Calcium and vitamin D supplements are not recommended to help prevent hip fractures

A recent meta-analysis  published in JAMA (2) of research on the efficacy of calcium and vitamin D supplements to help prevent hip fractures and other types of bone fractures in Senior Citizens or post-menopausal women found no benefit compared to placebo or no treatment.  The meta-analysis included 33 clinical trials involving 51,145 participants.

The brief overview article does not mention if harm was found but concludes with the simple statement that the findings do not support a routine recommendation or use of calcium and vitamin D supplements in community dwelling older people. Read more: Thumbs Down on Calcium and Vitamin D to Prevent Hip Fracture (1)

Adequate magnesium in a form the body is able to absorb well, which may require a topical form such as soaking with magnesium sulfate salt (Epsom salt) or magnesium chloride products, is required for maintaining bone health. The minerals silicon and boron are also important and the mineral strontium in microgram amounts may help. Vitamin K from leafy green vegetables and green herbs and spices (or in the form of vitamin K2 supplementally may be helpful) is also important for maintaining bone density. (3)

  1. Jack Cush, MD, Thumbs Down on Calcium and Vitamin D to Prevent Hip Fracture, Medpage Today, Jan 13, 2018, (Medpage Today)
  2. Jia-Guo Zhao, MDXian-Tie Zeng, MDJia Wang, MDet al, Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis, JAMA. 2017;318(24):2466-2482, (2)

  3. Charles T Price, Joshua R Langford, and Frank A Liporace,

    Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet, Open Orthop J. 2012; 6: 143–149. (3)


Nutrients Rock – “School house” style

More recently in the past than the days of my childhood, at some point when I was first writing online ~ 2010/2011, I mentioned a goal or rather an idea to “be like” a pop singer and I think my admiration and what my idea actually was may have been misunderstood. Memorable and entertaining music can be a fun way to deliver educational messages not just fill stadium shows for adults.

The children’s song and video series called School House Rock is an early example of education set to rock music. Examples are available online: [Youtube: Preamble to the Constitution]

Teaching in song goes farther back though to early nursery rhymes and the “clean up, clean up, time to clean up” song. I don’t know if that tune has a title, I learned it as an adult after my kids were already too old for it to have worked. Some lessons are learned at certain stages of development and then unlearning those habits can be difficult later in life.

Here’s a slightly different tune than I remember but – use it regularly during preschool and you may be more likely to end up with a teenager who simply is used to and prefers to have and maintain a neat room. Sing the song while cleaning up with the children everyday while they are young and need the help. In a few years they’ll be singing the song and cleaning up naturally and may even teach younger kids how much fun it is: [Youtube: Clean up song]

  • Teaching healthy eating habits and a love for a variety of flavors starts with pregnancy when mom eats a variety of healthy and flavorful foods and continues during breastfeeding. The fetus and infant do sense some of the flavor variety in their nutrition they receive from mom.
  • Offering a variety of easy to digest foods as the toddler and child grows helps teach them that a variety of flavors are interesting and enjoyable. There can be a tendency for children to prefer a favorite but offer it too often and then they may suddenly get tired of it and not want it again. Offering a variety regularly and encouraging tastes of new things without forcing a certain amount can help make an environment that feels safe for a child to explore new tastes without negative effects resulting due to feeling pressured.
  • Controlling food intake can make disordered eating habits more of a risk later on in life; eating too much, too little, or too limited a variety can be examples of disordered eating habits. Ideally it is best to encourage a child to learn to listen to their own body’s hunger and fullness signals and eat when their are hungry of a variety of foods and stop when full. A healthy microbiome, the good guy bacteria in the gastro-intestinal tract, also is important for appetite control and a good mood.
  • Fiber rich vegetables and other fiber foods are helpful for supporting the healthy types of GI tract bacteria. The good strains help protect us from bad strains and from yeast and other types of microscopic organisms. The good strains of GI bacteria have also been associated with a healthy weight and normal appetite. Some other types have been found to be common in patients with obesity and the bacteria may be playing a role in promoting an increased appetite and weight gain, more research is needed. Certain types of GI bacteria have also been found to produce different types of brain neurotransmitters, some that can increase anxiety and some that can increase a good mood.
  • So the take home point may be that bacteria that promote a good mood and healthy appetite sound like better passengers to feed and maintain during our journey through life.

Having wandered from my initial point, I’ll return to it, School-house rock style songs about nutrients might be a catchy, memorable way to learn about the nutrients. Young children could just be getting familiar with the larger message about their function and then the songs might be useful again during high-school or college along with flashcards to help learn the more complex nutrient names that go with the basic roles in the body. Chemistry students with a talent for tongue twisters can sing along with Tom Lehrer’s 1967 version of song from a Gilbert and Sullivan musical Pirates of Penzance where he shares all the chemical elements that were known at the time. [Youtube]

Now in a trip back through time you need either a time machine or a well-organized file cabinet. I’ve tried to organize my file cabinets over the years but at this particular stage of my life they are as rare as time machines – so instead of worrying about finding a particular scrap of paper with song lyrics about the vitamin B group from ten years ago I just grabbed a pencil and notepad:

B, B, B

You light my fire,

B, B, B

and give me energy

for all I require.

B, B, B

You light my fire,

B, B, B

energize my day

like a live wire.

Thiamin, Riboflavin,

Pyroxidine too,

Pantothenic acid, Cobalamin

and folate or folic acid are B’s,

Choline and biotin too,

Niacin or Niacinamide,

are also all B’s on my side.

B, B, B, B’s

Keep lightin’ my fire,

B, B, B, B’s

and I’ll never tire.*

(*obviously people do get tired eventually even with a good supply of B vitamins – lyrically the last line has more punch with the stronger statement then a more physiologically correct “so I won’t tire.” – this is why teams are helpful.) More info on the group of B vitamins:

Since I didn’t waste any time digging through old boxes or building a time machine, I just kept writing:

Iron, a red corpuscle’s friend,

helping make our muscles bend,

as we move about and play,

Iron carries oxygen all day,

delivering energy


each muscle needs

a fair amount

to shorten and

lengthen as we

bend about.

And I kept writing, there are lots of nutrients:

Phosphorus, potassium,

Molybdenum, manganese,

Magnesium, calcium,

Sodium and copper

Are all trace minerals

We need each day

for enzymes to work

so that we can play.

And a draft to introduce the macro-nutrients too:

Protein, carbohydrates,

and fats,

are the three,

big macro-nutrients

on the nutrient

family tree.

As drafts for song lyrics go, it might be time to hire a song lyricist.

Addition: But finding a song lyricist also takes time so I wrote a couple more drafts instead,

The discovery of Vitamin C is an exciting story:

Ascorbic acid,

also known as vitamin C,

protected sailors from scurvy,

while they were away at sea.

Limes were a source

of the mysterious stuff

that helped men stay well

when oceans were rough,

and journeys were long

without a single stop

for fresh supplies

and a chance to shop.

Limes would stay fresh

for months, while at sea,

and provided the sailors

a good source of vitamin C.

Scurvy was the feared

disease of the sea

until it was seen

that citrus fruit cured

and prevented the dread disease.

Bleeding gums and sore knees?

How could a sailor chew hard tack

or climb trees?

Let alone scurry up the ship’s mast

to keep watch in the lookout’s post?

Vitamin D was also discovered early for its role in preventing rickets in children, but now it has a new story to share as well:

Vitamin D, we know,

helps our bones

be strong and grow,

and now we also know

Vitamin D acts as defense

for our nutrient family tree.

It helps immune cells

learn to know

which other cells are

friend or foe

and helps mom and baby

safely get to know

each other’s cells as family

and not as foe.

Not quite ready for Youtube yet, but everything starts somewhere.

The lyrics about vitamin D contain information that is not part of standard education about the nutrient – yet. The area of immunology during pregnancy and early implantation is advancing. The fetus plays a role in decreasing the activity of the maternal immune T cells. A decrease in the internal level of tryptophan within the maternal T cells seems to be involved. A diet containing large amounts of tryptophan was associated with more fetal loss than a standard diet in animal research. For ethical reasons this field of research takes place with lab animals or murine animals. [1]

And third, fetal survival depends on tolerogenic mechanisms
that block maternal T cell responses.” [1]

The estrogen level of the mother may affect the ability of the fetus to inhibit her immune T cells:

Estrogen treatment and pregnancy both induced FoxP3 protein expression to a similar degree both in vitro and in vivo, suggesting that high estrogen levels during pregnancy may help maintain fetal tolerance by promoting regulation (65). Trophoblast-derived chemokines have also been implicated (63).” [2]

It had previously been known that estrogen has protective effects against autoimmune disease. Symptoms for some types can improve for a woman during her pregnancy and then flair back up after delivery.

Estrogen has been shown to protect against the development of autoimmune disease, yet the mechanism is not known.” (65)

The study found that estrogen treatment led to an increase in the FoxP3 protein in CD4+CD25 T cells. These are a type of regulatory T cell of the immune system which are essential for protecting against self intolerance – ie autoimmunity:

“Recently, in a TCR-transgenic mouse model where full protection against spontaneous experimental autoimmune encephalomyelitis could be achieved by the transfer of wild-type CD4+CD25 T cells, Furtado et al. (47) showed that responsiveness to IL-2 was required for the suppressive function.”  [5]

Having walked this around a ball park or ocean going vessel, I’ll get to the point, cholecalciferol, vitamin D3, helps the body make adequate supplies of Treg immune cells, and it is better at it than calcitriol. [7] Calcitriol is a synthetic form of vitamin D3 called “Rocaltrol“, [8] I’m not sure of the exact difference chemically – but they both can help our body tell us who is friend and who is foe.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. A. L. Mellor and D. H. Munn, Immunology at the Maternal-Fetal Interface: Lessons for T Cell Tolerance and Suppression. Annu. Rev. Immunol. 2000. 18:367–391. [1]
  2. Indira Guleria and Mohamed H. Sayegh, Maternal Acceptance of the Fetus: True Human Tolerance. J Immunol 2007; 178:3345-3351; [2]
  3. Saito, S., Y. Sasaki, and M. Sakai. 2005. CD4(+)CD25 +high regulatory T cells in human pregnancy. J. Reprod. Immunol. 65: 111–120. (63)
  4. Polanczyk, M. J., B. D. Carson, S. Subramanian, M. Afentoulis, A. A. Vandenbark,
    S. F. Ziegler, and H. Offner. 2004. Cutting edge: estrogen drives expansion of the CD4 (+)CD25(+) regulatory T cell compartment. J. Immunol. 173: 2227–2230. (65)
  5. Pascal FeunouLionel PoulinClaude HabranAlain Le MoineMichel Goldman and Michel Y. Braun, CD4+CD25+ and CD4+CD25 T Cells Act Respectively as Inducer and Effector T Suppressor Cells in Superantigen-Induced Tolerance. [5]

  6. Mostafa G. Aly, Karina Trojan, Rolf Weimer, Christian Morath, Gerhard Opelz, Mohammed A. Tohamy, and Volker Daniel,

    Low-dose oral cholecalciferol is associated with higher numbers of Helios+ and total Tregs than oral calcitriol in renal allograft recipients: an observational study. BMC Pharmacol Toxicol. 2016; 17: 24. [7]

  7. “Rocaltrol,” “Calcitriol,” [8]


Self injurious behavior in autism patients with low calcium levels

Trigger warning for people with a history of trauma, self injury or other PTSD type issues: this post is about difficult topics and was difficult for me to write and to recover from writing. It may trigger uncomfortable feelings in readers but denial of issues doesn’t help anyone learn how to modify and control the issues for an improved quality of life and/or improved level of self control and safety from self injury. Sexual assault is also a difficult topic but self injury or the urge to self-injure can happen everyday.

Interestingly, Coleman (1994) studied a group of autistic children who had low levels of calcium (i.e., hypocalcinuria). These individuals often exhibited eye-poking behavior. When given calcium supplements, the eye-poking decreased substantially. In addition, language functioning improved.” []

— secondary hyperparathyroidism perhaps?

For me secondary hyperparathyroidism can cause significant mental illness symptoms including a feeling of jittery thoughts and a jittery body, with a pent up feeling of needing to pop the bubble – ‘stabby’ feelings with a desire to self injure by stabbing myself. It is extremely unpleasant feeling and at times included a feeling of wanting to pop the eyes – gouge them out. Very unpleasant is an understatement, very dangerous to self is more accurate.

Secondary hyperparathyroidism can be caused by low vitamin D or low calcium. My endocrinologist was extremely insistent that I take both vitamin D and calcium but over the years I had learned, with lab test proof, that my hormone D tends to be in the elevated end of the normal range. Irritability to an excessive level can occur at the elevated end of the range of hormone D. Lab test ranges are just based on the averages that are seen by the lab — and lab tests are usually ordered for sick people not for healthy people, so those lab test ranges are really the range of values seen in sick people not a range based on the average values seen in only healthy people.

I didn’t comply with the endocrinologist’s recommendation and found that just increasing calcium intake stabilized my level of parathyroid hormone and took away the ‘stabby’ feelings.

It is common for corticosteroid balance to be different from normal in patients with autism. [see link below] Vitamin D and hormone D are actually seco-steroids and the active hormone D acts somewhat like steroids in the body. Autism patients may be like people with obesity and many other chronic illnesses, that have been associated with low vitamin D but supplements weren’t found to be helpful for the various conditions. The problem may be more like mine where I have too much hormone D which is converted from vitamin D, and which leads to low levels of vitamin D. []

Vitamin D is carried on a transport protein that acts to keep it inactive. When free within the body the vitamin form is quickly activated to the hormone form. There are many more Vitamin D receptors throughout the body than there is usually  enough hormone D to activate them all during states of normal health.

Autism and other chronic diseases that seem to associated with low lab test levels of vitamin D may actually be reflecting a problem or deficiency in the vitamin D carrier protein rather than representing an inadequate amount of vitamin D being supplied from the diet or an inadequate amount of time spent in direct sunshine. Vitamin D is based on cholesterol and is not actually an essential vitamin in the way that other vitamins are essential because our bodies can make vitamin D from cholesterol when we get about 15 to 30 minutes of sunshine per day on our face, throat, and bare arms.

Magnesium baths help circumvent the problem elevated hormone D causes within the gastrointestinal tract — calcium is absorbed preferentially and magnesium deficiency can result which also can be a cause of significant irritability.

Providing nutrition education and individualized nutrition care in the public health sector is where I have training and experience. — ie giving away free information. Making money is not where I’ve had experience. And traveling has proven to be difficult for me with my various autoimmune and food sensitivities, but I care a lot about pain and suffering and mental anguish, in myself and others.

It is unpleasant to have to feel an urge to hurt oneself, and it is hard to control an internal explosive feeling that has nothing to do with how your childhood went — talk therapy is not much help if the problem is actually hyperparathyroidism. Multiply that internal jitteriness and explosive feeling by days, months, or years, and it is really much better to take calcium supplements and magnesium baths then to talk to a therapist about your childhood — while trying to control the urge to poke yourself in the eyes. (They don’t understand, and the endocrinologist didn’t either. Lab tests are just lab tests and mood symptoms are referred to a psychiatrist for mood stabilizing medications – in my (bad) experience.)

  • Autistic kids wash up happier in an Epsom salt bath, .
  • I describe my current Epsom salt bath routine towards the end of this post: Substance P, neuropathic pain, migraines, and the cannabinoid system,

The way “fair use for educational purposes” works is that the information is provided not for profit. I share information, which may contain excerpts from copy-righted works, in the hopes that some individuals or clinicians will find some of the information helpful, and to keep within the guidelines for fair use I don’t ask for donations or charge money for the information.

(Brief excerpts fit the guidelines better, the Autistic kids wash up happier post was a post from years ago, before I had learned more about fair use guideline. It contains an extensive excerpt from a much longer article, but it is very helpful information regarding some special dietary needs that are common among children with autism and which I also found helpful for improving my own diet. I have recently found that I have several genetic defects that are also commonly found in children with autism. One of them affects two important amino acids so that might be a problem that could affect my ability to make the vitamin D carrier protein – but I haven’t looked into that metabolic pathway yet.)

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./