Top Foods to Eat
Here are the top foods you should include in your diet based on research of dietary approaches for bone health.¹
Fruits and Veggies
Higher fruit and vegetable intake is associated with less bone mineral density (BMD) loss and a resulting higher BMD. You see, fruits and vegetables provide a whole host of key nutrients like folate, and bone-supporting magnesium, potassium, and vitamin K1. Plus antioxidants like carotenoids and vitamin C. And let’s not forget calcium! Dark leafy greens like kale, collard greens, bok choy and broccoli rabe are all calcium-rich foods. And it couldn’t be easier to add them to your diet. They can all be incorporated into salads, soups, smoothies and even juices. If you want to change things up, try the lesser-known mustard and turnip greens, which have a bit of a spicier note. Don’t overlook the sea veggies either. Along with kelp, other sea veggies like nori, wakame, and kombu are packed with calcium, phosphorus, magnesium, iron and other trace minerals that contribute to strong bones. Just make sure your sea veggies are responsibly sourced to ensure sustainability and purity. When it comes to fruit, acerola cherries, guava, strawberries, and blueberries are all rich in antioxidants. Antioxidants (like vitamin C, beta-carotene, vitamin E and lutein) play a crucial role in bone health because they combat oxidative stress. And oxidative stress has been linked to many diseases, including osteoporosis. Antioxidants activate osteoblasts (bone-building cells), play a role in the mineralization process, and help reduce the activity of osteoclasts (bone-resorption cells).² If you have low bone density or worry about your bone health, there’s another wonder-fruit you’ll want to know about. You may know it as the main ingredient in your parents or grandparents favorite juice, but it’s got a lot more going for it than you may think! Yes, we’re talking about prunes (dried plums)!
Prunes have been shown to positively affect bone mineral density in a number of studies. In fact, their anti-inflammatory and antioxidant properties are just one aspect of their bone-building benefit. Prunes also contain boron, which is a trace mineral that’s been linked with reducing osteoarthritis symptoms and promoting stronger bone health. The most recent research shows that just 4-5 prunes per day is effective in protecting bone mineral density in postmenopausal women! To discover more, check out our post on Prunes and Osteoporosis.
If you’re a seafood fan, you’re in luck! You already know seafood tastes great, but research shows it protects your bones too. The Framingham Osteoporosis study looked at associations between polyunsaturated fatty acid and fish intake and hip bone mineral density.³ The levels were measured at baseline, and then four years later. Results showed that both women and men with who ate more than 3 servings of fish per week gained hip bone mineral density. And individuals with low to moderate fish intake ended up losing bone mineral density. The researchers concluded that fish consumption may protect against bone loss. They also noted that these protective effects on bone may be dependent on the omega 3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), specifically. EPA and DHA have been linked with positive bone health, improved eye health⁴, cardiovascular health⁵, and combatting depression⁶ and anxiety due to their anti-inflammatory properties.⁷ Additional cross-sectional studies have also associated habitual fish intake with greater BMD.⁸ Salmon, mackerel, sardines, and anchovies are among the oily fish packed with bone-healthy nutrients- especially those omega 3 fatty acids. In fact, canned sardines and sockeye salmon also pack a calcium-punch, boasting 383 mg of calcium and 239 mg of calcium in one serving! Finally, fish are an excellent source of protein and are typically lower in calories than meat or dairy.
There’s no doubt dairy is a great source of complex essential nutrients like calcium, magnesium, protein, vitamin D, vitamin B12, zinc and riboflavin. (To discover exactly how much calcium is in dairy milk– and non-dairy alternatives– check out our “How Much Calcium is in Milk?” page). Given that dairy foods are considered an essential source of bone-building nutrients, plenty of studies have been conducted to discover their protection against osteoporosis. Some cross-sectional studies have reported positive links between milk consumption and bone density in later life⁹, while others showing the benefits of milk on osteoporotic fractures is less convincing.¹⁰ The reason for all the mixed results? Lactose, a sugar found in cow’s milk. When it’s broken down in your body it produces two sugars: glucose and D-galactose. D-galactose promotes inflammation and chronic inflammation activates osteoclasts (cells that break down bones). We do acknowledge that dairy foods have been controversial and have been accused of leaching calcium from our bones, increasing the risk of fractures, osteoporosis and even cancer. However, when Bone Health Expert Lara Pizzorno sat down to sift through the research and evaluate the studies, she found some surprising results. Read more about the dairy, milk and osteoporosis controversy — including what lactose and D-galactose have to do with it — in our post: Milk and Osteoporosis.
However, the good news is the majority of the research indicates dairy products help support healthy bones. So if you’re not allergic or sensitive to dairy products, keep enjoying them! Also, be sure to enjoy fermented dairy foods, like yogurt and cheeses, especially aged cheeses as these are completely lactose-free. In particular, organic plain, full-fat yogurt delivers the widest range of beneficial nutrients for bones. Not only does plain yogurt contain calcium, but magnesium, zinc, plus small amounts of vitamin K2 (in the form of MK-4), vitamin A, and vitamin D (if it is fortified) and a hefty dose of protein. Research also shows prebiotic and probiotic properties in fermented dairy, like yogurt, may help your gut absorb nutrients from the food you eat, benefiting your bones.¹¹ Pre- and probiotics are in products like kefir, natural yogurt and raw cheeses. Discover more about prebiotics and probiotics in our ultimate guide.
Protein makes up about 50% of your bone volume and about one-third of its mass!¹² Bone health isn’t just a skeletal issue, rather, it’s a musculoskeletal issue. You see, bone loss and muscle loss that occur with aging are closely related. And factors that affect bone mass, like your protein intake, also affect muscle anabolism (growth). So keeping your entire musculoskeletal system happy and healthy is the goal – and adequate protein intake is crucial. Protein affects your bones in the following ways:
It provides the structural framework for bone.
It raises insulin-like growth factor (IGF-1) levels — a hormone that is important to boost bone density, muscle growth, and healing.¹³
It increases the amount of calcium absorbed in the intestines, and therefore, the amount used by the body.
It’s vital for muscle growth.
Alcohol in Moderation
You may be surprised to see this on the Foods for Osteoporosis section, however, alcohol in moderation has been shown to benefit overall health – and now bones! There are two types of alcohol that have been shown to have a positive effect on bone health.
Beer and Silicon
Silicon plays a key role in bone formation by stimulating our production of osteoblasts (bone-building cells), our synthesis of type 1 collagen, and by boosting calcium’s incorporation into bone. It’s also been shown in human studies to improve bone mineral density. Most notably is the large, U.S. population-based Framingham Offspring Study, which reported that higher dietary silicon intake in both men and younger women was associated with improved bone mineral density and skeletal health – especially cortical bone strength (the denser outer part of your bone).¹⁵ Consumption of at least 40 milligrams of silicon daily was the amount associated with increased bone mineral density. In fact, it accounted for up to 10% more bone mineral density between those individuals with the highest (> 40 mg/day) and lowest (< 14 mg day) intakes of silicon. Mineral waters and beer are by far the richest dietary sources of bioavailable silicon.¹⁶ To get the most silicon from beer, drink Indian Pale Ales (IPAs).¹⁷ The silicon all beers contain is highly soluble, but IPAs retain more because they are exposed to less heat during the malting process. The darker ales, such as the chocolate, roasted barley and black malt, all undergo substantial roasting and thus have far lower silicon content. Also look for beers with the highest amounts of hops. Hops contain surprisingly high levels of silicon — as much as four times more silicon than is found in malt. However, hops are used in much smaller quantities than grains in beer production. In Western countries, dietary intake of silicon ranges from 13-62 mg per day. Bone Health Expert, Lara Pizzorno recommends at least 40 mg per day. In addition to being clinically supported to increase bone density safely and naturally ─ Algaecal Plus contains 26 mg of silicon in every daily dose (4 capsules), plus the other 12 essential minerals required for strong bones.
Red Wine and Resveratrol
Red wine, in particular, has also been identified from the Framingham Osteoporosis Study to be beneficial to bone health in women.¹⁸ The potential contributor to this association is resveratrol. Resveratrol is a polyphenol that is abundant in red wine, grapes — and even nuts! It’s gained interested and attention for its heart-protecting and cancer-preventing benefits.¹⁹ Resveratrol also possesses anti-inflammatory properties, which are beneficial for bone health.
Alcohol and the “J”-Shaped Curve
Moderate alcohol consumption may offer protection for health and bones, but a review of the studies on alcohol and bone health found that intakes beyond a certain level may show negative effects as well.²⁰ They suggested what is known as the “J”-shaped curve. If you enjoy your glass of red wine or beer at dinner, continue to enjoy yourself! Just keep in mind that excess alcohol consumption has been shown to be detrimental to overall health and bones.
Nutrient Building Blocks for Osteoporosis
Your bones do best when they receive the full combination of all the micronutrients necessary to build new bone – a fact amply demonstrated by the Combination of Micronutrients for Bone (COMB) Study.²¹ The study was published in the Journal of Environmental and Public Health in February 2012. Right after the annual meeting of the American Academy of Orthopedic Surgeons first officially warned doctors that certain osteoporosis drugs increase the risk for “atypical femur fractures.”²² The COMB study firmly demonstrated that providing our bones with the nutrients they need along with regular weight-bearing exercise is as, or more, effective than any of them or strontium ranelate*, produces no adverse side effects and is a lot less expensive! (*Strontium ranelate is the unnatural patent medicine version of natural strontium. The many reasons you do not want to take strontium ranelate, but should consider including a natural form of strontium (e.g., strontium citrate) in your bone-building program, are discussed in our post on the truth about strontium.)
The COMB Micronutrient Combination
Each day, the participants of the COMB Study took vitamin D3 (2,000 IU), DHA (250 mg), K2 (in the form of MK-7,100 mcg), strontium citrate (680 mg), magnesium (25 mg), and dietary calcium. On top of that, they were advised to engage in daily weight-bearing exercise – that’s it! After the completion of the 12-month COMB Study, results revealed an increase of bone mineral density of more than 3% for a major proportion of participants. “This combined micronutrient supplementation regimen appears to be at least as effective as certain osteoporosis drugs or strontium ranelate in raising bone mineral density (BMD) levels in hip, spine, and femoral neck sites,” according to researcher Dr. Stephen Genius. In other words, you can maintain and restore your bone health the natural way with results that mirror or best prescription drugs. Not only did the results show an increase in bone mineral density, but there were no fractures in the group taking the micronutrient protocol, in the entire 12-month time period. If you have been on a bone drug in the past and did not receive the results you expected, this may work for you, too. “Micronutrient combination alone can improve BMD in many patients who failed to achieve success with medications.”
What’s the take home message?
The silver bullet approach (usually a prescription drug, but sometimes one or maybe two nutrients, typically calcium plus vitamin D) is likely to be ineffective. Or even in a “best case scenario,” will be nowhere near as effective at restoring the health of our disintegrating bones as a comprehensive approach that utilizes optimal doses of all the key nutrients our bones require along with regular weight-bearing exercise. Make sure to include all of the minerals, vitamins, and fats outlined in the section below and you’ll have strong, healthy bones for life—naturally.
Essential Nutrients for Healthy Bones
Each of the following nutrients plays a vital role in combating bone loss and building new bone. And ideally, you need to be consuming them all. Click on the name of a nutrient to find out why it’s important.
Major Minerals Required for Healthy Bones
Calcium is the most abundant mineral in the body and is definitely a “major” mineral within us. And for good reason. Without calcium, we couldn’t build (or maintain) our bones or teeth.
Almost 99% of the calcium in our bodies serves as the key structural component in our skeleton, where it’s also used as a calcium “bank account” from which withdrawals can be made to release calcium into our bloodstream should a drop in blood levels occur.
The National Health and Nutrition Examination Survey (NHANES), a program of studies designed to assess the health and nutritional status of adults and children in the United States, shows that Americans of all ages are not getting anywhere near enough calcium from the foods we eat.²³
And the two age groups most likely to be getting insufficient calcium from their diet are the two age groups who need calcium most:
- Children 9-18 years. This age group is supposed to be getting 1,300 milligrams/day, but is actually getting only 935 mg/day — or about 70% of what they need to produce their adult teeth and supply their growing bones.
- Women over age 40. Women aged 40-70+ are supposed to be getting 1,000 – 1,200 milligrams/day, but their average dietary intake is only 882 milligrams/day – just a little more than half the amount of calcium women are supposed to be getting to maintain a healthy skeleton, especially as we go through perimenopause and menopause. Average dietary calcium intake in women aged 60 and older is even lower: 842 milligrams/day.
Calcium supplementation to make up for these deficits is extremely important!
Did you know that as many as 80% of Americans are magnesium deficient? Deficiency of this mineral affects bone building, osteoblastic and osteoclastic activity, osteopenia, bone fragility, and alters calcium metabolism.
Calcium and magnesium work together in many cellular activities and need to be in balance for optimal function. Without magnesium, calcium may not be fully utilized and absorption problems may occur.
Ultimately, magnesium is needed for calcium absorption. Studies have shown that magnesium keeps calcium dissolved in the blood and without it, would leave deposits in the kidney, causing calcification of arteries and bone joints.²⁴
It’s also one of the most critical minerals for getting calcium to the bones — because it affects calcium metabolism and the hormones that regulate it. The ratio of calcium to magnesium that is recommended is 2:1, calcium: magnesium.
Trace Minerals Required for Healthy Bones
Boron is a trace mineral that boasts many bone health benefits such as:
- It helps you keep vitamin D around longer and use it more effectively to build bone.
- It prevents inflammation, greatly lowering levels of key inflammatory markers, including C-reactive protein (CRP). High levels of C-reactive protein significantly increase your risk for fracture!
- It’s been shown to reduce menopausal symptoms.
- It increases your ability to absorb and utilize magnesium, boosting all of magnesium’s beneficial effects.
- And it has no safety issues. The UL (upper limit) for boron is 20 milligrams per day and the good news is, you need nowhere near that.
In addition to these benefits, it also lessens the amount of urinary calcium excretion. Back in 1985, when the US Department of Agriculture conducted a study in which postmenopausal women took boron daily, the women’s daily loss of calcium in their urine dropped by 44%!²⁵
Yes, this study was conducted way back in 1985, but don’t let that fool you. The science is still relevant today as the study was extremely well done (gold standard) and still rings true.
Furthermore, boron was helpful in preventing calcium loss in women who were low in magnesium. And even in women with adequate levels of magnesium, boron further improved their calcium retention. What does this mean for your bones? It means that boron increases your ability to not only hold on to more calcium, but also increases magnesium absorption.
In turn, this reduces bone demineralization, which is a process that reduces the amount of mineral substances in your bone. So boron combats that, keeping more minerals where they belong – in your bones where they can reduce your fracture risk!
Copper is another very important trace mineral for your bones and overall health. In animal studies, copper deficiency results in reduced bone strength and deterioration of bone quality leading to osteoporotic lesions.²⁶
Similar results have been seen in research involving humans. A study performed on post-menopausal women found those with osteoporosis had significantly lower blood levels of copper compared to controls with healthy bones.²⁷
Other research has reported an important and common coincidence among periodontal disease, copper insufficiency, and osteoporosis in men as well as women.²⁸ For more on copper, check out our copper overview page.
Manganese is critical for bone because it’s required for the production of chondroitin sulfate, which plays a key role in the first steps in bone formation. And it’s the co-factor for an antioxidant enzyme called mitochondrial superoxide dismutase (MnSOD), which is so critical for life that animals bred to lack MnSOD die almost immediately.²⁹
Bone mineralization cannot start without manganese due to this trace mineral’s essential role in our production of chondroitin sulfate.³⁰ Chondroitin sulfate in partnership with the osteocalcin (vitamin K2-dependent bone-mineralizing enzyme) forms the extracellular matrix, which makes up connective tissues like tendons, ligaments, bone, skin and cartilage. Like glucosamine, chondroitin sulfate has also been used as a dietary supplement for osteoarthritis.³¹
In addition to giving cartilage its elastic properties, chondroitin sulfate is also thought to have an anti-inflammatory effect, which can help reduce pain and swelling associated with osteoarthritis.³²
In humans, manganese insufficiency promotes low bone mineral density and osteoporosis, and low MnSOD activity increases risk for osteoporosis – and cancer, diabetes, cardiovascular disease, and Alzheimer’s disease.
Research conducted in Belgium showed that women with osteoporosis were found to have significantly lower blood levels of manganese compared to healthy controls.³³ Those with osteoporosis also had lower trabecular bone volume and lower bone mineral density. (Trabecular bone is the interior, more metabolically active portion of our bones. If your bones were M&Ms, trabecular bone would be the soft chocolate center. Cortical bone, the hard exterior, would be the thin candy shell.)
Other research found that men fed a diet lacking in manganese became manganese deficient in just 39 days. And their blood levels of calcium increased significantly too, indicating that manganese deficiency hindered calcium deposition into bone and/or increased calcium withdrawal from their bones.
For more on manganese, check out our manganese overview page.
Selenium is a trace mineral essential for bone health for two reasons:
- Selenium plays a vital role in an array of antioxidant defenses that both lessen the production and activation of bone-resorbing osteoclasts, and increase the proliferation and activity of bone-building osteoblasts.³⁴
- Healthy thyroid hormone function is dependent upon selenium since this trace mineral is also the required co-factor for the deiodinase enzymes, which activate and deactivate our thyroid hormones.³⁵ Too little thyroid hormone activity (hypothyroidism) causes bone loss, but so does too much (hyperthyroidism).
For these reasons, an insufficient supply of selenium adversely changes bone metabolism, promoting bone loss.
A number of studies have now confirmed that blood levels of selenium are inversely related to the rate of bone turnover: low selenium results in increased bone resorption and loss of BMD, while adequate selenium correlates with lessened bone resorption and increased BMD.³⁶
One of the largest of these studies, The Osteoporosis and Ultrasound Study (OPUS), a 6-year prospective study of 2,374 healthy postmenopausal women from five European cities, confirmed that selenium status impacts bone turnover and bone mineral density (BMD), and is highly likely to affect fracture susceptibility.³⁷
In this large group of healthy European postmenopausal women, higher selenium levels were associated with higher hip BMD both at study entry and after the 6-year follow-up. Conversely, lower selenium levels were associated with higher bone turnover rates and lower BMD. Whether this translated into increased risk for fracture was not as clear – in part because even the women who were low in selenium were not fully deficient, and also because follow up was only for 6 years. The researchers concluded that the data collected clearly showed adequate selenium intake is required to maintain bone.
Strontium is a common mineral that is naturally found in your bones. It has a unique benefit as it provides dual activity in your bones. Strontium inhibits bone resorption while simultaneously stimulating bone building. No other drug or natural substance is known to provide this dual effect!
While there has been some controversy over strontium’s safety, it has all stemmed from the particular drug form of strontium, strontium ranelate, which has been shown to increase blood clot risk, cardiovascular events and more. (Strontium ranelate has never been approved in the U.S. and is now significantly restricted in Europe). The good news is, natural strontium in the form of strontium citrate, is safe and highly beneficial ─ and freely available.
Experts now believe strontium is, “an essential trace mineral necessary for the optimal normal development and accretion of peak bone mass, and the sustained health of our bones.”³⁸
Vanadium is categorized as an ultra-trace element because it’s found in such low concentrations in foods and biological tissues. In humans, the average body content of vanadium ranges from just 100 micrograms to 1 milligram.³⁹
Almost all the vanadium we consume via food or supplements is excreted, but the tiny amount that we keep has significant beneficial effects on our bones – impacts that are just now being confirmed in the current research.⁴⁰ But why is it important to your bones?
For several reasons actually:
- Promotes bone-building cells. Vanadium stimulates growth of unique stem cells that turn into osteoblasts ─ your bone-building cells! Vanadium also acts as a growth factor that produces more of these bone-building cells, too.
- Helps bones absorb minerals. Vanadium stimulates a special enzyme called bone alkaline phosphatase, which is crucial in drawing calcium and other minerals into bone.⁴¹
- Increases organic bone material. Vanadium increases type-1 collagen production. Type-1 collagen is an elastic protein making up the organic part of bone. It’s also the most common form of collagen in the body!
It should come as no surprise that not having enough zinc adversely affects health in numerous ways. Impairing physical growth (including that of our bones), and disrupting healthy bone remodeling, immune function, thyroid function, reproductive function, and brain-sensory functions (like taste and smell).
When zinc intake is inadequate, zinc is no longer available for its many important biological roles in bone. Zinc plays a critical role in collagen formation, promotes the proliferation of our bone-building cells, the osteoblasts, and is required for osteoblasts’ creation of the bone matrix and its calcification.⁴² In other words, we cannot effectively build bone without zinc.⁴³
Zinc’s role in bone is both structural because bone mineral is composed of hydroxyapatite crystals, which contain zinc, and formative because zinc is required for osteoblasts’ activity. Plus zinc promotes bone mineralization through its role as a cofactor for the bone-building enzyme, bone alkaline phosphatase.
Vitamins Required for Healthy Bones
Although our focus is the importance of vitamin D for your bones’ health, you’ll be happy to know that getting enough vitamin D3 is associated with lower risk of not just osteoporosis, but cancer, diabetes, obesity, cognitive decline, rheumatoid arthritis, and multiple sclerosis.
The three most important of vitamin D’s beneficial effects on your bones are that it:
- Enables active calcium absorption. Without adequate vitamin D, you will absorb only 10–15% of the calcium you consume, whether from your diet or from a calcium supplement. Why?
Calcium is absorbed both actively and passively in our intestines. Active absorption occurs in the first two sections of the small intestine, the duodenum and the jejunum, and accounts for almost all (85-90%) of all the calcium absorbed. Passive absorption takes place in the final portion of the small intestine, the ileum, but accounts for only a minor fraction of the calcium absorbed. Active absorption of calcium doesn’t happen without the help of vitamin D.
Vitamin D in its fully activated form of 1,25-D that attaches to vitamin D receptors in cells in the lining the small intestine.⁴⁴ 1,25-D binding stimulates these cells to produce and secrete special calcium-binding proteins, collectively called “calbindin,” which collect calcium and transport it across the intestinal lining into the bloodstream.
- Improves muscle strength and repair. The latest research is reporting numerous ways that muscle mass and bone mass are linked with vitamin D.⁴⁵ For instance, vitamin D increases the formation and development of new muscle cells and helps regulate how quickly our muscles heal and regenerate after injury.⁴⁶ Vitamin D deficiency causes loss of muscle along with bone, and is a key reason why sarcopenia (muscle wasting) is typically present along with osteoporosis.⁴⁷
- Lessens inflammation. Vitamin D can improve immune function and lessen inflammation by helping to prevent excessive activation of osteoclasts, the cells that break down bone.
- Enables active calcium absorption. Without adequate vitamin D, you will absorb only 10–15% of the calcium you consume, whether from your diet or from a calcium supplement. Why?
Vitamin K is not just a single nutrient, it comes in two different forms, vitamin K1 or phylloquinone, and vitamin K2 or menaquinone. Each plays a different, but key role in the health of our bones.
Vitamin K1: Vitamin K1 has very powerful anti-inflammatory actions. Too little vitamin K1 promotes inflammation, leading to excessive osteoclast activation and bone loss.⁴⁸ Vitamin K1’s most critical role is to help your blood clot. Without enough vitamin K1, you would bleed to death even from the tiniest of cuts.⁴⁹
For healthy bones, vitamin K1 intake should be at least 1,000 micrograms (1 milligram) per day.
A healthy diet that includes lots of leafy greens can easily provide 1,000 micrograms of vitamin K1 daily. Vitamin K1 is found in highest amounts in kale, spinach, Swiss chard, collards, parsley and broccoli, and is also present in oils derived from plants, especially unhydrogenated soybean and canola oils. (Oils in most processed foods have been partially hydrogenated and do not contain usable vitamin K1)
Vitamin K2: Vitamin K2 is not a single nutrient either, but a family of vitamins, the menaquinones (MKs). MK-4 and MK-7 are the best researched and the two types of K2 available in supplements.
Vitamin K2’s most critical roles is that it determines where calcium gets deposited in your body. When vitamin K2 is adequate, it directs calcium straight to your bones⁵⁰ and keep it out of soft issues like blood vessels⁵¹, kidneys⁵², breasts or brain ─ where you don’t want it to go!
Medical journal articles claiming that calcium, with or without vitamin D, increases risk for heart attack, does not prevent falls, or does not lessen risk of fracture are based on a lack of awareness of this fact of human physiology. In none of the studies in any of these articles is vitamin K2 included – or even considered.
Vitamin K2 is found in highest amounts in one food – a Japanese fermented soybean product called Natto. A few cheeses fermented by K2-producing bacteria provide tiny amounts of K2: English blue cheese, Swiss Emmental and Norwegian Jarlsberg.⁵³ But not enough for healthy bones. K2 is also present, but again in insignificant amounts, in liver, meat and egg yolks.⁵⁴
To meet your bones’ needs for vitamin K2, you need to take a supplement. Healthful absorption and use of calcium requires both vitamin D and vitamin K2. For more on vitamin K2 and its different forms MK4 and MK7, check out our vitamin K2 dedicated page.
Vitamin C is a water-soluble vitamin that must be obtained from our diets as human are unable to make it ourselves. Also known as ascorbic acid, this vitamin benefits your bones by lessening inflammation, restoring the antioxidant glutathione, and promoting collagen formation.
It has been extensively studied for its importance for bone health, particularly in men and women over the age of 60. The majority of studies have reported a significant beneficial effect of vitamin C on the risk of fracture and bone mineral density. Read more on vitamin C in our Ultimate Guide.
Vitamin E is a fat-soluble antioxidant that protects against free radical damage, which would otherwise excessively activate osteoclasts and cause bone loss.⁵⁵
Natural vitamin E (mixed tocopherols and tocotrienols) lowers inflammation by neutralizing free radicals.⁵⁶ Vitamin E has been linked to increased bone mineral density⁵⁷, lowered risk of sarcopenia, dementia, and osteoporosis.⁵⁸
The RDA (recommended dietary allowance) for vitamin E is currently set at 15 mg/day of α-tocopherol for adults (aged 19 and older). However, current evidence strongly suggests that the RDA is far too low to protect against the increasing free radical damage (and resulting increase in chronic inflammation⁵⁹, which promotes bone loss) typically seen with aging or to support healthy immune function, which is also typically compromised as we age.⁶⁰
A consensus about the exact daily intake of vitamin E for optimal health protection has not yet been reached. But the medical researchers publishing the most current papers on vitamin E believe that the scientific evidence is strong enough to recommend daily intakes of at least 150 IU of α-tocopherol per day.⁶¹
If you are taking a certain bone drug, your needs for vitamin E will be increased as these drugs greatly suppress levels of both ƴ-tocopherol and CoQ10.⁶² This adverse effect is thought to contribute to some of the side effects of the drug, including osteonecrosis of the jaw, musculoskeletal pain, and “atypical” fractures of long bones.
There are eight B vitamins and while they work as a team, each also plays its own role within your body.
Now, recent human research have shown that five B vitamins, B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folate) and B12 (cobalamin)⁶⁴ all play major roles in supporting the health of your bones, too.⁶³
Vitamin B2 – Riboflavin: Riboflavin is important for preventing free radical damage, contributing to growth, boosting energy levels and maintaining healthy blood cells.⁶⁵
Riboflavin is also required for the reactions through which iodine is recycled to produce more thyroid hormones.⁶⁶ A lack of adequate riboflavin increases risk of hypothyroidism⁶⁷, which promotes bone loss.⁶⁸
The current U.S. RDI is 1.3 mg/day for male adults and 1.1 mg/day for female adults.⁶⁹ The top food sources of riboflavin are dark leafy green vegetables like spinach and beet greens, asparagus, cremini mushrooms and almonds.
In addition, the biggest contributors of B2 in Western populations are fortified milk and dairy products. Food fortification is the process of adding micronutrients like vitamins and trace minerals to foods.
Vitamin B3 – Niacin: Niacin is required for the production of nitric oxide, which relaxes blood vessels, lowers blood pressure and improves blood flow and nutrient delivery to cells. Current research has confirmed that a healthy blood supply is crucial for healthy bones.
Bone receives up to 10% of cardiac output, which is the volume of blood being pumped by the heart.⁷⁰ The process of bone turnover and formation requires lots of nutrients and are delivered by the bloodstream.
The U.S. RDI for niacin is 16 mg/day for men and 14 mg/day for women.⁷¹ The top food sources of niacin are yellowfin tuna, pasture-raised chicken and turkey, and wild-caught Alaskan salmon.
Vitamin B6 – Pyridoxine: Vitamin B6 includes three pyridines: pyridoxine, pyridoxal and their 5′-phosphorylated derivatives.⁷² Pyridoxine is important for major functions such as memory, blood flow, and energy expenditure.
It also helps your body maintain a healthy nervous system and can create antibodies that your immune system uses to protect you! Once vitamin B6 is converted with the help of riboflavin into its active form, it increases your cells’ ability to absorb magnesium. In other words, your ability to absorb magnesium depends on both riboflavin and vitamin B6.
The current U.S. RDI is 1.7 mg/day for men and 1.5 mg/day for women over 50.⁷³ The top food sources of vitamin B6 include pasture-raised turkey, grass-fed beef, sweet potatoes, sunflower seeds, and bananas.
Vitamin B9 – Folate: Folate plays a crucial role in the process of DNA, RNA, proteins and phospholipids.⁷⁴
The U.S. RDI for folate is 400 mcg for both adult women and men.⁷⁵ The top food sources of folate include asparagus, artichokes, spinach, mustard greens, pinto beans, and free-range eggs.
This is the one B vitamins where deficiency is rare so the key takeaway is to eat folate-rich foods. And if you are taking a vitamin B complex (typically delivers all eight B vitamins) supplement, make sure it contains folate and not folic acid. Folic acid does not equal folate.
Vitamin B12 – Cobalamin: Cobalamin plays important roles in the processing of fats, proteins and carbohydrates in your body. It’s also needed for energy production.
Mild to moderate deficiency in vitamin B12 can be found in 20% of the elderly population and can lead to impaired cognition.⁶³ This can be attributed to poor absorption and gastrointestinal issues. Deficiency in vitamin B12 can also result in pernicious anemia – this is a condition that causes numbness of extremities, general weakness, and pallor (unhealthy pale appearance.) In fact, vitamin B12 was first revealed to be related to fractures and osteoporosis in patients with pernicious anemia.⁷⁶
The mechanisms on how vitamin B12 impacts your bones is still unclear, however, the link has been confirmed in research. The Framingham Osteoporosis Study looked at vitamin B12 levels and bone health indicators in 2,576 women and men from 30-87 years old.⁷⁷ Bone mineral density was measured by a DEXA at the hip and spine and plasma vitamin B12 was measured. Both men and women with lower concentrations of vitamin B12 had lower bone mineral density than those with vitamin B12 above the concentration cut-off. The differences were significant for women at the spine and for men at most hip sites.
Additional studies⁷⁸ support that vitamin B12 may preserve bone mineral density⁷⁹ and reduce fracture risk.⁸⁰ However, further research is needed to discover the specific mechanisms between vitamin B12, bone mineral density, and fracture risk.
The U.S. RDI is 2.4 mcg per day for adults 50 years or older.⁸¹ The top food sources of vitamin B12 are in animal sources and include sardines, wild-caught Alaskan salmon, shrimp, scallops, grass-fed lamb and beef, and yogurt.
Unfortunately, the RDI recommendations do not take into account that deficiencies of all B vitamins are frequently seen in the U.S. population overall and increase dramatically with age. There are also commonly used drugs that deplete B vitamins, further increasing needs.
For instance, proton pump inhibitors (PPIs) and drugs to treat peptic ulcers can interfere with vitamin B12 absorption. While anticonvulsants and oral contraceptives can deplete vitamin B6. They also negatively impact your bones. For more on, check out our top post on Common Prescription Drugs That Cause Bone Loss.
When all five B vitamins are present, they enable two essential metabolic processes (the folate and methylation cycles) to function properly. But they all must be present to work properly and support the health of your bones in the following ways:
- Support healthy thyroid function
- Support blood flow and the delivery of nutrients and oxygen to bone
- Improve magnesium absorption
- Increase production of glutathione (which is the body’s premier antioxidant)
- Contribute to energy production
- Prevent increases of highly inflammatory compounds that destroy bones
- Regenerate vitamin K
Fats Required for Healthy Bones
Omega 3 Fatty Acids
The omega-3 essential fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), defend your bones against osteoporosis by lowering inflammation through many different mechanisms.⁸² Chronic inflammation has been shown to be a major contributor to osteoporosis.⁸³
In addition to providing your bones with all the nutrients they require to rebuild, lowering inflammation is the most important action you can take to prevent or reverse osteoporosis. Why?
Lowering inflammation is essential to prevent osteoporosis because chronic low grade inflammation continuously activates osteoclasts, the specialized cells that break down bone.
EPA and DHA are found in highest amounts in animal foods such as anchovies, salmon, mackerel, and sardines. Can we get enough of the omega-3s, EPA and DHA, we need to maintain healthy muscles and bones from fish? While it’s possible, it’s not practical.
To ensure optimal intake of EPA and DHA, we still need to take a supplement. Here’s why…
The only good dietary sources of EPA and DHA are wild caught cold water fatty fish, such as sardines, salmon, sablefish, halibut and tuna. It’s important to specify that the fish be “wild caught” because the amount of EPA and DHA in fish is highly dependent on the fish or animal’s diet. Wild fish eat algae, sea plants, and other smaller fish that are rich in omega-3s, so they produce and store EPA and DHA in their tissue.
Authorities recommend optimal health benefits provided by omega-3s are associated with intakes of from 2-4 grams of EPA and DHA per day. You’d need to consume at least two 3-ounce portions of the fish that are low in mercury every day to safely provide enough EPA and DHA to beneficially impact the health of your bones. That’s a lot of fish! So again, to ensure you’re getting optimal amounts of EPA/DHA you need to supplement with a high-quality fish oil.
One thing to note is that this recommendation does not consider omega 6 fatty acids (omega 6s). To talk about omega 3s without talking about omega 6s is irresponsible. Why?
Because balance is key. While optimal amounts of omega 3s are important, you have to take your omega 6 fatty acid intake into consideration, too. Without doing so, you’d be doing a disservice to your health. Why?
Omega 6 fatty acids are pro inflammatory, while omega 3 fatty acids are anti inflammatory. Authorities say that the optimal omega 6 to omega 3 ratio is 2:1. However, the ratio found today in Western diets is closer to 16:1!⁸⁴
So making sure you’re balancing these two types of omega fatty acids is crucial to your bones and overall health. For more, check out our post on The Modern Omega 6 to Omega 3 Ratio and How To Fix It.
According to the International Olive Oil Council, virgin olive oil is defined as follows: extra virgin olive oil (EVOO), virgin olive oil, and ordinary virgin olive oil.
Virgin olive oil is one of the main sources of dietary fat in the Mediterranean diet. The Mediterranean diet is a well-known diet for the prevention of chronic diseases. It has been shown to be beneficial for blood pressure, all cause and cardiovascular mortality⁸⁵, lipid metabolism⁸⁶ and weight loss and has also been associated with a reduced risk of Parkinson’s disease, Alzheimer’s disease and cancer.
The key aspects of a Mediterranean diet are as follows:
- Eating primarily plant-based with vegetables, fruits, whole grains, legumes and nuts being the focus
- Limiting red meat intake to fewer than a few times per month
- Eating fish and poultry at least 2x per week
- Using olive oil and canola oil in place of butter
- Using spices and herbs to flavor foods in place of salt
- Eating with family and friends
- Participating in regular exercise
- Drinking red wine in moderation (optional)
Research over the last decade has also strengthened the case of a Mediterranean diet for osteoporosis. The Women’s Health Initiative (WHI) observational study, which has been published in the Journal of the American Medical Association (JAMA) is one of the largest studies to date spanning more than 15 years and 93,676 women from 50 to 79 years old.⁸⁷ It found that those a higher adherence to a Mediterranean diet is associated with a lower risk for hip fractures. However, no significant difference in bone loss and changes in lead body mass were found.
The Mediterranean diet contains a variety of foods, including olive oil, with antioxidant and anti-inflammatory properties that may protect bones.⁸⁸ While further research is needed for its impact on bone health specifically, there is strong evidence that it benefits chronic diseases.
Olives, olive oil, and olive polyphenols have been highlighted as protective for bone health specifically.⁸⁹ Olives and its products’ bone-building effects have been attributed to their ability to inhibit bone resorption (bone break down) and increase bone formation, by suppressing inflammation and oxidative stress. When it comes to olive oil, more studies have been done, especially in humans.
Black olives, particularly Lucques olives produced in southern France, seem to have a higher levels of polyphenols (compounds in plants packed with antioxidants) than green olives.
One study compared the osteoporosis-preventing effects of these black Lucques olives and green olives in a 6-month rat study.⁹³ It found that black Lucque olives significantly prevented the decrease in bone density in the inflamed rat group, but this was not seen with green olives. In other words, black Lucque olives were far superior in osteoporosis-preventing effects compared to green olives, which could be attributed to the higher polyphenol levels.
One potential issue with olives, especially those that are well cured, is the salt content. So while olives may osteoporosis-preventing effects, limiting your salty olive intake in favor of the oil itself may be better way to go.
Olive polyphenols can be found in various parts of the plants like the leaves, the fruits, and in the water that is used during olive oil production (also called olive mill waste).
For instance, olive mill waste is a byproduct of olive oil production. It also contains high levels of polyphenols.
One study looked at whether or not the main phenolic compounds in olive oil: tyrosol and hydroxytyrosol could improve bone loss in rats.⁹⁴ They found that these two phenolic compounds prevented osteopenia by increasing bone formation. This is most likely due to their antioxidant properties.
Research on olive oil and bone health in human trials could be improved by conducting longer treatment periods and larger sample sizes. While the bone protective effects of olive, olive oil, and olive products have the ability to increase bone formation, inhibit bone resorption more research is needed to discover the exact pathways they do so.
The All-in-One Bone Building Package
In the space of 70 years, our diets have gone from nutrient-dense to nutrient-depleted. It’s been caused by a variety of reasons:
- The Standard American Diet- appropriately acronymed SAD – and our nutrient-stripped crops – All fruits and vegetables, beans and legumes, and nuts and seeds used to be organically grown. All meat and dairy products were derived from pastured animals, all chickens were free-range, and all fish were “wild-caught.” In comparison, the average consumer today eats feedlot meats, nutrient-stripped refined grains, and lots of added sugars and chemicals. And SAD contains next to no nutrient-dense foods.
Modern farming and agricultural practices – Farming techniques that focus on high crop yields are destructive to the topsoil. As a result, the soil is less capable of holding moisture, and therefore minerals too. A 2006 whitepaper from the Nutrition Security Institute claimed that our food system is rapidly losing its ability to produce food with nutrient levels adequate to maintain our health.
Here’s the reality. The produce our parents and grandparents ate had significantly more vitamins and minerals than today’s food supplies. A study in the Journal of the American College of Nutrition compared the nutritional data of 43 fruits and vegetables from both 1950 and 1996.⁹⁵ The study found that the crops suffered “statistically reliable declines” in protein, calcium, phosphorus, iron, riboflavin, and vitamin C within that time frame. So even if you are one of the few eating well to support overall and bone health – it still may not be enough. The need for supplementation is ever increasing. Taking supplements is the easiest way to ensure your body is getting enough of the vitamins and minerals that it needs to promote bone health. And as we’ve discussed, it’s not all about calcium. Bone building and maintenance rely on many other minerals and vitamins too: magnesium, boron, copper, manganese, silicon, nickel, selenium, strontium, phosphorus, potassium, vanadium, zinc and vitamins C, D3, and K2. Plus omega 3 fatty acids like EPA and DHA. Now, you might be thinking that that’s a lot of supplements to be taking every day. But what if you could get all of those bone supporting elements in one convenient package?
Well, you can. With our AlgaeCal products:
- Sahni, S., Mangano, K. M., McLean, R. R., Hannan, M. T., & Kiel, D. P. (2015). Dietary Approaches for Bone Health: Lessons from the Framingham Osteoporosis Study. Current osteoporosis reports, 13(4), 245–255. doi:10.1007/s11914-015-0272-1
- Domazetovic, V., Marcucci, G., Iantomasi, T., Brandi, M. L., & Vincenzini, M. T. (2017). Oxidative stress in bone remodeling: role of antioxidants. Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 14(2), 209–216. doi:10.11138/ccmbm/2017.14.1.209
- Farina, E.K.; Kiel, D.P.; Roubenoff, R.; Schaefer, E.J.; Cupples, L.A.; Tucker, K.L. Protective effects of fish intake and interactive effects of long-chain polyunsaturated fatty acid intakes on hip bone mineral density in older adults: The Framingham Osteoporosis Study. Am. J. Clin. Nutr. 2011, 93, 1142–1151. doi:10.3945/ajcn.110.005926
- SanGiovanni, J.P.; Chew, E.Y. The role of omega-3 long-chain polyunsaturated fatty acids in health and disease of the retina. Progr. Retin. Eye Res. 2005, 24, 87–138. doi: 10.1016/j.preteyeres.2004.06.002
- Peter, S., Chopra, S., & Jacob, J. J. (2013). A fish a day, keeps the cardiologist away! - A review of the effect of omega-3 fatty acids in the cardiovascular system. Indian journal of endocrinology and metabolism, 17(3), 422–429. doi:10.4103/2230-8210.111630
- Mozaffari-Khosravi, H., Yassini-Ardakani, M., Karamati, M. & Shariati-Bafghi, S. E. Eicosapentaenoic acid versus docosahexaenoic acid in mild-to-moderate depression: a randomized, double-blind, placebo-controlled trial. Eur. Neuropsychopharmacol. 23, 636–644 (2013). doi:10.1016/j.euroneuro.2012.08.003
- Mangano KM, Sahni S, Kerstetter JE, Kenny AM, Hannan MT. Polyunsaturated fatty acids and their relation with bone and muscle health in adults. Curr Osteoporos Rep. 2013;11:203–12. doi:10.1007/s11914-013-0149-0
- Chen YM, Ho SC, Lam SS. Higher sea fish intake is associated with greater bone mass and lower osteoporosis risk in postmenopausal Chinese women. Osteoporos Int. 2010;21(6):939–946. doi:10.1007/s00198-009-1029-4
- Teegarden D, Lyle RM, Proulx WR, et al. Previous milk consumption is associated with greater bone density in young women. Am J Clin Nutr. 1999;69:1014–1017. doi:10.1093/ajcn/69.5.1014
- Kalkwarf HJ, Khoury JC, Lanphear BP. Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J Clin Nutr 2003;77(1):257–65. doi:10.1093/ajcn/77.1.257
- René Rizzoli, Dairy products, yogurts, and bone health, The American Journal of Clinical Nutrition, Volume 99, Issue 5, May 2014, Pages 1256S–1262S. doi:10.3945/ajcn.113.073056
- Robert P Heaney, Donald K Layman, Amount and type of protein influences bone health, The American Journal of Clinical Nutrition, Volume 87, Issue 5, May 2008, Pages 1567S–1570S. doi:10.1093/ajcn/87.5.1567S
- Kerstetter, J.E.; Kenny, A.M.; Insogna, K.L. Dietary protein and skeletal health: A review of recent human research. Curr. Opin. Lipidol. 2011, 22, 16–20. doi:10.1097/MOL.0b013e3283419441
- Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE study group. J Am Med Dir Assoc 2013; 14: 542–559. doi:10.1016/j.jamda.2013.05.021
- Jugdaohsingh, R., K. L Tucker, N. Qiao, L. A. Cupples, D. P. Kiel, J. J. Powell, Dietary silicon intake is positively associated with bone mineral density in men and premenopausal women of the Framingham Offspring Cohort. Journal of Bone and Mineral Research, 2004, 19, 297–307. doi:10.1359/JBMR.0301225.
- Casey TR, Bamforth CW (2010) Silicon in beer and brewing. J Sci Food Agric 90(5):784–788. doi:10.1002/jsfa.3884
- Wiley-Blackwell. (2010, February 9). Beer is a rich source of silicon and may help prevent osteoporosis. ScienceDaily. Retrieved August 30, 2019 from www.sciencedaily.com/releases/2010/02/100208091922.htm
- Tucker KL, Jugdaohsingh R, Powell JJ, Qiao N, Hannan MT, Sripanyakorn S, Cupples LA, Kiel DP. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. Am J Clin Nutr 2009;89:1188–96.
- Berman AY, Motechin RA, Wiesenfeld MY, Holz MK. The therapeutic potential of resveratrol: a review of clinical trials. NPJ Precis Oncol. 2017;1(1):35. doi:10.1038/s41698-017-0038-6
- Sahni, S., Mangano, K. M., McLean, R. R., Hannan, M. T., & Kiel, D. P. (2015). Dietary Approaches for Bone Health: Lessons from the Framingham Osteoporosis Study. Current osteoporosis reports, 13(4), 245–255. doi:10.1007/s11914-015-0272-1
- Stephen J. Genuis and Thomas P. Bouchard, “Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention,” Journal of Environmental and Public Health, vol. 2012, Article ID 354151, 10 pages, 2012. doi:10.1155/2012/354151
- Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008;83:1032–1045. doi:10.4065/83.9.1032
- Hoy MK, Goldman JD. Calcium intake of the U.S. population: What We Eat in America, NHANES 2009- 2010. Food Surveys Research Group Dietary Data Brief No. 13. September 2014.
- King, D.E.; Mainous, A.G.; Geesey, M.E.; Woolson, R.F. Dietary Magnesium and C-reactive Protein Levels. J. Am. Coll. Nutr. 2005, 24, 166–171.
- Pizzorno L. (2015). Nothing Boring About Boron. Integrative medicine (Encinitas, Calif.), 14(4), 35–48.
- Medeiros, D. M., Ilich, J., Ireton, J., Matkovic, V., Shiry, L. and Wildman, R. 1997. Femurs from rats fed diets deficient in copper or iron have decreased mechanical strength and altered mineral composition. ─ J. Trace Elem. Exp. Med. 10: 197-203. doi:10.1002/(SICI)1520-670X(1997)10:3<197::AID-JTRA7>3.0.CO;2-8
- Mahdavi-Roshan, M., Ebrahimi, M., & Ebrahimi, A. (2015). Copper, magnesium, zinc and calcium status in osteopenic and osteoporotic post-menopausal women. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 12(1), 18–21. doi:10.11138/ccmbm/2015.12.1.018
- Sierpinska T, Konstantynowicz J, Orywal K, Golebiewska M, Szmitkowski M (2014) Copper deficit as a potential pathogenic factor of reduced bone mineral density and severe tooth wear. Osteoporos Int 25:447–454. doi:10.1007/s00198-013-2410-x
- Bresciani G, da Cruz IBM, González-Gallego J. Manganese superoxide dismutase and oxidative stress modulation. Adv Clin Chem. 68: Elsevier; 2015. p.87-130. doi:10.1016/bs.acc.2014.11.001
- Samsel A, Seneff S (2015) Glyphosate, pathways to modern diseases III: Manganese, neurological diseases, and associated pathologies. Surg Neurol Int 6: 45. doi:10.4103/2152-7806.153876
- Henrotin, Y., Mathy, M., Sanchez, C., & Lambert, C. (2010). Chondroitin sulfate in the treatment of osteoarthritis: from in vitro studies to clinical recommendations. Therapeutic advances in musculoskeletal disease, 2(6), 335–348. doi:10.1177/1759720X10383076
- Questions and Answers: NIH Glucosamine/Chondroitin Arthritis Intervention Trial Primary Study. Retrieved from https://nccih.nih.gov/research/results/gait/qa.htm?nav=gsa
- P.D. Saltman, L.G. Strause, The role of trace minerals in osteoporosis, J. Am. Coll. Nutr. 12 (1993) 384–389. PMID: 8409100
- Zeng, H., Cao, J. J., & Combs, G. F., Jr (2013). Selenium in bone health: roles in antioxidant protection and cell proliferation. Nutrients, 5(1), 97–110. doi:10.3390/nu5010097
- Beukhof, C. M., Medici, M., van den Beld, A. W., Hollenbach, B., Hoeg, A., Visser, W. E., ... Peeters, R. P. (2016). Selenium status is positively associated with bone mineral density in healthy aging European men. PLoS ONE, 11, e0152748. doi:10.1371/journal.pone. 0152748
- Jakob, F.; Becker, K.; Paar, E.; Ebert-Duemig, R.; Schütze, N. Expression and regulation of thioredoxin reductases and other selenoproteins in bone. Methods Enzymol. 2002, 347, 168–179. doi:10.1016/s0076-6879(02)47015-2
- Hoeg A, Gogakos A, Murphy E, Mueller S, Köhrle J, Reid DM, Glüer CC, Felsenberg D, Roux C, Eastell R, et al. Bone turnover and bone mineral density are independently related to selenium status in healthy euthyroid postmenopausal women. J Clin Endocrinol Metab. 2012;97:4061-4070. doi:10.1210/jc.2012-2121
- Genuis SJ and Schwalfenberg GK. Picking a bone with contemporary osteoporosis management: nutrient strategies to enhance skeletal integrity. Clin Nutr 2007; 26: 193–207. doi:10.1016/j.clnu.2006.08.004
- Rehder D (2013) Vanadium. Its role for humans. Met Ions Life Sci 13:139–169. doi:10.1007/978-94-007-7500-8_5
- Dermience, M.; Lognay, G.; Mathieu, F.; Goyens, P. Effects of thirty elements on bone metabolism. J. Trace Elem. Med. Biol. 2015, 32, 86–106. doi:10.1016/j.jtemb.2015.06.005
- Sharma U, Pal D, Prasad R. Alkaline phosphatase: an overview. Indian J Clin Biochem. 2014;29:269–78. doi:10.1007/s12291-013-0408-y
- King, J. C., Brown, K. H., Gibson, R. S., Krebs, N. F., Lowe, N. M., Siekmann, J. H., & Raiten, D. J. (2016). Biomarkers of Nutrition for Development (BOND)-Zinc Review. The Journal of nutrition, 146(4), 858S–885S. Advance online publication. doi:10.3945/jn.115.220079
- Lowe, N.M.; Lowe, N.M.; Fraser, W.D.; Jackson, M.J. Is there a potential therapeutic value of copper and zinc for osteoporosis? Proc. Nutr. Soc. 2002, 61, 181–185. doi:10.1079/PNS2002154
- Gunton JE, Girgis CM, Baldock PA, et al. Bone muscle interactions and vitamin D. Bone 2015; 80: 89–94. doi:10.1016/j.bone.2015.02.029
- Girgis CM, Baldock PA, Downes M. Vitamin D, muscle and bone: Integrating effects in development, aging and injury. Mol Cell Endocrinol. 2015; 410:3–10. doi:10.1016/j.mce.2015.03.020
- Stratos, I.; Li, Z.; Herlyn, P.; Rotter, R.; Behrendt, A.-K.; Mittlmeier, T.; Vollmar, B. Vitamin D Increases Cellular Turnover and Functionally Restores the Skeletal Muscle after Crush Injury in Rats. Am. J. Pathol. 2013, 182, 895–904. doi:10.1016/j.ajpath.2012.11.006
- Tagliaferri C, Wittrant Y, Davicco MJ, et al. Muscle and bone, two interconnected tissues. Ageing Res Rev 2015; 21: 55–70. doi:10.1016/j.arr.2015.03.002
- Shea, M. K., Dallal, G. E., Dawson-Hughes, B., Ordovas, J. M., O'Donnell, C. J., Gundberg, C. M., … Booth, S. L. (2008). Vitamin K, circulating cytokines, and bone mineral density in older men and women. The American journal of clinical nutrition, 88(2), 356–363. doi:10.1093/ajcn/88.2.356
- McCann, J.C.; Ames, B.N. Vitamin k, an example of triage theory: Is micronutrient inadequacy linked to diseases of aging? Am. J. Clin. Nutr. 2009, 90, 889–907. doi:10.3945/ajcn.2009.27930
- Scheiber, D.; Veulemans, V.; Horn, P.; Chatrou, M.L.; Potthoff, S.A.; Kelm, M.; Schurgers, L.J.; Westenfeld, R. High-dose menaquinone-7 supplementation reduces cardiovascular calcification in a murine model of extraosseous calcification. Nutrients 2015, 7, 6991–7011. doi:10.3390/nu7085318
- Vossen, L.M.; Schurgers, L.J.; van Varik, B.J.; Kietselaer, B.L.; Vermeer, C.; Meeder, J.G.; Rahel, B.M.; van Cauteren, Y.J.; Hoffland, G.A.; Rennenberg, R.J.; et al. Menaquinone-7 supplementation to reduce vascular calcification in patients with coronary artery disease: Rationale and study protocol (VitaK-CAC Trial). Nutrition 2015, 7, 8905–8915. doi:10.3390/nu7115443
- Holden, R. M., Booth, S. L., Day, A. G., Clase, C. M., Zimmerman, D., Moist, L., … Heyland, D. K. (2015). Inhibiting the progression of arterial calcification with vitamin K in HemoDialysis patients (iPACK-HD) trial: rationale and study design for a randomized trial of vitamin K in patients with end stage kidney disease. Canadian journal of kidney health and disease, 2, 17. doi:10.1186/s40697-015-0053-x
- Manoury E, Jourdon K, Boyaval P, Fourcassié P. Quantitative measurement of vitamin K2 (menaquinones) in various fermented dairy products using a reliable high-performance liquid chromatography method. J Dairy Sci. 2013;96:1335–46. doi:10.3168/jds.2012-5494
- Elder, S.J.; Haytowitz, D.B.; Howe, J.; Peterson, J.W.; Booth, S.L. Vitamin K Contents of Meat, Dairy, and Fast Food in the U.S. Diet. J. Agric. Food Chem. 2006, 54, 463–467. doi:10.1021/jf052400h
- Pekmezci, D. Vitamin E and immunity. Vitam. Horm. 2011, 86, 179–215. doi:10.1016/B978-0-12-386960-9.00008-3
- Q. Jiang, “Natural forms of vitamin E: metabolism, antioxidant, and anti-infammatory activities and their role in disease prevention and therapy,” Free Radical Biology & Medicine, vol. 72, pp. 76–90, 2014. doi:10.1016/j.freeradbiomed.2014.03.035
- Shi, W. Q., Liu, J., Cao, Y., Zhu, Y. Y., Guan, K., and Chen, Y. M. (2016). Association of dietary and serum vitamin E with bone mineral density in middle-aged and elderly Chinese adults: a cross-sectional study. Br. J. Nutr. 115, 113–120. doi:10.1017/S0007114515004134
- J. M. Mata-Granados, R. Cuenca-Acebedo, M. D. Luque De Castro, and J. M. Quesada Gomez, “Lower vitamin e serum levels are associated with osteoporosis in early postmenopausal women: a cross-sectional study,” Journal of Bone and Mineral Metabolism, vol. 31, no. 4, pp. 455–460, 2013. doi:10.1007/s00774-013-0432-2
- Calder, P.C.; Albers, R.; Antoine, J.-M.; Blum, S.; Ferns, G.A.; Folkerts, G.; Bourdet-Sicard, R.; Friedmann, P.S.; Frost, G.S.; Guarner, F.; et al. Inflammatory disease processes and interactions with nutrition. Br. J. Nutr. 2009, 101, S2–S14. doi:10.1017/S0007114509377867
- Serafini M. Dietary vitamin E and T cell-mediated function in the elderly: effectiveness and mechanism of action. Int J Dev Neurosci 2000;18:401–10.
- Weber P, Bendich A, Machlin LJ. Vitamin E and human health: rationale for determining recommended intake levels. Nutrition 1997; 13:450–60.
- S. Kalyan, P. Huebbe, T. Esatbeyoglu et al., “Nitrogenbisphosphonate therapy is linked to compromised coenzyme Q10 and vitamin E status in postmenopausal women,” Journal of Clinical Endocrinology & Metabolism, vol. 99, no. 4, pp. 1307–1313, 2014. doi:10.1210/jc.2013-3648
- Dai, Z., & Koh, W. P. (2015). B-vitamins and bone health--a review of the current evidence. Nutrients, 7(5), 3322–3346. doi:10.3390/nu7053322
- Rosalie A. M. Dhonukshe-Rutten, Martine Lips, Nynke de Jong, Marijke J. M. Chin A Paw, Gerrit J. Hiddink, Marijke van Dusseldorp, Lisette C. P. G. M. de Groot, Wija A. van Staveren, Vitamin B-12 Status Is Associated with Bone Mineral Content and Bone Mineral Density in Frail Elderly Women but Not in Men, The Journal of Nutrition, Volume 133, Issue 3, March 2003, Pages 801–807. doi:10.1093/jn/133.3.801
- B. J. Henriques, R. K. Olsen, P. Bross and C. M. Gomes, Emerging roles for riboflavin in functional rescue of mitochondrial ß-oxidation flavoenzymes, Curr. Med. Chem., 2010, 17, 3842–3854. doi:10.2174/092986710793205462
- Lienhart, W. D., Gudipati, V., & Macheroux, P. (2013). The human flavoproteome. Archives of biochemistry and biophysics, 535(2), 150–162. doi:10.1016/j.abb.2013.02.015
- Gietka-Czernel M. (2017). The thyroid gland in postmenopausal women: physiology and diseases. Przeglad menopauzalny = Menopause review, 16(2), 33–37. doi:10.5114/pm.2017.68588
- Williams, G. R., & Bassett, J. (2018). Thyroid diseases and bone health. Journal of endocrinological investigation, 41(1), 99–109. doi:10.1007/s40618-017-0753-4
- (n.d.). Office of Dietary Supplements - Riboflavin. Retrieved from https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/
- Marenzana M, Arnett TR (2013) The key role of the blood supply to bone. Bone Res 1:203–215. doi:10.4248/ BR201303001
- (n.d.). Office of Dietary Supplements - Niacin. Retrieved from https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/
- (n.d.). Office of Dietary Supplements - Vitamin B6. Retrieved from https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/
- Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academies Press; 1998.
- Fenech, M. Folate (vitamin B9) and vitamin B12 and their function in the maintenance of nuclear and mitochondrial genome integrity. Mutat. Res. 2012, 733, 21–33. doi:10.1016/j.mrfmmm.2011.11.003
- (n.d.). Office of Dietary Supplements - Folate. Retrieved from https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
- Goerss JB, Kim CH, Atkinson EJ, Eastell R, O'Fallon WM, Melton LJ. Risk of fractures in patients with pernicious anemia. J Bone Miner Res. 1992;7:573–9. doi:10.1002/jbmr.5650070514
- Tucker KL, Hannan MT, Qiao N, et al. Low plasma vitamin B12 is associated with lower BMD: the Framingham Osteoporosis Study. J Bone Miner Res 2005;20:152–8. doi:10.1359/JBMR.041018
- Dhonukshe-Rutten, R.A.M.; Lips, M.; de Jong, N.; Chin, A.; Paw, M.J.M.; Hiddink, G.J.; van Dusseldorp, M.; De Groot, L.C.P.G.M.; van Staveren, W.A. Vitamin B-12 status is associated with bone mineral content and bone mineral density in frail elderly women but not in men. J. Nutr. 2003, 133, 801–807. doi:10.1093/jn/133.3.801
- Stone KL, Bauer DC, Sellmeyer D, et al. Low serum vitamin B-12 levels are associated with increased hip bone loss in older women: a prospective study. J Clin Endocrinol Metab 2004;89:1217-21. doi:10.1210/jc.2003-030074
- McLean RR, Jacques PF, Selhub J, et al. Plasma B vitamins, homocysteine, and their relation with bone loss and hip fracture in elderly men and women. J Clin Endocrinol Metab 2008;93:2206–12. doi:10.1210/jc.2007-2710
- (n.d.). Office of Dietary Supplements - Vitamin B12. Retrieved from https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
- Orchard, T. S., Pan, X., Cheek, F., Ing, S. W., & Jackson, R. D. (2012). A systematic review of omega-3 fatty acids and osteoporosis. The British journal of nutrition, 107 Suppl 2(0 2), S253–S260. doi:10.1017/S0007114512001638
- T. Montalcini, S. Romeo, Y. Ferro, V. Migliaccio, C. Gazzaruso, and A. Pujia, “Osteoporosis in chronic inflammatory disease: the role of malnutrition,” Endocrine Journal, vol. 43, no. 1, pp. 59–64, 2013. doi:10.1007/s12020-012-9813-x
- Simopoulos AP. Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomed Pharmacother. 2006 Nov; 60(9):502–7. doi:10.1016/j.biopha.2006.07.080
- Limongi, F.; Noale, M.; Gesmundo, A.; Crepaldi, G.; Maggi, S. Adherence to the Mediterranean Diet and all-cause mortality risk in an elderly Italian population: Data from the ILSA study. J. Nutr. Health Aging 2017, 21, 505–513. doi:10.1007/s12603-016-0808-9
- Mitjavila, M.T.; Fandos, M.; Salas-Salvadó, J.; Covas, M.I.; Borrego, S.; Estruch, R.; Lamuela-Raventós, R.; Corella, D.; Martínez-Gonzalez, M.Á.; Sánchez, J.M.; et al. The Mediterranean diet improves the systemic lipid and DNA oxidative damage in metabolic syndrome individuals. A randomized, controlled, trial. Clin. Nutr. 2013, 32, 172–178. doi:10.1016/j.clnu.2012.08.002
- Haring B, Crandall CJ, Wu C, et al. Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women’s Health Initiative. JAMA Intern Med. 2016;176(5):645–652. doi:10.1001/jamainternmed.2016.0482
- Puel, C.; Coxam, V.; Davicco, M.-J. Mediterranean diet and osteoporosis prevention. Med. Sci. 2007, 23, 756– 760. doi:10.1051/medsci/20072389756
- Chin, K. Y., & Ima-Nirwana, S. (2016). Olives and Bone: A Green Osteoporosis Prevention Option. International journal of environmental research and public health, 13(8), 755. doi:10.3390/ijerph13080755
- Fernández-Real, J. M. et al. A Mediterranean diet enriched with olive oil is associated with higher serum total osteocalcin levels in elderly men at high cardiovascular risk. J. Clin. Endocrinol. Metab. 97, 3792–3798 (2012). doi:10.1210/jc.2012-2221
- Liu, H.; Huang, H.; Li, B.; Wu, D.; Wang, F.; Zheng, X.H.; Chen, Q.; Wu, B.; Fan, X. Olive Oil in the Prevention and Treatment of Osteoporosis After Artificial Menopause. Clin. Interv. Aging. 2014, 9, 2087–2095. doi:10.2147/CIA.S72006
- L. Mazzanti, M. Battino, L. Nanetti et al., “Effect of 1-year dietary supplementation with vitaminized olive oil on markers of bone turnover and oxidative stress in healthy post-menopausal women,” Endocrine, vol. 50, pp. 326–334, 2015. doi:10.1007/s12020-015-0529-6
- Puel, C.; Mardon, J.; Kati-Coulibaly, S.; Davicco, M.J.; Lebecque, P.; Obled, C.; Rock, E.; Horcajada, M.N.; Agalias, A.; Skaltsounis, L.A.; et al. Black lucques olives prevented bone loss caused by ovariectomy and talc granulomatosis in rats. Br. J. Nutr. 2007, 97, 1012–1020. doi:10.1017/S0007114507659030
- Puel, C.; Mardon, J.; Agalias, A.; Davicco, M.-J.; Lebecque, P.; Mazur, A.; Horcajada, M.-N.; Skaltsounis, A.-L.; Coxam, V. Major phenolic compounds in olive oil modulate bone loss in an ovariectomy/inflammation experimental model. J. Agric. Food Chem. 2008, 56, 9417–9422. doi:10.1021/jf801794q
- Davis DR, Epp MD, Riordan HD, Davis DR. Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999. J Am Coll Nutr. 2004; 23: 669–682. doi:10.1080/07315724.2004.10719409
- Kaats GR, Preuss HG, Stohs S, Perricone N, et al. (2016) A 7-year longitudinal trial of the safety and efficacy of a vitamin/mineral enhanced plant-sourced calcium supplement. Nutr J 2, 91. doi: 10.1080/07315724.2015.1090357
- Takada Y, Bhardwaj A, Potdar P, Aggarwal BB. Nonsteroidal anti-inflammatory agents differ in their ability to suppress NF-kappaB activation, inhibition of expression of cyclooxygenase-2 and cyclin D1, and abrogation of tumor cell proliferation. Oncogene. 2004;23(57):9247–9258. doi:10.1038/sj.onc.1208169