Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment

Magnes Res. 1990 Sep;3(3):197-215.


Prophylactic treatment of postmenopausal osteoporosis with oestrogen and calcium, often in combination, disregards the likelihood that an excess of each agent may increase magnesium requirements and decrease serum Mg levels. Relative or absolute Mg deficiency, which is likely in the Occident where the Mg intake is commonly marginal, can militate against optimal therapeutic bone response, Mg being important for normal bone structure, and can increase the risk of adverse effects. Although oestrogen has cardiovascular protective effects (expressed by the lower incidence of heart disease in premenopausal women than in men, and also in postmenopausal women given low dosage oestrogen replacement treatment), high dosage oestrogen oral contraceptives have caused increased intravascular blood clotting with resultant thromboembolic cardio- and cerebrovascular accidents. This might be contributed to by the oestrogen-mediated shift of circulating Mg to soft and hard tissues, which in persons with marginal Mg intakes may lead to suboptimal serum levels. If the commonly recommended dietary Ca/Mg ratio of 2/1 is exceeded (and it can reach as much as 4/1 in countries with low to marginal Mg intakes), relative or absolute Mg deficiency may result, and this may increase the risk of intravascular coagulation, since blood clotting is enhanced by high Ca/Mg ratios. Mechanisms by which Ca activates the various steps in blood coagulation that are also stimulated by oestrogen are considered here, as are the multifaceted roles of Mg that favourably affect blood coagulation and fibrinolysis, through its activities in lipoprotein and prostanoid metabolism.

Publication types

  • Review

MeSH terms

  • Aged
  • Calcium, Dietary / administration & dosage
  • Calcium, Dietary / adverse effects
  • Drug Therapy, Combination
  • Estradiol Congeners / administration & dosage
  • Estradiol Congeners / adverse effects
  • Female
  • Humans
  • Magnesium / administration & dosage*
  • Magnesium / blood
  • Magnesium Deficiency / chemically induced
  • Osteoporosis, Postmenopausal / blood
  • Osteoporosis, Postmenopausal / drug therapy*
  • Parathyroid Hormone / antagonists & inhibitors
  • Thrombosis / etiology
  • Vitamin D / metabolism


  • Calcium, Dietary
  • Estradiol Congeners
  • Parathyroid Hormone
  • Vitamin D
  • Magnesium