A hormone often associated with sleep, melatonin, may have an important role in maintaining and improving bone density in menopausal women.

A number of medical studies have shown that melatonin can increase the activity of bone-building cells called osteoblasts as well as the actual thickness of the bone itself.

Osteoporosis is a medical condition that involves a loss of bone density. It is most common in menopausal women and can significantly increase the risk of bone fracture in the spine and thigh.

The annual medical costs of treating an osteoporosis-associated fracture exceeds $14 billion per year. The cost of preventing an osteoporosis-related fracture with medications exceeds $2 billion per year. Treating osteoporosis is very expensive.

Can we do better by preventing it naturally?

Melatonin is a hormone produced by both animals and plants. In animals it is produced by the pineal gland located in the lower back part of the brain. In both plants and animals, it is used as a powerful antioxidant.

In animals, one of the functions of melatonin is to regulate sleep, but it also helps to regulate the immune system, sex hormones, sleep cycle and, according to recent research, bone health.

Increasing age, sleep deprivation, changes in sleep patterns, some blood pressure and pain medications and low levels of zinc, magnesium and folate all can reduce the amount of melatonin produced by the pineal gland.

A 2017 study in Scientific Reports detailed how melatonin regulates the activity of a protein, Osterix, that is crucial to the formation and activity of bone-building cells called osteoblasts. In several related clinical studies, people who were chronically sleep deprived as a result of obstructive sleep apnea (and as a result melatonin depleted) had a higher risk of osteoporosis and bone fractures.

One important clinical trial (Journal of Pineal Research 2015) showed that supplementation with melatonin had significant bone-related benefits. In this study 81 osteopenic women took one or three mg of melatonin or a placebo every night for a year.

Those taking one mg of melatonin saw a 0.5 percent increase in femoral neck bone density. A very significant 2.3 percent increase in bone density was found in the three mg of melatonin group. In addition, calcium loss in the urine was reduced by 12.2 percent.

Osteoporosis is a serious medical condition, but is one that seems to be more of a lifestyle decision than an irreversible, metabolic and genetic disease.

There is good research to show that exercise, stress reduction, diet, work schedules, alcohol, tobacco and even select supplements can either positively or negatively impact the risk and progression of osteoporosis.

Now there is evidence that the lack of sleep and a low melatonin level also increases the risk of osteoporosis. Conversely, taking melatonin on a regular basis may not only improve sleep, but also be protective against the bone fractures associated with osteoporosis.

Melatonin is generally quite safe. However, some may experience headaches, sleepiness and bowel issues. In addition, melatonin cannot be taken together with the blood thinner warfarin.

• Patrick B. Massey, MD, PH.D., is medical director for complementary and alternative medicine at Alexian Brothers Hospital Network and president of ALT-MED Medical and Physical Therapy, 1544 Nerge Road, Elk Grove Village. His website is www.alt-med.org.