![]() They require vitamin K for carboxylation in order to function properly. Vitamin K 1 is principally transported to the liver, regulating the production of coagulation factors, while vitamin K 2 is transported to extrahepatic tissues, such as bone and the vascular wall, regulating the activity of matrix Gla protein (MGP) and osteocalcin (bone Gla protein)-the main vitamin K-dependent proteins. Vitamin K stores are limited, but they can be recycled to a certain extent. Vitamin K is another fat-soluble vitamin that exists in two forms of vitamin K: vitamin K 1 (phylloquinone, mainly found in green leafy vegetables) and vitamin K 2 (menaquinone, mainly found in fermented dairy and produced by lactic acid bacteria in the intestine). Ample evidence recommends vitamin D supplementation for the prevention of falls and fractures however, evidence suggests calcium precipitation in the vasculature and other potential side effects. Vitamin D plays a main role in regulating calcium metabolism by increasing intestinal calcium absorption. Calcitriol is also produced endogenously by extrarenal production through peripheral 1- α-hydroxylase and has positive effects on immune function and anticancer activity. Circulating 25(OH)D is further metabolized by the kidney for full biological activity into its most active form 1,25-dihydroxyvitamin D (1,25(OH)D) also known as calcitriol. In the liver, vitamin D is hydroxylated to 25(OH)D, the main circulating vitamin D metabolite that is measured to assess and classify vitamin D status. Vitamin D is a fat-soluble vitamin that can be ingested by foods such as fatty fish, dairy products, and eggs, but is mainly synthesized by the human skin when exposed to sunlight. However, little is known about potential long-term high-dose vitamin D supplementation. Over the last decade, large vitamin D supplementation is promoted to restore 25-hydroxyvitamin D (25(OH)D) concentrations and is considered to be safe with doses up to 4000 international units (IU) per day. In Europe, depending on a country and sex, between 1 and 66% of the adult population use vitamin D supplements. Worldwide, a large group of people is prescribed to a supplemental regime of both vitamin D and calcium. ![]() As more is discovered about the powerful combination of vitamins D and K, it gives a renewed reason to eat a healthy diet including a variety of foods such as vegetables and fermented dairy for bone and cardiovascular health. Current evidence supports the notion that joint supplementation of vitamins D and K might be more effective than the consumption of either alone for bone and cardiovascular health. These limited studies indicate that joint supplementation might be beneficial for cardiovascular health. Few intervention trials studied vitamin D and K supplementation with cardiovascular-related outcomes. Most clinical trials studied vitamin D and K supplementation with bone health in postmenopausal women. Animal and human studies suggest that optimal concentrations of both vitamin D and vitamin K are beneficial for bone and cardiovascular health as supported by genetic, molecular, cellular, and human studies. The purpose of this review is to summarize available evidence of the synergistic interplay between vitamins D and K on bone and cardiovascular health. Vitamin D promotes the production of vitamin K-dependent proteins, which require vitamin K for carboxylation in order to function properly. Vitamins D and K are both fat-soluble vitamins and play a central role in calcium metabolism.
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