Vitamin K for Osteoporosis Prevention and Build Strong Bones.
Have you heard Vitamin K is good for your osteoporosis or osteopenia, but you aren't sure if you are getting enough in your diet, and questioning whether you or not you need a supplement? Or maybe you heard you don't get much Vitamin K when you eat spinach, even though spinach is rich in Vitamin K. And how does Vitamin K relate to Vitamin D?
You are not alone. I get these questions regularly.
Vitamin K research is a rabbit hole that takes you in so many directions and gets confusing very fast. Let's see how I do in explaining it and helping you navigate what you should be trying to achieve with your intake.
Optimal bone density and the ability to build more bone relies on many factors. Two of the “ingredients” needed to build and maintain bone are Vitamin K and Vitamin D. Vitamin K helps make the proteins osteocalcin and matrix Gla-protein (MGP). These proteins bring Calcium from your blood to your bone, help you maintain bone strength, and assist with bone metabolism. Vitamin D helps with Calcium uptake, and is needed to build bone (osteoblast activity).
While you can get both of these vitamins from your diet (or the sun for Vitamin D), it is good to double-check that you have good levels of both.
First, a well-rounded, Mediterranean diet is the best way to ensure you are getting all of the nutrition you need for bone health (Andreo-López et al, 2023). But is this enough?
You can have your vitamin levels checked.
Vitamin D is easier to measure than Vitamin K. A blood test by your primary care physician can tell you your levels. I have had mine measured yearly for over five years, and my levels are finally in the normal range. It took time.
Vitamin K is harder to measure. It is absorbed and broken down rapidly making it difficult to say who has low levels. This means other tests are needed to determine your levels. Because Vitamin K is necessary for proper blood clotting, one way to determine adequate levels is to measure your prothrombin time (the time it takes for blood to clot). It is not a direct indication, but it can help. There is another test that is not clinically available for most people. The test measures circulating levels of carboxylated osteocalcin (cOC) relative to undercarboxylated osteocalcin (ucOC). A low ucOC serum concentration seems to provide the most relevant information on insufficient vitamin K status (Aaseth et al, 2024).
What is Vitamin K?
Vitamin K is more than just one vitamin. Here is the breakdown:
Vitamin K-1 (phylloquinone) - Fat soluble. Absorbed in the intestines in the presence of dietary fat. Important in blood clotting. It is found in green plants, like spinach, broccoli, iceberg lettuce, Swiss chard, prunes and kale.
Vitamin K-2 (menaquinone) - Fat soluble. Important in bone health. It is found in fermented soybeans (natto), egg yolk, pork, hard cheeses (Gouda, blue cheese, swiss) chicken breast, liver, and sauerkraut, and can be produced by gut bacteria. Menaquinone has multiple forms, which show up on supplements as MK-4 through MK-13 (for example, many supplements for Vitamin K say either MK-4, MK-7, or MK-9, which have been studied more than the others).
Vitamin K-3 (menadione) - a water-soluble synthetic form and is classified as a pro-vitamin
For bone health, a deficiency of Vitamin K-2 (menaquinone) is more common than Vitamin K-1 (phylloquinone).
Vitamin K is present in most multivitamins. I checked my Multi, and it said "Phytonadione". This is a form of K-1.
I am a big proponent of food before supplements. Supplements are good if you have trouble getting enough nutrition from food, for instance, if you have a digestive issue that impairs your absorption. If you eat a well-rounded, purposeful diet, your nutrients are best absorbed in their natural form. Supplements are also unregulated, so getting what is stated on the label is not guaranteed.
What food has Vitamin K?
One specific food that has been studied in relation to bone health is dried plumes or prunes. Eating 4-6 prunes per day can be one way to get Vitamin K into your diet.
With all diet changes, checking with your healthcare provider is important. Anyone taking blood thinning medication, such as Coumadin, should be especially diligent when consuming Vitamin K in higher amounts. Remember above, one way to measure Vitamin K levels was to measure your blood clotting time. Adding too much Vitamin K could be a problem if you are on blood thinners, so please check with your physician.
Take home message:
Vitamin K, specifically K2, along with adequate Vitamin D, is good for your bone density. Have your Vitamin D levels tested the next time you get blood work and if it is low, supplementing may be a good way to increase your levels. For Vitamin K, the blood test is a little more complex. Eating foods rich in Vitamin K, and adding prunes to your diet can help ensure you are getting enough. If you take a multivitamin, you are likely already supplementing with Vitamin K.
I hope this is helpful. Figuring out how to get the best nutrition for combatting osteoporosis and osteopenia is tricky. I try not to get too hung up on specific vitamin levels. I would encourage you to focus on getting the best quality food you can afford, rather than spending money on supplements. If you spend more than $100/month on supplements, I would suggest this money is better spent on organic, local food, or a meal service if cooking isn't your thing.
And if you are not investing in exercise to get weight bearing into your week, whether with a personal trainer or online program, switch your focus from supplements to building strength. Supplements will NOT change your bone status without exercise. Osteoporosis and osteopenia are conditions that can change with proper nutrition and weight-bearing exercise.
If you are wondering exactly what exercises you should be doing, I wrote all about them, read here: Weight-Bearing Exercises for Osteoporosis and Osteopenia, the LIFTMOR study
Let’s get you headed in the right direction today.
To your health,
Andrea
References:
Aaseth JO, Finnes TE, Askim M, Alexander J. The Importance of Vitamin K and the Combination of Vitamins K and D for Calcium Metabolism and Bone Health: A Review. Nutrients. 2024 Jul 25;16(15):2420. doi: 10.3390/nu16152420. PMID: 39125301; PMCID: PMC11313760.
Alonso N, Meinitzer A, Fritz-Petrin E, Enko D, Herrmann M. Role of Vitamin K in Bone and Muscle Metabolism. Calcif Tissue Int. 2023 Feb;112(2):178-196. doi: 10.1007/s00223-022-00955-3. Epub 2022 Feb 12. PMID: 35150288; PMCID: PMC9859868.
Andreo-López MC, Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. The Influence of the Mediterranean Dietary Pattern on Osteoporosis and Sarcopenia. Nutrients. 2023 Jul 20;15(14):3224. doi: 10.3390/nu15143224. PMID: 37513646; PMCID: PMC10385532.
Curtis J. Ingold; Shane R. Sergent. National Institute of Health. National Library of Medicine. Phytonadione (Vitamin K1). Accessed 8/30/24.https://www.ncbi.nlm.nih.gov/books/NBK557622/.
National Institute of Health. Vitamin K Fact Sheet for Health Professionals. Updated March 29, 2021. https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/#:~:text=The%20most%20common%20sources%20of,oil%20%5B5%2C7%5D.
USDA Agricultural Research Service. https://fdc.nal.usda.gov/fdc-app.html#/food-details/168162/nutrients
Wallace TC. Dried Plums, Prunes and Bone Health: A Comprehensive Review. Nutrients. 2017 Apr 19;9(4):401. doi: 10.3390/nu9040401. PMID: 28422064; PMCID: PMC5409740.