Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention.

J Environ Public Health. 2012;2012:354151. Epub 2012 Jan 15.
Genuis SJ, Bouchard TP.
Faculty of Medicine, University of Alberta, Edmonton, AB, Canada T6K 4C1.

Along with other investigations, patients presenting to an environmental health clinic with various chronic conditions were assessed for bone health status. Individuals with compromised bone strength were educated about skeletal health issues and provided with therapeutic options for potential amelioration of their bone health. Patients who declined pharmacotherapy or who previously experienced failure of drug treatment were offered other options including supplemental micronutrients identified in the medical literature as sometimes having a positive impact on bone mineral density (BMD).

After 12 months of consecutive supplemental micronutrient therapy with a combination that included

• vitamin D(3),
• vitamin K(2),
• strontium,
• magnesium and
• docosahexaenoic acid (DHA),

repeat bone densitometry was performed.
The results were analyzed in a group of compliant patients and demonstrate improved BMD in patients classified with normal, osteopenic and osteoporotic bone density.
According to the results, this combined micronutrient supplementation regimen appears to be
at least as effective as bisphosphonates or strontium ranelate in raising BMD levels in hip, spine, and femoral neck sites.

No fractures occurred in the group taking the micronutrient protocol.
This micronutrient regimen also appears to show efficacy in individuals where bisphosphonate therapy was previously unsuccessful in maintaining or raising BMD. Prospective clinical trials are required to confirm efficacy.

About 4% improvement in bone density

Those who do not take it (noncompliant) reduced bone density about 3%

Bone density increased by at least 3% in about half of the participants

PMID: 22291722
PDF is attached at the bottom of this page
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Table 1: Combination of micronutrients (COMB) Protocol for Bone Health.

COMB protocol for bone health

(1) Docosahexanoic acid or DHA (from Purified Fish Oil): 250 mg/day
(2) Vitamin D3: 2000 IU/day
(3) Vitamin K2 (non-synthetic MK7 form): 100 ug/day
(4) Strontium citrate: 680 mg/day (Comment: seems rather high)
(5) Elemental magnesium: 25 mg/day (Comment: seems rather low)
(6) Dietary sources of calcium recommended
(7) Daily impact exercising encouraged

Wonder why Boron and Silicon were not included

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See also VitaminDWiki

• All items in Bone Health and Vitamin D 312 items
• Bones grow better with high level of magnesium: rat study – Dec 2013
• Magnesium may be more important to kids’ bone health than calcium – May 2013
• Bone Health and vitamin D book - 2011
• Vitamin D is the first of three ways to make unbreakable bones – Oct 2011
• Calcium (alone) does not reduce risk of bone fracture
• Overview Osteoporosis and vitamin D
• Overview Bone fractures and vitamin D
• Overview Falling, Fractures and Vitamin D
• Bisphosphonates 4.5 X more likely to work when vitamin D level above 33 ng – Sept 2011
• Osteoporosis medication 7X more effective when more than 33 ng of vitamin D – June 2011
• 6500 IU vitamin D not improve bone density without cofactors – Jan 2012
• Vitamin K and Vitamin D
  Includes problems with excess Calcium at end of page
• In addition to vitamin D co-factors are essential for bone health – April 2012
• Must balance co-factors when increasing vitamin D has the following graph

• co-factors such as Magnesium, Vitamin K2, and Boron essential for Bone development has the following

4Bs = Bone, Bioavailability, Balance your Body

Have been unable to find a single study which considered including more than 2 of the co-factors

Must balance co-factors when increasing vitamin D

There is a lack of evidence of the interactions - the following are guesses based on incomplete information

Co-factor	How Much	Benefit Bone	Bioavailability	Balance body	Notes
Calcium	<750mg	Yes	probably	Yes	Avoid getting too much
Magnesium	500mg	Yes	Yes	Yes	Very important, big range in bio-availability
Vitamin K2		Yes	maybe	?
Vitamin A		maybe	?		need some, but too much is bad
Boron	5-10mg	Yes	25%	?
Silica		Yes	no	?
Strontium		Yes	no	?	rarely available in a co-factor pill
Zinc		Yes	maybe	?

The underlined items above link to more information

• Magnesium is probably the most important co-factor
  • Virtually everyone has become deficient in the past 50 years
  • What appears to be reaction to vitamin D is often due to a lack of Magnesium
  • Having more Magnesium increases vitamin D bio-availability