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Vitamins D-3 and K, and Bones

Dear Dr. Roach: I was prescribed Boniva and Fosamax by my gynecologist when my bone scan indicated a decreased bone density. I had severe esophagus spasms and ceased that treatment.

My primary doctor suggested that I take calcium citrate, vitamin D-3 and vitamin K-2. My scan two years later was near perfect, and it has remained that way! My doctor said that the K-2 helps transport the calcium and D-3 to the bones. How do you feel about this combo? — P.O.

Answer: Boniva and Fosamax are in the class of drugs called bisphosphonates, which usually are reserved for people with osteoporosis — low bone density with fracture or very low bone density. They have numerous side effects and aren’t right for everybody.

Calcium and vitamin D are appropriate for most people, women and men, with low bone density or osteoporosis. In people with low vitamin D, this treatment can be particularly effective.

Vitamin K can help with calcium metabolism. In several studies from Japan, adding vitamin K reduced fracture risk. However, it did not help in a subsequent study of Caucasian women, who probably have very different dietary habits from the Japanese women. I think most people with low bone density can get enough vitamin K from leafy vegetables and do not need to take supplements.

Dr. Roach Writes: In February, I wrote about prevention of diabetes; however, I inexplicably did not specify that I was speaking of Type 2 diabetes, and readers certainly let me have it. Let me take this time to clarify the difference between Type 1 and Type 2 diabetes.

Type 1 diabetes is caused by the destruction of beta cells, the cells in the islets of the pancreas that secrete insulin in response to blood sugar, as well as other triggers. The body’s own immune system destroys the cells, but the exact reason why is not understood. Type 1 diabetes usually occurs in childhood, but it can occur in young-adulthood or even later. People with Type 1 diabetes typically are thin, though they can be of any size. They are absolutely dependent on insulin, except during the “honeymoon period” after initial diagnosis. Unfortunately, we do not have any way to reliably prevent Type 1 diabetes, although studies with drugs that modulate the immune system have shown early promise. Pancreas transplantation, and even islet cell transplant, can “cure” Type 1 diabetes, though the solution is far from perfect.

Type 2 diabetes represents 90 percent to 95 percent of diabetics, and is epidemic in North America. Type 2 diabetes is caused by resistance to insulin, and again, it isn’t exactly clear why. Most people with Type 2 diabetes are overweight or obese, but not all are. It is probable that there is more than one underlying cause of what we call Type 2 diabetes. It is Type 2 diabetes that is potentially preventable (or at least delayed) with diet and exercise, and also, to a lesser extent, with medication. Unfortunately, there are people, many of whom wrote to me, who still will develop diabetes despite what I would consider extraordinary compliance to prescribed dietary and exercise regimens. Type 2 diabetes can be treated with oral medications, insulin or other injectable medications, in combination with proper diet and exercise.

There are other rare types of diabetes. Some people have combinations of Type 1 and Type 2. Gestational diabetes, during pregnancy, is a separate issue, although it tends to predict eventual onset of Type 2 diabetes. During my training, I saw several cases involving antibodies to the insulin receptor, requiring thousands of units of insulin daily.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.