In a study published on Oct 28, 2014 by Dr. Michaelsson of Uppsala University, Sweden in the BMJ, high milk intake was associated with an increased rate of death in a large observational study completed in Sweden.

In this study 61,433 Women (39-74 years at baseline 1987-90) were followed for 20.1 years and 45,339 men (45-79 years at baseline 1997), were followed for 11.2 years. They completed food frequency questionnaires. During the follow-up of 20.1 years, 15,541 women died and 17,252 had a fracture, of whom 4259 had a hip fracture. Of the men being followed for an average of 11.2 years, 10,112 men died and 5,066 had a fracture, with 1,166 hip fracture cases. In women, the death rate was higher in those drinking three or more glasses of milk a day compared to those drinking just one glass a day (hazard ratio 1.93; 95% confidence interval 1.80 to 2.06). There did not appear to be a decrease in the risk of fracture with a higher intake of milk. Similar findings were seen in the men in this study. The researchers concluded that high milk intake was associated with a higher death rate and did not appear to protect from developing fractures.

This study design was not ideal however for determining cause and effect between the high intake of milk and the increased risk of death. Other researchers have actually observed a lower rate of heart attacks in those with a diet rich in dietary sources of calcium. In 2012, Li and colleagues evaluated a German cohort study of 23,980 people ages 35-64 followed over 11 years and found that a calcium enriched diet was associated with a lower rate of MI by 30%.

Clearly further research with well-designed studies is necessary before it can be concluded that high intake of milk is harmful. Osteoporosis Canada recommends that Canadians over 50 get 1200 mg of calcium daily through food and supplement, with food being the preferable source.

Strontium ranelate (Protelos) is a drug approved for the treatment of osteoporosis in Europe, but not in Canada. It is effective in reducing fractures . Recently the European Medicines Agency has completed their review regarding the safety of this drug and recommend that strontium ranelate not be taken by patients with heart or circulatory problems. Individuals who have had a heart attack, angina, stroke or uncontrolled blood pressure should not take this medicine and should discuss their osteoporosis therapy with their physician.

The safety of strontium citrate commonly available at health food stores in Canada has not been evaluated and its effects on fracture risk reduction are not known.

Osteoporosis Canada recommends that all patients with osteoporosis or at an increased risk of fracture discuss their treatment options with their physician.

In 15 of the studies the mean baseline vitamin D level was over 50 nmol/l which is higher than values seen in a significant number of Canadian men and women particularly during the winter months. In 1 study of adult Canadians who were not using vitamin D supplements, 34% had evidence of vitamin D insufficiency with vitamin D levels below 40 nmol/L.

The meta analysis completed by Reid and colleagues did not show an effect of vitamin D supplements on bone mineral density.

It is important to remember that vitamin D enables optimal calcium absorption from the bowel and inadequate vitamin D results in poor mineralization of the bone in addition to bone loss due to high levels of parathyroid hormone.

The majority of Canadians have inadequate vitamin D levels and do require approximately 400-2000 IU of vitamin D daily to reach a normal vitamin D level. Osteoporosis Canada’s guidelines for vitamin D are safe and are designed to prevent vitamin D deficiency, which is clearly harmful for bone health.

In those with osteoporosis it is necessary to take adequate calcium and vitamin D as well as drug therapy in order to significantly reduce fracture risk.

In 2008 the results of a small study were published reporting on the use of choline stabilized orthosilicic acid a form of silicon, or placebo in 184 women with low bone density. The women also received 1,000 mg of calcium in addition to vitamin D3 supplements. At 12 months 136 women had completed the study. There was wide variation in the markers of bone repair and renewal, a trend for higher markers of bone formation in the group receiving the orthosilicic acid. There was no significant change in the bone density at 12 months between the placebo group and the orthosilicic acid group.

There may be a potential benefit with this compound and it may warrant further research. However, at this time the research data available is extremely limited and has not confirmed that this product is of value in improving bone health and reducing the risk of fracture. Individuals with osteoporosis or low bone density should consult their physician regarding the best treatment options for them.

Prepared and reviewed by members of the Scientific Advisory Council of Osteoporosis Canada – Updated August 6, 2013

Calcitonin is a hormone found naturally in our bodies. A synthetic form of calcitonin (Miacalcin NS® or generic calcitonin) is used in a nasal spray It decreases the function of the osteoclast (bone-eroding cells) and can decrease bone loss and the risk of spine fractures. It has also been found to be helpful in decreasing bone pain after a spine fracture. Calcitonin is also approved for the treatment of Pagets bone disease as well as for the treatment of high blood calcium in those with cancer. In 2012, the European Medicines Agency (EMA) reviewed the benefits and risks of taking this medication and noted that a small increased risk of cancer has been seen with long term use of calcitonin. The EMA reviewed all available information including safety data following release of the drug on the market as well as information from experimental cancer studies. A 2.4% increased rate of cancer was seen in those taking nasal calcitonin long term. The concern regarding cancer risk did not appear to be present with short term use (≤6 months). At this time the increased risk of cancer has not been confirmed to be caused by calcitonin and may simply be an association.

In July 2013, Health Canada decided to withdraw all nasal spray calcitonin products from the market following a review of the safety and effectiveness data for synthetic calcitonin. Calcitonin does not have a very potent anti-osteoporosis effect, and does not decrease the risk of hip or nonspine fractures. For this reason, Osteoporosis Canada has previously advised that it not be used as a first line treatment for osteoporosis. People taking nasal calcitonin for osteoporosis should speak to their physician regarding a switch to an alternative product.