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Strong Bones

Summary: Nutrients and lifestyle play a major role in maintaining bone health. It’s much more than just calcium!

Nutritional and Lifestyle Strategies to Build and Maintain Strong Bones

Nutritional Support:

Calcium: Nutrients play a major role in maintaining bone health. Multiple studies have shown a diet rich in protein, phosphate, and vitamin D have positive effects on calcium metabolism and on markers for bone health, delaying or preventing osteoporosis. (Bonjou 2005) While calcium is the cornerstone mineral of bone, consumption of calcium alone does not build strong bones. The American Heart Association suggests that calcium supplementation may be associated with increased risk of cardiovascular disease. (Anderson 2016). A meta-analysis of calcium supplements, given without co-administered vitamin D, found increased risk of myocardial infarction. Even if the increased risk is modest, additional studies are indicated regarding the use of calcium supplements in the management of osteoporosis. (Bolland 2010). The ideal amount of daily calcium consumption has not been established but about 800mg/day is used as a general guideline. Consuming leafy greens, kefir, yogurt and/or cheese every day should meet or exceed daily requirements.

Vitamins and Other Minerals: Thirteen minerals have been identified in bone. These minerals (boron, calcium, zinc, magnesium, copper, potassium, phosphorus, vanadium, strontium, silica, selenium, nickel, and manganese) are each required in unique amounts and they work synergistically. Vitamins (D3 and K2) are also critically important for maintaining bone strength. These vitamins have been shown to be effective in reducing fracture incidence. (Hosoi 2007). Vitamin D3 (found in sunshine exposure, salmon, red meat, egg yolks and liver) is necessary for calcium absorption and works with phosphate, magnesium, and vitamin K to stimulate bone mineralization. Several studies have reported a link between higher vitamin K2 concentrations (found in cheese, egg yolk, butter, traditionally made sauerkraut, chicken liver, beef) and reduced fracture risk. (Gagne & Maizes 2018). Individuals should know and optimize vitamin D status (optimal range 40-70 ng/mL). Daily intake of vitamin K should be at least 90 mcg for women and 120 mcg for men. Low magnesium status is common in women with osteoporosis. Studies have shown supplementing with magnesium can increase bone density in postmenopausal women. (Hudson 2013).

Estrogen: Estrogen suppresses synthesis of bone-resorbing cytokines, inhibits osteoclast (cells that break down bone) activity, and has anti-inflammatory properties. (Gagne & Maizes 2018). Following menopause, bone loss accelerates due to decreasing circulating estrogen concentrations. Estrogen replacement therapy can decrease fracture rates and improve bone mass density scores. However, hormonal therapy increases risk of stroke, breast cancer, cardiovascular disease, and thromboembolic events. (Rossouw, Anderson, Prentice 2002). Bioidentical Hormone Replacement Therapy is another option. According to The Cleveland Clinic “Bioidentical hormones are artificial hormones that are similar to the hormones produced by the human body. They are used as treatment for people whose own hormones are low or unbalanced. Some people benefit from bioidentical hormones, but there are risks to treatment.”

Fatty Acids: Omega-3 fatty acids play an important role in bone health by increasing calcium absorption, decreasing inflammation, and promoting synthesis of osteoblasts (cells that build bone). (Gagne & Maizes 2018) Omega-6 to omega-3 fatty acid intake should have a 1:1 ratio.

Collagen: Collagen is a key component of bone matrix (structure). Vitamin C is a cofactor for the formation of collagen. Bell peppers, oranges, and broccoli are excellent sources of natural vitamin C. Glycine and proline also build collagen. Grass-fed bone broth, rich in both nutrients, has been shown to help reverse osteoporosis. (Calton & Calton 2015).

Nutrients to Avoid

Certain nutrients displace vitamins and minerals. Phytic acid found in wheat and soy has been shown to reduce micro-nutrient absorption by binding to vitamin B3 (niacin), calcium, chromium, copper, iron, magnesium, manganese, and zinc. Consequently, osteoporosis is common in populations with high phytic acid intake. (Calton & Calton 2015). For some individuals, gluten and/or dairy can cause chronic low-grade inflammation which is associated with osteoporosis. Inflammation promotes accelerated bone loss by inhibiting collagen production in osteoblasts, activation of osteoblasts, and enhanced breakdown of the extracellular matrix. (Gagne & Maizes 2018)

Lifestyle Support and Recommendations

Reduce/eliminate smoking, alcohol, and caffeine consumption. Smoking has been shown to cause more rapid bone loss and it initiates menopause an average of two years earlier than in women who do not smoke. (Hudson 2013). Minimize/eliminate processed foods. Sugar increases the loss of calcium from the body. Soft drinks are high in phosphates, contain no calcium, and can be a major contributor to the development of osteoporosis. (Hudson 2013). Consuming an anti-inflammatory whole-food-diet rich in seasonal, organic, local fruits, vegetables (leafy greens are a rich source of many vitamins and minerals including calcium, vitamin K1 and boron), kefir/yogurt, legumes, nuts, seeds, herbs, teas, ferments, and healthy fats (avocado, olive, coconut oil & grass-fed butter). Wild-caught fish (salmon & anchovies are high in omega 3 EFAs) and shellfish (contain magnesium, copper, selenium, zinc, vanadium & strontium) are beneficial. Meat and organs from grass-fed animals, pasture raised poultry, eggs, and bone broth are valuable for bone health. Maintaining a healthy microbiome is also connected to strong and healthy bones. Studies continue to understand its role in osteoporosis. Supplements should be considered when diets fall short of providing critical nutrients, particularly minerals that build bone, vitamins B 6,9 & 12, C, K, and D.

Exercise and Stress Reduction. Weight bearing exercises improve bone strength. Failure to exercise sends a clear message to the skeleton that strength of bone is not essential. One hour of moderate activity three times a week has been shown to increase bone mass density in postmenopausal women.(Hudson 2013) Stress reduction through a daily mind/body practice promotes overall wellness and can decrease inflammation.

Individuals at risk for fracture are encouraged to be mindful of side effects associated with any medication taken. Antidepressants (SSRIs), anti-seizure medications, breast cancer treatment (Tamoxifen and aromatase inhibitors), chemotherapeutic agents, gonadotropin releasing hormones, proton pump inhibitors, steroids and excess use of thyroid hormone can all have a negative impact on bone density. (Gagne & Maizes 2018)


Anderson, J.J.B., Kruszka, B., Delaney, J.A.C., He, K., Burke, G.L., Alonso, A., Bild, D.E., Budoff, M., Michos, E.D. (11 Oct 2016) Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the multi-ethnic study of atherosclerosis (MESA) Journal of the American Hearth Associations

Bolland, M.J., Avenell, A., Baron, J.A., Grey, A., MacLennan, G.S., Gamble, G.D., Reid, I.R. British Medical Journal, 2010 Jul 29 Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. PMCID: PMC2912459

Bonjou, J.P. (2005 Dec 24) Dietary protein: an essential nutrient for bone health. Journal of American College of Nutrition

Doi: 10.1080/07315724.10719501

Calton, J., Calton, M. (2015). The Power Nutrient Solution Rodale Books, New York, New York

Gagne, L. & Maizes, V. (2018) Osteoporosis, in Rakel’s Integrative Medicine, (4th edition Pp.370-381) Elsevier, Philadelphia, PA

Hosoi, T. & World Health Organization (2007 July, 17) Journal of Clinical Calcium, Absolute risk for fracture and WHO guideline. Pharmacological intervention to prevent osteoporotic fractures in the elderly.

PMID: 17607078

Hudson, T. (2013). Osteoporosis, in Pizzorno & Murray’s Textbook of Natural Medicine, (4th edition Pp. 1662-1677) Elsevier, St. Louis, Missouri

Rossouw, J.E., Anderson, G.L., Prentice, R.L. (17 Jul 2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 288 (3):321-333 2002 12117397

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