Watch for misleading claims on supplements

Q. I have osteoporosis and have been on Fosamax for several years, to generally good effect. I've been taking a dietary supplement called Bone Builder, and it contains the mineral boron. I was told that this particular calcium product does not get absorbed with the help of Vitamin D. Aside from what's in my daily multivitamin supplement, I do not take a separate D supplement. However, my recent bone-density test showed a small amount of bone loss since my last scan three years ago. Have I been making a mistake?

L.M., via e-mail

A. I am aware of a product named Bone Builder that is based on hydroxyapatite as a source of calcium. I assume this is the product to which you are referring.

Hydroxyapatite is the name of the crystalline mineral structure that makes up bones. Apparently, the idea was to put ground-up hydroxyapatite into a capsule and use it as a dietary supplement. The issue here is that dietary calcium has to be absorbed before it can be used, and while hydroxyapatite contains all the minerals in the correct ratio, I have not found convincing evidence that it is a superior calcium supplement.

In 1996, the Federal Trade Commission took issue with advertising claims for Bone Builder. The manufacturer had claimed that Bone Builder was better than other products in its ability to stop bone loss, eliminate pain associated with bone ailments and restore lost bone, and that it was better absorbed and utilized than other forms of calcium.

There wasn't enough evidence to back those claims, and the company was ordered to stop making them. (Details of the ruling are available online at tinyurl.com/ytdvxw.) This product does, however, provide calcium and other bone minerals, so there doesn't appear to be anything wrong with it.

The more typical forms of supplementary calcium include calcium citrate, calcium citrate malate and calcium carbonate. Dairy products are always a reliable source, and foods such as orange juice, soy milk and almond milk are often fortified with calcium. The bottom line here is that it is more important to get the calcium than spend too much time worrying over which form is best.

Irrespective of how you get it, the best time to take calcium is at mealtime, and it is essential to get enough vitamin D. (Adequate intake of vitamin D for seniors age 51-70 is 400 IUs per day, but take care not to overdo it. Toxicity symptoms have been reported with levels four times this amount.)

The fact that you've experienced a small amount of bone loss over the past few years might be a normal effect of aging. As we move from midlife to our senior years, the calcium in the bones tends to leave more rapidly than it can be replenished. The problem is with people who did not have a large reserve of bone calcium to begin with.

Getting a baseline reading is an essential part of this formula. You cannot know how fast something has fallen until you know the starting point. If the level of minerals drops to a certain point, your physician will diagnose the problem as osteopenia (low bone mass) or osteoporosis. All of this highlights the importance of good nutrition, including calcium, throughout life.

There are many medications and strategies that can help you. Weight-bearing exercises, such as walking, stretching and other floor exercises, and weight training can also help. Have an ongoing discussion about these issues with your health professional.

The National Library of Medicine has an extensive online library on osteoporosis at tinyurl.com/34jox.