When most people think about bone health, calcium is often the first—and sometimes only—nutrient that comes to mind.
But is calcium the only key to maintaining strong, healthy bones? Not really!
To support optimal bone health, your bones need other nutrients to keep them strong, dense, and resilient. Without these nutrients, even the best calcium intake may not be enough.
In this article, we share seven important bone-supporting nutrients that work alongside calcium to help maintain robust bone health and keep your bones strong as you age.
7 Nutrients for Strong, Healthy Bones
Vitamin D
Vitamin D is more than just a vitamin; it is a hormone essential for overall health, particularly in maintaining strong bones. (1)
In the early 20th century, people started to shift from outdoor to indoor workplaces, such as from agricultural work to factories and schools.
This also marked the beginning of widespread vitamin D deficiencies, leading to health issues such as rickets. (2)
Fortunately, around the 1920s, children who consumed cod liver oil, which has an abundance of vitamin D, rarely developed rickets.
This led to the discovery of vitamin D and the start of its supplementation in diets.
Vitamin D is best known for enhancing the body’s ability to absorb calcium, a mineral for building and maintaining strong bones and teeth.
Research shows that without sufficient vitamin D, the body absorbs only 10-15% of dietary calcium.
However, when vitamin D levels are adequate, calcium absorption increases to 30-40%, supporting bone mineral density and reducing the risk of fractures and bone diseases. (3)
A study published in The New England Journal of Medicine found that men and women aged 65 and older who supplemented with calcium and vitamin D experienced a moderate reduction in bone loss in the femoral neck, spine, and total body over three years, as well as a lower incidence of nonvertebral fractures. (4)
The body naturally produces vitamin D when the skin is exposed to sunlight, specifically ultraviolet B (UVB) rays.
These rays convert 7-dehydrocholesterol, a form of cholesterol in the skin, into vitamin D3, then transport this to the liver, where it picks up extra oxygen and hydrogen molecules to become 25-hydroxyvitamin D or 25(OH)D. (5)
This is the form that doctors typically measure when diagnosing vitamin D deficiencies.
However, while 25(OH)D is crucial for diagnosis, it remains inactive until it reaches the kidneys.
Once in the kidneys, it undergoes a final conversion, adding another pair of oxygen and hydrogen molecules to become the active form known as 1,25-dihydroxy vitamin D, or 1,25(OH)2D, also called calcitriol or what most people call vitamin D.
This active form is crucial for the body’s ability to absorb calcium and maintain bone health.
Although sunlight is a natural and effective source of vitamin D, factors such as the winter season, northern latitudes, and limited sun exposure can lead to deficiencies.
As a result, many people rely on vitamin D supplements to maintain optimal levels.
Studies suggest that a daily intake of 2,000 IU to 5,000 IU of vitamin D3 is beneficial for most people, especially during the colder months or when sunlight exposure is limited. (6)
This has been shown in a study in the Journal of Life, where participants taking 2,000 IU of vitamin D3 daily for two consecutive 60-day periods had boosted serum vitamin D levels. (7)
These levels continued to rise throughout supplementation and stabilized about 30 days after the subjects stopped taking vitamin D3.
However, make sure to avoid blind supplementation.
Before starting vitamin D supplementation, it’s important to test your vitamin D levels using a 25-hydroxyvitamin D (25(OH)D) lab test and then monitor these levels regularly.
The National Institutes of Health recommends maintaining levels above 30/mL, while many functional medicine doctors believe optimal vitamin D levels are 40-80 ng/mL for most people. (8) (9)
Since vitamin D is fat-soluble, it’s best to take it in the day with a meal that contains healthy fats such as avocados, extra virgin olive oil, or grass-fed ghee or butter so your body can effectively absorb it. (10)
Vitamin K2
Human bone is encased in a tough outer membrane called the periosteum, which protects a soft, spongy matrix rich in blood and lymphatic vessels. (11)
It is also constantly undergoing remodeling, where old bone is broken down and new bone is formed. This process ensures that the skeleton is entirely replaced every seven to ten years.
During this process, calcium is released into the bloodstream, and its replacement in the bone is regulated by osteoblasts and osteoclasts. (12)
Osteocalcin, produced by osteoblasts, is responsible for taking up calcium and delivering it to the bone matrix. (13)
However, this process can only occur when osteocalcin is activated by vitamin K2.
Vitamin K2 works by supporting the balance between bone-forming osteoblasts and bone-resorbing osteoclasts to ensure that your bones remain strong and healthy throughout life. (14)
Vitamin K was discovered in 1929 as a vital component for blood coagulation—hence the "K" from the German word "Koagulationsvitamin." (15)
Since then, vitamin K has been found to support bone metabolism.
There are two primary forms of vitamin K: vitamin K1 (phylloquinone) and vitamin K2 (menaquinone). (16)
Vitamin K1 is found in leafy green vegetables, while vitamin K2 is found in animal products and fermented foods and is also produced by gut bacteria.
Although vitamin K1 can be converted into K2 in the body, this process is not efficient, making vitamin K2 more beneficial for bone health.
Vitamin K2 assists in bone mineralization and formation by activating osteocalcin, a protein that helps bind calcium to the bone matrix. (17)
Without sufficient vitamin K2, osteocalcin remains inactive, leading to weaker bones and an increased risk of fractures.
Vitamin K2 has several subtypes, and MK-4 and MK-7 are two of the most important. (18)
Specifically, MK-4, or Menaquinone-4, has been shown to support bone metabolism and health, as evidenced in a study published in the Journal of Bone and Mineral Metabolism. (19)
Postmenopausal Japanese women aged 50-65 years who were given MK-4 for 6 to 12 months experienced a reduction in their undercarboxylated osteocalcin (ucOC) levels.
Undercarboxylated osteocalcin is a form of protein that hasn’t been fully activated due to a lack of "carboxylation."
For osteocalcin to properly bind calcium to bones and help build strong bones, it needs to be activated, which requires vitamin K – specifically, vitamin K2.
If osteocalcin remains in its undercarboxylated or inactive form, it leads to poor calcium binding in bones, weakening them over time and increasing the risk of bone-related issues such as fractures or bone loss.
The use of MK-4 improved undercarboxylated osteocalcin levels, supporting bone metabolism and enhancing bone health in postmenopausal women, particularly in the forearm.
Another study from Osteoporosis International shows that MK-7 can also activate undercarboxylated osteocalcin. (20)
In this study, 142 postmenopausal women who received vitamin K2 MK-7 for three years experienced a reduction in undercarboxylated osteocalcin levels and maintained healthy bone mineral density in the hip, femoral neck, and lumbar spine, with only minor losses observed.
Vitamin K2 also supports a healthy heart by directing calcium to the bones, rather than accumulating in the arteries. (21)
This process helps prevent arterial calcification, a risk factor for cardiovascular issues, while simultaneously supporting strong bones.
While there is no official recommended daily allowance (RDA) for vitamin K2, dosages typically range from 90-200 mcg for MK-7 and 10-45 mg for MK-4.
Individual needs may vary, so it's important to adjust your intake accordingly to find the right balance for optimal bone and cardiovascular health.
Vitamin C
Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that is crucial for your body to grow, repair, and maintain tissue.
Unlike fat-soluble vitamins, your body doesn’t store vitamin C, so you need to get it from vitamin C-rich foods such as citrus fruits, broccoli, and tomatoes.
When it comes to bone health, vitamin C supports collagen production. (22)
Collagen is a building block for skin, cartilage, tendons, ligaments, and blood vessels. It also forms the foundation of your bones’ structure.
Vitamin C works by stabilizing the collagen’s triple-helical structure, making sure that the collagen is robust and functional. (23)
It also stimulates the activity of alkaline phosphatase, an enzyme that supports the formation of osteoblasts—cells responsible for building bones.
This enzyme plays a key role in bone mineralization, a process that strengthens bones and maintains their density.
In a study published in the Journal of Bone and Mineral Research, researchers discovered that vitamin C supplementation helps maintain healthy bones in postmenopausal women, who are particularly prone to bone loss. (24)
Among the 994 participants, those who consistently used vitamin C supplements had about 3% higher bone mineral density at important skeletal sites, such as the femoral neck and hip, compared to those who did not take the nutrient.
Vitamin C is also a potent antioxidant, working alongside other antioxidants like vitamin E and beta-carotene to protect the body from oxidative stress. (25)
Free radicals, which are unstable molecules that can damage cells and DNA, contribute to the aging process and bone loss.
By neutralizing free radicals, vitamin C helps protect bone cells from damage, further supporting overall bone health.
The recommended dietary allowance (RDA) for vitamin C is 90 mg for men and 75 mg for women.
However, experts believe that higher intakes—up to 1,000 mg or more daily—may be more beneficial for maintaining strong bones. (26)
Various forms of vitamin C supplements, such as organic whole-food vitamin C, buffered ascorbates, and liposomal vitamin C, are available to help you meet your daily needs.
Because vitamin C is water-soluble, it can be taken with or without meals.
When consuming larger doses (1-2 g or more), it’s advisable to start with a lower amount and gradually increase it to avoid potential digestive discomfort like loose stool.
Magnesium
Magnesium is a vital mineral involved in over 300 enzymatic functions within the body, including energy production (ATP generation), protein synthesis, and acting as a key structural element in bones.
In fact, about 50-60% of the body’s magnesium is stored in the bones, making it integral to maintaining strong and healthy bones. (27)
It not only supports the structural development of bones but also helps in regulating bone turnover.
This mineral directly influences the activities of osteoblasts (cells that build bone) and osteoclasts (cells that break down bone. (28)
When magnesium levels are low, the activity of osteoblasts decreases, leading to reduced bone formation.
Simultaneously, the activity of osteoclasts increases, causing more bone breakdown—a combination that can weaken bones over time.
Furthermore, magnesium boosts the absorption and metabolism of vitamin D, a nutrient critical for calcium absorption and bone mineralization. (29)
Without sufficient magnesium, your body’s ability to effectively use vitamin D is compromised, which can result in brittle and weak bones, making you more prone to fractures.
In fact, in a study published in PLoS One, researchers reported that among 358 patients undergoing hemodialysis, those with the lowest magnesium intake experienced three times more fractures than those with the highest intake. (30)
A review of 787 studies published in Bone also showed that high magnesium intake supports healthy bone mineral density in the hip and femoral neck – two areas that commonly experience fractures. (31)
Magnesium also influences the concentrations of parathyroid hormone (PTH) and calcitonin, both of which are vital for maintaining calcium balance in the body. (32)
PTH increases calcium levels in the blood by stimulating bone resorption, while calcitonin lowers blood calcium levels by inhibiting bone resorption.
Adequate magnesium helps regulate these hormones, ensuring a healthy balance of calcium in the blood and bones.
The recommended dietary allowance (RDA) for magnesium is 320 mg per day for women and 420 mg per day for men.
Individual dosage may vary, particularly if you have higher calcium and vitamin D intake, as both can increase your body's need for magnesium.
A red blood cell (RBC) magnesium test can help determine your magnesium levels and whether you need to increase your intake. (33)
B Vitamins
B vitamins, although often recognized for their role in energy production and nervous system function, also support bone health and the reduction of fracture risk.
Two of the most popular B vitamins for bone health are vitamins B9 (folate) and B12 (cobalamin).
Vitamin B12 supports healthy bone formation and remodeling. It also helps bone cell production and supports calcium absorption, which is important for maintaining bone density.
However, a deficiency in vitamin B12 can result in low bone density, disrupt bone cell function, reduce blood flow to bones, and interfere with collagen formation. (34)
Vitamin B9 or folate helps in proper cell division and is particularly important during periods of rapid growth, such as pregnancy.
Adequate folate intake is crucial for the development of the spine and can help reduce the risk of neural tube defects in newborns. (35)
Folate also works synergistically with B12 to support overall bone health.
Both B vitamins are also involved in the remethylation process of homocysteine metabolism. (36)
Elevated homocysteine levels have been linked to an increased risk of fractures, and these vitamins can support healthy levels.
This was evidenced in a study published in the New England Journal of Medicine where researchers looked at the connection between homocysteine levels and the risk of fractures in 2,406 people aged 55 and older.
Throughout the study, 191 participants had fractures. The researchers found that higher homocysteine levels increased their risk of fractures by 1.4 times. (37)
People with the highest levels of homocysteine were almost twice as likely to break a bone.
In a study published in Bone, researchers discovered that B vitamin deficiency, particularly, B6, B12, and folate, can result in bone degradation and increase the risk of fractures. (38)
Using cells from 10 healthy male participants, researchers found that low levels of B6, B12, and folate can increase the activity of osteoclasts, the cells responsible for breaking down bone.
Specifically, low vitamin levels led to a 250% increase in osteoclast activity, while elevated homocysteine levels caused an even greater rise – nearly 400%.
Therefore, it’s important to maintain healthy levels of B vitamins to support healthy and strong bones and reduce your risk of fractures as you age.
While dietary sources such as lean meats, eggs, leafy greens, and fortified cereals can provide these essential nutrients, some people may require supplementation, especially those with increased needs or dietary restrictions.
Omega-3
Omega-3 fatty acids, a type of polyunsaturated fat, play a crucial role in supporting bone health.
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) specifically help maintain bone mineral density, improve bone turnover markers, and reduce the risk of hip fractures. (39)
They also support calcium absorption and healthy levels of calcium-ATPase levels (an enzyme essential for calcium regulation), as well as block compounds that contribute to bone loss. (40)
In a study published in Aging, 65 older women on a low-calcium diet who received EPA and DHA supplements saw improvements in their bone health.
After 18 months, their lumbar spine density increased by 3.1%, and femoral bone density rose by 4.7%. (41)
In another study published in the Journal of Nutrition Research, researchers investigated how fortified milk supplemented with fish oil, oleic acid, and vitamins can support bone health. (42)
72 hyperlipidemic adults aged 35-65 were divided into two groups.
The supplement group consumed fortified milk with fish oil, oleic acid, and vitamins, while the control group drank regular semi-skimmed milk.
Over one year, the fortified milk group had increased eicosapentaenoic acid by 42%, docosahexaenoic acid by 60%, and vitamin B6 by 38%.
This group also had higher levels of osteoprotegerin (18%), vitamin D (11%), and calcium (4%).
Additionally, bone formation markers, including osteocalcin, rose by 22%.
EPA and DHA also support bone health by turning off the inflammatory response in the body.
They serve as precursors to specialized pro-resolving mediators (SPMs), which help manage inflammation. (43)
You see, chronic inflammation can activate cytokines like tumor necrosis factor (TNF) alpha, interleukin 1 (IL-1), and interleukin 6 (IL-6), which can activate osteoclasts that break down bone, leading to bone fragility and loss. (44)
Omega-3s combat this by decreasing the production of pro-inflammatory molecules such as PGE2 and increasing the production of anti-inflammatory molecules like PGE1. (45)
PGE1 helps reduce inflammation by producing lipoxin B4, which can further decrease inflammatory markers like IL-6 and IL-8. (46)
Thus, adding omega-3 fatty acids into your diet can support inflammation for healthy and strong bones.
Foods rich in omega-3s include fatty fish like salmon, mackerel, and sardines, as well as plant-based sources such as flaxseeds, walnuts, and chia seeds.
For those who may find it challenging to consume enough omega-3-rich foods, you can opt for supplements to make sure you are meeting your daily requirements to reduce your risk of fractures and bone loss as you age.
Vitamin E
Vitamin E is often recognized for its antioxidant properties, but its benefits go well beyond improving skin and boosting the immune system—it also plays a critical role in maintaining bone health.
Research from American River Nutrition found that compounds in the annatto plant, specifically annatto tocotrienols and geranylgeraniol (GG), are highly effective in supporting bone strength and health. (47)
Annatto is the richest known source of tocotrienols, containing 90% delta-isomers and 10% gamma-isomers, which are the most potent forms of this powerful antioxidant. (48)
These compounds help prevent fat oxidation and reduce free radical damage, which can weaken bones over time.
As we age, bones are more vulnerable to damage from inflammation and free radicals, making antioxidants essential for protection. (49)
Annatto tocotrienols offer support, particularly for postmenopausal women who experience a natural drop in estrogen—a key antioxidant that helps protect bones. (50)
Annatto tocotrienols step in as a "replacement antioxidant," helping to bridge the gap left by declining estrogen levels.
A study published in the Journal of Osteoporosis International revealed that postmenopausal women taking tocopherol-free tocotrienols for 12 weeks have supported bone resorption and turnover rates. (51)
87 postmenopausal women receiving DeltaGold® annatto tocotrienol at doses of 300 mg and 600 mg daily showed a 100% increase in the BALP/NTX ratio (a measure of bone remodeling) and a 13-24% reduction in the RANKL/OPG ratio, which indicates bone resorption.
The placebo group, by contrast, saw an increase of 21-36% in the RANKL/OPG ratio.
This goes to show that annatto tocotrienols not only promote bone strength by reducing high bone turnover but also improve bone formation, even at the genetic level, all while being a safe option for postmenopausal women. (52)
Another compound found in the annatto plant is geranylgeraniol or GG.
It's a building block for producing CoQ10 and MK-4, the latter being the primary form of vitamin K2 in the body. (53)
MK-4 is crucial for transporting calcium to bones and removing it from arteries, helping to maintain both bone density and cardiovascular health.
Unfortunately, as we age, our bodies produce less GG, and this decline worsens in people who use statins and bisphosphonates.
By replenishing GG levels, we can support healthy bones and overall musculoskeletal health as we age.
A study published in the Journal of Biochemical and Biophysical Research Communications reported that both MK4 and geranylgeraniol support bone health by supporting healthy osteoclast formation, which is responsible for bone breakdown. (54)
MK4 works by blocking the production of COX-2 and PGE2 – compounds that contribute to inflammation and bone degradation.
Meanwhile, geranylgeraniol suppresses RANKL, a protein essential for osteoclast creation, and protects the structure of osteoclasts from disruption caused by certain osteoporosis drugs, such as N-BP.
This shows that MK4 and geranylgeraniol help prevent bone breakdown, with geranylgeraniol providing additional protection when used alongside bone treatments.
Therefore, taking a vitamin E supplement that contains annatto tocotrienols and geranylgeraniol can help combat the effects of aging on your bones and support the maintenance of muscle and bone mass as you age.
Vitamin E for Bone Health
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