Diseases of the musculoskeletal system “rheumatic diseases”:
4 groups

1. Degenerative – non-inflammatory – disorders (z.B. Osteoarthritis deformans)
2. Primary inflammatory diseases (z.B. Rheumatoid arthritis, para- && post-infectious
   Arthritis, Paraneoplastic Arthritis)
3. Metabolic (secondary) inflammatory diseases (z.B. Gout)
4. Soft tissue rheumatic, “non-inflammatory” complaints
   (z.BFibromyalgia (a chronic painful muscle disease)

Main problems:

• Pain (chronicity!)
&Restriction of mobility && quality of life
• incapacity for work && Early retirement

Non-drug measures && Orthopedics

A) Nutrition

Relationship between joint diseases and nutrition They already exist from the time of Hippocrates. Biochemical research in recent years has been able to identify the inflammatory mediators of rheumatic diseases and the Connections with food
Point it out.

Recommended diet:

• with a high proportion of micronutrients
• Wholesome (Mediterranean or Asian-oriented), natural,
  high-fiber diet with a high proportion of fruit, Vegetables, (Fish)
  herbs and nuts, high-quality oils
• with affordable acid-base ratio; v.aReduction of
  • Alkaline-depleting foods (sugar, white flour, industrially produced
    Groceries)
  • Acid-forming substances such as animal protein &animal fats, alcohol, coffee and nicotine, certain cereal products (z.B. White bread, crispbread), certain vegetables (z.BBrussels sprouts, peas, artichokes), certain types of cheese (z.B. (processed cheese)

B) Healthy exercise

• (Exhalation of CO2 = carbonic acid, sweating, increased oxygen supply)
  It affects overall metabolism and the aging process.
• Endurance-oriented sports (z.BCycling, swimming, cross-country skiing)

C) Stress reduction, mental balance && Relaxation ---> Relaxation exercises enable better processing of stress and pain.

D) Important micronutrients in orthopedics &and in rheumatic diseases

Vitamin C

• Vitamin C is the most effective antioxidant in blood plasma.
• Vitamin C is essential for collagen formation.
• Vitamin C It regenerates oxidized vitamin E and thereby protects the lipid membranes (see Niki et al., 1991)
• Hydrophilic compartments in which vitamin C acts as an antioxidant:
  • Cell plasma
  • blood plasma
  • Synovial fluid (fluid in the cavities of movable joints)

Vitamin E

• Antioxidant in the cell membranes (lipid solubility!)
• It traps membrane-damaging oxygen radicals.
• Inhibition of NF-κB activation – a protein important in the immune response and therefore in the inflammatory process (cf. Miehle, Bad Aibling, Fortschritte der Medizin 115, 1997, p.39-42)
• Inflammation-reducing and central analgesic effects (Influence on pain perception and processing) with an increase in β-endorphins (which are the most effective endorphins with regard to pain suppression) (cf. Edmonds et al., Ann of the rheum.Diseases 56, 1997)
• Improved mobility and improved general well-being
• Lipophilic compartments in which vitamin E acts as an antioxidant: v.aMembranes
• Indications
  • Inflammatory °enerative diseases of the musculoskeletal system
  • Rheumatoid arthritis && Ankylosing Spondylitis (inflammation of the spine) with pathological immune reactions in the joint
  • Activated osteoarthritis, spinal syndromes, Dupuytren's disease (disease of the connective tissue of the palm of the hand)
  • Savings on medications such as non-steroidal anti-inflammatory drugs (NSAIDs) && Corticoids (such as cortisone)
  • Reduction of side effects (42 patients with chronic polyarthritis were treated in a 3-week inpatient study with either 1600 I.E.
    Vitamin E or 50 mg of diclofenac (an NSAID) per day were administered. Both treatment groups showed comparable, highly significant improvements in rheumatological findings such as grip strength, morning stiffness, pain, walking time, and Ritchie joint indices. The results were not statistically separable (KOLARZ et al., 1990).
  • Increased vitamin E consumption in rheumatism sufferers
  • Reduced vitamin E concentrations in the synovial fluid of inflamed
    joints
  • Typical dosage: up to 2x600mg Vitamin E/day and higher!

Omega-3 fatty acids

• have anti-inflammatory effects --> Omega-3 fatty acids are antagonists of the pro-inflammatory arachidonic acid (omega-6 fatty acid, v.a(contained in meat)
• reduce collagen breakdown --&They inhibit the formation of messenger substances.
  which cause collagen degradation (TNFα + Interleukin-1α/-β)
• Omega-3 and Omega-6 fatty acids…
  • cannot be converted into one another
  • compete for the same enzyme pathways
  • They inhibit each other
  • Recommended intake: Omega 3 to Omega 6 in a ratio of 1 : 5
• These omega fatty acids have an anti-inflammatory effect:
  • γ-Linolenic acid (Omega-6 fatty acid, u.a(contained in hemp seed oil or in evening primrose and blackcurrant oil): displaces arachidonic acid from cyclooxygenase/cell membrane, increases PGE1 (Prostaglandins of groups 1 and 3 have anti-inflammatory effects, while those of group 2 have a pro-inflammatory effect.) and (small amounts) eicosapentaenoic acid (EPA)
  • alpha-linolenic acid (Omega-3 fatty acid, u.a(contained in hemp seed oil): acts as a neural structural lipid, increases PGE3 (anti-inflammatory effect)
  • Fish/algae oils (contain EPA and DHA, with EPA being relevant for inflammatory processes) i.d.R(only present in high concentration in fish oil):
    They displace arachidonic acid from cell walls, increase PGE3 (v.a.EPA (due to structural similarity to arachidonic acid) prevent eicosanoid- && inflammatory mediator formation

PGE 2 from arachidonic acid

• Arachidonic acid is 90% incorporated into cell membranes when ingested.
• Arachidonic acid serves as a prostaglandin 2 (PGE 2) precursor.
• PGE 2 …
  • Promotes local inflammatory activity in the joint
  • systemically inhibits lymphocyte proliferation
  • triggers pain
  • can be blocked by: NSAIDs/COX inhibitors, vitamin E, histidine,
    γ-Linolenic acid/Dihomo-γ-Linolenic acid

PGE 1 &lower PGE3 Inflammatory activity

• PGE 1 from γ-linolenic acid
• PGE 3 from long-chain omega-3 fatty acids (eicosapentaenoic acid (EPA)) && Docosahexaenoic acid (DHA)

Micronutrients of the cartilage: 4 cartilage building blocks

1. Collagen hydrolysate
   Collagen, as a structural protein, forms the supporting substance of cartilage.

• Proline/glycine (contained in collagen hydrolysate) are important protein building blocks for the formation of collagen.
• can save on painkillers
• support the improvement of symptoms

• Crossover study (Source: Adam M. Therapiewoche 1991;41:2456-61.): Reduction of pain and analgesic use ≥50%
• • Duration: 2 months collagen hydrolysate + 2 months break + 2 months placebo, n= 52
  • Dosage: 3-4 grams/day
  • Conclusion:
    • The half of the patientsThose who took collagen hydrolysate reported a 50% reduction in pain.
    • 69.2% of the collagen hydrolysate patients were able to Reduce painkiller intake by half

2. Glucosamine and chondroitin sulfate

• support cartilage metabolism, are building blocks of cartilage cells for the formation of
  the cartilage components and the synovial fluid
• can be given in addition to painkillers and to save money
  this contribute
• support the improvement of symptoms (Pain, joint stiffness, difficulty walking and performing everyday activities)
• EULAR Recommendation (European League Against Rheumatism) 2003: Glucosamine and chondroitin sulfate were assessed with the (highest) level of evidence 1A.; h.There are studies that meet the highest level of scientific validity; they are among the 10 most important recommendations.
• Indication: mild to moderate osteoarthritis
• Effect: Inhibition of progression of primary gonarthrosis, structural modification
  (Cartilage degradation is stopped), improvement of symptoms. (according to WOMAC, the "Western Ontario and McMaster Universities Osteoarthritis Index" is a self-assessment questionnaire and serves to evaluate the most important and everyday-life-relevant consequences of osteoarthritis)
• Possible side effects: hair loss, dizziness, visual disturbances, drop in blood pressure, fainting (Source: Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis. Ann Rheum Dis 2003;62:1145-55)
• The combination of glucosamine and chondroitin sulfate is more effective than the single substance.

--&20% improvement in WOMAC pain score (baseline vs. 24 weeks)
(Source: Glucosamine/Chondroitin Intervention; Clegg DO et al., New England Journal Med 2006; 354(8):795-808)

3. Hyaluronic acid

• Characteristics
  • pronounced ability to bind water
  • viscous = gel-like
• Determine the properties
  • of the aqueous humor (eye)
  • the lymph fluid
  • the synovial fluid
• Improves cartilage quality (long-term effect unclear)
• Indication: Pain associated with degenerative joint changes
• Dosage: 3-5-x intra/para-articular at intervals of 1 week – or subcutan or orally is
  is also possible
• Possible side effects: pain, sensation of heat, swelling (rare)
• Studies:
  • Oral hyaluronic acid in horses with OCD (osteochondrosis dissecans); Source: Bergin BJ, et al. Equine Vet J 2006;38(4):375-8
  • Hyaluronic acid 50 mg orally, human study, placebo-controlled double-blind study (Source: Ubia A. NutraCos 2007; July/August: 21-2) à the increase in the "Bodily Pain" score by 11.2 (point value) corresponds to a significant pain reduction of 33% (p<0,05); n = 20

Amino acids in orthopedics

Amino acids are important in orthopedics for…

• Structure of hyaline structures (hyaline cartilage is a form of cartilage tissue that is v.a.located in the articular cartilage) of the musculoskeletal system
• Regulation of bone &cartilage metabolism (“cartilage protectant”)
• Additionally, a direct effect on inflammation && pain

Examples of important amino acids

• Histidine
  • Inhibits the formation of pathogenic immune complexes (low histidine levels in rheumatoid arthritis!)
  • Does prostaglandin affect metabolism? (inhibits PGE2 synthesis)
• Tryptophan
  • Improves mobility, walking distance, pain
• Methionine/S-Adenosyl-Methionine (SAM)
  • Affects the release of inflammatory mediators
  • Involved in glutathione synthesis (after conversion to cysteine)

Enzymes in orthopedics = Mechanisms of action of proteases

• Proteases break down proteins
• Have anti-inflammatory activity
• Reduce pro-inflammatory cytokines (IL-1β, TNF-α) and adhesion molecules such as z.BCD44 (adhesion molecules are proteins on the surface of cells that mediate the binding of one cell to another; in inflammation, numerous cells migrate into the inflamed area via adhesion molecules)
• Support of antioxidant enzymes (superoxide dismutase (SOD), catalases, glutathione peroxidase)
• Immunomodulating effect
• Destruction of immune complexes (immune complexes consisting of antibodies/antigens are difficult for phagocytes to break down and enter surrounding tissue via the bloodstream, where they trigger inflammatory processes)
• Analgesic effect (indirectly through the breakdown of pain mediators such as kinins) && prostaglandins, as well as directly through action on the pain-receiving sensor (nociceptor)
• Breakdown of cell fragments in degenerative joint processes
• Anti-edematous effect

Mechanisms of action of proteases in orthopedics

Other micronutrients for bone and cartilage metabolism

• B complex vitamins
  • Vitamin B6: Cofactor of the enzyme that cross-links collagen
  • Positive influence on symptoms through vitamin B12, folic acid (vitamin B9), nicotinamide (vitamin B3)
• boron
  • Anti-inflammatory, bone building, metabolism of steroid hormones
  • A boron supplement, due to its anti-inflammatory properties, leads to a subjective improvement in activated osteoarthritis. Boron exerts its effect by reducing ROS (reactive oxygen species) and its... Inhibition of cyclooxygenase (COX II) and lipoxygenase (LOX), which are mediators in the inflammatory cascade. There is an incidence of osteoarthritis in countries with boron-deficient soils of 20 to 70% (Jamaica, Mauritius). Countries with boron-rich soils show an incidence of only 0 to 10% (Israel).
• Vitamin D
  • It is essential for calcium absorption from the intestine as well as for calcium incorporation into bones.
• Vitamin K
  • Supports bone metabolism through osteocalcin formation à Osteocalcin is a protein that binds bone calcium.
  • Vitamin K2 (MK-7) inhibits cyclooxygenase-2 (an enzyme that oxidizes arachidonic acid to PGE2) in a dose-dependent manner, thereby inhibiting the synthesis of PGE2 (group 2 prostaglandins are pro-inflammatory).

Disease patterns in orthopedics &and in rheumatic diseases

A) Osteoarthritis

• Most common disease of the musculoskeletal system &and connective tissue: Affects approximately 80% of &60-year-olds!
• Imbalance between load and resilience
• &Possible causes:
  • Genetic predisposition (z.B. Protein synthesis disorders with incorporation of cysteine ​​instead of arginine)
  • Incorrect loading && Injuries/ Operations &Overload, overweight
  • Lack of exercise &Protective postures, gender (women more frequently), age
  • Inflammation
  • Metabolic disorders (z.BHyperuricemia, osteoporosis, hyperthyroidism, acidosis)
  • Chronic micronutrient deficiencies
• Pathogenesis:
  • Damage to the articular cartilage ("hyaline cartilage", suspension- && shock absorber function), v.a. in the stress zones, with degradation of proteoglycans (important components of cartilage tissue)
  • Change in the basic substance with unmasking &&; Separation of collagen fibers and roughening of the surface && Increase in frictional resistance
  • Cartilage deformation && bone structures
  • complete destruction of the cartilage &reactive bone remodeling in the marginal zones (sclerotic bone as "articular surface") && bone defects)
  • pain
  • Muscle reduction (muscle protection of the joint!)
  • Decline in strength
  • Restriction of mobility up to and including stiffness
• Symptoms of osteoarthritis:
  • Pains
  • Joint stiffness
  • Limited mobility
  • Uncertainty and instability
  • Joint swelling
  • Joint noises

Micronutrients and typical dosage for osteoarthritis:

• Glucosamine sulfate: approx. 15-20mg/kg body weight per day; d.h600-2000 mg per day divided into 3 doses (~ 3 x 500 mg/day)
• Chondroitin sulfate: 400-1200 mg/day (z.B. 3x 400mg/day)
• Methylsulfonylmethane (MSM): 2 x 2 capsules of 500 mg each
• Methionine/SAM: 400-1200 mg
• Niacinamide (Vitamin B3): 500-3000 mg (z.B. 3 x 500 mg/day)
• Vitamin K2 MK7: 100-200 µg (has analgesic and anti-inflammatory effects; involved in the synthesis of osteocalcin (a protein important for bone formation))
• Omega 3 fatty acids: 2000-3000 mg per day; important: high EPA content (v.a(This is the case with fish oils)
• Collagen hydrolysate: 2.5 grams up to 10 grams
• Vitamin C: 500-2000mg (initially also infusions with 7.5-15g, 1.(2x per week): Antioxidant, immune system
• Vitamin E: 200-1000 I.E. per day; Antioxidant, Energy- &Protein metabolism, connective tissue, bones
• Vitamin D3: 5000-20,000 I.Edaily; bones && teeth (osteoporosis!)
• Folic acid: 0.4-5 mg
• Adequate protein intake (0.8 grams per kg of body weight)
• Vitamin B12: 50-1000 mcg
• Vitamin B6: 5-50 mg; especially for pain (analgesic, anti-inflammatory)
• Calcium: 600-1000mg (z.BCalcium citrate); the most important mineral component of the
  bones
• Boron: 6-9 mg – arthritic symptoms: Boron supplementation leads to a subjective improvement in activated osteoarthritis due to its anti-inflammatory properties. Boron exerts its effect by reducing ROS (reactive oxygen species) and its Inhibition of cyclooxygenase (COX II) and lipoxygenase (LOX), which are mediators in the inflammatory cascade. There is an incidence of osteoarthritis in countries with boron-deficient soils of 20 to 70% (Jamaica, Mauritius). Countries with boron-rich soils show an incidence of only 0 to 10% (Israel).

B) Rheumatoid arthritis

• Most common primary inflammatory disease of the musculoskeletal system &connective tissue
• Autoimmune reaction with unclear origin of a destructive inflammatory reaction
  against the body's own (connective tissue) structures
• Immunological process leads to
  • Stimulation of B- && T lymphocytes
  • Release of arachidonic acid &and their oxidation Eicosanoids
  • Joint inflammation (modulated by prostaglandins)
• Consequences:
  • pain && movement restriction
  • Reduction in quality of life
  • Incapacity for work and early retirement (after 5 years of illness, ~50% of patients are unable to work!)
  • Drug-induced susceptibility to infection
  • Gastrointestinal complications caused by medication (reduce life expectancy by approximately 7 years)

• Rheumatoid arthritis therapy / Rheumatism “natural remedies”
  • A wholesome (lacto-vegetarian = plant-based food + dairy products and eggs) diet, sometimes only a vegan diet is successful
  • Movement, relaxation
  • Physical measures
    • Active, z.BMuscle strengthening
    • Passive, z.BClassical massage therapy, electrotherapy
  • warmth && cold (z.BRye pillow, hay sack, rheumatism bath)
  • γ-Linolenic acid (GLA) 150-600 mg, e.g. contained in hemp seed oil
  • Boswellic acids from frankincense inhibit lipoxygenase (an enzyme that oxidizes unsaturated fatty acids in the presence of oxygen) and thus have an inhibitory effect on leukotrienes (pro-inflammatory messenger substances released from immune cells).
• Typical dosages:
  • Omega 3 fatty acids (v.a.EPA (contained in larger quantities in fish oil): 2000-6000 mg, converted in metabolism into anti-inflammatory prostaglandin E1
  • Vitamin A and β-carotene: 0.3 mg, inhibits the conversion of arachidonic acid into inflammatory mediators
  • Vitamin C (important: high bioavailability due to liposomal carrier molecules): 160 mg with Qidosha Bio+ System, otherwise 500-2000 mg (initially also infusions with 7.5-15 g, 1.2 times per week); antioxidant with anti-inflammatory properties && pain relief
  • Vitamin E: approx. 1200 I.E., fat-soluble antioxidant, inhibits eicosanoid synthesis (inhibition of 5-hydroxy lipogenase activity and thus inhibition of the synthesis of pro-inflammatory prostaglandin PGE2 and leukotrienes), central analgesic effect
  • Vitamin D: 10,000-20,000 I.E. (d.h10-20 drops per 1000 I.E.), possibly even significantly higher (see Coimbra Protocol)
  • Vitamin B12: 1,000 mcg
  • Vitamin B6: 50 mg, especially beneficial for pain, with analgesic (pain-relieving) and anti-inflammatory effects.
  • Selenium: 100-300 mcg, antioxidant, often deficient in arthritis
  • Zinc: 10-100 mg, improves tissue tension, reduces inflammation, accelerates wound healing
  • Proteolytic enzymes (breakdown of proteins by peptidases) such as papain and broelain: analgesic (direct effect on the nociceptor), anti-inflammatory and decongestant effects
  • Boron: 6-9 mg; boron exerts its effects by reducing ROS (reactive oxygen species) and inhibiting cyclooxygenase (COX II) and lipoxygenase (LOX), which are mediators in the inflammatory cascade. These cause joint swelling, reduced joint mobility, and other arthritic symptoms.
  • Magnesium: 150-300 mg; magnesium intake correlates positively with bone density; long-term therapy with PPIs (proton pump inhibitors/"acid blockers") increases the risk of magnesium deficiency, Clostridium difficile infection, and osteoporotic fractures. US epidemiologists led by Benjamin Lazarus from the University of Baltimore have now shown that chronic kidney disease is also observed more frequently in patients with long-term PPI use (JAMA Intern Med 2016, online January 11).
  • Copper: 1-2 mg
  • Manganese: 2-20 mg
  • Folic acid (as folate): 0.4-5 mg
  • Adequate protein intake: 0.8g per kg of body weight
  • Calcium: 600-1000 mg (z.BCalcium citrate), calcium as the most important mineral component of bone
  • Resveratrol: 500 mg

C) Osteoporosis

• Type 1: Post-menopausal osteoporosis
  Sex hormone deficiency (estrogen, testosterone): Bone resorption (osteoclasts, whose activity is hormonally controlled, break down bone tissue and create new bone fragments). u.aCalcium released into the bloodstream &Bone formation, resulting in an increased fracture rate
• Type 2: Senile osteoporosis
  Reduced bone formation and decreased production of vitamin D3. This leads to loss of cortical (outer bone layer) and trabecular (inner part of the bone) bone, with an increased risk of fractures of the hip, long bones, and vertebrae.
• Type 3: Secondary osteoporosis:
  Increased bone loss due to medication (z.B. glucocorticoids) or other causes (z.B.Malnutrition/micronutrient deficiency)

Normal bone:

Bones with osteoporosis:

• Increased risk of osteoporosis in:
  • aluminum (z.B. in medicines for neutralizing stomach acid (so-called "antacids"), such as Maaloxan or Masigel)
  • Proton pump inhibitors (PPIs)
  • Drugs for the treatment of epileptic seizures (so-called "anticonvulsants"), such as phenobarbital, phenytoin
  • Cytotoxic drugs
  • Glucocorticosteroids and adrenocorticotropin (up to 10% bone loss in the first year of therapy) (Source: Homic, Cochrane Library 2004, 5 randomized controlled trials)
  • Immunosuppressants
  • lithium
  • Long-term use of heparin (anticoagulant)
  • Supraphysiological (d.h(Doses of thyroxine exceeding the body's needs)
  • Premenopausal use of tamoxifen (estrogen receptor modulator)
  • TPN (Total Parenteral Nutrition)
  • Selective serotonin reuptake inhibitors (SSRIs) (antidepressants that block serotonin transporters and thereby increase the concentration of serotonin in the cerebral fluid): Men using SSRIs have significantly lower bone mineral density in the hip and lumbar vertebrae (in a range comparable to that seen with chronic cortisone use) than controls (this does not apply to other antidepressants) (Source: Cross-sectional analysis of 5995 men (Osteoporotic Fractures in Men-Study) Haney EM et al. Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men; Arch Intern Med 2007; 167: 1246-1251. Cauley JA et al.; Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 2005; 16: 1526-1537)
  • Continuously high Vitamin A intake from &1.5 mg/day (approx. 5,000 I.E.), v.aall-trans-retinol increases the risk of osteoporotic hip fracturesThis does not apply to beta-carotene. (Source: Nurses Health Study, JAMA 287, 2002, 47-54, 102-103)
  • The intake of vitamin E, beta-carotene and selenium shows a significantly inverse correlation with the fracture risk.
  • smokers (2564 participants; hang J; Antioxidant Intake and Risk of Osteoporotic Hip Fracture in Utah: An Effect Modified by Smoking Status; Am J Epidemiol; 2006; 163; 9-17)

Primary prevention in the pre-menopause

• Nutrition: B. high in calcium (dairy products), low in phosphate (cola, sausage, meat), not too high in protein
• Sun exposure: Vitamin D synthesis in the skin (only possible from May to September in our latitudes, otherwise supplementation is necessary)
• Avoid/reduce stimulants: Nicotine, alcohol
• Movement: Sports, leisure activities, gardening, fitness, strength training
• Elevated plasma levels of the amino acid homocysteine ​​(hyperhomocysteinemia) Homocysteine ​​levels are a significant risk factor for osteoporosis. Lowering homocysteine ​​levels with vitamins B6, B12, and folic acid (vitamin B9) should be considered. (Source: Van Meurs; 2406 patients; Rotterdam Study, Longitudinal Aging Study Amsterdam 2004, prospective, population-based cohort studies)
• At Vitamin B12-concentrations of &Below 148 pmol, men have a significantly lower bone density at the hip, and women have a significantly lower bone density at the spine. (Source: Tucker KL et al.); 2005: Inhibition of osteoblast activity in B12 deficiency)
• Seniors, the falls, have significantly lower Folic acid levels. A high folic acid serum level turns out to be the only protective factor for reducing the risk of falls.
  For every nanogram/ml increase in folic acid concentration, the risk of falls decreases by 19%.
  (Source: Hahar D et al.; Nutritional Status in Relation to Balance and Falls in the Elderly; A Prelaminary Look at Serum Folate; Ann Nutr Metab 2009; 6; 59-66)

Calcium and osteoporosis

• Dosage: 1000 mg total daily intake including food ("normal" food provides 650-900 mg)
• Absorption: 30-35%; particularly poor absorption in cases of anacidity (low stomach acid as a result of proton pump inhibitor use); calcium citrates, gluconates, and lactates are better absorbed.
• Excretion: approx. 300-350 mg per day
• Calcium supplementation: Cardiovascular mortality increases with regularly very high calcium intake (Source: Dtsch Arztebl 2013; 110(13): A-614/B-546/C-546)

Vitamin D and Osteoporosis

• Increases calcium absorption and stabilizes calcium homeostasis.
• Maintains bone density
• Affects neuromuscular function
• Dosage: 000-10,000 I.E. Vitamin D3 / day (depending on the mirror)
• Sun – possible endogenous production up to 20,000 I.E./day; Prerequisite: full sun exposure without sunscreen

Vitamin C and Osteoporosis

• Increases bone density
• Essential for collagen and bone matrix synthesis
• Even a slight deficiency leads to bone loss.
• In a cohort study of 994 older women, additional intake through food increased 500 mg Vitamin C the bone density Significant (stimulates procollagen formation and collagen synthesis as a precursor for bone matrix). Vitamin C acts synergistically with estrogen. (Source: D.J. Morton, San Diego, 29th Meeting of the American Society of Bone and Mineral Research; 10/15/1997)
• Dosage: 2-4 x 500-1000 mg/day; with highly bioavailable liposomal vitamin C, 180-240 mg/day is sufficient.

Magnesium and osteoporosis

• Activates enzymes of bone synthesis
• Partners of calcium (magnesium deficiency leads to calcium deficiency)
• Deficiency is common in osteoporosis
• Dosage: 300-1,200 mg/day

Boron and osteoporosis

• Boric acid acts as a hydroxyl group donor in the hydroxylation of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (d.h. the actual active form of vitamin D3) in the kidneys.
• Bor shows Synergistic with vitamin D, inhibits protein breakdown
• boron reduces calcium excretion via urine
• Boron can prevent osteoporosis; in cases of magnesium deficiency, boron replaces its magnesium.
  Function, whereby the boron concentration in bone tissue is increased.
• Boron has a positive effect on the metabolism of steroid hormones as a hydroxyl group donor. Thus It increases serum levels of 17-β-estradiol and testosterone in women, thereby increasing the effectiveness of estrogen..(Source: Journal of Dental Sciences Volume 11, Issue 3, September 2016, Pages 331-337; The effect of boron on alveolar bone loss in osteoporotic rats; Conclusion: Within limitations of this study, we conclude that boric acid may decrease alveolar bone loss in a rat model with periodontitis and osteoporosis.)

Silicon/Silica and Osteoporosis

• More than 30 years ago, the first report on the positive effects of silicon on bone and various other tissues. Since then, numerous studies on this topic have been published. (Sources: Carlisle EM. Silicon: a possible factor in bone calcification. Science 1970; 167: 279–80. Schwarz K, Milne DB. Growth-promoting effects of silicon in rats. Nature 1972; 239: 333–4.)

Arginine && Lysine and Osteoporosis

The role of arginine and lysine in bone metabolism (u.a(also to accelerate fracture healing)

* Osteocalcin (Synonym: "bone γ-carboxylglutamic acid containing p"red" or: "BGP", the
Gene: BGLAP) is a peptide hormone. It is produced in bone by osteoblasts and in teeth.
It is formed by odontoblasts and binds to hydroxyapatite and calcium.

Vitamin K and osteoporosis

• Vitamin K &Calcium leads to an increase in bone density of the bones of the spine. (so-called vertebral bone); Synergism of Vitamin K + Calcium + Vitamin D3
• Vitamin K is a coenzyme of vitamin K-dependent γ-glutamyl carboxylase: it controls conversions in various proteins such as z.B. in osteocalcin (binds bone calcium) and matrix Gla protein (inhibits the incorporation of calcium into the arterial wall). This carboxylation is important for protein function because it makes their Binding capacity for calcium and its binding to phospholipids allows.
• Vitamin K2 (but not vitamin K1) also inhibits osteoclast activity: In postmenopausal women, vitamin K2 (45 mg) increases bone mass and femoral neck thickness compared to placebo. Hip bone strength does not change with vitamin K2, but decreases significantly with placebo (measured by DXA). (Source: Randomized, placebo-controlled trial; 325 participants over 3 years; Knapen MH et al.; Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women; Osteoporosis Int 2007; 18; 963-972)

Phytoestrogens and Osteoporosis

• Secondary plant compounds (structurally similar to estrogen)
• a. Isoflavones, lignans
• Happen z.B. in soy, oilseeds or whole grains
• Societies where soy is regularly consumed have:
  • Lower rates of breast and ovarian cancer
  • Fewer menopausal syndromes (&<25% vs. 80%)
  • Fewer cardiovascular diseases
  • Less osteoporosis
• By giving Isoflavones (84 or 126 mg) a significant linear effect occurs.
  Improvement in bone density at the lumbar spine and femoral neck compared to placebo. (Source: Randomized, placebo-controlled, single-blind; 90 participants over 6 months; Ye YB et al.); Soy isoflavones attenuate bone loss in early postmenopausal Chinese women: a single-blind randomized, placebo-controlled trial; Eur J Nutr 2006; 45; 327-334)
• Typical dosage: Isoflavones (including genistein): approx. 50 mg/day (z.B. 100 g tofu, 100 g soy sprouts)