Anatomy of a Bone

To understand bone health, it is important to understand exactly what bone is. Bone is dynamic living tissue composed of a mineral matrix (including calcium, phosphorous, magnesium, silica, etc.) and a non-mineral matrix made mostly of protein, namely collagen. The minerals make bones hard and dense, while the proteins provide flexibility. Without protein, bones would become too brittle and break, and without minerals, bones would become too soft and lose their density. In optimal health, your bones have just the right balance of minerals and protein to maintain their strength, density, and flexibility.

Throughout your lifetime, the bone matrix is constantly being broken down and rebuilt in a two-part repair process called “remodeling.” This process consists of resorption and formation. During resorption, old bone tissue is broken down and removed by cells called osteoclasts. During bone formation, new bone tissue is laid down to replace the old by cells called osteoblasts.

During childhood and through the teenaged years, new bone is added faster than old bone is removed, resulting in bones becoming larger and denser. When peak bone mass is reached, around age 30, the activity of the osteoblasts and osteoclasts shifts, with more bone being broken down than formed, resulting in loss of bone mass. Keep in mind that it is normal to lose some bone mass as we age. In addition to aging and genetic makeup, there are many other factors involved that can either make, or break, the health of your bones. 

Bone Health Breakers

There are many factors that can lead to weak bones, including smoking, excessive alcohol intake, consumption of processed foods and sugar, the use of certain medications, compromised digestion, changing hormones, and even stress. These things may reduce the body’s ability to absorb minerals, can increase mineral excretion from the bones, and may damage bone cells, inhibiting new bone growth. Understanding, and then eliminating or addressing these factors, is the first step to healthier and stronger bones.

Inflammation—a major contributor to poor bone health—is promoted by many of the above factors, including smoking and diets high in processed foods and sugar. Specifically, chronic inflammation has been shown to promote the formation and activity of osteoclasts while decreasing the formation and activity of osteoblasts, overall impairing bone formation.^{1 2}

Hormonal changes may also contribute greatly to bone loss. With increasing age, the production of the sex hormones estrogen and testosterone (two important hormones involved with bone formation) begins to decline, increasing the risk of osteoporosis. This decline in hormones is further exaggerated in women at the onset of menopause, when estrogen levels drop dramatically.³ In addition, aging has also been shown to promote increased levels of sex hormone-binding globulin (SHBG), which decreases free hormone levels by binding tightly to estrogen and testosterone, thus, inactivating them and contributing to greater bone turnover and loss of bone mass.^{4 5 6}

Dietary bone breakers that should be avoided, or at least limited, include:

• Sugar-sweetened beverages – A major contributor to most people’s overall sugar intake is sugar-sweetened beverages. Excess sugar, from any source, contributes to the formation of advanced glycation end products (AGEs) that damage proteins in bone, causing impaired mineralization. AGEs also increase the number of osteoclasts, which leads to an imbalance in bone formation and remodeling.⁷ When sugar is combined with caffeine, such as in a soft drink, the impact on bones is even worse, since excessive caffeine has been reported to increase urinary calcium excretion and reduce its absorption.⁸
• Phosphates & Phosphoric Acid - Many processed foods (breakfast cereal bars, processed meats) and beverages (dark colored sodas, bottled/canned iced teas & coffee beverages) commonly contain phosphates and phosphoric acid, which are used as preservatives and give drinks their tangy flavor.⁹ Excess consumption of phosphates and phosphoric acid is linked to decreased calcium absorption and lower bone density.¹⁰ One study looking at over 1,000 pre- and post-menopausal women found that daily soda intake (both regular and diet) was associated with lower bone mineral density of the hip, leading researchers to conclude that regular consumption of beverages containing phosphoric acid is likely a contributing factor in the development of osteoporosis.¹¹
• White Sugar/White Flour – In addition to the formation of AGEs mentioned above, excess intake of refined carbohydrates can lead to increased urinary losses of bone-supporting nutrients (calcium, magnesium, and potassium). Sugar consumption is also associated with a decrease in the active form of vitamin D, which is important for the normal absorption of calcium.¹²
• Grains – Grain consumption should be minimized as these foods are less nutrient dense and offer less bone supportive nutrients compared to other, more nutrient-dense foods like vegetables, fruits, nuts, and naturally raised meats.
• Unhealthy Fats – These include fats found in overly-heated oils (used mostly for frying foods), trans fats from partially hydrogenated vegetable oils (found in margarine and many packaged foods such as crackers and breads), interesterified fats (found in packaged foods and identified in the ingredients label as interesterified soybean oil, interesterfied vegetable oil, fully hydrogenated oil, high in stearic acid, or stearate rich), and omega-6 fats (corn, sunflower, soy, and safflower oils). These fats promote chronic inflammation, which is detrimental to bone health.

Bone Health Makers        

Just as there are many factors that can harm your bones, there are also those that can improve their health, and calcium is just the tip of the proverbial bone health iceberg. A healthy diet that focuses on eating foods in their most natural forms and avoids processed and refined foods is the foundation of bone health. Build on a healthy diet with the following bone health makers:

Regular Exercise

Physical activity puts force on the bones, which creates a mechanical strain. This strain causes an adaptive response in which old bone is broken down and replaced with new, healthy bone. For bone-building benefits the best exercises are weight-bearing aerobic exercises (such as walking, court sports, dancing, and Tai Chi) and strength and/or resistance training (employing free weights, weight machines, or one’s own body weight).¹³ An exercise routine that includes a variety of exercise types and is practiced for 30 minutes two to four times a week over a prolonged period appears to be best to maintain or improve bone.¹⁴

Bone Building Nutrients

There are many nutrients crucial to bone health. Some of these nutrients may come from food, but for various reasons, we often don’t get optimal amounts of important bone-building nutrients from food alone. For this reason, you may consider implementing a supplement plan to support bone health.

Contrary to popular belief, one of the most important nutrients for bone health is not calcium, but vitamin D; without optimal levels of vitamin D your body cannot properly absorb calcium. Vitamin D not only aids absorption but also ensures that calcium is delivered to the bones. It also regulates the production of the important bone-building protein, osteocalcin, the second most abundant protein in the bones after collagen. One study recently found that women with higher blood levels of vitamin D could take one-third the recommended amount of calcium without compromising the health of their bones. 

Recommendation: Most experts recommend that adults take between 2,000 and 5,000 IU daily to reach optimal blood levels of 50 ng/mL.

Vitamin K is another often forgotten nutrient that plays a crucial role in bone health. Vitamin K is necessary for the activation of the proteins osteocalcin and matrix Gla. Once activated, osteocalcin holds calcium to the bone, and matrix Gla ensures that calcium is delivered from the blood to the bones, and not deposited in places where it should not be, such as the arteries or joints. Additionally, vitamin K has been shown to increase the number of bone-building osteoblasts, while it decreases the number of osteoclasts, the cells responsible for breaking down bones.           

Recommendation: There are two main forms of vitamin K; K1 and K2. Further, vitamin K2 occurs in different forms, including MK-4 and MK-7. Both MK-4 and MK-7 appear to have the most biological activity and offer the most bone supportive benefits. A three-year randomized controlled trial supplemented postmenopausal women with 180 mcg/day of MK-7  and found significantly decreased age-related decline in bone mineral density and bone strength.¹⁵ Another study looking at healthy postmenopausal women found that 1500 mcg/day of MK-4 supplementation versus placebo for 6-12 months maintained bone mineral density and increased activated osteocalcin.¹⁶ Dosages of MK-7 are typically lower than dosages of MK-4 in supplements since MK-7 is absorbed and eliminated less quickly from the body compared to MK-4.¹⁷ In other words, because it stays in circulation longer, not as much is needed for the same effects. MK-7 and MK-4 can be found individually or combined as supplements and in some multi-nutrient formulas. Both K2 forms are naturally present in food, with MK-7 found in natto, a type of fermented soybean, and MK-4 found in eggs, meat, and dairy.

Other important bone-building nutrients include magnesium, part of the mineral-protein matrix that regulates the transport of calcium to bones; calcium, the most abundant mineral in the bones and one that is easily depleted from our bodies; strontium, another part of the mineral-protein matrix that imparts strength to bone tissue and has been shown to increase bone formation and decrease bone resorption, resulting in increased bone density; and vitamin C, essential for the production of collagen, the most abundant protein in the bone matrix. Additionally, zinc, copper, silicon, boron, and vitamin B12 are also important bone-building nutrients; many of these can be found in a good multivitamin and in combinations formulated specifically for bone health. 

Recommendation: Magnesium citrate and magnesium glycinate are both well absorbed forms of magnesium. Take 200 to 400 mg daily. Regarding calcium, although calcium is essential for normal bone development and maintenance, it should not be taken to the exclusion of magnesium, vitamin D, and other nutrients needed for bone health. Thus, while the RDA for calcium is 1,000 mg daily for most adults, less (500 to 800 mg daily) may be sufficient when other bone nutrients are also consumed. Many different types of calcium supplements are available. See the Customer Literature File Calcium –Absorption for more information.

Healthy Digestion

Digestion is another important factor in supporting bone health. Key components of healthy digestion include adequate amounts of stomach acid (hydrochloric acid) and digestive enzymes, which are both necessary for the absorption of bone supportive minerals, including calcium. Unfortunately, impaired digestion might be more prevalent than commonly thought. Factors that negatively impact stomach acid production include advancing age, chronic stress, and acid suppressing medications such as Proton Pump Inhibitors (PPIs).^{18 19 20} The production of digestive enzymes also decreases with age.^{8 9} For these reasons, supplementation with digestive enzymes and hydrochloric acid (HCl) may be an important piece to consider in supporting overall bone health.

• Betaine Hydrochloric Acid (HCl) – If low stomach acid is suspected, betaine hydrochloric acid supplements can support healthy levels. Betaine hydrochloride is a synthesized molecule that provides a safe way to deliver hydrochloric acid to the stomach. For more information, see the Customer Literature Files Acid for Digestion

• Digestive Enzymes – Digestive enzymes increase our ability to absorb crucial nutrients known to support bone density. Consider a broad-spectrum enzyme supplement with a wide range of enzymes to support protein, carbohydrate and fat digestion. For the best results, take digestive enzymes about 10 minutes before each meal or with your first bite. Start by taking enzymes with about two meals per day and adjusting your dosage as needed.

Inflammation Modulation

As mentioned previously, chronic inflammation is a major contributor to poor bone health. Consuming a healthy and well-balanced diet and implementing a targeted supplement routine are crucial components for supporting healthy levels of inflammation in the body and maintaining bone health well into advanced age. Two important inflammation fighting nutrients to consider are:

• Omega-3 Fatty Acids (Fish & Flax Oils) – The omega-3 fatty acids found in fish oil (EPA and DHA) and in flax oil (ALA) have been shown to have powerful anti-inflammatory effects.²¹ They also decrease osteoclast activity, increase osteoblast formation and activity, and improve overall calcium balance.²² Those who consume higher amounts of oily fish (tuna, mackerel, salmon) have greater bone mineral density compared to those with lower fish consumption.²³ To support bone health, it is recommended to take a daily supplement providing a minimum of 600-800mg EPA and 500mg DHA.²⁴
• Curcumin – Curcumin has been shown to decrease osteoclast activity through its ability to modulate inflammation. By decreasing the activity of bone-breaking cells, curcumin may reduce bone loss and could be of potential benefit in preventing and/or attenuating osteoporosis.²⁵ Adults may consider 400-600mg of turmeric extract three times per day or as directed on the product label.²⁶

Hormone Balance

Lastly, hormonal imbalance associated with aging and onset of menopause is known to be a major risk factor for osteoporosis and poor bone health. There are a variety of things that you can do to support hormone balance naturally, including:

• Eat a Well-Balanced Diet – Contrary to popular belief, consuming plenty of healthy fats is an important component of any hormone balancing program, because fat is essential for making cholesterol, a key building block of our sex hormones, including progesterone, estrogen, and testosterone.²⁷ In addition, consuming adequate protein also supports hormonal balance. For instance, in one study, higher protein intakes were associated with decreased levels of sex hormone-binding globulin (SHBG), a compound in the body that binds to and inactivates estrogen and testosterone.²⁸ For more information our article on Natural Foods for Optimal Health.
• Manage Stress - Chronic stress causes the adrenals glands to upregulate cortisol (our primary stress hormone) production, leading to elevated cortisol levels in the body. Chronically elevated cortisol levels block calcium absorption, thus decreasing bone cell growth, and have also been linked to age-related decreases in bone mineral density.^{29 30} For ideas on how to effectively manage your stress refer to our article on Stress Management.
• Liver Support – By detoxifying substances, including toxins such as xenoestrogens (known endocrine or hormone disruptors), the liver plays a primary role in promoting healthy estrogen balance and overall hormonal health. For simple strategies to support liver health, refer to our articles on Detoxification-Chemicals and Milk Thistle—Liver Health.
• Isoflavones/Phytoestrogens – Isoflavones are a class of phytoestrogens found in a wide variety of foods, most notably soybeans and soy products, but also legumes and vegetables. These compounds have been shown to possess estrogen-agonist (weak estrogenic or hormone-like) activity.³¹ Some controlled trials in postmenopausal women have found that increasing intakes of isoflavones may offer potential protection against bone mineral density loss. Because many soy foods also contain anti-nutrients that may interfere with thyroid function and digestion, it is important to stick to fermented forms of soy such as natto, tempeh, miso, and fermented soy protein powder. Better yet, soy isoflavone extracts and supplements might be the best option for daily use.³²

In closing, losing some bone mass is an inevitable part of getting older, but by eliminating lifestyle factors like smoking, excess stress, and processed and refined foods that can be detrimental to your bones and embracing a whole, natural-foods diet, enjoying regular weight-bearing exercise, and supplementing your diet with specific bone-building nutrients, you can ensure a lifetime of strong, healthy bones.

References

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9. Price, A. (2019). Phosphoric Acid: the Dangerous Hidden Additive You’ve Likely Consumed. Retrieved from https://draxe.com/nutrition/phosphoric-acid/
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16. Koitaya, N., Sekiguchi, M., et al. (2014). Low-dose vitamin K2 (MK-4) supplementation for 12 months improves bone metabolism and prevents forearm bone loss in postmenopausal Japanese women. J Bone Miner Matab, 32(2):142-50. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23702931
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20. Jillian Levy. (2018). The stomach acid that defends against GERD, candida & leaky gut. Retrieved from https://draxe.com/hydrochloric-acid/
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28. Longcope, C., Feldman, H. A., McKinlay, J. B., & Araujo, A. B. (2000). Diet and sex hormone-binding globulin. The Journal of Clinical Endocrinology & Metabolism, 85(1), 293-296. doi:10.1210/jcem.85.1.6291
29. Mathis, S. L., Farley, R. S., Fuller, D. K., Jetton, A. E. & Caputo, J. L. (2013). The relationship between cortisol and bone mineral density in competitive male cyclists. Retrieved from https://www.hindawi.com/journals/jsm/2013/896821/
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32. Linus Pauling Institute (2014). Soy isoflavones. Retrieved from https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/soy-isof…