Calcium

Nearly all of the body’s calcium is used to make and maintain bone and teeth. The mineral combines with phosphate (which is abundant in foods) to form hydroxylapatite, the actual mineralized part of bones. Bone and teeth mineralization is an ongoing process, with old cells being replaced by newer cells—assuming the nutritional building blocks are present.

Yellow Alert. Calcium intake may influence your life expectancy. A study conducted at McGill University in Montreal found that women who consumed up to 1,000 mg of calcium daily—regardless of whether it came from foods or supplements—had a 22 percent lower risk of dying from any cause.ⁱ

Recommendation:

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. Calcium citrate provides a well-absorbed form of the mineral at a reasonable price.

Magnesium

After calcium, magnesium is the second most important mineral for maintaining normal bone density. In a study of 2,000 men and women, people with high intake of magnesium had greater bone-mineral density throughout their bodies. For every 100 mg increase in daily magnesium intake, the subjects had a 2 percent increase in whole-body bone-mineral density. The impact of magnesium was comparable to the effect of calcium on bone-mineral density, wrote Kathryn M. Ryder, MD, in the Journal of the American Geriatrics Society. ⁱⁱ Another study found that magnesium supplements increase bone-mineral density in teenage girls—the time of life when bones should become their strongest.ⁱⁱⁱ

Yellow Alert. Low magnesium intake may influence your risk of other serious health problems. The mineral plays roles in more than 300 biochemical reactions in the body, affecting heart rhythm, blood sugar, and cancer risk. Muscle spasms are a common sign of magnesium deficiency. A recent five-year Spanish study found people with the highest magnesium intake were 34 percent less likely to die of any cause, including cardiovascular diseases and cancer, compared with people who consumed relatively little magnesium. The researchers also noted, significantly, that a low-fat diet may significantly reduce a person’s intake of magnesium.iv Another recent study by Harvard University researchers determined that women who had the highest dietary intake of magnesium were 37 percent less likely to suffer from sudden cardiac death. Meanwhile, those with the highest blood levels of magnesium were 77 percent less likely to experience sudden cardiac death.^v

Recommendation:

Magnesium citrate and magnesium glycinate are both well absorbed, but there are many different types of magnesium supplements available. Take 200 to 400 mg daily. Larger amounts may cause loose stools.

Vitamin D

Vitamin D is necessary for calcium absorption. Not surprisingly then, low vitamin D levels reduce bone development and bone density. In children, the consequence is rickets and in adults it is osteomalacia (soft bones). Numerous studies have shown that a combination of vitamin D and calcium help maintain bone density and reduce the risk of hip fractures (one of the consequences of osteoporosis). In a study conducted at the Fred Hutchinson Cancer Research Center, Seattle, women who took both vitamin D and calcium supplements for at least five years were 38 percent less likely to suffer a hip fracture, compared with women who did not take these supplements.^vi However, the amount of vitamin D is critical. In a Scottish study, researchers found that women taking 1,000 IU of vitamin D daily maintained their bone density, whereas those taking only 400 IU lost bone density over one year.vii Vitamin D is also needed for muscle development and maintenance, and many osteoporotic falls may be related to weak muscles rather than bone. ^{viii ix x xi}

Yellow Alert. There are vitamin D receptors in all cells in the body, including the brain cells. Not surprisingly, vitamin D influences almost all aspects of health, including cardiovascular health, brain and nerve health, and immune health, and insufficiencies increase the risk of many diseases. Several studies have found that adequate vitamin D helps maintain normal blood sugar levels, therefore potentially reducing the risk of developing type-2 diabetes.^{xii xiii xiv} Vitamin D might also provide broad-spectrum protection against multiple types of cancer and neurodegenerative diseases such as multiple sclerosis, Parkinson’s, and Alzheimer’s.

Recommendation:

Most experts recommend that adults take between 2,000 and 5,000 IU daily to reach optimal levels of 50 ng/mL—levels associated with lowering disease risk.

Vitamin K

Vitamin K is required for the carboxylation, or activation, of osteocalcin, one of the key proteins in the bone matrix. Without adequate vitamin K, bones cannot develop or remain strong. The vitamin is also needed to make matrix Gla protein (MGP), which helps direct calcium to bones instead of arteries.

Recent studies by Dutch and Japanese researchers found that large supplemental amounts of vitamin K2 can actually reverse osteoporosis.^{xxv xxvi} Most of these studies used 45 mg (45,000 mcg) daily of the MK-4 form of vitamin K2, although it is probably not necessary for most people to take that much vitamin K. In one study, researchers asked 325 postmenopausal women to take either 45 mg of vitamin K2 or placebos daily for three years. Bone density improved among women taking vitamin K2, but decreased among those taking placebos. An analysis of seven similar studies, published in the Archives of Internal Medicine, found that high-dose vitamin K2 supplements consistently reduced bone fractures in women by more than 60 percent.^xxvii

Yellow Alert. Adequate intake of vitamin K may offer protection against diabetes and cancer. Osteocalcin regulates the number of insulin-producing cells in the pancreas, the secretion of insulin, sensitivity to insulin, and the size of fat cells—all of which impact the risk of type-2 diabetes. ^{xxviii xxix xxx} Several studies have noted that vitamin K supplements appear to reduce the risk of breast and liver cancers.^{xxxi xxxii} And because vitamin K is necessary to activate MGP, which directs calcium to the bones and away from the arteries, it is thought to play a major role in the prevention of atherosclerosis.

Recommendation:

Three different types of vitamin K can make things confusing, so here are some guidelines. Take 10,000 mcg of vitamin K2 (MK-4 form) to reduce the risk of osteoporosis. If you have severe osteoporosis, take 45,000 mcg daily under a doctor’s supervision. For blood sugar control, try 1,000 mcg of vitamin K1. For prevention of coronary calcification, try 150 mcg of vitamin K2 (MK-7 form). If you take the anticoagulant drug Coumadin (warfarin), do not take vitamin K without the explicit guidance of your physician.

Vitamin C

Your body requires this popular vitamin to make collagen, a protein that holds together much of our bodies, including bone. In a study at Tufts University, Boston, researchers tracked almost 1,000 elderly men and women for up to 17 years. Overall, people who consumed more than 300 mg daily of vitamin C had the lowest risk of hip and nonvertebral (nonback) fractures, compared with people with the lowest intake of the vitamin. Most of the benefits were related to vitamin C supplements. People who took an average of 260 mg of vitamin C or more daily were about 69 percent less likely to experience a hip fracture and 42 percent less likely to suffer a nonvertebral fracture.^xxxiii

Yellow Alert. Vitamin C has broad health benefits, and low levels can reduce resistance to infection and contribute to bruising and bleeding gums. And because vitamin C is required in energy production, deficiencies can result in fatigue and irritability.

Recommendation:

Adults can benefit from taking 1,000 to 3,000 mg daily in divided doses.

B Vitamins

Low levels of vitamins B12 and folic acid are associated with a greater risk of osteoporosis and bone fractures. A Swedish study published earlier this year including 790 elderly men found that low vitamin B12 levels were associated with a two-thirds greater risk of fractures.^xxxiv Other studies have noted a similar link. Japanese researchers studied people’s risk of fractures after suffering a stroke. “Hip fractures are associated with more deaths, disabilities, and medical costs than all other osteoporosis-related File Under “Bone Health--Osteoporosis” Created 3/14 4 fractures combined,” wrote Yoshihiro Sato, MD, of the Keio University School of Medicine, Japan. When Sato and his colleagues supplemented more than 600 stroke patients with either a combination of vitamin B12 and folic acid or placebos, he found that the B vitamins reduced the risk of fracture by 80 percent.^xxxv

Yellow Alert. Low levels of vitamin B12 and folic acid may influence the risk of other diseases. With inadequate intake of these vitamins, homocysteine levels increase—and homocysteine is strongly related to risk of stroke, atherosclerosis, heart attack, and possibly Alzheimer’s disease. Low levels of these vitamins also lead to DNA damage, which could increase the risk of cancer.

Recommendation:

Take a B-complex supplement, a multivitamin (which will contain the B vitamins), or 1,000 mcg of B12 and 400 to 600 mcg of folic acid daily.

Silica, Strontium, and Boron

These three nutrients play small but important roles in bone formation and maintenance. Silicon is involved in the synthesis and stabilization of collagen, and is involved in establishing the matrix that forms bone.xxxvi Concentrations of the mineral are especially high in cells actively forming new bone. Similarly, strontium plays roles in maintaining and increasing bone formation.^xxxvii Meanwhile, boron aids in the metabolism of calcium, magnesium, and vitamin D—all of which are involved in bone formation and maintenance. Animal studies have found that boron supplementation can increase bone strength.xxxviii

Yellow Alert. Silicon (also known as silica) may protect against Alzheimer’s disease by reducing aluminum levels in the body and brain. In a 2013 study in the Journal of Alzheimer’s disease, researchers reported that consumption of silicon-rich mineral water for 12 weeks reduced aluminum levels in Alzheimer’s patients. In addition, cognitive function improved significantly in some of the people in the study.^{xxxix xl}

Recommendation:

Strontium and boron are typically found in formulas designed to support bone health, rather than standalone supplements. Silicon is available in various forms, including silica and stabilized silicic acid.

Finally…

Because the bone matrix consists of both minerals and protein, it is also important to consume adequate amounts of dietary protein. Higher protein content (more than 68 grams daily, or about 9 ounces of fish or animal protein) is associated with stronger bones.^xli However, consuming a ratio of two-thirds vegetables to one-third protein is crucial for maintaining an alkaline body pH, which will also help preserve both bone and muscle.

References available upon request.