormous scam based on misinformation and greed. People are also unhappy about adding fluoride to drinking water because there is no control over the amount of fluoride they are taking in. People who drink a lot of water, babies and children consume far too much fluoride, which in turn may suppress the function of the pineal gland.


Magnesium works in conjunction with many of the enzymes in the body to maintain body temperature, nerve conduction, hormone activity, muscle contraction (including the function of the cardiac muscle) and synthesis of proteins. Magnesium is involved in more than 300 different enzyme reactions. The metabolism of calcium and magnesium and their mutual functions are also interdependent. Magnesium is mainly an intracellular mineral (within the cells). Most of the calcium and magnesium (about 70-80 per cent) is stored in the skeleton (bone). A total of 20-30 per cent of the body’s magnesium is in the muscles and only 2 per cent is outside the cells, therefore in the blood and interstitial fluid between the cells. Magnesium levels in the blood are therefore not a good indication of magnesium levels in the body.

Research has shown that hypertension and diabetes are linked to low levels of magnesium in the cells, but it has not yet been established whether the low magnesium is the cause or the effect. However, magnesium levels appear to be a better indicator of these health challenges than calcium or sodium.

Low magnesium levels can result in slow digestion of food and increased irritability, along with tremor, muscle spasm, muscle cramps, muscle strain and facial tics. In severe cases this can lead to convulsions,confusion, hallucination, weakness, anorexia, nausea and vomiting. These symptoms are not only caused by a lack of magnesium. This is why it is so difficult to detect a magnesium deficiency.

People with high blood pressure and diabeties should supplement their diet with about 300 mg of magnesium per day. Magnesium is found in dairy products, vegetables, fish and poultry. Other good sources of magnesium are soya bean flour, wheatgerm, bran, sesame seeds, peanuts and cocoa beans. (Note that cravings for chocolate can be due to a lack of magnesium).

The main problem with magnesium intake is that only 30-50 per cent of the daily intake is absorbed. Any additional calcium intake also interferes with the absorption of magnesium. Vitamin D, proteins and lactose promote the absorption of magnesium (and calcium). If a person is taking a calcium supplement, it is therefore essential to take magnesium with it. Taking additional calcium is essential, therefore also take 300-500 mg of magnesium together with vitamin D.

Calcium and magnesium compete for absorption in the digestive tract of the body, therefore the ratio between the two has to be optimally balanced. Based on the recommended daily allowance, the ratio of calcium to magnesium should be about two to one. This ratio can be used as a general indicator for food supplementation. People who take magnesium supplements must also take calcium.

People who take too many laxatives may take in too much magnesium. Most laxatives contain a large amount of magnesium. Side effects can include low blood pressure, weakness and exhaustion. Elderly people with weakened kidney function, can display these side effects even after a few days of injudicious laxative intake. (Milk of magnesia is one of the worst offenders in this respect).

The role of vitamins D, C and boron

Vitamin D

The body makes vitamin D when sunlight is absorbed by the skin. As long as people get enough exposure to the sun, it is not necessary to supplement with vitamin D. However, low vitamin D status is very common in the general population, with many research studies illustrating that few people fall within the optimal range for vitamin D. This is due to extremely low sun exposure, even in sunny countries. Globally, people are afraid of the sun and slather themselves with sunblock that further exacerbates the problem, blocking the skin from the sun’s beneficial rays. We need sun exposure for at least 30 minutes early morning and later afternoon, within an hour of sun rise and sun set.

Facts around the importance of vitamin D:

  • Important in the regulation of calcium and phosphorus homeostasis.
  • Influences male and female reproductive health and pregnancy outcomes.
  • Human and animal data suggest that low vitamin D status is associated with impaired fertility, endometriosis and polycystic ovary syndrome. Evidence from observational studies shows higher rates of preeclampsia (high blood pressure during pregnancy), preterm birth, bacterial vaginal infection and diabetes during pregnancy, in women with low vitamin D levels.
  • Part of its role in the female reproductive system, is implicated in ovarian dysfunction (polycystic ovarian disease or PCOD) and its clinical manifestations may include obesity, increased insulin resistance with high insulin levels in the blood, low ovulation rates or lack of ovulation, with infertility. Studies regarding vitamin D status in patients with PCOD show that low vitamin D levels are linked with metabolic risk factors, e.g. insulin resistance, high BMI (body mass index) and WHR (waist-to-hip-ratio), triglycerides and high blood pressure – the classic symptoms of metabolic syndrome.
  • Populations especially at risk for low vitamin D status are infants, children, pregnant and postmenopausal women. Besides the classical diseases such as rickets, osteoporosis and osteomalacia, vitamin D deficiency in women might be associated with lower fertility and an increased risk for adverse pregnancy outcomes.
  • Vitamin D deficiency is often clinically unrecognised, however laboratory measurements are easy to perform, and treatment of vitamin D deficiency is inexpensive.

To summarise vitamin D’s functions in the body:

  • Cognitive protection – key to keeping mind sharp well into your golden years
  • Reduces the risk of breast cancer
  • Improves muscle strength
  • Supports immune system
  • Helpful in treating endometriosis
  • Prevents polycystic ovarian disease – PSOD
  • Important to prevent and treat insulin resistance, metabolic syndrome and the inevitable increase in weight, especially around the abdomen
  • Helpful in treating hypertension or high blood pressure during pregnancy (preeclampsia)
  • Plays an important role in foetal programming. Vitamin D induces more than 3 000 genes, many of which have a role in foetal development. Therefore, vitamin D may be particular relevant to the ‘developmental origins’ or ‘foetal programming hypothesis’ in which environmental factors such as vitamin D status in the mother, influence the genomic programming of foetal and neonatal developmental and subsequent disease risk in both childhood and adult life. In later life, children of mothers with low vitamin D serum levels during pregnancy, have a higher risk for developing certain chronic health challenges, such as asthma, schizophrenia, multiple sclerosis, type 1 diabetes mellitus and insulin resistance. This suggests intrauterine programming as possible mechanism. Epigenetic (above the gene, i.e. more important than the genetic expression itself, in the cell membrane or the environment of the cell), mechanisms that lead to persistent changes in structure and function in endocrine systems, are extensively being researched at present.

It is recommended to take vitamin D with calcium and magnesium for balance and the optimal absorption of all these important micronutrients. Vitamin D also improves the bioavailability of calcium. Take 300-600 IU of vitamin D with 600-900 mg calcium and 300-450 mg magnesium every evening.

Vitamin C ensures that the calcium is absorbed into the osteoblasts. These are the bone cells that are responsible for the formation of bone and the deposits of calcium in the bone. It is therefore also advisable to take about 200 mg of vitamin C in the evenings with your calcium and magnesium. Vitamin C also plays a role in the relief of backache, pain caused by slipped discs and all inflammatory pain associated with arthritis and exercise induced muscle and joint injuries.

Boron (2 mg a day) is important for the metabolism of calcium, magnesium and phosphorus. It can be used in the treatment of arthritis and hypertension because of its effect on the metabolism of calcium and magnesium. Boron can also prevent the removal of calcium from the bone.

Extensive research has shown that calcium supplementation especially with magnesium included, plays no role in the formation of calcium oxalate stones in the kidney. High sodium intake (as found in table salt) plays a greater role in the formation of calcium oxalate stones than calcium. Magnesium is often used to treat oxalate stones. Vitamin C plays no role in the development and growth of kidney stones.

Form of intake and bonding of minerals

The suffix –oxalate mentioned above, brings us to the next important point, namely the form in which minerals such as calcium should be taken. A mineral has to be bonded before it can be absorbed from the digestive tract. If minerals are bonded with salts such as carbonates, sulphates and oxides, the mineral salt compounds have to go through a long, complicated digestive and absorption process before they can be absorbed by the body. This process can lead to constipation, nausea, black stools (such as caused by iron-mineral salt compounds taken during pregnancy) and bloating.

The best way of bonding is a chelation process in which minerals are linked to amino acids. Amino acid bonding is also the natural way in which the body absorbs minerals and transports them through the walls of the intestine. Amino acids are the building blocks of proteins and are therefore natural food based nutrients, recognised by the body as such.

By bonding minerals to amino acids, excellent absorption, bioavailability (optimal utilisation of minerals by the body) and biological activity of minerals in the body, is assured. The safety and tolerance of the body to such minerals are also excellent and side effects are rare. The amino acid-mineral compound is absorbed as a whole.

In the liver the amino acids are metabolised further and the minerals are released into the blood to perform all their necessary functions. These amino acids must be in the stomach and the rest of the digestive tract at the same time as the minerals so that chelation can occur.

Try to buy mineral supplements that are already in an amino acid chelation. However, the manufacturing process of amino acid chelates of high quality is expensive. When choosing a mineral supplement, you get what you pay for. If you can’t find a calcium product in an amino acid chelation or if it is too expensive, the next best way to take in calcium is as a carbonate, gluconate or lactate. Food form minerals are also well absorbed by the body. Food form is, as the name implies, extracts from food complexes

Calcium and magnesium supplements

Some calcium and magnesium supplements may also contain:

  • Potassium (about 200 mg per day) is important for the correct pH balance of the metabolism of calcium and magnesium in bones and muscles (cardiac, skeletal and smooth muscle). Potassium stabilises the internal structure of cells and is essential for nervous, cardiac and musculoskeletal function. Potassium is generally used for the treatment of hypertension, exhaustion and muscular weakness. It is also useful for treating allergies.
  • Glycine (about 250 mg a day) is an amino acid which is an excellent natural sedative.

Remember to take calcium and magnesium supplements at night. This ensures that the nervous system is less irritable and allows the musculoskeletal system to relax. Causes of insomnia include being unable to switch off one’s thoughts, having a continuous ‘monkey chatter’ in your mind and not being able to relax.

Calcium, magnesium and glycine help to calm down the thought processes (in addition to relaxation techniques and meditation). Glycine has been used successfully to treat spastic conditions of the nervous system, anxiety attacks, to improve wound healing and epilepsy. Glycine is an important component of collagen which forms part of the connective tissue in bone, cartilage, joints and muscle. Glycine reduces acidity in the stomach and is useful in the treatment of ulcers, gastritis, reflux and heartburn.

Glycine also delays the degeneration of muscle tissue by providing additional creatinine. Creatinine is present in all muscles and is essential for muscle contraction and relaxation. Glycine and creatinine are involved in the formation of RNA and DNA (nuclear matter). Glycine is also essential in the synthesis of haemoglobin (the molecules that carry the oxygen in the red blood cells) and glutathione (an important part of the antioxidant enzyme glutathione peroxidase).

  • L-taurine (about 250 mg a day) is an amino acid with various functions. (Consult Chapter 7 on the cardiovascular system). Taurine is important for the relaxation of the muscles after contraction. It preserves antioxidants and stabilises cell membranes. It facilitates the movement of potassium, sodium, magnesium and calcium across the cell membranes. It is therefore important for the generation and conduction of nerve impulses. Taurine is often used with magnesium in treating epilepsy, anxiety, tension, high cholesterol, hypertension, arrhythmia (irregular heartbeat) and insomnia.
  • Methyl sulphonyl methane (MSM, about 200 mg a day) is a natural, safe physiological active sulphur compound with anti-inflammatory and antioxidant properties. It is also used for the treatment of all forms of arthritis and joint infection. It supplies sulphur for the formation of healthy connective tissue, enzymes and compounds which are effective in fighting allergies. MSM strengthens the body’s natural defence against allergens (substances that induce an allergic reaction in sensitive people). Sulphur is also essential for healthy hair, skin and nails. MSM fights parasites, improves general digestion and helps to relax tense, tired muscles and joints. People who suffer from allergies often have a lack of calcium. Calcium supplements with MSM alleviate most allergies.
  • Phytosterols (about 50-100 mg a day) are natural substances that are present in all plants (also called plant sterols). They are also the part of the plant that is often removed through food processing (wheatgerm is rich in phytosterols). Phytosterols are built into the cell membrane as part of the phospholipid chain and improve the transfer of calcium through the cell membrane into the cell. They therefore improve the bioavailability of calcium.
  • Silica (about 20 mg a day) stimulates the cells that are responsible for the formation of collagen and elastin, the connective tissue that is found in the bone matrix and beneath the skin. It prevents the skin from losing its elasticity and the loss of bone density.

Silica improves the elasticity of blood vessels and plays an important role in the prevention of cardiovascular disease. It is also important in preventing osteoporosis and Alzheimer’s disease. It supports the immune function and delays the ageing of tissue.

  • Manganese (about 20 mg a day) nourishes the nervous system and improves sugar and fat metabolism. It is essential for the formation of DNA and RNA and prevents fatigue, irritability and sensitivity of the nervous system, as well as lower back pain. It reduces the frequency of epileptic seizures. Manganese forms part of the antioxidant enzyme superoxide dismutase, which protects the body from the damage by free radicals. Manganese improves the immune function and prevents atherosclerosis, poor hair and nail growth, hearing loss and poor muscle and joint co-ordination.
  • Copper (about 2-4 mg a day) is important in the formation of bone, haemoglobin and red blood cells. It works in conjunction with vitamin C, zinc and silica to form elastin. Copper helps to control the inflammatory reaction in arthritis and bursitis. It is important for a healthy nervous system and smooth joint operation. Copper also helps with the mineralisation of bone (calcium deposits) and is also part of many antioxidant enzyme systems.

Summary of the functions of calcium and magnesium

  • Calcium and magnesium are important in the prevention and treatment of osteoporosis.
  • Both calcium and magnesium are extremely effective natural sedatives (for insomnia and tension or anxiety). Always take them at bedtime with a hot drink. This is also good for children who sleep badly or are hyperactive.
  • Calcium and magnesium ensure healthy hair, bone growth, teeth and strong nails – especially important for children and people whose nails and hair are brittle and break easily. Increase your intake after any bone fracture.
  • Supplementation is essential for pregnant women and women who are breastfeeding – for the mother’s needs as well as those of the unborn foetus and growing baby. Supplement with 600 mg of calcium and 300 mg of magnesium a day. If your intake of dairy products is low (or absent), use 900 mg of calcium and 450 mg of magnesium.
  • Calcium and magnesium are essential in the treatment of hypertension and other disorders of the cardiovascular system.
  • Most headaches will be cured by taking 300-600 mg of calcium and 150-300 mg of magnesium instead of a headache pill. It is also an effective treatment for migraine. It is worth trying!
  • Remember that calcium and magnesium can be used for allergies. Children and adults who are allergic to dairy products in any case take in too little calcium and magnesium in their diet.
  • All those who participate in sport, should take calcium and magnesium supplements to be able to cope with the increased demands made on the body’s metabolism, enzymes and musculoskeletal system.
  • Calcium and magnesium provide great relief from all forms of leg cramps (also night cramps) and growing pains in children.
  • Calcium and magnesium alleviate the symptoms of premenstrual tension (depression, irritability, headaches, moodiness, bloating, backache and cramps), menopause and painful menstruation.
  • Calcium and magnesium can also reduce the symptoms of tinnitus (ringing in the ears) and vertigo (dizziness when moving).
  • Calcium and magnesium can help to alleviate the symptoms of multiple sclerosis and other forms of muscular dystrophy because of its important function in muscle contraction.
  • Calcium and magnesium improve neural transfer and are recommended in the treatment of depression, hyperactivity and anxiety conditions.
  • Calcium and magnesium are essential in the treatment of low blood sugar levels as well as in diabetes (people with high blood sugar levels).
  • Research shows that calcium plays a major role in the prevention and treatment of cancer (especially of the colon and rectum).