Taking Calcium and Magnesium Together

I always grin to myself when I read about not taking calcium and magnesium together because the two are together in many foods. It is true that if you take a large amount of calcium (e.g., 500 mg) with a smaller amount of magnesium (e.g., 250 mg), you will not absorb as much of the magnesium, but you will probably absorb the calcium better. We need magnesium to absorb and metabolize calcium and vitamin D. Below is a chart of calcium and magnesium in foods.  

Calcium and Magnesium in Foods (milligrams)

Collards (1 cup, boiled)
268 Ca
40 Mg
Orange juice, calcium-fortified (1 cup)
349 Ca
27 Mg
Oatmeal, fortified instant (1 packet)
98 Ca
36 Mg
Figs, dried (10 medium)
136 Ca
57 Mg
Tofu, calcium-set (1/2 cup)
861 Ca
73 Mg
Spinach (1 cup, boiled)
245 Ca
157 Mg
Soybeans (1 cup, boiled)
261 Ca
108 Mg
White beans (1 cup, boiled)
161 Ca
113 Mg
Mustard greens (1 cup, boiled)
165 Ca
18 Mg
Navy beans (1 cup, boiled)
128 Ca
96 Mg
Great northern beans (1 cup, boiled)
120 Ca
88 Mg
Black turtle beans (1 cup, boiled)
102 Ca
91 Mg
Swiss chard (1 cup, boiled)
102 Ca
152 Mg
Broccoli (1 cup, boiled)
62 Ca
33 Mg
Kale (1 cup boiled)
94 Ca
23 Mg
English muffin
101 Ca
21 Mg
Butternut squash (1 cup, boiled)
84 Ca
60 Mg
Pinto beans (1 cup, boiled)
79 Ca
86 Mg
Chick peas (1 cup, canned)
109 Ca
61 Mg
Sweet potato (1 cup, boiled)
76 Ca
54 Mg
Green beans (1 cup, boiled)
55 Ca
22 Mg
Barley (1 cup)
61 Ca
245 Mg
Brussels sprouts (8 sprouts)
60 Ca 
34 Mg
Navel orange (1 medium)
60 Ca
15 Mg
Raisins (2/3 cup)
54 Ca
35 Mg
Source: U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 26. 
*Nutrient Data Laboratory Home Page, http://ndb.nal.usda.gov/
https://www.pcrm.org/good-nutrition/nutrition-information/health...

Supplements to Take Along with Strontium

Both the Combination of Micronutrients for Bone (COMB) study and Melatonin-Micronutrients Osteopenia Treatment Study (MOTS) investigated using strontium in conjunction with other supplements. You cannot take strontium without taking sufficient calcium (from food and/or supplements) and vitamin D. You also need magnesium, which was not included in the MOTS protocol, and was provided at a very low dosage in the COMB study. 

The COMB study for osteoporosis: 

strontium citrate (680 mg) 

D3 (2000 IU) 

dietary sources of calcium

magnesium (25 mg) 

K2 (MK7) (100 mcg) 

DHA (250 mg) 

daily impact exercises were encouraged. 

MOTS for osteopenia:

strontium citrate (450 mg)

D3 (2000 IU)

K2 (MK7) (60 mcg)

melatonin, 5 mg 

These ingredients were called MSDK for melatonin, strontium citrate, vitamins D3 and K2.

In addition to study medication, participants were allowed to take less than 1000 IU D3 and less than 1000 mg of calcium. Nearly 87% of the subjects in the MOTS study were taking either calcium/vitamin D3, multivitamins, and/or other dietary supplements.

The BoneLady uses her own protocol for osteoporosis: 

strontium citrate (682 mg),

D3 (1300 IU)

calcium (500 mg tablet, about 700 mg from dietary sources) 

magnesium (450 mg)

daily low-impact exercises  

I do not take DHA, K2, or melatonin. I do take several other supplements: https://strontiumforbones.blogspot.com/2020/07/my-current-supplements.html

Strontium Citrate Protocols

If you decide to take strontium citrate, you need to ensure you are also getting adequate calcium, magnesium, vitamin D, other vitamins and minerals, and protein. You can get these nutrients from a combination of diet and supplements. Choosing a supplement plan, or protocol, that is right for you can be as simple as choosing one of the three protocols described in this post or by modifying one of them with your own choice of supplements. 

Protocols for Osteoporosis:

 COMB                                                                                 BoneLady 

Strontium citrate                   680 mg                                                  680 mg

Vitamin K2 (MK7)               100 mcg                                                none

Vitamin D3                         2000 IU                                                 1000 IU

Docosahexanoic acid (DHA)250 mg                                                 none

Magnesium                             25 mg                                                  250 mg*

Calcium                       Dietary sources                                    500 mg*  

*BoneLady takes a supplement tablet that contains 250 mg Mg and 500 mg Ca. In addition, she gets about 700 mg Ca from food for a total of about 1200 mg Ca per day.  

Protocol for Osteopenia:

MOTS 

Strontium citrate     450 mg

Vitamin K2 (MK7)     60 mcg

Vitamin D3            2000 IU*

Melatonin                    5 mg

DHA                             none

Magnesium                  none    

Calcium                          * 

*In addition to study medication, participants in the MOTS study were allowed to take less than 1000 IU of vitamin D3 and less than 1000 mg of calcium daily. 

http://strontiumforbones.blogspot.com/2017/02/mots-and-comb-study-comparison.html

http://strontiumforbones.blogspot.com/2012/02/combination-of-micronutrients-for-bone.html

https://s3-us-west-1.amazonaws.com/paperchase-aging/pdf/vmFJfarchkyMAtwWn.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310667/

https://clinicaltrials.gov/ct2/show/NCT01870115?term=strontium+citrate&rank=1

In Memory of Sara Shackleford DeHart

December 18, 1931 - November 8, 2017

Sara was born December 18, 1931 and passed away at her Lynnwood, WA home on November 8, 2017.
 

Arrangements under the direction of Purdy & Walters at Floral Hills, Lynnwood, WA.

Published in The Herald (Everett) on Nov. 22, 2017

Read obituary at Herald, The (Everett).

http://obits.dignitymemorial.com/dignity-memorial/obituary.aspx?n=Sara-DeHart&lc=4171&pid=187298167&mid=7633682&Affiliate=heraldnet&PersonID=187298167&FHID=11419

Sara DeHart was an inspiration to me and others. Ten years ago, when I started looking for alternatives to Fosamax, there was little information about strontium citrate (SC). Strontium ranelate was registered in Europe in 2004 for postmenopausal osteoporosis. I started using SC on January 21, 2008, and Sara's first article about strontium and osteoporosis was posted July 7, 2008.

Sara DeHart wrote three case studies about her struggle with osteopenia and fragility fractures while taking osteoporosis drugs. Only after taking strontium citrate with sufficient vitamin D3, calcium, and magnesium did the fractures cease. She later added vitamin K2 as well. I wrote a post about each of her articles on strontium.

Sara underwent radiation for inoperable throat cancer in 2000 and again for ductal carcinoma in situ in 2016. Of course, she wrote about those experiences and how to minimize the risk of radiation skin burns. She was a medical professional, professor, and writer until the end. She died November 8, 2017, three weeks short of her 86^th birthday.

http://strontiumforbones.blogspot.com/2009/02/strontium-and-osteoporosis.html

http://strontiumforbones.blogspot.com/2010/08/another-strontium-citrate-success.html

http://strontiumforbones.blogspot.com/2012/10/case-study-on-strontium-citrate-for.html

http://www.intrepidreport.com/archives/2608

http://www.intrepidreport.com/archives/2612

http://www.intrepidreport.com/archives/7529

 

MOTS and COMB Study Comparison

A one-year study on strontium citrate combined with melatonin and other supplements and named the Melatonin-micronutrients Osteopenia Treatment Study (MOTS) was recently published (January 26, 2017). I’d like to compare it to the Combination of Micronutrients for Bone (COMB) Study published in 2012. See the following chart:

        
    COMB Study                                                               MOTS

Study size                        114                                                                                  20

Baseline BMD status      osteoporosis                                                                   osteopenia

Strontium (citrate)               680 mg                                                                          450 mg

Vitamin K2 (MK7)               100 mcg                                                                         60 mcg

Melatonin                              none                                                                                5 mg                        

Vitamin D3                         2000 IU                                                                          2000 IU

Docosahexanoic acid (DHA)   250 mg                                                                      none

Magnesium                             25 mg                                                                          none

Lumbar spine BMD             6% increase                                                             4.3% increase

Femoral neck BMD             4% increase                                                             2.2% increase

Total hip BMD               3% increase                                                             No sign. diff., pos. trend

I could have predicted the results on BMD. How? Well, it had previously been shown, from studies on strontium ranelate, that strontium increased BMD at all dosages studied, but the optimum increases were gained with 680 mg strontium. Also, melatonin has been used for years as a sleep aid, but there is little evidence for it as a bone supplement. The authors of MOTS named two studies on melatonin listed below.         

“Limitations to this study include low number of subjects, lack of a diverse cohort and lack of different micronutrient combinations on primary and secondary endpoints in MOTS clinical trial.”

Despite the limitations of MOTS, there is valuable information to be gained from it:

MOTS increased awareness of the importance of preventative care in patients with osteopenia. “Over half of all women in the U.S. above age 50 have osteopenia with a prevalence of approximately 3.4 times more than osteoporosis. Consequently, twice the number of fractures arises from women with osteopenia as they represent almost 50% of the total population at risk.”

“The 10-year vertebral fracture risk probability decreased by 6.48% in response to MSDK (melatonin, strontium, vitamins D and K) therapy compared to 10.8% increase in placebo.”

“MSDK reduced bone marker turnover primarily by increasing the bone formation marker P1NP and maintaining healthy bone turnover.”

“MSDK demonstrated positive effects on inflammatory status and improved quality of life especially related to sleep.”

MOTS confirmed that dosages lower than 680 mg strontium will increase BMD by lower percentages.

                       

http://strontiumforbones.blogspot.com/2012/02/combination-of-micronutrients-for-bone.html

https://s3-us-west-1.amazonaws.com/paperchase-aging/pdf/vmFJfarchkyMAtwWn.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310667/

https://clinicaltrials.gov/ct2/show/NCT01870115?term=strontium+citrate&rank=1

Kotlarczyk MP, Lassila HC, O’Neil CK, D’Amico F, Enderby LT, Witt‐Enderby PA, Balk JL. Melatonin osteoporosis prevention study (MOPS): a randomized, double‐blind, placebo‐controlled study examining the effects of melatonin on bone health and quality of life in perimenopausal women. J Pineal Res. 2012; 52:414–26. doi: 10.1111/j.1600‐079X.2011.00956.x

Amstrup AK, Sikjaer T, Heickendorff L, Mosekilde L, Rejnmark L. Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia: a randomized controlled trial. J Pineal Res. 2015; 59:221–29. doi:10.1111/jpi.12252