A big welcome to the November 2024 edition of CMG Topic Series, where we look at bone health, with a particular focus on nutrients in bone health.

Bone Health

By Dr Brad McEwen PhD, MHSc (Hum Nutr), MPH, BHSc

CMG Head of Products and Innovation

The human skeletal system functions as a complex sophisticated organ that maintains a dynamic balance with other body systems.

Beyond providing structural support, bones serve as a primary storage site for various minerals and compounds crucial for sustaining an optimal pH level. As people age, the natural decline in bodily functions makes older adults especially vulnerable to issues related to bone health.

Conditions such as osteoporosis, which is marked by the degradation of the bone's structural integrity, significantly heighten the likelihood of hip fractures. Bone mineral density (BMD) serves as a critical metric for assessing bone health. A diminished bone mineral density value signifies a heightened susceptibility or risk of osteoporosis or fractures.

Nutrition is the foundation of optimum health and wellbeing.

Essential nutrients such as vitamins and minerals offer a wide range of health benefits, including promoting bone and joint health, improving cardiometabolic health, supporting energy metabolism, regulating immune system function, reducing inflammation, and having antioxidant effects.

UC-II^®

UC-II® supplies a patented form of collagen with undenatured type II collagen for joint health support.

UC-II has undergone rigorous third-party research and testing for efficacy, safety and quality. The research path of UC-II began when researchers, including those at Harvard University Medical Center, found the benefits of undenatured type II collagen for joint health and published research in peer-reviewed journals. Please find below a summary of some of the research on UC-II®.

A multicentre, randomised, double-blind, placebo-controlled clinical study found that after 24 weeks, there was a statistically significant increase in knee range of motion flexion observed in the UC-II® (undenatured collagen) group versus the placebo group (3.23° vs. 0.21°; p = 0.025).

In addition, there was an increase in knee range of motion extension by 2.21° over time in the UC-II® group (p = 0.0061), while the placebo group showed a nonsignificant increase by 1.27° (p > 0.05).

A randomised trial investigated the effect of UC-II® vs placebo on knee injury and osteoarthritis outcome score (KOOS). After 120 days of supplementation, subjects in the UC-II® group exhibited a statistically significant improvement versus the placebo in KOOS items which include reduced pain during standing upright and going up or down stairs, decreased discomfort in climbing ascending stairs or bending to floor to pick an object or squatting during period of high physical activity (p<0.05).

In a study of 226 people, 40 mg of UC-II® undenatured type II collagen for 90 days significantly improved joint function, mobility, and flexibility compared to baseline.

A study aimed to test the hypothesis that UC-II® relieves pain, improves health-related quality of life, and joint function of individuals aged from 60 to 80 years with osteoarthritis of the knee. The main results of the study indicated that UC-II® improved pain, joint stiffness, and quality of life (Physical domain).

A study assessed whether UC-II® I could improve joint symptoms in moderate-to-severe knee osteoarthritis. People consuming UC-II had better clinical outcomes versus those supplemented with placebo or glucosamine hydrochloride plus chondroitin sulfate. Analysis of the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) subscales showed that reductions in all three WOMAC subscales (pain, stiffness, physical function) contributed to the improvement in the overall WOMAC score observed in people supplemented with UC-II®.

Calcium

Calcium is essential for bone health.

Calcium is involved in the mineralisation of bone, structural components of bones and teeth, essential for bone rigidity, modulation of the differentiation, proliferation, and maturation of keratinocytes and fibroblasts, regulation of muscle contraction, wound healing, enzyme regulation, coagulation and blood clotting, signal transduction, and cell signalling.

Vitamin D3

Vitamin D is involved with the absorption and metabolism of calcium, calcium homeostasis, metabolism of phosphate, stimulates active intestinal absorption of phosphate, bone metabolism, proper mineralisation of bone, muscle function, differentiation, immune regulation, and overall metabolic function.

The importance of vitamin D for bone health and prevention of rickets has been known since the early 1930s.

Vitamin D3 functions as a prohormone synthesised in the skin via the ultraviolet irradiation (from the sun) of 7-dehydrocholesterol. Initially biologically inactive, it requires conversion to 25-hydroxyvitamin D3 in the liver, followed by further metabolism to 1α,25-dihydroxyvitamin D3 in the kidneys to exert its physiological effects.

Vitamin K2

Vitamin K2 (Menaquinone-7) plays a significant role in various aspects of health, including bone health, coagulation, vascular health, transcription regulation, brain health, and brain signalling.

Vitamin K2 has anti-inflammatory and antioxidant properties. Vitamin K2 has shown beneficial effects in reducing arterial stiffness and vascular calcification.

Menaquinone-7 has numerous clinical applications, some of these include osteoporosis, rheumatoid arthritis, arterial stiffness, coronary and vascular calcification, type 2 diabetes, brain health, and depression in women with polycystic ovary syndrome.

A 3-year placebo-controlled trial in healthy postmenopausal women found that vitamin K2 (MenaQ7; 180 micrograms per day) significantly improved vitamin K status and decreased the age-related decline in bone mineral content and bone mineral density at the lumbar spine and femoral neck. Bone strength was favourably affected by vitamin K2. Vitamin K2 significantly decreased the loss in vertebral height of the lower thoracic region at the mid-site of the vertebrae.

Tocotrienols

Vitamin E Tocotrienols are antioxidants and free radical scavengers.

Vitamin E Tocotrienols protect cell membranes from oxidative damage, which can be useful in musculoskeletal conditions. Tocotrienols optimise and enhance the immune system. Additionally, tocotrienols have cholesterol-lowering properties.

Magnesium

Magnesium ranks among the most well-known and favourite minerals of health professionals, playing a crucial role in more than 300 enzymatic reactions.

Magnesium is involved in the synthesis of ATP, DNA, and RNA, mitochondrial health, metabolic functions, energy metabolism, metabolism of carbohydrates, protein and fats, glycolysis, and oxidative phosphorylation. Magnesium is involved in nerve function, neurotransmission, neurotransmitters, nitric oxide metabolism, regulation of intracellular calcium levels, and transmembrane electrolyte flux.

In the musculoskeletal and nervous systems, magnesium is involved in the relaxation of smooth muscle, normal muscle function, muscle contraction, muscle relaxation, bone strength, bone metabolism, bone mineralisation, bone mineral density, and bone integrity. Magnesium is involved in the maintenance of normal muscle and nerve function, heart rhythm, and the immune system.

A deficiency of magnesium has been associated with muscle spasms, nervousness, fatigue, depression, anxiety, apathy, agitation, and irritability.

Zinc

Zinc has various roles within the human body that can directly and indirectly support bone health.

Zinc is involved in for catalytic, structural, and regulatory functions. This essential mineral is a constituent of approximately 300 enzymes and plays a critical role in the synthesis of DNA and RNA, regulation of gene expression, maintenance of cell structure, facilitation of neurotransmission, neuromodulator in synaptic vesicles, and supports brain function. It is involved in the enhancement of immune system health, promotion of cardiovascular wellbeing, and exhibits both antioxidant and anti-inflammatory effects.

Omega-3 and Omega-11

Omega-3 has anti-inflammatory properties, and is involved in cell membrane composition and function, cell membrane integrity, cell signalling, endothelium function, vasodilation, regulation of blood pressure and heart rate, and platelet function.

CETO3® is a natural fish oil ingredient which contains a high level of Cetoleic acid (Omega-11) with Omega-3 (EPA and DHA). CETO3® is derived from North Atlantic herring. High levels of Omega-11 are uniquely found in North Atlantic pelagic fish. Omega-11 have proven to increase the human body's own production of EPA/DHA.

A 12-week study demonstrated that a lower dose of CET03® increased the Omega-3 Index comparable to Fish oil. Compared to the fish oil capsules used in this trial, it would appear from the results of this pilot study, on a pro-rata dose equivalence, that CET03® might deliver a 50% improvement in the Omega-3 Index.

Conclusion

Bone is important for structural integrity and serve as a primary storage site for various minerals and compounds crucial for sustaining an optimal pH level.

Nutritional medicine is the foundation of optimum health. Various nutrients are utilised for optimising bone and joint health, such as UC-II, Vitamin D3, Vitamin K2, Tocotrienols, Magnesium, Zinc, and Omega-3 and Omega-11. Contact CMG to discuss NPD opportunities for your brand.

References:

Costa AP, et al. Associated strengthening exercises to undenatured oral type II collagen (UC-II®). A randomized study in patients affected by knee osteoarthritis. Muscles Ligaments Tendons J, 10(3), 481-492.
DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004; 80(6 Suppl): 1689S-96S.
Khazai N, Judd SE, Tangpricha V. Calcium and vitamin D: skeletal and extraskeletal health. Curr Rheumatol Rep. 2008; 10(2): 110-7.
Knapen MH, et al. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporos Int. 2013 Sep;24(9):2499-507.
Lai J, et al. The efficacy of zinc supplementation in depression: Systematic review of randomised controlled trials. Journal of Affective Disorders 2012; 136(1): e31-e9.
Li Z, et al. The Important Role of Zinc in Neurological Diseases. Biomolecules 2023; 13(1): 28.
Lugo JP, et al. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutr J. 2016; 29; 15:14.
McEwen B. Vitamedicine: Foundations for Optimising Health and Wellbeing. Balboa Press; 2024. ISBN 9781982299514.
McEwen, B. Nootropic effects of herbal medicines: a brief introduction. JACNEM 2024; 43(2): 6-13.
McEwen B. Vitamin K2 (Menaquinone-7): The vital nutrient for the prevention and management of chronic disease. JACNEM 2024; 43(1): 8-21.
McEwen B, Martin T. Chronic fatigue syndrome: The potential of nutritional medicine. JATMS 2023; 29(3): 124-131.
McEwen B, Martin T. The importance of Nutritional and Lifestyle Medicine in Mental Health and Wellbeing: A focus on depression. J ATMS 2023; 29(4): 188-195.
McEwen B. The Clinical Utility of Minerals: A snapshot. Part 1. J ATMS. 2022 28(1): 14-16.
McEwen B. The Clinical Utility of Minerals: A snapshot. Part 2. J ATMS. 2022 28(2): 81-84.
McEwen B. Magnesium: The multipurpose mineral. J ATMS. 2021; 27(3):140-141.
McEwen B. Vitamin E Tocotrienols: the next generation antioxidant and anti-inflammatory nutrient. JATMS 2019; 25(4): 204-206.
Mehra et al. A non-interventional, prospective, multicentric real life Indian study to assess safety and effectiveness of un-denatured type 2 collagen in management of osteoarthritis. Int J Res Orthop. 2019; 5(2): 315-320.
Sadigursky D, et al. Undenatured Collagen Type II for the Treatment of Osteoarthritis of the Knee. Acta Ortop Bras. 2022; 15;30(2): e240572.
Saiyed, Z., et al. Efficacy of UC-II® undenatured type II collagen on knee joint function in healthy subjects: an exploratory post hoc analyses of a randomized double blind, placebo - controlled trial. The FASEB Journal. 2021; 35, S1.
Schön C, et al. UC-II Undenatured Type II Collagen for Knee Joint Flexibility: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Study. J Integr Complement Med. 2022; 28(6): 540-548.
Wakeman M. Equal effectiveness of omega-3 polyunsaturated fatty acids (n-3 PUFAs) from CET03 and fish oil in elevating the omega-3 index: A 12-week randomized placebo controlled parallel study. International Journal of Scientific Research. 2024;13(1)

If symptoms persist, talk to your health professional.

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