Preventing osteoporosis with MCHA

While we are young it is easy to think we’re invincible. Without any real effort or care, we remain healthy and can meet the demands of life. So it’s an incredibly difficult task to persuade someone who has had no health problems to understand that their actions are placing them onto a path of a debilitating disease. Among the most common, osteoporosis. If you’ve somehow succeeded in persuading someone to look after their bones, there is still the matter of finding suitable treatment, which is not as simple as it should be.

Understanding calcium supplements

Calcium, the main mineral that crystallizes to form bone tissue (and replaces bone that is lost) comes in many different compounds. Some of the most common are calcium bound with carbonate, citrate, malate, phosphate, gluconate or lactate. Each varies with the amount of elemental calcium present, but this is only one factor in determining which form is best. Other considerations are the absorption, transportation and general bioavailability of calcium within that form. Thus while calcium carbonate is the highest elemental calcium source, it has one of the worst bioavailability profiles of calcium compounds.

In addition, restoring or maintaining bone mass isn’t just reliant on the sheer amount of calcium. There are many other vitamins and minerals that play crucial roles in bone mineralization. Bone strength isn’t just determined by mineralization either. There is an array of proteins that are critical to bone structure and formation as well. If these other nutrients and proteins are neglected, all the calcium in the world won’t prevent osteoporosis, regardless of which form is possibly more bioavailable.

Microcrystalline hydroxyapatite

Under the realization that calcium alone will not prevent osteoporosis, microcrystalline hydroxyapatite (MCHA) is emerging as an effective treatment option as it has shown that it cannot only reduce bone loss, it can also reverse it. MCHA is the essentially the structure within our bones that makes them strong. It is typically sourced from young bovine bone and is also referred to as ossein hydroxyapatite or MCHC and is different from hydroxyapatite derived synthetically or from phosphate rock. Because it is a natural, organic compound it contains everything bone tissue needs and in the right ratio. It contains calcium (24%) and phosphate (12%) in its natural 2:1 ratio, combined with matrix proteins, type I collagen, glycosaminoglycans, trace minerals and bioactive growth factors. All these components combined, are essential for strong bone formation, bone metabolism and regeneration. MCHA displays the capabilities of increasing osteoblast proliferation, differentiation and activity [1]. Thus the properties of MCHA compared to basic calcium supplements are far more superior for the means of preventing osteoporosis. Furthermore, the unique, natural microcrystalline structure and components within make for a very absorbable and bioavailable source of calcium, another distinct advantage.

Not to be confused with bone meal supplements

MCHA is considered the next generation of bone meal and with today’s manufacturing standards; the problems that arose with bone meal are eradicated with MCHA. In the 1980’s it was discovered that bone meal supplements were contaminated with lead, mercury and other heavy metals. Then in the UK, Europe and North America it was a vector for bovine spongiform encephalopathy (BSE or ‘mad cow’s disease’) in the 1990’s. In addition, the treatment methods and extraction from old bovine bone meant efficacy was poor. Fast forward to today and a lot has changed. MCHA has learnt from the early mistakes of bone meal and is stringently tested for contamination, younger cows are sourced and all proteins are retained (not destroyed by treatment), whilst quality control ensures the absence of any transmissible spongiform encephalopathies. The best quality sources of MCHA are from Australia or New Zealand, two countries that have never had a case of BSE and have comprehensive surveillance programs to prevent them from entering the country. So with today’s knowledge and manufacturing conditions, MCHA (sourced from Australia or New Zealand) is as safe and possibly more effective than any calcium supplement on the market.

Evidence of MCHA effectiveness

MCHA supplementation in post-menopausal women has shown to effectively prevent any bone loss or reduction in BMD over a 1 to 4 year period [2-6]. In addition, several of those studies have illustrated MCHA supplementation can induce a significant reversal in bone metabolism and increase BMD [2, 4, 6] or cortical bone thickness [5] from baseline. Other studies demonstrated MCHA can significantly reduce bone loss greater than that of placebo controls or other commonly used calcium supplements [7, 8]. MCHA has also been proven to significantly slow the progression of osteoporosis and reduce related back pain in patients at risk of osteoporosis. After the 12 month trial, only 10% of patients taking MCHA still reported any pain, whereas 100% of the control group either reported that pain stayed the same or had become worse.

Overall, clinical studies have shown MCHA to be a safe, favourable treatment option for those at risk of osteoporosis. Most appealing is that it displays the ability to not only reduce bone loss but also restore and increase BMD as well. The reason why MCHA appears so effective is possibly because it contains a readily bioavailable source of calcium combined with key bone proteins required for bone formation.

Comparison to other calcium forms

A fairly recent meta-analysis reviewed and compared the effectiveness of MCHA against calcium carbonate [1]. From the 6 randomized controlled trials that were included, MCHA was significantly more effective at improving BMD and preventing bone loss than calcium carbonate. In addition to those trials, two more studies [4, 7] have shown the superiority of MCHA over calcium carbonate with another two showing the same conclusion against calcium gluconate [5, 9]. To date no study has compared MCHA with calcium citrate in regards to BMD and bone loss.

Factors affecting calcium to be aware of

There are many factors that enhance or hinder the amount of calcium that is ultimately deposited into the bones. Acknowledging these interactions are just as important as supplementation itself.

Enhance

Vitamin D supports calcium absorption, transportation and deposition in bone. This is well established to the point where a calcium supplement without vitamin D should not waste your time considering.

Vitamin K supports calcium deposition and strong bone formation as it’s required for the posttranslational modification of the bone protein, osteocalcin. As a co-factor of the enzyme gammaglutamate carboxylase (GGCX), vitamin K is required for the carboxylation of osteocalcin, converting its glutamate residues into glutamic acid (Gla) residues which have a strong binding affinity to calcium. After this change, carboxylated osteocalcin binds to calcium and deposits it into bone tissue in its strongest form, a hexagonal hydroxyapatite structure.

Alkaline calcium forms (eg. carbonate, phosphate) are recommended to be taken with or just after eating food. Their adequate absorption relies on the presence of stomach acid. Acidic calcium compounds (eg. Citrate, malate) do not require stomach acid for absorption so can be taken with or without meals.

The time a calcium supplement is taken is also a factor. Circadian rhythmic fluctuations of PTH influence osteoprotegrin levels and osteoblast and osteoclast activity, favouring bone mineralization during the day and bone loss at night [10]. This rhythmicity favours a greater need for calcium at night to suppress the rise in PTH and attenuate the bone loss occurring at night. Therefore evening calcium supplementation appears to have a greater effect on bone density [11].

Hinder

Foods containing phytates (such as oatmeal, corn, rye, whole wheat, nuts, seeds, beans, potatoes, blackberries, strawberries, broccoli, carrots and peas) can reduce the amount of calcium absorbed from supplements as they bind to calcium to produce insoluble compounds. However, soaking or cooking the food help by degrading phytates to reduce their influence. Foods containing oxalates also produce insoluble calcium compounds, but only interact within the food source, thus will not affect supplements.

A diet in excess of protein, alcohol, caffeine or sodium can all affect the availability of calcium and increase the excretion of calcium.

A single dose should not exceed 500mg of calcium as this is the maximum amount of calcium the intestines can absorb at one time. Thus if a higher daily dose is required it should be split into multiple doses so a single dose doesn’t exceed 500mg.

Calcium absorption competes with iron, magnesium and zinc. Thus if taking one of these mineral supplements, leave at least a 2 hour gap between the supplement intake to optimize calcium absorption. Medications such as bile acid sequestrates, heartburn treatment and long-term corticosteroid use can also reduce the availability of calcium.

Concluding remarks

If going to the effort of preventing osteoporosis, there are many things to consider beyond the simple means of increasing calcium intake. MCHA demonstrates the unique ability to restore bone mass that other calcium supplements cannot achieve. In addition to taking calcium supplements, one must look at other factors that can enhance (eg. Vitamin D, Vitamin K, dosing issues) or hinder (eg. diet, phytates, excess protein, iron supplements) the amount of calcium that is deposited into bones.

References

  1. Castelo-Branco, C., M. Ciria-Recasens, M.J. Cancelo-Hidalgo, S. Palacios, J. Haya-Palazuelos, J. Carbonell-Abello, J. Blanch-Rubio, M.J. Martinez-Zapata, J. Manasanch, and L. Perez-Edo, (2009) ‘Efficacy of ossein-hydroxyapatite complex compared with calcium carbonate to prevent bone loss: a meta-analysis.’ Menopause. 16(5): p. 984-91.
  2. Castelo-Branco, C., M.J. Martinez de Osaba, F. Pons, E. Casals, A. Sanjuan, J.J. Vicente, and J.A. Vanrell, (1999) ‘Ossein-hydroxyapatite compounds for preventing postmenopausal bone loss. Coadjuvant use with hormone replacement therapy.’ J Reprod Med. 44(3): p. 241-6.
  3. Castelo-Branco, C., F. Pons, J.J. Vicente, A. Sanjuan, and J.A. Vanrell, (1999) ‘Preventing postmenopausal bone loss with ossein-hydroxyapatite compounds. Results of a two-year, prospective trial.’ J Reprod Med. 44(7): p. 601-5.
  4. Ciria-Recasens, M., J. Blanch-Rubio, M. Coll-Batet, M. Del Pilar Lisbona-Perez, A. Diez-Perez, J. Carbonell-Abello, J. Manasanch, and L. Perez-Edo, (2011) ‘Comparison of the effects of ossein-hydroxyapatite complex and calcium carbonate on bone metabolism in women with senile osteoporosis: a randomized, open-label, parallel-group, controlled, prospective study.’ Clin Drug Investig. 31(12): p. 817-24.
  5. Epstein, O., Y. Kato, R. Dick, and S. Sherlock, (1982) ‘Vitamin D, hydroxyapatite, and calcium gluconate in treatment of cortical bone thinning in postmenopausal women with primary biliary cirrhosis.’ Am J Clin Nutr. 36(3): p. 426-30.
  6. Fernandez-Pareja, A., E. Hernandez-Blanco, J.M. Perez-Maceda, V.J. Riera Rubio, J.H. Palazuelos, and J.M. Dalmau, (2007) ‘Prevention of osteoporosis: four-year follow-up of a cohort of postmenopausal women treated with an ossein-hydroxyapatite compound.’ Clin Drug Investig. 27(4): p. 227-32.
  7. Pelayo, I., J. Haya, J.J. De la Cruz, C. Seco, J.I. Bugella, J.L. Diaz, J.M. Bajo, and M. Repolles, (2008) ‘Raloxifene plus ossein-hydroxyapatite compound versus raloxifene plus calcium carbonate to control bone loss in postmenopausal women: a randomized trial.’ Menopause. 15(6): p. 1132-8.
  8. Ruegsegger, P., A. Keller, and M.A. Dambacher, (1995) ‘Comparison of the treatment effects of ossein-hydroxyapatite compound and calcium carbonate in osteoporotic females.’ Osteoporos Int. 5(1): p. 30-4.
  9. Windsor, A.C., D.P. Misra, J.M. Loudon, and G.E. Staddon, (1973) ‘The effect of whole-bone extract on 47Ca absorption in the elderly.’ Age Ageing. 2(4): p. 230-4.
  10. Joseph, F., B.Y. Chan, B.H. Durham, A.M. Ahmad, S. Vinjamuri, J.A. Gallagher, J.P. Vora, and W.D. Fraser, (2007) ‘The circadian rhythm of osteoprotegerin and its association with parathyroid hormone secretion.’ J Clin Endocrinol Metab. 92(8): p. 3230-8.
  11. Blumsohn, A., K. Herrington, R.A. Hannon, P. Shao, D.R. Eyre, and R. Eastell, (1994) ‘The effect of calcium supplementation on the circadian rhythm of bone resorption.’ J Clin Endocrinol Metab. 79(3): p. 730-5.

 

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