Constructive interactions among nutrients and bone-active pharmacologic agents with principal emphasis on calcium, phosphorus, vitamin D and protein

Current and emerging bone active pharmacologic agents are capable of produc ing substantial gains in bone mass. However. nutrition must be adequate if this potential is to be realized. Calcium and vitamin D supplementation, fo r example, have both been demonstrated to augment substantially the skeleta l response to estrogen therapy in postmenopausal women. The bisphosphonates and selective estrogen receptor modulator (SERMs) have all been tested onl y in the context of supplemental calcium and vitamin D. Therefore, it canno t be assumed that these bone active agents would be effective in the absenc e 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 import ant than currently recognized, particularly in elderly individuals living a lone, eating little meat, and receiving anti-osteoporosis treatment agents.