Written by Jessica Patella, ND. Protein, calcium, magnesium, flouride, zinc, copper, boron, potassium, and  vitamins D, K, C, A, and B are important for bone health.

Approximately 10 million Americans over 50 years of age have osteoporosis of the hip (1). In 2005, the economic cost of fractures from osteoporosis was $17 billion. By 2025, the annual economic cost is expected to increase by 50%, equaling $25.5 billion (2). One of the risk factors for osteoporosis and bone loss is an inadequate dietary intake of nutrients that support bone health (3). Recent research reviewed the following nutrients that have been shown to be associated with bone health (3).

PROTEIN
Protein is an important part of the bone matrix (inner part of the bone), yet high protein intake has been shown to be a risk factor for osteoporosis (3, 4). This is because high protein diets result in increased calcium excretion to balance out the acidity caused by high protein in the body (3). Although when diets are high in both calcium and protein, favorable changes in bone health have been observed (3, 5). The Recommended Dietary Allowance (RDA) for protein is 0.8 grams of protein per kilogram of body weight (or 56 grams (2 ounces) for a 70 kg (154 lb.) person) (1).

CALCIUM
Calcium is the main mineral in the bone. Calcium supplementation reduces risk of hip fracture by 25-70% (3, 6). Calcium has the most effect on bone health early in life. Calcium supplementation helps prevent bone loss later in life (3). The recommended intake of calcium for developing maximum bone mass is 1300 mg per day for adolescents, 1000 mg per day for adults and 1200 mg per day for adults 51 years and older (3, 7).

MAGNESIUM
About 60% of the magnesium in the body is in bone, and supplementation of magnesium has been shown to increase bone mineral density (3). For ages 19-30, the RDA is 310 mg per day for women and 400 mg per day for men. Over 30 years of age, the RDA is 320 mg per day for women and 420 mg per day for men (3).

FLUORIDE
Greater bone mineral density and decreased fracture risk has been reported in populations with fluoridated water at 1 ppm (parts per million). In populations with fluoridated water at greater than 4.32 ppm, an increase in risk of fracture has been shown (3, 8). This suggests that excessive fluoride may lead to large crystals forming in the bone, resulting in brittle bone (3).

ZINC
Zinc supplementation in postmenopausal woman of 15 mg per day is associated with increased bone mineral density.  This is higher than the current RDA of 8 mg per day (3).

COPPER
Copper supplementation for 2 years was associated with decreased bone loss (3). Supplementation of copper at 2.5-3 mg per day, which is higher than the RDA (900 mg per day) have been associated with increased bone mineral density and decreased bone loss (3, 9).

BORON
Boron has been shown to prevent calcium loss and demineralization of bone (3). The level of boron supplementation associated with an increase in bone density was 3 mg per day (3, 10).

POTASSIUM
Potassium is high in fruits and vegetables and promotes an alkaline environment in the body, thereby decreasing bone loss in the body (3). Recommendations are 3500 mg per day for ages 1-3 years, 3800 mg per day for ages 4-8 years, 4500 mg per day for ages 9-18 years and 4700 mg per day for ages 19 and older (3).

ViTAMIN D
Vitamin D is an essential nutrient for bone health, and decreased blood levels are associated with increased risk of hip fractures (3, 11). Vitamin D intakes of 500 IU per day were associated with a 37% lower fracture risk in postmenopausal women (3, 12).

VITAMIN K
Studies have shown that populations with low vitamin K intake have lower bone mineral density and higher facture risk (3, 13).

VITAMIN C
Vitamin C intakes of 500 to 1,000 mg per day, which are higher than the RDA, have been related to better bone health (3, 14).

VITAMIN A
Levels of vitamin A that are too high or too low are related to increased fracture risk (3). It has been shown that vitamin A intake of 2333 IU per day for women and 3000 IU per day for men is associated with optimal bone mineral density, close to the current RDA (3, 15).

B VITMAINS
Most of the B vitamins (thiamine, riboflavin, niacin, vitamin B6 and vitamin B12) also have been shown to increase bone health (3).

In conclusion, multiple vitamins and minerals are required for optimal bone health. In many cases the Recommended Daily Allowance (RDA) was not adequate for optimal bone health (3).  In order to increase bone mineral density, prevent bone loss and prevent fractures, supplementation with a wide rage of the reviewed nutrients is shown to be beneficial (3).

Source: Palacios, Cristina. “The role of nutrients in bone health, from A to Z.” Critical reviews in food science and nutrition 46, no. 8 (2006): 621-628.

© Taylor and Francis Group, LLC

References:

  1. National Osteoporosis Foundation. 2002. America’s Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC.
  2. Burge R, et al.  Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025.  J Bone Miner Res 2001 Mar; 22(3): 465-75.
  3. Palacios, C.  The Role of Nutrients in Bone Health, from A to Z.  Critical Rev in Food Sci and Nutr. 2006. 46: 621-628.
  4. Feskanich, D., Willett, W.C., Stampfer, M.J., and Colditz, G.A. 1996. Protein consumption and bone fractures in women. Am. J. Epidemiol., 143:472–479.
  5. Schurch, M.A., Rizzoli, R., Slosman, D., Vadas, L., Vergnaud, P., and Bon-jour, J.P. 1998. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann. Intern. Med., 128:801–809.
  6. Cumming, R.G., and Nevitt, M.C. 1997. Calcium for prevention of os-teoporotic fractures in postmenopausal women. J. Bone Miner. Res., 12:1321–1329.
  7. Food and Nutrition Board. 1997. Standing Committee on the Scientific Evaluation of Dietary Reference Intake, Institute of Medicine, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, Fluoride. Washington DC: National Academy Press.
  8. Li, Y., Liang, C., Slemenda, C.W., Ji, R., Sun, S., Cao, J., Emsley, C.L., Ma, F., Wu, Y., Ying, P., Zhang, Y., Gao, S., Zhang, W., Katz, B.P., Niu, S., Cao, S., and Johnston, C.C., Jr. 2001. Effect of long-term exposure to fluoride in drinking water on risks of bone fractures. J Bone Miner. Res, 16:932–939.
  9. Strause, L., Saltman, P., Smith, K.T., Bracker, M., and Andon, M.B. 1994. Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals. J. Nutr., 124:1060–1064.
  10. Beattie, J.H., and Peace, H.S. 1993. The influence of a low-boron diet and boron supplementation on bone, major mineral and sex steroid metabolism in postmenopausal women. Br. J. Nutr., 69:871–884.
  11. Sahota, O., Masud, T., San, P., and Hosking, D.J. 1999. Vitamin D insufficiency increases bone turnover markers and enhances bone loss at the hip in patients with established vertebral osteoporosis. Clin. Endocrinol. (Oxf), 51:217–221.
  12. Feskanich, D., Willett, W.C., and Colditz, G.A. 2003. Calcium, vitamin D, milk consumption, and hip fractures: A prospective study among post-menopausal women. Am. J. Clin. Nutr., 77:504–511.
  13. Feskanich, D., Weber, P., Willett, W.C., Rockett, H., Booth, S.L., and Colditz, G.A. 1999. Vitamin K intake and hip fractures in women: A prospective study. Am. J. Clin. Nutr., 69:74–79.
  14. Morton, D.J., Barrett-Connor, E.L., and Schneider, D.L. 2001. Vitamin C supplement use and bone mineral density in postmenopausal women. J.Bone Miner. Res., 16:135–140.
  15. [100] Promislow, J.H., Goodman-Gruen, D., Slymen, D.J., and Barrett-Connor, E. 2002. Retinol intake and bone mineral density in the elderly: The Rancho Bernardo Study. J. Bone Miner. Res., 17:1349–1358.