British Journal of Nutrition

Full Papers

Human and Clinical Nutrition

The effect of menaquinone-7 (vitamin K2) supplementation on osteocalcin carboxylation in healthy prepubertal children

Marieke J. H. van Summerena1 c1, Lavienja A. J. L. M. Braama2, Marc R. Liliena1, Leon J. Schurgersa2, Wietse Kuisa1 and Cees Vermeera2

a1 Department of Paediatrics, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands

a2 VitaK and Cardiovascular Research Institute, Maastricht University, PO Box 616 (UNS50), 6200 MD Maastricht, The Netherlands


Vitamin K contributes to bone health, probably through its role as cofactor in the carboxylation of osteocalcin. Intervention studies in adults have demonstrated that markedly higher osteocalcin carboxylation is obtained by intakes of vitamin K well above the current recommended dietary intake. However, the relationship between increased vitamin K2 intake and enhanced osteocalcin carboxylation has never been shown in healthy children. The objective was to study the effect of 45 μg menaquinone-7 (MK-7; one of the vitamin K2 species) on the circulating levels of undercarboxylated osteocalcin (ucOC) and carboxylated osteocalcin (cOC) in healthy prepubertal children. We hypothesised that MK-7 supplementation will reduce the ucOC:cOC ratio (UCR), indicating an improved vitamin K status. The present study is a double-blind randomised placebo-controlled trial examining the effect of 8 weeks MK-7 supplementation on the carboxylation of osteocalcin in healthy children (n 55). Serum levels of ucOC, cOC and MK-7 were measured at baseline and after 8 weeks, together with bone markers and coagulation parameters. The UCR was used as an indicator of vitamin K status. In the MK-7-supplemented group (n 28), the circulating concentration of inactive ucOC reduced and the UCR improved whereas the concentration of MK-7 increased. Within the placebo group, ucOC, cOC, UCR and MK-7 did not significantly change over time. In both groups, bone markers and coagulation parameters remained constant over time. These findings demonstrate that in healthy, prepubertal children, modest supplementation with MK-7 increases circulating concentrations of MK-7 and increases osteocalcin carboxylation.

(Received May 13 2008)

(Revised March 17 2009)

(Accepted April 07 2009)

(Online publication May 19 2009)


c1 Corresponding author: Marieke J. H. van Summeren, fax +31 88 7555349, email


Abbreviations: cOC, carboxylated osteocalcin; Gla, γ-carboxyglutamate; MK, menaquinone; ucOC, undercarboxylated osteocalcin; UCR, ucOC:cOC ratio