A Guide To Bone Health: Key Nutrients and Supplements For Strong Bones


Bones are active, living tissues that continually grow, weaken, break, and rebuild throughout our lives. In the first year of our lives, almost 100% of our skeletons are replaced through bone remodeling. And in most healthy adults, remodeling slows down to a turnover rate of 3.6% per year. (1) As you age, there is a natural course of decline in bone health. This makes knowing what you can do to support a healthy bone metabolism essential to avoiding low-impact injury. Find out what vitamins and natural supplements are proven to promote bone health.

Many factors influence bone health such as gender or family history, but one crucial and controllable aspect you can focus on at any age of life is bone-healthy nutrients. Find out what the top bone health support supplements are to help you build strong bones at any age by referring to our bone health guide below.

doctor examining patient's spine

One factor that affects bone health, which you can control, are bone-healthy nutrients to strengthen your bones.

Top bone health nutrients & supplements

We’ve spoken to healthcare practitioners using Fullscript about important vitamins and minerals for supporting bone health. Here is the list of the top supplements they recommend for preventing or slowing down bone loss, how much you should take, and why.

You’ll notice we have included two different recommended daily values: We have included a bone health supplement RDA based on the average North American diet.

calcium powder next to a glass of milkshake with yellow straw and a banana

Calcium supplementation for those who might experience deficiencies can be found in powder form to add to smoothies and milkshakes.

Calcium

Bone Health RDA Supplementation: 500-1,200 milligrams daily
Needed for: bone development, strength, and rigidity
Found in: dairy products, greens, nuts, seaweed, bone marrow

Calcium is essential (2) for building bone tissues and overall bone health. Bones are constantly absorbing and releasing calcium and other minerals, depending on factors such as hormones, exercise, diet, or genetics. For people who don’t eat enough foods naturally rich in calcium, dietary supplements can make up for the shortfall.

According to the NIH, the following groups (3) have a higher risk of calcium deficiency than the rest of the general U.S. population.

  • Vegetarians
  • Postmenopausal women
  • Amenorrheic women or a female athlete triad
  • Individuals with lactose intolerance

Did you know?
Building strong bone metabolism at an early age is vital for young women because calcium is lost during pregnancy and menopause. 90% (4) of adolescent girls and teens are missing calcium in their diet, putting them at higher risk for bone fractures.

Peak bone density (or bone mass) is hit around age thirty. After age thirty, bone resorption begins to exceed new bone production, and as the years pass, you will experience significant bone loss. Around the world, at least one in five men and one in three women over fifty years old will suffer a fracture due to fragile bones, according to the International Osteoporosis Foundation. (5)

Before we reach peak bone mass, healthy adolescents and young adults absorb calcium and other minerals faster they break down. After this, remineralization naturally slows down. This is why the amount of calcium your body needs changes as you age, and why you should take advantage while you are young.

Recommended daily intake for calcium

For both men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. That recommendation goes up to 1,200 milligrams daily once they turn 50, and for men once they reach 70. The tolerable upper intake level for calcium for all adults is 2,500 mg daily, including pregnant and lactating women. (6)

Did you know?
We have limited time to influence our peak bone mass. The best time to build bone density is during years of rapid growth. Childhood, adolescence, and early adulthood are the times when we can significantly increase our peak bone mass through diet, lifestyle choices, and physical activity.

As mentioned before, our bone health changes based on multiple factors, age being a dominant one. Active bone growth for men and women lasts from the day we are born until we reach the age of 30. From 30 to 50, we experience slow loss, our bones stop growing. Between the ages of 60 and 65, we experience rapid loss of bone mass but the from 65 and on the speed of bone mass loss stabilizes and is less rapid. (7) Age is just one factor amongst other environmental and health factors.

The higher your peak bone mass measurement is, the less likely (8) you are to have weak bones and develop osteoporosis as you age. Calcium intake has a lower effect on bone mineral density once you’re past peak bone mass, but calcium combined (9) with vitamin D has been shown to improve Bone mineral density after peak bone mass levels.

Did you know?
The National Institute of Health (NIH) recommends that teens and children consume 1,300 mg of calcium and 600 IU of vitamin D daily to help develop strong, healthy bones.

eggs. butter, raw fish, dairy products all together on table

Vitamin D helps reduce the risk breaking bones when falling, and helps reduce age-related muscle loss and improves muscle function.

Vitamin D

Bone Health RDA Supplementation: 600-1,000 D3 IU daily or intermittently at higher doses
Needed for: calcium absorption, even small amounts
Found in: fatty fish, beef life, eggs, butter

Vitamin D is needed for bone remodeling and growth. And without adequate vitamin D, Calcium can’t do its job. Vitamin D bolsters the absorption of calcium in the gut and helps the body maintain adequate calcium blood levels. Vitamin D also reduces (10) the risk of falling and breaking bones, and helps reduce age-related muscle loss and improves muscle function. Especially in lower legs.

According to the NIH, the following groups have a higher risk of vitamin D deficiency than the rest of the population:

  • Breastfed infants
  • Older adults
  • People with dark skin
  • People with limited sun exposure
  • Obese people who have undergone bypass surgery
  • People with conditions causing fat malabsorption

Lack of vitamin D is a huge problem (11) for seniors. Research shows (12) over 70% of women from 51- 70 years old are not getting enough vitamin D from food or supplements. And 90% of women over 70 are vitamin D deficient. For most people, food supplies only a small portion of the vitamin D their body needs, and supplementation is a smart choice.

Recommended daily intake for vitamin D

Do keep in mind that vitamin D can cause toxicity and levels vary depending on age. (13) Vitamin D toxicity leads to non-specific symptoms such as weight loss, polyuria, and heart arrhythmias. The following are guidelines for tolerable upper intake levels for vitamin D:

  • 0-6 months newborns should limit intake to 1,000 IU daily
  • 7-12 months 1,500 IU daily
  • 1-3 years should stay below 2,500 IU daily
  • 3-8 years don’t want to go over 3,000 IU daily
  • 9+ should avoid taking more than 4,000 IU Daily

Did you know?
In 2016, a panel of experts from the National Osteoporosis Foundation conducted an in-depth meta-analysis (14) on the effectiveness of calcium and vitamin D supplements to improve bone health. They found calcium plus vitamin D produced a 30% reduction in hip fractures and a 15% reduction in total bone fractures.

variety of fermented foods in jars on table

Fermented foods are a great food source of vitamin K!

Vitamin K2

Bone Health RDA Supplementation: 50-150 micrograms daily
Needed for: synthesis of osteocalcin for the structure of bone tissue + binding of calcium to bone matrix
Found in: hard cheeses, fermented foods

Epidemiological studies and clinical trials have consistently indicated (15) vitamin K has a positive effect on bone mineral density. Vitamin K is a group of compounds, broken down into vitamin K1 and vitamin K2. K2 is a group of compounds you can find in dairy products and meats, whereas K1 is found in leafy greens and other vegetables. Recently, people have begun supplementing their diets with vitamin K2 in tablet form for bone health.

Bones use vitamin K2 to synthesize proteins involved in calcium absorption, and K2 has been specifically found (16) to help improve bone strength and particularly beneficial for older women after menopause.

A study conducted by the International Osteoporosis Foundation found (17) that low doses of vitamin K (180 micrograms) can help reduce fracture risk and help a postmenopausal woman prevent bone loss. Some experts feel that results need to be further explored and more data needs to be analyzed before K2 is recommended for osteoporosis treatment.

Recommended daily intake for vitamin K

Keep in mind vitamin K interferes (18) with the anticoagulant warfarin (Coumadin), and that is often found in most multivitamins. And typically a multivitamin will contain 10 to 25 mcg of vitamin K. It’s important to discuss how much vitamin K to take with your doctor, especially if you take any blood thinners. Men and women do not differ for daily intake of vitamin K, ages are the changing factors. From 6 months all the way to 18 years old, there is a steady increase in vitamin K intake for men and women and it stays the same, regardless of gender. Once we reach 19+ the daily intake is 120 mcg for man and 90 mcg for women, including pregnancy and lactation. (19)

nuts, beans, avocados, spinach in bowls and on plates

Calcium needs magnesium to convert vitamin D into its active form so that it can turn on calcium absorption.

Magnesium

Bone Health RDA Supplementation: 250-420 milligrams daily
Needed for: calcium absorption, production of bone-preserving hormones, regulation of bone breakdown force, conversion of vitamin D to the active form
Found in: spinach, avocado, tofu, squash, flax, beans, almonds, brown rice

Magnesium works very closely (20) with calcium and vitamin D forming and maintaining bones. Calcium needs magnesium to convert vitamin D into its active form so that it can turn on calcium absorption. So it’s no surprise a lack of magnesium in the body has been shown (21) to increase the risk of osteoporosis, and adequate levels of magnesium intake are linked (22) to higher bone mineral density in senior men and woman.

According to the NIH, magnesium inadequacy (23) occurs when intakes are below the RDA but above the amount needed to stop a deficiency from developing.

  • People with alcohol dependence
  • People with gastrointestinal diseases
  • People with type-2 diabetes
  • Older adults

Recommended daily intake for magnesium

The tolerable upper intake level for supplemental magnesium is 350 mg daily for anyone above the age of 9. Because magnesium works closely (24) with calcium, it’s essential to have a ratio of both minerals for them both to be effective. A lower amount of magnesium intake below the recommended daily intake is associated (25) with lower BMD for the entire whole body.

Men and women experience a steady increase in daily intake recommendation of magnesium from birth to the age of 13. From 14 to the age of 50, intake levels between men and women differ and there is an increase between women who are not pregnant vs women who are, with a 30-40 mg increase (increase for those who are pregnant). Lactating vs nonlactating women stay the same with their intake recommendations matching. 51+ years of age, men are recommended to take 420 mg of magnesium and woman are recommended to take 320 mg of magnesium. (26)

Other key nutrients for bone health: protein, potassium, phosphorus

Overall good nutrition and exercise are key to keeping bones healthy through the years. Other nutrients that play minor roles in bone health include (27) protein, phosphorus, potassium, iron, zinc, silicon, boron, vitamin C, and vitamin B12.

There has been debate over the years about consuming too much protein being linked to calcium loss in bones, but a systematic review (28) by the National Osteoporosis Foundation found high intakes of protein won’t damage bone and may help protect the spine.

Bone mineral density tests (DEXA)

Before the 1980s, osteoporosis was only able to be diagnosed after a low-impact fracture. Now a bone density test, also called bone densitometry, dual-energy x-ray absorptiometry, DEXA or DXA, X-rays is used to measure bone mineral density (BMD) for early diagnosis. (29) A BMD test is one of the best predictors of your risk for breaking a bone.

This chart shows the difference between the stages of the T-scores, which defines normal bone mass, low bone mass, and osteoporosis.

The results of a bone density test are reported in two numbers: T-score and Z-score. The World Health Organization (WHO) uses (30) T-scores to define normal bone mass, low bone mass, and osteoporosis. Expressed in standard deviations from the mean, 0 means you’re equal to the norm. Your Z-score compares your results to a person of the same gender and age as yourself. The U.S. Preventive Services Task Force (31) recommends women get BMD measured at age 65 or younger, depending on additional risk factors such as hormonal changes during menopause.

What causes bone loss?

Many different factors besides nutrient intake or your age affect bone health, according to the National Institute of Health. (32) Here’s a list of 12 factors that are known to have an effect on bone health.

  • Gender: You have a higher risk of bone fractures as a woman. (33) Women have less bone tissue than men.
  • Body size: If you are very thin with a body mass index of 19 or less or if you have a small body frame because you might have less bone mass to draw from as you age, you’re at a higher risk (34) for osteoporosis.
  • Eating disorders: People who have suffered from an eating disorder such as anorexia or bulimia have been found to have a higher risk (35) for osteoporosis and early onset.
  • Hormone levels: Lowered sex hormone levels weaken bone. Menopause causes a dramatic bone loss in women due to a drop (36) in estrogen levels, while low testosterone level in men (37) can cause a loss of bone mass. The prolonged absence of menstruation before menopause also increase the risk of weaker bones. High doses of thyroid hormone medication can cause (38) bone loss.
  • Shrinking stature: People who have lost at least 1.6 inches (4 centimeters) in height may have compression fractures in their spines, according to The Mayo Clinic. (39)
  • Activity level: people who are sedentary have a higher risk of developing osteoporosis than people (40) that are more active.
  • Race & family history: If you have a parent or sibling who has osteoporosis you are at higher risk, and this is especially true (41) if you have a family history of fractures. You also have an increased risk if you’re white or of Asian descent.
  • Certain conditions or gastrointestinal surgery: Weight loss surgery and conditions affecting the stomach such as Celiac disease, Chron’s disease, (42) and Cushing’s disease can affect calcium absorption.
  • Transplants: People who have recently received bone marrow or an organ transplant have a higher risk for bone fractures. There are multiple reasons transplant surgery puts bones at risk. There is a higher risk factor of fractures in adult kidney transplant recipients because the administration of glucocorticoids after transplantation (anti-rejection drugs) interferes (43) with bone mineral metabolism.
  • Certain prescription drugs: Long-term use (44) of corticosteroid medications, such as cortisone, increases the risk of osteoporosis. Other examples of drugs that cause bone damage are selective serotonin reuptake inhibitors, proton pump inhibitors, and some anti-seizure medications.
  • Tobacco use: Research has shown that smoking can reduce (45) bone mass and increase fracture risk.
  • Alcohol use: Having more than two alcoholic drinks a day increases the risk (46) of bone fractures. Experts believe this may be because alcohol can interfere with the body’s ability to absorb calcium.

Talk to your healthcare practitioner about bone health supplements

Depending on your medical condition, age, and prescription drugs you may be on and other factors, there are factors that are important to take into consideration with bone health supplements. People often assume that supplements are safe, but keep in mind these products carry the same properties as other pharmacologically active compounds. Fully understand bone health with the help of a practitioner.

It is always a good idea to consult with a healthcare practitioner before taking any supplements.

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  2. https://orthoinfo.aaos.org/en/staying-healthy/calcium-nutrition-and-bone-health/
  3. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
  4. https://onlinelibrary.wiley.com/doi/abs/10.1177/0884217503258280
  5. https://www.iofbonehealth.org/facts-statistics
  6. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
  7. https://www.bones.nih.gov/health-info/bone/SGR/surgeon-generals-report
  8. https://www.ncbi.nlm.nih.gov/books/NBK45503/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330619/
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  13. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en1
  14. https://www.ncbi.nlm.nih.gov/pubmed/26510847
  15. https://www.ncbi.nlm.nih.gov/pubmed/17906277
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/
  17. https://link.springer.com/article/10.1007/s00198-013-2325-6
  18. https://www.stoptheclot.org/news/vitamin-k-and-coumadin-what-you-need-to-know/
  19. https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/
  20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775240/
  21. https://www.ncbi.nlm.nih.gov/pubmed/22662000/
  22. https://www.ncbi.nlm.nih.gov/pubmed/10197575/
  23. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
  24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086864/
  25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953885/
  26. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
  27. https://www.ncbi.nlm.nih.gov/pubmed/17092827
  28. https://www.ncbi.nlm.nih.gov/pubmed/28404575
  29. https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measurement-what-numbers-mean#c
  30. https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measurement-what-numbers-mean
  31. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/osteoporosis-screening
  32. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview
  33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380170/
  34. https://www.bones.nih.gov/health-info/bone/SGR/surgeon-generals-report
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  41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111798/
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  43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919741/
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  46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692368/