Investigating the Effects and Mechanisms of Combined Vitamin D and K Supplementation in Postmenopausal Women: An Up-to-Date Comprehensive Review of Clinical Studies
Abstract
:1. Introduction
2. Methods
2.1. Search Strategy
2.2. Eligibility Criteria
2.3. Data Extraction Process
3. Results and Discussion
3.1. Aging and Vitamins D and K
3.2. Cardiovascular Health
3.2.1. Vitamins D and K in Cardiovascular Health
3.2.2. Randomized Controlled Trials of Vitamins D and K in Cardiovascular Health
3.3. Bone Health
3.3.1. Osteoporosis and Vitamins D and K
3.3.2. Randomized Controlled Trials of Vitamins D and K in Bone Health
3.4. Findings and Recommendations
Parameter | Number of Studies | References |
---|---|---|
OC; cOC; ucOC; cOC/ucOC ratio | 20 | [73,76,92,94,95,96,97,98,99,100,102,103,104,105,110,111,113,114,115,118] |
BMD | 15 | [93,94,96,99,101,102,103,105,106,112,113,114,116,117,118] |
PINP, CTX; CTX/P1NP | 4 | [76,116,117,119] |
IGF-1 | 3 | [98,100,102] |
MGP; dp-ucMGP | 3 | [72,74,134] |
BAP | 2 | [113,118] |
Adiponectin | 1 | [76] |
CC; DC; IMT | 1 | [71] |
DPD | 1 | [102] |
NO; hROS | 1 | [75] |
NTX | 1 | [97] |
3.5. Mechanisms of Action
3.6. Strength and Limitations
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
---|---|
The study was published in a peer-reviewed scientific journal | The study was published in commentaries, case reports, books, dissertations, editorials, and conference proceedings |
The study was a review | |
The study utilized clinical trial study design | Not randomized clinical trial |
The study aimed to examine the effects of vitamin D and vitamin K co-treatment | Not examining the co-treatment of vitamin D and vitamin K supplements |
English (abstract) | Participants not experiencing menopause |
Not Human | |
Age group under 50 years |
No. | Study, Year, Ref. | Country | Population Age | Duration Type of Study | Intervention | Comparison/Diets | Outcomes |
---|---|---|---|---|---|---|---|
1 | Braam et al., 2004 [71] | The Netherlands | 181 PM women of which 150 completed the study; analysis performed on 108 participants | 3 years, double-blind, parallel, placebo-controlled intervention study | The participants were divided into 3 groups that received a daily supplement:
| The elastic properties of the common carotid artery were measured (including CC, DC, IMT, E) | After 3 years of supplementation and after adjustment for baseline heart rate, mean arterial pressure, age, weight and smoking: ↓ DC (8.8%, 95% CI: 1.9 to 21.4; p < 0.05) and CC (8.6%, 95% CI: 1.8 to 20.3; p < 0.05) in MDK group vs. placebo; ↑ Pulse pressure (6.3%, 95% CI: 0.7 to 17.1; p < 0.05) and E (13.2%, 95% CI: 5.3 to 35.8; p < 0.01) in MDK group vs. placebo; - no significant differences between the MD group and placebo for all parameters, as well as between the three groups for the change of IMT |
2 | Shea et al., 2009 [72] | USA | 388 healthy men and PM women (60–80 y) | 3 years, double-blind study |
| CAC progression | In a subgroup analysis of the participants who were adherent to supplementation (≥85%, n = 367): ↓ CAC progression in the phylloquinone group vs. control group (p = 0.03); In a subgroup analysis of the participants with preexisting CAC (Agatston score > 10 at baseline): ↓ CAC progression in the phylloquinone group at 6% vs. control group (p = 0.04); ↑ serum MGP in the phylloquinone group and ↓ in the control group (treatment effect: p ≤ 0.03 in all analysis) |
3 | Knapen et al., 2015 [73] | The Netherlands | 39 healthy men and 26 PM women, mean age 56 ± 5 y (45–65 y) | 12 weeks |
| Comparison between the groups at baseline and after 12 weeks | ↑ circulating MK-7 levels (from 0.28 to 1.94 ng/mL) (p = 0.004 vs. standard yogurt) ↓ serum ucOC levels (p = 0.001) and plasma dp-ucMGP levels (p < 0.0001) vs. standard yogurt |
4 | Knapen et al., 2016 [74] | The Netherlands | 43 healthy men and 64 PM women, 45–65 y | Intervention period of 42 days followed by a washout period of 2 weeks |
| The plasma MK-7, dp-ucMGP and ucOC were quantified and compared between the groups at baseline and after 14, 28, and 42 days - plasma MK-7 also determined at days 45, 49, and 56 (during the washout period) | Plasma MK-7 levels after 42 days: (A) 2.29 ± 0.08 ng/mL; (B) 2.17 ± 0.09 ng/mL; (C) 2.00 ± 0.09 ng/mL (p = 0.047 between the three groups) (mean ± SE) ↑ plasma MK-7 in (A) vs. (C) (p = 0.042) ↓ plasma MK-7 levels to 0.79 ± 0.05 ng/mL after 14 days of the washout period, being still higher compared with that at the start (p < 0.0001) ↓ plasma dp-ucMGP levels after 42 days: overall 445 ± 18 pmol/L (p = 0.005); (A) 485 ± 30 pmol/L; (B) 417 ± 33 pmol/L; (C) 434 ± 31 pmol/L (p = 0.019 between-group comparisons) ↓ ucOC levels after consumption of the yogurt products and the MK-7 capsules (p = 0.012), but w/o significant differences between groups |
5 | Vignini et al., 2017 [75] | Italy | 60 healthy white PM women, 50–61 y | 1 year, placebo-controlled trial | Oral supplementation with: (1) VitVOO group: 20 mL/d VOO fortified with D3 (50 μg/100 mL), K1 (0.70 mg/100 mL), and B6 (6.0 mg/100 mL); (2) PlaVOO group: only 20 mL/day VOO as placebo | Comparison between the groups at baseline and after 1 year | After 1 year of supplementation: ↓ NO levels in Vit VOO group vs. PlaVOO (37.20 ± 3.2 vs. 42.59 ± 4.31 nmol/mg protein; p < 0.001) ↓ hROS levels in Vit VOO group vs. PlaVOO (159.24 ± 15.3 vs. 226.23 ± 21.57; p < 0.05) ↑ plasma Na+/K+-ATPase activity in Vit VOO group vs. PlaVOO (0.650 ± 0.073 vs. 0.411 ± 0.043 µmol Pi/mg protein; p < 0.001) ↓ anisotropy in Vit VOO group vs. PlaVOO (0.152 ± 0.015 vs. 0.208 ± 0.025 arbitrary fluorescence numbers, p < 0.001); (0.204 ± 0.011 vs. 0.240 ± 0.014 arbitrary absorbance numbers, p < 0.001) |
6 | Rønn et al., 2021 [76] | Denmark | 142 PM women with osteopenia, 63–73 y | 12 months, placebo-controlled trial |
| Comparison between the groups at baseline and after 3, 6, and 12 months | ↓ ucOC in the MK-7 group (−70.3 (−75.6; −63.8)%) vs. placebo (−7.2 (−15.9; 2.0)%) after 12 months (p < 0.01) ↑ P-adiponectin in the MK-7 group (6.1 ± 20.1%) vs. placebo group (−0.7 ± 15.5%) after 12 months (p = 0.03) HOMA-IR and p-leptin—no changes |
No. | Study, Year, Ref. | Country | Population Age | Duration Type of Study | Intervention | Comparison/Diets | Outcomes |
---|---|---|---|---|---|---|---|
1 | Schaafsma et al., 2000 [92] | The Netherlands | Healthy PM Dutch women (>5 y PM) with documented normal (n = 96) and low BMD (n = 45), 50–77 y | 1 year | (1) Women with normal BMD (a double-blind study): Group A: 400 IU D3 and 80 μg K1; Group B: 80 μg K1; Placebo: 2.5 g of skimmed milk powder (2) Women with low BMD (an open study): Group C: 350 IU D3 and 80 μg K1; Group D: 400 IU D3 | - Comparison vs. baseline and between the groups, at 3, 6, and 12 months; - All women (except placebo group) received about 1000 mg of additional calcium (total daily calcium intake of 2200 ± 2300 mg) | ↑ 25(OH)D serum level after 3 months (p ≤ 0.0001), 6 months (p ≤ 0.0001), and 12 months (p < 0.001) in group A vs. group B + placebo, as well as vs. baseline (p < 0.005) ↑ 25(OH)D serum level after 1 y of supplementation with D3: 33 ± 29% (95% CI, 24.8–41.8%) and 68 ± 58% (95% CI, 50.1–84.6%) in women with normal and low BMD, respectively ↓ maximum 25(OH)D level: 29% in women with low BMD during supplementation with D3 in winter ↑ % cOC after 6 months (p = 0.009) and 12 months (p = 0.001) vs. placebo, and after 3, 6, 12 months (p ≤ 0.0001) vs. baseline in women with normal BMD after K1 supplementation (group A + B) ↓ % cOC at baseline for women with low BMD (of the lumbar spine and femoral neck, p < 0.005) vs. women with normal BMD; the difference disappeared after 1 y of supplementation with vitK1: 68 + 11% (95% CI, 64.5 ± 71.2%) vs. 72 + 6% (95% CI, 70.1 ± 72.9%), respectively |
2 | Braam et al., 2003 [93] | The Netherlands | 181 healthy PM women (50–60 y), 155 completed the study | 3 years, double-blind, parallel, placebo-controlled intervention study | The participants were divided into 3 groups that received a daily supplement:
| - Usual diets for all participants with supplements containing calcium, vitD, or vitK avoided throughout the study; - Comparison between the treated groups after 1, 2, and 3 years of supplementation | ↑ BMD in femoral neck in MDK group vs. placebo and MD group (p < 0.05) after 3 years of supplementation ↓ Bone loss of the femoral neck with 1.7% (95% Cl: 0.35–3.44) in the MDK group vs. placebo and with 1.3% (95% Cl: 0.10–3.41) vs. MD group, respectively, after 3 years of supplementation and adjustment for baseline BMD, age, BMI, and years since menopause - No significant differences in BMD at the site of the lumbar spine among the three groups after 3 years of supplementation |
3 | Bolton-Smith et al., 2007 [94] | UK | 244 healthy PM Scottish women, 60 y | 2 years, double-blind, placebo-controlled trial |
| - Comparison between the treated groups at baseline and after successive 6-month intervals of supplementation | ↑ BMD and BMC at the site of the ultradistal radius in combined group (4) vs. baseline (p < 0.01) after 2 years of supplementation ↑ serum vitK1 by 157% (95% CI, 101, 212) (p < 0.001) after 2 years of vitK supplementation ↓ ucOC by 51% (95% CI, −47.5, −54.0) (p < 0.001) after 2 years of vitK supplementation ↑ serum 25-hydroxyvitD [25(OH)D] by 17% (p < 0.001), and ↓ PTH by 11% (p = 0.049) after 2 years of vitD supplementation |
4 | Bügel et al., 2007 [95] | Denmark | 48 healthy PM women, 31 (62.5 ± 4.0 y) completed all three intervention periods | 3 × 6-week, cross-over study, with 3-week washout periods | Usual diet supplemented with 0 (placebo), 200, and 500 μg phylloquinone (vitK1)/day; - all volunteers received 10 μg D3/day throughout the study period | - Comparison between the treated groups after each 6-week period of K1 supplementation | ↑ daily K1 intake = ↑ cOC serum level and ↓ ucOC serum level, respectively, in a dose-dependent manner (p < 0.001) ↑ K1 serum level (p < 0.001) for 500 μg phylloquinone/day vs. placebo or 200 μg phylloquinone/day supplementation periods (which did not differ) (p = 0.15) ↑ serum total OC level (p < 0.001) for 500 (but not 200) μg phylloquinone vs. placebo |
5 | Booth et al., 2008 [96] | USA | 452 healthy, ambulatory men and PM women (60–80 y), which 401 participants completed the trial | 3 years, randomized, double-blind, parallel controlled trial | Diet supplemented with calcium (600 mg elemental calcium/day) and vitD (400 IU/day) containing either:
| - Comparison between treatment groups at baseline and after 3 years of supplemented diet | ↑ plasma phylloquinone concentrations (p < 0.0001) and ↓ % ucOC (p < 0.0001) after 3 years of vitK supplementation vs. the group that did not receive phylloquinone - overall increase in 25-hydroxyvitD plasma levels (p < 0.001) and a decrease of 1,25- dihydroxyvitD levels (p < 0.001) after 3 years of a daily supplement of 400 IU vitD, with the exception of women in the non-vitamin-K-supplemented group - No differences in lumbar spine or whole-body BMD between the two groups (p = 0.98 and 0.81, respectively) after 3 years of supplemented diet |
6 | Binkley et al., 2009 [97] | USA | 381 healthy PM women | 1 year, double-blind, placebo-controlled study | Phylloquinone (1) mg daily) (2) MK4 (45 mg daily), or (3) placebo - all participants received daily 315 mg calcium and 200 IU D3 supplementation. | - comparison between the groups at baseline and 1, 3, 6, and 12 months for biochemical parameters, and at baseline, 6, and 12 months for BMD, respectively | ↓ serum ucOC after both Phylloquinone (−61.1%, 95% CI: −65.5%, −56.1%; p < 0.0001) and MK4 (−60.7%, 95% CI: −65.1%, −55.8%; p < 0.0001) treatment after 1 year vs. placebo ↓ total OC after both Phylloquinone (−8.38%, 95% CI: −13.15%, −3.35%; p < 0.005) and MK4 (−5.65%, 95% CI: −10.5%, −0.54%; p < 0.005) treatment after 1 year vs. placebo - No effect of phylloquinone or MK4 on serum bone-specific alkaline phosphatase (BSALP) or n-telopeptide of type 1 collagen (NTX) as well as on lumbar spine or proximal femur BMD measurements |
7 | Holick et al., 2010 [98] | USA | 32 healthy PM women (50–70 y) | 14-week, single-blinded, 2-arm placebo-controlled pilot study |
| - all women consumed a modified Mediterranean -style, low-glycemic-load diet and limited aerobic exercise; - comparison between the groups at baseline and at 10 and 14 months | ↓ serum OC by 31% (p = 0.02) in the treatment group and ↑ by 19% (p = 0.03) in the placebo group vs. baseline at 14 weeks ↑ serum 25(OH)D by 13% (p = 0.24) in the treatment group and ↓ by 25% (p < 0.01) in the placebo group ↑ serum IGF-I in the treatment group at 14 weeks (p < 0.01) |
8 | Je et al., 2011 [99] | Korea | 78 healthy PM women (> 60 y), 45 completed the study | 6 months, randomized intervention study |
| - comparison between the groups after 6 months of treatment | ↑ L3 BMD in K group vs. contro group (0.01 ± 0.03 g/cm2 vs. −0.008 ± 0.04 g/cm2, p = 0.049) ↓ ucOC in K group vs. contro group (−1.6 ± 1.6 ng/dL vs. −0.4 ± 1.1 ng/dL, p = 0.008) |
9 | Lamb et al., 2011 [100] | USA | 51 PM women with the metabolic syndrome (no osteopenia/osteoporosis), 35–70 y, 45 completed the study | 14-week, single-blind, 2-arm placebo-controlled randomized trial |
| - all women consumed a modified Mediterranean -style, low-glycemic diet and limited aerobic exercise - comparison between the groups at baseline and at 10 and 14 months | ↓ serum OC (25%) to 2.28 ± 0.19 nmol/L and to 2.48 ± 0.19 after 10 and 14 weeks, respectively, vs. 3.31 ± 0.23 nmol/L at baseline (both p < 0.001) in the intervention arm ↑ serum OC (21%) to 2.96 ± 0.27 nmol/L and to 3.43 ± 0.28 (p < 0.001) after 10 and 14 weeks, respectively, vs. 2.84 ± 0.23 nmol/L at baseline in the placebo arm - Statistical changes in serum OC between arms after both 10 and 14 weeks (p < 0.001) ↑ serum 25(OH)D by 23% (139.95 ± 8.26 nmol/L vs. 113.69 ± 7.26 nmol/L, p = 0.001) in the intervention arm and ↓ by 12% (79.97 ± 5.27 nmol/L vs. 90.75 ± 6.46 nmol/L, p = 0.03) in the placebo arm after 14 weeks - Statistical changes in serum 25(OH)D between arms after both 10 and 14 weeks (p < 0.01) ↑ serum IGF-I in the intervention arm after 14 weeks (p < 0.01) |
10 | Moschonis et al., 2011 [101] | Greece | 115 healthy PM women | 12 months, RCT, with nutrition and lifestyle counseling |
| Comparison between the groups at baseline and after 12 months | ↑ BMD in all intervention groups (p < 0.001 vs. CO) after 12 months ↑ L2-L4 BMD in the CaDK1 and CaDK2 groups (p = 0.001 vs. CO) after 12 months |
11 | Kanellakis et al., 2012 [102] | Greece | 115 healthy PM women (55–65 y, mean of 62.0 ± 5.8 y) | 12 months, RCT, with nutrition and lifestyle counselling |
| All three intervention groups received calcium and vitamins in fortified dairy products; Comparison between the groups at baseline and after 12 months | ↑ serum 25(OH)D levels in all intervention groups vs. CG (p = 0.01) ↑ serum IGF-I levels in the CaDK2 group vs. CG (p < 0.05) ↓ serum ucOC/OC ratio and ↓ urine deoxypyridinoline (DPD) levels for both CaDK1 and CaDK2 groups vs. CaD and CG groups (p = 0.001 and p < 0.05, respectively) ↑ total-body BMD for both CaDK1 and CaDK2 groups vs. CG (p < 0.05) ↑ L2-L4 BMD in the CaDK1 and CaDK2 groups vs. CG (p < 0.01) |
12 | Mazzanti et al., 2015 [103] | Italy | 60 Caucasian healthy PM women, 50–61 y | 1 year, randomized, placebo-controlled trial | Oral supplementation with: (1) VitVOO group: 20 mL/day VOO fortified with D3 (50 mg/100 mL), K1 (0.70 mg/100 mL), and B6 (6.0 mg/100 mL); (2) PlaVOO group: only 20 mL/day VOO as placebo | - Comparison between the groups at baseline and after 1 year | ↓ ucOC levels in Vit VOO group vs. PlaVOO (2.60 ± 0.14 vs. 3.12 ± 0.19 ng/mL, p < 0.001) ↓ ucOC/carbOC ratio in Vit VOO group vs. PlaVOO (p < 0.05) ↑ BMD-T-score in Vit VOO group vs. PlaVOO after 1 year (−1.28 ± 0.18 vs. −2.43 ± 0.32, p < 0.05) ↓ oxidative stress biomarkers in VitVOO group vs. PlaVOO after 1 year: TBARS (12.10 ± 1.70 vs. 41.68 ± 3.68 nmol/mL, p < 0.001), lipid hydroperoxide (3.10 ± 0.30 vs. 8.8 ± 0.6 nmol/mg prot, p < 0.01) and conjugated diene (2.10 ± 0.30 vs. 4.5 ± 0.41, p < 0.01) plasma levels |
13 | Graff et al., 2016 [104] | Norway | 122 healthy PM women, 55 ± 5 y | 12 weeks, randomized intervention trial | Salmon groups (150 g/2x/week + 1000 mg Ca/day) fortified with:
| Comparison between the groups at baseline and after 12 weeks | ↓ serum ucOC within the HD/HK (p < 0.001) and LD/HK (p = 0.026) groups vs. baseline, and in all treated groups vs. the tablet group (HD/HK group: p = 0.004; LD/HK group: p = 0.035; HD/LK group: p = 0.020) ↓ serum cOC within the tablet (p < 0.05) and HD/LK (p < 0.001) groups vs. baseline ↓ GLU/GLA ratio decreased within the HD/HK group (p < 0.001) vs. baseline and in all treated groups vs. the tablet group (HD/HK group: p = 0.001; LD/HK group: p = 0.025; HD/LK group: p = 0.003) |
14 | Zhang et al., 2020 [105] | China | 311 healthy men and PM women, 50–75 y (59.78 ± 6.60 y) | 12 month, single-blind RCT |
| After 12 months of intervention: ↓ BMD in the placebo group (−0.006 g/cm2; 95% CI − 0.017, 0.004), but not in the 90-K2-plus group at lumbar spine (0.002 g/cm2; 95% CI − 0.005, 0.009) ↓ the bone loss of femoral neck in PM women in the 90-K2 and 90-K2-plus groups (treatment × time, p = 0.006) vs. placebo, but no effects in men ↑ serum vitK2 increased in all the three treatment groups (50-K2 group: + 0.43 nmol/L; 90-K2 group: + 0.22 nmol/L; 90-K2-plus group: + 0.40 nmol/L) (treatment × time, p = 0.015) ↑ cOC/ucOC ratio in the intervention groups (treatment × time, p < 0.001) ↑ serum 25(OH)D of 90-K2-plus group after additional vitD3 supplementation (treatment × time, p = 0.013) |
No. | Study, Year, Ref. | Country | Population Age | Duration Type of Study | Intervention | Comparison/Diets | Outcomes |
---|---|---|---|---|---|---|---|
1 | Douglas et al., 1995 [110] | UK | 20 osteoporotic PM women with previous Colles fractures, 52–73 y (mean of 61.7 y) | 2 weeks followed by 4 weeks without vitamins; Crossover study controlled with placebo, with a washout period of 3 months | Group 1 (n = 10): K1 Group 2 (n = 10): K1 + D2 Doses: 1 mg K1/day (in the morning); 200 IU D2/day (in the afternoon or evening) | - Each group was its own control (vs. placebo); - Comparison of OC level between the study’s PM women and younger pre-menopausal (PRE) women on the staff (n = 10, 22–39 y, mean of 29,6 y); - Comparison of bone mass measurements with 2 community controls of same age (who have no specific role in the study) | ↑ total serum OC after K1; higher level after K1 + D2 (p < 0.01) ↑ degree of carboxylation (p < 0.001 after K1; p < 0.01 after K1 + D2) at values comparable to those in PRE women (73% vs. 57%, the initial values) - The degree of carboxylation persists 4 weeks after K1 treatment (64%, p < 0.05), being completely lost at 14 weeks |
2 | Iwamoto et al., 2000 [106] | Japan | 92 osteoporotic PM women (>5 y PM), 55–81 y | 2 years, parallel study | D group (n = 29, mean of 63.4 y): D3 (1α hydroxyvitD3), 0.75 µg/day; K group (n = 22, mean of 65.8 y): K2 (MK-4), 45 mg/day; DK group (n = 21, mean of 63.6 y): D3 + K2; C group (n = 20, mean of 63.5 y): calcium (as calcium lactate), 2 g/day | - Comparison vs. baseline and between the groups, at 0, 1, and 2 years | ↓ BMD in C group (p < 0.001) vs. baseline ↑ BMD in D group (p < 0.05) and K group (p < 0.001) vs. C group ↑ BMD in DK group vs. C, D, and K groups (p < 0.0001, p < 0.05, and p < 0.01, respectively) |
3 | Takahashi et al., 2001 [111] | Japan | 43 PRE (22–52 y, 34.5 ± 10.3) and 48 PM (54–87 y, 74.4 ± 6.9) healthy females, 89 osteoporotic female patients (49–94 y, 73.5 ± 9.4) with vertebral fractures (VX), and 24 female patients (52–93 y, 79.9 ± 9.5) with hip fracture (HX) | 4 weeks | 56 of 89 VX patients were treated orally as follows: Group K2: 22 VX patients (56–81 y, 67.6 ± 6.8) received 45 mg K2(MK-4)/day; Group D3: 13 VX patients (61 ± 88 y, 72.1 ± 8.9) received 1 μg of 1α-hydroxyvitD3/day; Group K2 + D3: 21 VX patients (49 ± 88 y, 75 ± 9.2) received 45 mg K2 and 1 μg D3/day | - Comparison between the PRE, PM, VX, and HX groups; - comparison between the treated VX groups after 4 weeks of treatment and vs. baseline | ↑ OC in PM (p < 0.001 vs. PRE) and in VX (p < 0.001 vs. PRE and p < 0.05 vs. PM) ↓ OC in HX than in PM (p < 0.05) and VX (p < 0.001) - UcOC was higher in PM, VX, and HX than in PRE, but not significantly - The ucOC/OC ratio was higher in HX (p < 0.05) than in PM and in VX ↓ ucOC in the groups K2 and K2 + D3 after 4 weeks of treatment with K2, D3, and K2 + D3 vitamins, respectively, in the 56 VX patients ↓ ucOC/OC ratio to approximately 80% after 4 weeks of treatment with K2 and K2 + D3 (only vitD3 did not decrease this ratio) |
4 | Ushiroyama et al. 2002 [112] | Japan | 172 PM women with vertebral BMD of the lumbar spine < 0.98 g/cm2 (osteopenia and osteoporosis), of which 126 completed the study | 2 years | All patients were divided into 4 groups (n = 43 for each group at the start of the study): K2 group (n = 30, 54.1 ± 7.4 y): MK-4, 45 mg/day; D3 group (n = 32, 52.8 ± 5.6 y): 1 μg/day vit D3 (1α- hydroxyvitD3) K2 + D3 group (n = 31, 53.3 ± 4.5 y): combined therapy; Control group (n = 33, 53.5 ± 6.0 y) | - Control group received dietary therapy alone; - BMD and the bone markers were measured after 0, 6, 12, 18, and 24 months of treatment; - Comparison between the treated groups after 4 weeks of treatment and vs. baseline | ↑ BMD with 0.278 ± 6.55% and 0.135 ± 5.44% (both p < 0.05 vs. control) after 18 and 24 months of K2 treatment, respectively ↑ BMD with 4.10 ± 5.88%, 5.86 ± 6.85%, 5.01 ± 8.11%, and 4.92 ± 7.89% (p < 0.001 vs. control in all cases) after 6, 12, 18, and 24 months of combined therapy K2 + D3, respectively |
5 | Yasui et al. 2006 [113] | Japan | 34 PM women (mean of 53 y) with BMD at the lumbar spine < 0.809 g/cm2 (osteopenia and osteoporosis), which 30 completed the study | 2 years | Group K2: (n = 17, 52.9 ± 6.2 y) 45 mg K2/day, orally; Group K2 + D3: (n = 17, 54.9 ± 6.8 y) 45 mg K2 + vitD3 (1α-hydroxyvitD3) daily. One patient from group K2 and 3 patients from group K2 + D3 dropped out of the study | - Comparison between the treated groups before and at 1 and 2 years after the start of supplementation | ↓ ucOC serum levels in group K2 at 1 year and in group K2 + D3 at 1 and 2 years after the start of supplementation (p < 0.05) ↓ intact OC and BAP serum levels only in group K2 + D3 at 1 and 2 years after the start of supplementation (p < 0.05) ↓ BMD in group K2 at 1 and 2 years (p < 0.05 and p < 0.01, respectively) BMD was sustained in group K2 + D3 |
6 | Cheung et al., 2008 [114] | Canada | 440 PM women with osteopenia, with a mean serum 25-hydroxyvitD level of 77 nmol/L at baseline | 2 years, randomized, double-blind, placebo-controlled trial, extended to an additional 2 years for earlier participants | (1) 5 mg/day vitK1 (n = 217, 58,9 y (40.1–80.5), 198 completed the study at 2-y, 97 at 3-y, and 33 at 4-y) (2) placebo (n = 223, 59.2 y (46.1–82.3), 202 completed the study at 2-y, 107 at 3-y, and 40 at 4-y); - all participants received a daily diet supplemented with 1500 mg of calcium and 800 IU of vitD (diet plus supplements) | - Comparison between the two groups at baseline, 3, 12, 24, 36, and 48 months for serum parameters, and at baseline, 24, and 48 months, or at final visit, for BMD, respectively | ↓ BMD by −1.28% and −1.22% (p = 0.84) (difference of −0.06%; 95% CI, −0.67% to 0.54%) at the lumbar spine and −0.69% and −0.88% (p = 0.51) (difference of 0.19%; 95% CI, −0.37% to 0.75%) at the total hip in the vitK and placebo groups, respectively, over 2 years - No significant differences in changes in BMD at any site between the two groups over the 2- to 4-y period ↑ K1 serum levels in the K1 group vs. Placebo (22.6 nmol/L vs. 2.0 nmol/L, p < 0.0001) at 2 years ↓ ucOC and ↓ % ucOC in the K1 group vs. placebo (−52.8% vs. −3.5%, p < 0.0001, and −21.4% vs. −2.0%, p < 0.0001, respectively) at 2 years - Fewer women in the vitK group had clinical fractures (9 vs. 20, p = 0.04) and fewer had cancers (3 vs. 12, p = 0.02) |
7 | Rønn et al., 2016 [115] | Denmark | 142 osteopenic PM women, 60–80 y | 12 months, double-blind, randomized, placebo-controlled trial |
| - Comparison between the groups at baseline and after 3, 6, and 12 months | ↓ ucOC in the MK-7 group −65.6% (59.1; 71.0) vs. placebo −6.4%(−13.5; 1.2) after 3 months (p < 0.01), remaining low throughout the study (p < 0.05) ↓ ucOC in the MK-7 group (−65.2 ± 23.5%) vs. placebo (−0.03 ± 38.5%) after 1 year (p < 0.01) - Trabecular number in tibia (−0.1 ± 1.9%), trabecular spacing (+1.2 ± 8.0%), and trabecular thickness (+0.2 ± 1.7%) were unchanged in the MK-7 group (vs. −3.5 ± 2.2%, +4.5 ± 9.7%, and +4.0 ± 2.2%, respectively, in placebo group) (p < 0.05 between-groups) |
8 | Maria et al., 2017 [116] | USA | 23 osteopenic PM women, 49–75 y (mean of 58.6 ± 1.12 y), which 22 completed the study | 1-year, double-blind, randomized, placebo-controlled trial |
| - Comparison between the groups at baseline and after 12 weeks | ↑ BMD in lumbar spine L1-L4 (4.3%) and left femoral neck (2.2%) in the MSDK group vs. placebo, with an upward trend for total left hip (p = 0.069) ↑ serum P1NP levels in the MSDK group vs. placebo (p ≤ 0.05 after 6 months and p ≤ 0.01 after 1 year) ↓ bone turnover (CTX/P1NP) in the MSDK group in a time-dependent mode ↑ mood and sleep quality in the MSDK group ↑ urinary melatonin-sulfate levels in the MSDK group vs. placebo (p = 0.0463) - Correlation between melatonin levels and lumbar spine BMD (p = 0.029, r = 0.487; 95% CI = 0.0566 to 0.7648) |
9 | Morato-Martínez et al., 2020 [117] | Spain | 79 osteopenic PM women | 6 months, randomized, parallel, double-blind clinical trial |
| - Comparison between the groups at baseline and after 6 months | ↑ bone mass in the EG group vs. the CG group (0.01 ± 0.03 vs. −0.01 ± 0.03 kg; p < 0.05) ↑ serum P1NP levels in the EG group vs. the CG group (13.19 ± 25.17 vs. −4.21 ± 15.62 ng/mL; p < 0.05) ↓ CTX in the EG group vs. the CG group (−0.05 ± 0.19 vs. 0.04 ± 0.14 ng/mL; p < 0.05) ↓ systolic and diastolic blood pressure in the EG group vs. baseline |
10 | Rønn et al., 2021 [118] | Denmark | 119 PM women with osteopenia, 67.3 ± 4.4 y | 3 years |
| - Comparison between the groups at baseline and after 3, 6, and 12 months | ↓ total OC by 9.1 ± 25.6% (p < 0.01) in the MK-7 group (remaining unchanged 2.1 ± 19.6% (p = 0.11) in the placebo group) - Significant interaction between treatment group and time for total OC after 3 years (p <0.01) ↑ P1NP by 15.2 ± 39.4% (p < 0.05) in the MK-7 group (remaining unchanged in the placebo group) ↑ CTX and vitD in both groups (p < 0.03 for all) ↓ BAP in both groups (p < 0.01 for both) ↓ BMD at total hip (by 1.5 ± 2.5% for MK-7 vs. 2.4 ± 2.7% for placebo) and lumbar spine (by 1.8 ± 3.9% for MK-7 vs. 1.1 ± 3.1% for placebo) in both groups (p < 0.02 for all), and at the femoral neck only in the MK-7 group (p < 001) (by 1.5 ± 3.5% for MK-7 vs. 1.0 ± 5.0% for placebo) - Changes in microstructure were similar between groups over 3 years |
11 | Moore et al., 2023 [119] | UK | 105 PM women with osteoporosis and sub-optimum vitK status, 55–85 y (68.7 ± 12.3 y) | 18 months |
- all three groups: standard treatment of oral bisphosphonate and calcium (1 g/day) and/or vitD (800 IU/day) | - Comparison between the groups at baseline and after 3, 6, 12, and 18 months | ↑ trend in CTX and P1NP (p < 0.001) over time in all 3 arms Changes in HSA parameters at the intertrochanter (IT) and femoral shaft (FS):
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Rusu, M.E.; Bigman, G.; Ryan, A.S.; Popa, D.-S. Investigating the Effects and Mechanisms of Combined Vitamin D and K Supplementation in Postmenopausal Women: An Up-to-Date Comprehensive Review of Clinical Studies. Nutrients 2024, 16, 2356. https://doi.org/10.3390/nu16142356
Rusu ME, Bigman G, Ryan AS, Popa D-S. Investigating the Effects and Mechanisms of Combined Vitamin D and K Supplementation in Postmenopausal Women: An Up-to-Date Comprehensive Review of Clinical Studies. Nutrients. 2024; 16(14):2356. https://doi.org/10.3390/nu16142356
Chicago/Turabian StyleRusu, Marius Emil, Galya Bigman, Alice S. Ryan, and Daniela-Saveta Popa. 2024. "Investigating the Effects and Mechanisms of Combined Vitamin D and K Supplementation in Postmenopausal Women: An Up-to-Date Comprehensive Review of Clinical Studies" Nutrients 16, no. 14: 2356. https://doi.org/10.3390/nu16142356
APA StyleRusu, M. E., Bigman, G., Ryan, A. S., & Popa, D. -S. (2024). Investigating the Effects and Mechanisms of Combined Vitamin D and K Supplementation in Postmenopausal Women: An Up-to-Date Comprehensive Review of Clinical Studies. Nutrients, 16(14), 2356. https://doi.org/10.3390/nu16142356