20 Key Bone Nutrients | Folic Acid

by Dr. Susan E. Brown, PhD

Depending on how we count them, there are at least 20 bone‐building nutrients that are essential for optimal bone health — “essential” in that our bodies cannot manufacture them on their own, so we must get them from our food and drink. Let’s take a quick look at them, one by one, so you can get a better idea of their role in bone health and how much you should be getting. Remember, none of these nutrients do their work in isolation — you need some of each and every one, so they can all work together to keep your bones standing strong all your life long. Taking a top‐grade multivitamin–mineral complex and essential fatty acids will ensure that your cells have adequate levels of these nutrients ready at hand from minute to minute, day after day, to prevent bone loss leading to osteoporosis, other degenerative diseases, and accelerated aging. (Click through on individual nutrients to learn more…)

TABLE OF 20 ESSENTIAL BONE‐BUILDING NUTRIENTS

Nutrient

Adult RDA or AI Common therapeutic range for bone health (daily intake) 800–1200 mg 800–1200 mg Dietary considerations concerning adequacy of average daily intake Your intake

Key minerals Calcium (Ca) Phosphorus (P)

1000–1300 mg 1250 mg 9–18 yrs 700 mg adults Typical diet is inadequate, averaging 500– 850 mg.1 Inadequate intake is rare except in elderly and malnourished. Excess intake common with use of processed foods and soft drinks — ~ 1500 mg/day in men and ~1025 mg/day in women.

US DHHS. 2004. Bone health and osteoporosis: A report of the Surgeon General. Chapter 1: A public health approach to promote bone health. URL: http://www.surgeongeneral.gov/library/bonehealth/chapter_1.html (accessed 05.28.2008). Wright, J., et al. 2003. Dietary intakes of ten key nutrients for public health, United States: 1999–2000. Adv. Data, (334), 1–4. URL (PDF): http://www.cdc.gov/nchs/data/ad/ad334.pdf (accessed 05.28.2008). Morgan, K., et al. 1985. Magnesium and calcium dietary intakes of the US population. J. Am. Coll. Nutr., 4 (2), 195–206. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/4019942 (accessed 05.28.2008).

Susan E. Brown, PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse, NY 13057 www.betterbones.com

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20 Key bone‐building nutrients — an overview

Nutrient

Adult RDA or AI Common therapeutic range for bone health (daily intake) 200–1000 mcg Dietary considerations concerning adequacy of average daily intake Common intake in the US is 50 mcg or lower.2 Your intake

Chromium (Cr)

30–35 mcg, adult males 20–25 mcg, adult females No values set to date

Silica (Si)

5–20 mg

Intake significantly higher in men (30–33 mg/day) than in women (~25 mg/day),3 yet generally suboptimal. Silica is the first element to go in food processing. Average intake is 46–63% of RDA (Pennington, et al., 1986). Marginal zinc deficiency is common, especially among children (Brown, 2005). Intake generally inadequate, at 1.76 mg adolescent girls; 2.05 mg adult females; and 2.5 mg adult men.4

Zinc (Zn)

11 mg adult males 8 mg adult females 2.3 mg (AI) adult males 1.8 mg (AI) adult females 900 mcg adults (0.90 mg) No RDA established 4700 mg adults

12–30 mg

Manganese (Mn)

2–10 mg

Copper (Cu) Boron (B) Potassium (K)

2

1–3 mg 3–5 mg 4000–6000 mg

75% of diets fail to contain RDA.5 Average daily intake is below the RDA (Brown, 2005). Common daily intake is only 0.25 mg,6 to possible optimum of 3.0 mg. Adult intake averages 2300 mg for women and 3100 mg for men.7

Kumpulainen, J. 1992. Chromium content of foods and diets. Biol. Trace Elem. Res., 32 (1–3), 9–18. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/1375091 (accessed 10.19.2009). 3 Jugdaohsingh, R., et al. 2002. Dietary silicon and absorption. Am. J. Clin. Nutr., 75 (5), 887–893. URL: http://www.ajcn.org/cgi/content/full/75/5/887 (accessed 05.28.2008). 4 Freeland–Graves, J., et al. 1988. Metabolic balance of manganese in young men consuming diets containing five levels of dietary manganese. J Nutr., 118 (6), 764–773. URL: http://jn.nutrition.org/cgi/reprint/118/6/764 (accessed 05.28.2008). 5 Pennington, J., et al. 1986. Mineral content of foods and total diets: the Selected Minerals in Foods Survey, 1982 to 1984. J. Am. Diet. Assoc., 86 (7), 876–891. URL: http://www.ncbi.nlm.nih.gov/pubmed/3722652 (accessed 05.28.2008). Klevay, L. 1979. Evidence of dietary copper and zinc deficiencies. JAMA, 241, 1917–1918. URL (abstract): (accessed 05.13.2008). 6 Nielsen, F., et al. 1987. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB J., 1 (5), 394–397. URL: http://www.fasebj.org/cgi/reprint/1/5/394 (accessed 05.13.2008). 7 Hajjar, et al. 2001. Impact of diet on blood pressure and age‐related changes in blood pressure in the US population: Analysis of HNANES III. Arch. Intern. Med., 161 (4), 589–593. URL: http://archinte.ama‐ assn.org/cgi/content/full/161/4/589 (accessed 05.28.2008).

Susan E. Brown, PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse, NY 13057 www.betterbones.com

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9 >50% of population consume <70% RDA.13.4 mcg adults
150–1000 mcg
Moshfegh. 2005..8
Vitamin B6
25–50 mg
Studies indicate widespread inadequate vitamin B6 consumption among all sectors of the population. NY 13057 www.2008). 66 (12).5 adult females 400 mcg adults (0. 2005. although improving with food fortification. 862. J.3–1. Am. Your intake
Strontium
No RDA established
Key vitamins Vitamin A
2997 IU adult males 2331 IU adult females 1.2008).ajcn. Coll. Inadequate intake common among all age groups. Serum homocysteine concentration of US adults associated with fortified cereal consumption.12 Up to 40% of US population have marginal B12 status..17. W.4 mg) 44% of US population has intake below EAR. Vitamin B6 revisited. et al. 2000 — News from the USDA Agricultural Research Service.nih. URL: http://www. B12 Deficiency may be more widespread than thought — August 1.2008). 5.
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Susan E.14
Folic acid/folate (vitamin B9)
400–1000 mcg (0. Q. L. 24 (6). Am.gov/IS/pr/2000/000802.2008).ncbi.nlm. et al.com
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20 Key bone‐building nutrients — an overview
Nutrient
Adult RDA or AI Common therapeutic range for bone health (daily intake) 3–30 mg (supplements) Up to 680 mg (in medications) 5000 IU or less Dietary considerations concerning adequacy of average daily intake Daily dietary intake thought to vary from 1 mg to more than 10 mg. 14 Brown.10 49% of participants in NHANES survey had intakes below estimated average requirement (EAR).21. 2005. Brown.jacn..gov/pubmed/6385307 (accessed 05.org/cgi/content/full/24/6/503 (accessed 06. 10 Brown.htm (accessed 06. 11 Song. URL: http://www. 151 (6)..ars.17. & Yang. Afr.13 Older people and vegans are especially at risk. Evidence of subclinical deficiencies in various segments of the population and possible consequences thereof. 13 McBride.7 mg adult males 1. et al. URL (abstract): http://www. W. J. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. J. A. Med.. 2000. S. J.betterbones. Epidem.11 Anywhere from 5–50% of population (varying by geographic region and ethnicity) have genetic variants that impact the ability to optimally metabolize folate.. 437–440.usda.org/cgi/reprint/87/3/734 (accessed 07. Nutr.3–1. 12 Botto. Serfontein. 1984.10‐Methylenetetrahydrofolate reductase gene variants and congenital anomalies: A HuGE review. URL: http://www. 2005. 2000.4–1 mg)
Vitamin B12
2. 503–509..

18 K2: Average US intake 9–12 mcg (if any) Your intake
Vitamin C
90 mg adult males 75 mg adult females
Vitamin D
200 IU infancy–59 yr 400 IU 51–70 yr 600 IU >70 yr
Vitamins K1 and K2
K1: 120 mcg adult males 90 mcg adult females K2: No recommended intake Should comprise minimum of 7% total calories. however. as needed. 18 Booth.. inexpensive blood test for 25(OH)D is the best way to determine vitamin D status and need.
20 Key bone‐building nutrients — an overview
Nutrient
Adult RDA or AI Common therapeutic range for bone health (daily intake) Oral 500–3000 mg (and upward to bowel tolerance15). Location and vitamin D synthesis: Is the hypothesis validated by geophysical data? J. URL: http://www. 19 Brown. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse.ncbi. M.16 The overwhelming news from numerous experts is that up to a billion people worldwide are deficient. Dietary considerations concerning adequacy of average daily intake Average daily intake is about 95 mg for women and 107 mg for men. 2005. 2005. Photochem. Photobiol. et al.2008). [No date listed]. 357 (3). 800–2000 IU and up.com
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. Generally not to exceed 30% caloric intake..com/drugs/altmed/altmed‐ mono. S.gov/pubmed/17142054 (accessed 05.13. Vitamin D deficiency. Based on US survey of nearly 9000 people.
Susan E. Consumption of essential fatty acids (EFA’s). 1998. 17 Holick. A.org/cgi/content/full/128/5/785 (accessed 05. M.
K1: 250–1000 mcg K2: 45–180 mcg MK‐7 (menaquinone‐7) 20–30% of total calories is perhaps more ideal. Dietary intake and adequacy of vitamin K. as needed. URL: http://jn. Review. J.2008). and those with little UV sunlight exposure.pdrhealth. 16 Moshfegh.aspx?contentFileName=ame0173.nutrition.2008).nejm.nih. URL: http://www. NY 13057 www. 234–249.betterbones. which is well below the recommended AI. 128 (5). New Eng. J. et al. dark‐skinned.. is frequently inadequate.. supplements | PDRHealth.20.. K1: Averages 45–150 mcg. J Nutr.2008).17 Deficiency is especially common among the elderly.nlm.org/cgi/content/full/357/3/266 (accessed 05.28. Brown.19
PDRHealth. & Suttie.. intake for 31% of population is below Estimated Average Requirement (EAR). URL: http://content. Med. 266–281. 785–788. Vitamin C | Herbal remedies. 2007. Kimlin.
Other nutrients
Fats
Average American consumes ~33% of his/her calories in fat. A simple. 2007. 86 (3).xml&contentName=Vitamin+C&contentId=336 (accessed 05.28.

8 g/kg per day adult males and females 125–lb person = 45 g 175–lb person = 63 g 56 g adult males 46 g adult females20
National Academy of Sciences.
Susan E. Institute of Medicine.06.2008).com
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.pdf (accessed 05. 21 Brown.21 Higher protein intake should be balanced with higher RDA level potassium intake from food sources.0–1. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. NY 13057 www.
20 Key bone‐building nutrients — an overview
Nutrient
Adult RDA or AI Common therapeutic range for bone health (daily intake) 1.betterbones. Dietary Reference Intakes for individuals. Your intake
Protein
0. Brown.] Through the United States Department of Agriculture Food and Nutrition Information Center website.File/Master/21/372/0. 2005.5 g/kg Dietary considerations concerning adequacy of average daily intake Daily intake commonly exceeds 100 g. PDF: http://www.iom.edu/Object. but the elderly and some women often have very deficient intake. Food and Nutrition Board. [No publication date listed.

Susan E. Food Sci. 46 (8). et al.ars. but both may be used as goals for nutrient intake. not for optimizing health! The common therapeutic dose for healthy and strong bones may be higher for most. Dietary Reference Intakes for individuals.17.d
a Wikipedia.2008).. NY 13057 www. Adequate Intakes (AI).06. If there is insufficient evidence to determine an RDA.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables2001-02.

• •
Adequate Intake (Al) values are more tentative than RDA. In addition to the values that serve as goals for nutrient intakes the DRI include a set of values called Tolerable Upper Intake Levels (UL). Food and Nutrition Board. The role of nutrients in bone health. Brown. 2005.. It was first introduced in 1997 to broaden the existing Recommended Daily Allowances (RDA). NHANES 2001–2002: Usual nutrient intakes from food compared to Dietary Reference Intakes.2008). URL: http://www.nih. US Department of Agriculture. d Palacios.c

Keep in mind that these systems and the nutrient values they represent were established to cover nutritional adequacy for most folks. Nutr.a The DRI includes two sets of values that serve as goals for nutrient intake (from the National Academy of Science). These are the RDA and Adequate Intake (AI). What we eat in America. C. A.org/wiki/Dietary_Reference_Intake (accessed 05. They are established by the Institute of Medicine (IoM). URL (abstract): http://www.pdf (accessed 06.nlm. URL: http://en.wikipedia. and Estimated Average Requirements (EAR)

The Dietary Reference Intake (DRI) is a system of nutritional guidelines developed by the Institute of Medicine (IoM) of the US National Academy of Sciences. b Ibid. and significantly higher in “special need” cases. Rev. an AI is set. The UL represent the maximum amount of a nutrient that appears safe for most healthy people to consume on a regular basis.betterbones.usda.13. Adult RDA figures from: National Academy of Sciences.org. c Moshfegh.
20 Key bone‐building nutrients — an overview
About… Dietary Reference Intakes (DRI). Dietary Reference Intake. The Estimated Average Requirement (ERA) calculations are the average daily nutrient intake level estimated to meet the requirement of half of the healthy individuals in a particular life stage and gender group. Adult Recommended Dietary Allowances (RDA).ncbi. Institute of Medicine.gov/pubmed/17092827 (accessed 05.b The RDA’s reflect the average daily amount of a nutrient considered adequate to meet the needs of most healthy people. which is the system currently still in use in food nutrition labeling. Recommended Dietary Allowances (RDA) represent the daily dietary intake of a nutrient regarded to be sufficient for meeting the requirements of nearly all (97– 98%) healthy individuals in each age and gender group. from A to Z. 621– 628. 2006. Crit. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. through the United States Department of Agriculture Food and Nutrition Information Center website.com
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.2008). Agricultural Research Service.

Nutr..ncbi.org/cgi/content/full/22/2/142 (accessed 05. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. J.22 While most Americans think they need to drink milk to get enough calcium. called hydroxyapatite. & Weaver. Vitamin D and fracture reduction: An evaluation of the existing research. 656–657. 1990. URL (accessed): http://www. and gives our bones both strength and rigidity.nih. is formed principally from calcium and phosphorus.06. R. Here in the United States. C. Med. S.06.. et al. Br. URL (abstract): http://www.org/cgi/reprint/51/4/656 (accessed 05. Am.). 32 (1).. Calcium and vitamin D. C. 12 (3).nih. Trace Elem.. Heaney. 32 (1). a variety of Chinese cabbage. Encyclopedia of Natural Medicine. 2000. bok choy. Roseville.thorne. all the calcium in the world will result in little material gain for our bones.2008).pdf (accessed 05. 148–154.nlm.
Susan E. Coll. Biol. Calcium and vitamin D. Clin. Bone is made up of a crystalline mineral compound embedded within a living protein matrix. Rev. Endocrinol. 21–33. 1998. Clin.nlm. R. Metab. vii–viii. 23 Weaver. & Weaver. 25 Murray. 459. CA: Prima Publishing. Calcium absorption from small.. Am. people have been boiling up bones for the rich nutrients they contain. 181–194.. But research indicates that dietary calcium from sources such as vegetables.gov/pubmed/12699298 (accessed 05. Nutr. R. URL (PDF): http://www.2008). NY 13057 www. 51. C. 2003.ncbi.2008). Am.nih. URL (abstract): http://www. Clin.gov/pubmed/12699298 (accessed 05. vii–viii. it’s prophylactic for bone health!) As for calcium supplements. Whole small fish as a rich calcium source. 70 (Suppl.ajcn..ncbi. 27 Heaney. & Pizzorno.. Am.2008).06. Clin. & Weaver. Nutr. C.22.
20 Key bone‐building nutrients — an overview Key minerals for bone health — calcium
Of all the minerals in the body.gov/pubmed/9857327 (accessed 05.2008). 83 (2). et al. 22 (2) 142–146. Heaney. 2008. J. soft‐boned fish. Nutr.fulltext/13/1/21. But the biggest story with calcium is not so much about which form to use as it is about calcium absorption — which itself is contingent on a complex interplay of hormones and other factors. Endocrinol. there is more calcium than any other. chief of which is vitamin D. Med. T. 181–194.. M. Choices for achieving adequate dietary calcium with a vegetarian diet.betterbones. It makes up somewhere around 2% of our total adult body weight. Robert Heaney has found that different individuals can have a nearly threefold difference in their calcium absorption rates — a phenomenon for which we currently have only limited
Larsen. URL (abstract): http://www.nlm. J. 13 (1).. or the small bones of fish such as canned salmon or anchovies. N.2425 While it’s interesting that calcium comes in all these various forms. 24 Heaney.. may be much more readily absorbed than calcium from dairy foods. 1998.2008). without adequate vitamin D on board (vitamin D sufficiency is commonly defined as a 25(OH)D blood level26 of at least 32–34 ng/mL). et al. Calcium absorption varies within the reference range for serum 25–hydroxyvitamin D.. M. fruits. Metab. Calcium absorption from kale.. 26 Brown.com
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.27 In fact.com/altmedrev/. 2003. URL: http://www. URL: http://www. 2003. This crystalline mineral compound. J.gov/pubmed/10743499 (accessed 05. noted calcium researcher Dr. Am.20.. J. (Homemade broth is not only curative for the common cold.2008). Hansen. 191–196.nlm.20. Brown. et al. it’s true that not all are created equally.. 543S–548S. It is essential for healthy bone development and bone maintenance. is one of the best calcium bargains around as far as absorbability per unit of energy — providing around 1800 mg calcium per 100 calories!23 Another good source is bones themselves: since the invention of fire. N. Alt. R. stored mostly in our bones and teeth. We hear a lot about the different forms of supplemental calcium and which ones are best. 1999.ncbi..nih.22.jacn. about 80% of our calcium comes from dairy sources. J.

. Pharmacokinetic and pharmacodynamics comparison of two calcium supplements in postmenopausal women. Coll. et al.nih. including food and supplements. 2000. 11. Many US experts now suggest that the ideal daily calcium intake from all sources. 2357–2358. and does not appear to interfere with iron absorption from food. et al. NY 13057 www.nlm. calcium ascorbate.nih. 1237–1244. are sources that do not require hydrochloric acid (HCl) from the stomach for absorption. Nearly all the biochemical reactions taking place in the body involve phosphorus. As to which forms optimize both absorption and bioavailability.. 1992.. 955.) Regardless of what form your calcium supplementation takes. [No author listed. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. DC: National Osteoporosis Foundation. Calcium citrate and its relative. H. would be in the range of 1000–1200 mg. 29 Sakhaee. Physician’s Resource Manual on Osteoporosis. calcium citrate–malate. Calcium in the form of calcium citrate also appears to play a protective role against the formation of kidney stones. See also our list of calcium‐rich foods for the best dietary sources of this important bone‐building mineral. Modification by food of the calcium absorbability and physiochemical effects of calcium citrate.] 1986. 2004.30 but does alkalize well in the body if taken with food. C.. Citrate for calcium nephrolithiasis.. 548–552.2008). Urol. Nutr. so the calcium in them is very bioavailable to the body and a good choice for people with low stomach acid. want to use equal amounts of magnesium and calcium (1:1).
Randall. J. URL (abstract): http://www. C. 1991.gov/pubmed/15311008 (accessed 05. K. Pharmacol.betterbones. including regulation of proteins and energy production through the process known as phosphorylation. making up a full 25% of all the mineral material in the body.28 Aside from how replete our vitamin D stores are.. hormones. et al.
Susan E. Wabner. and in most cases I prefer nearly as much magnesium as calcium. 1992.31 For more on how bone serves as a calcium reserve for everyday body processes. and calcium carbonate.com
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. see our article on the natural approach to bone health.nlm. J. Stone forming risk of calcium citrate supplementation in healthy postmenopausal women. URL (abstract): http://www. 958–961..nih. 31 Peck W.ncbi. Brown.28. Lancet. Return to table
Key minerals for bone health — phosphorus
Phosphorus is the second most abundant mineral in the body.
20 Key bone‐building nutrients — an overview
explanation.2008). (Calcium absorption from all forms is generally better when taken with a meal. URL: (abstract): http://www. Some bone specialists favor magnesium‐centered formulations with equal or slightly more magnesium than calcium. People with osteoarthritis. T.2008).06.29 Calcium carbonate is often found not to be as well absorbed as citrate. Washington.ncbi. I recommend at least half as much magnesium as calcium (a ratio of 1 part magnesium to 2 parts calcium).06. calcium citrate–malate (CCM).nlm. These forms include calcium citrate. in particular. J. & Pak. 172 (3). JAMA. Clin. it should always be balanced with magnesium supplementation. alkalizing calcium salts are the best calcium compounds known to date.gov/pubmed/1452953 (accessed 05. Am. 40 (11).ncbi. As a rule of thumb. and metabolism in life of skeleton. Longitudinal study pursues questions of calcium. 268 (17). how well we absorb calcium has much to do with the health of our digestive system.gov/pubmed/11075309 (accessed 05. 1 (8487). 30 Heller.

also
Food and Nutrition Board. 1981. The average American diet contains much more phosphorus than calcium (see table). URL: http://www. D. and regulating parathyroid hormone. fat and starch metabolism. MO: Mosby Co.ajcn. J. In Dietary Reference Intakes: Calcium.34 Return to table
Key minerals for bone health — magnesium
Overall. B. Nutr.edu/books/0309063507/html/index. URL: http://www. Contemporary Developments in Nutrition. Vitamin D resistance in magnesium deficiency.gov/pubmed/7250387 (accessed 05. it’s no surprise that it’s essential for healthy bones and teeth. and Fluoride..html (accessed 05. Am. What we eat in America. and a deficiency of magnesium can lead to a syndrome known as vitamin D resistance. Most notably. in supporting bone health: stimulating the thyroid’s production of calcitonin. or more phosphorus than calcium. It must work in delicate balance with calcium in our bones and blood.2008).C. Phosphorus. 1997.ncbi. Proc.20.. NHANES 2001–2002: Usual nutrient intakes from food compared to dietary reference intakes.: National Academy Press. But while phosphorus is essential for bone health. glucose.usda. cell growth and repair. et al. URL: http://www. 34 Worthington–Roberts.nap. and pH buffering to maintain acid–alkaline balance in the body. ISBN= 0801656273. 33 Moshfegh.13. Brown. adequate magnesium is essential for absorption and metabolism of calcium.32 Large amounts are found in meat. Washington. Fed. alkaline phosphatase. R.2008). magnesium assures the strength and firmness of bones and makes teeth harder. Louis.nih. Protein‐induced hypercalciuria. URL: http://www. 80% of it is found in the teeth and bones in the form of crystalline bone.2008). Magnesium also has a role to play.ars..06. 40 (9). A. 35 Medalle. and processed foods. many Americans consume twice as much. heart contraction. a function of which is to regulate bone breakdown in a number of ways. Linkswiler. 2005. Clin. Vitamin D.
Susan E. 146–189. H. 854–858.org/cgi/reprint/29/8/854 (accessed 05. NY 13057 www. together with the thyroid and parathyroid glands. calcium. Magnesium is an essential cofactor in 80% of all cellular enzymes. 240–253.betterbones. Phosphorus. 29. 1976. Since magnesium participates in an astonishing array of biochemical reactions.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables2001‐02. Institute of Medicine.
20 Key bone‐building nutrients — an overview
hormone signaling. too much of it is not a good thing..12.. 1981.2008). Also of special interest to us is the fact that phosphorus combines with calcium to form a mineral crystal that gives strength and structure to our bones and teeth. Of all the phosphorus in the body. hydroxyapatite. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. nerve and muscle activity. Instead of the more ideal ratio of nearly one part calcium to one part phosphorus. 2429–2433. et al.33 This high phosphorus‐to‐ calcium ratio can be detrimental to our bones. It is necessary for the conversion of vitamin D into its active form. Magnesium.pdf (accessed 05. et al. soft drinks.35 The enzyme required for forming new calcium crystals. St.nlm. which acts as a bone‐preserving hormone.com
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A.. NHANES 2001–2002: Usual nutrient intakes from food compared to dietary reference intakes. the use of calcium supplements in the face of a magnesium deficiency can lead to calcium deposition in the soft tissues.12. Moshfegh. Med.. 1022–1032. Seelig. Similarly.12. D.pdf (accessed 05. J. R.ncbi. 29–31.” In Modern Nutrition in Health and Disease.nlm. Am.ars.gov/pubmed/10612083 (accessed 05. et al. 1747–1763. 26 (6). Even mild magnesium deficiency is reported to be a leading risk factor for osteoporosis. J.. as well as low blood and bone magnesium levels.nih. URL: http://www. Magnesium Deficiency in the Pathogenesis of Disease. Osteoporos. Health World.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables2001‐02. URL: http://www.. 1981. Mineral intake and bone loss. URL: http://www. Shils. J.39 Despite its recognized importance. 37 (2). 17 (7).. ed.2008). Res. Nutrients and bone health. URL: (abstract): http://www.40 In fact. & French. L. 2005. Gaby.2008). R. Nutr.13.03. Iseri.nih.36 As with calcium.. L. “Magnesium. 2005. et al. where it can promote arthritis. 211–219.. most Americans consume less than the Estimated Average Requirement (EAR) for magnesium. Infrared spectroscopy and magnesium content of bone mineral in osteoporotic women. 126 (9 Suppl.. R.ncbi.org/cgi/content/full/84/4/843 (accessed 05. R. 2006.org/cgi/reprint/126/9_Suppl/2304S (accessed 05. 40 Hunt. & Kitzes.2008). 843–852. so deficiency of one markedly affects the metabolism of the other. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse.2008). Nutr.ncbi.mgwater. 17. URL (abstract): http://www. Brown. A.13. Magnesium deficiency‐induced osteoporosis in the rat: Uncoupling of bone formation and bone resorption. 39 Pennington. 2304S–2308S. 108. Goodhart & M.). M. Magnes. et al. as of 2001. M. NY 13057 www. transferring magnesium into the blood stream in times of need. 1988. R. Am. 56% of the US population was not consuming the Estimated Average Requirement for this mineral. the majority of the body’s reserves of magnesium are held in the bone (60%).. Magnesium requirements: New estimations for men and women by cross‐sectional statistical analyses of metabolic magnesium balance data.betterbones.13. such as the joints. Clin.nlm.nlm.gov/pubmed/7327911 (accessed 03. abnormal bone crystal formation can result. has been widely associated with osteoporosis in women. Low magnesium intake. contributing to kidney stones. 14 (4). 1980. 2006.com
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. Adequate daily intake of magnesium is important throughout life to keep the magnesium that is stored in the bones from being lost.12. URL: http://www.
Susan E. L. New York: Plenum Press. 1999. and the bones act as a storage reservoir.
20 Key bone‐building nutrients — an overview
requires magnesium for activation. Proceedings. 1984. Israel J. C. Rude.nutrition.nih. and if levels are low.com/Seelig/Magnesium‐Deficiency‐in‐the‐Pathogenesis‐of‐Disease/preface.. Heart J. ISBN: 0781741335.. In fact. Hegsted.2008). 257–267. 1996. & Johnson. 38 Shils.gov/pubmed/16601920 (accessed 05. Rude. What we eat in America. increasing calcium supplementation without increasing magnesium supplementation can actually increase magnesium loss.37 It’s often overlooked that magnesium and calcium function together.41
Rude. Bone.2008).12.nih. Sci. 84 (4).nlm.. 188–193. Fed. et al. & Wright.usda.ncbi..gov/pubmed/15923157 (accessed 05.2010). Reduction of dietary magnesium by only 50% in the rat disrupts bone and mineral metabolism. Int. Magnesium: Nature’s physiologic calcium blocker. 1973.38 There has been conflicting opinion about the need for concern about the adequacy of our magnesium intake. 37 Cohen. 1967.shtml (accessed 05. Philadelphia: Lea & Febiger.2008). or in the kidney. URL (abstract) http://www.ajcn. 1123–1125. Intakes of minerals from diets and foods: Is there a need for concern? J. Dietary magnesium reduction to 25% of nutrient requirement disrupts bone and mineral metabolism in the rat. URL: http://jn. J.

9. D.org/cgi/content/full/23/4/351 (accessed 10. Effects of acute chromium supplementation on postprandial metabolism in healthy young men. 218–235. NY 13057 www.2009).. DC: National Academy Press. 45 (3). NHANES 2001–2002: Usual nutrient intakes from food compared to dietary reference intakes. Altern.long (accessed 10. 23 (4).usda. breastfeeding. J. Washington. URL: http://care. pregnancy.pdf (accessed 05.2008). M.ncbi.. Nutr.nih. and according to Dr. The safety and efficacy of high‐dose chromium. What we eat in America. 1995. Chromium picolinate decreases calcium excretion and increases dehydroepiandrosterone (DHEA) in postmenopausal women.43 A third bone‐protective aspect was identified in a similar study. FASEB J.20. 41 Moshfegh. 42 Martin. URL (abstract): http://www.44 Chromium absorption from foods tends to be poor. infection. vitamin D.20. A449.13. Am.2009). magnesium.nlm.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables2001‐02.
20 Key bone‐building nutrients — an overview
Return to table
Key minerals for bone health — chromium
Chromium helps to keep insulin activity in the body efficient. et al. [As quoted in Lamson. A. URL: http://www.jacn. Anabolic effects of insulin on bone suggest a role for chromium picolinate in preservation of bone density. Rev.org/content/29/8/1826.ncbi. 2002. a hormone that may play a physiological role in preserving bone density among postmenopausal women.gov/pubmed/8569546 (accessed 10. 2006. Evans. Med.. et al.20. McCarty.ars. Institute of Medicine. et al. Coll. 1826–1832.diabetesjournals. 7 (3).]
Susan E.gov/pubmed/12126463 (accessed 10.. chromium levels in the blood can also be diminished by a number of stressors: high sugar intake. and physical injury. and by moderating bone breakdown (resorption). Hypotheses.. 2004. Frauchiger. Richard Anderson of the Beltsville Human Nutrition Research Center in Maryland. Dietary reference intakes for calcium. 241–246.nih.2009). These concerns can all be
Food & Nutrition Board. 29 (8). 1997. 1995. 351–357. URL: http://www. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. Brown. G. S. where along with improving insulin regulation and lowering calcium excretion.20. supplementing with chromium picolinate raised blood levels of DHEA. Diabetes Care.com
44 43
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. This latter effect was demonstrated in a study where postmenopausal women supplementing with the insulin‐sensitizing nutrient chromium picolinate were found to have less calcium and collagen protein molecules in their urine.nlm. Med.betterbones. intense exercise.. 2005. J. M. URL: http://www. et al.. Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes.42 an effect that may be bone‐protective in a couple of ways: by promoting the production of collagen by our bone‐building cells (called osteoblasts). & Plaza..2009). and fluoride. Chromium levels also tend to diminish with age. phosphorus.

124.nih. Silicon with the osteoblast…49 Of interest is that the major source of
Anderson. Int. and teeth.gov/pubmed/18438624 (accessed 05. et al. A relationship between silicon and calcium in bone formation. thus helping us to maintain strong.. Biol. B. & Wright. et al. E. We don’t fully understand its full range of functions in the human body.2008). skin. flexible bones. April 2003. et al. A. Although no RDA has been established yet for silica. F. & Stewart. Carlisle.gov/pubmed/9425497 (accessed 05.). 1997. 10 (3).ncbi.org/cgi/content/full/70/3/539S (accessed 05.. J. B. Fluoride and silicon intake in normal and endemic fluorotic areas. J. Boston.48 Silica is plentiful in many fibrous foods.46 Populations with higher intakes of plant‐based foods have higher silica intakes than do Western populations.. J.ajcn. 196–201. Gaby. Osteoporosis: What It Is. “Chromium in Health and Disease. tendons. 265. the bond‐forming cell. Anasuya. the fiber in foods (and its silica content) is the first to go in the processing of foods.” Council for the Advancement of Diabetes Research and Education (CADRE) Chromium Summit.gov/pubmed/8905558 (accessed 05.
20 Key bone‐building nutrients — an overview
addressed by supplementing with a medical‐grade bone formulation containing certain chelated forms of chromium.. URL: http://www. A. URL (abstract): http://www. 70 (3) (Suppl.45 Return to table
Key minerals for bone health — silica
Silica is the most abundant mineral on earth. Plant‐based diets and bone health: nutritional implications.ncbi. 1975. Brown. such as chromium polynicotinate or chromium picolinate. Trace Elem. collagen. 1996.28.nlm. 7.13. 49 Kamen. NY: Pinnacle Books. 927. Osteoporos.. A. Nutr. 1970. Am. Nutritional Medicine: The Drug‐free Guide to Better Family Health.nlm. but we do know that silica content is high in the strongest tissues of the body. Y.. connective tissue..nih. 48 Gullberg. Biol. and silica combines with calcium in the bone‐building cell. Short‐term administration of water‐soluble silicon improves mineral density of the femur and tibia in ovariectomized rats. Proc. 539S–542S. J. S. 34.2008). Dietary silicon appears to increase the rate of mineralization. ISBN = 0330288334 Carlisle. ligaments. Davies.. this mineral clearly makes a direct contribution to bone health. Fed. particularly when calcium intake is low. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. 2008.nlm. 1994. the incidence of hip fractures in these communities is also lower. 149–155. 47 Anderson.betterbones.47 and not surprisingly.com
46
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. et al. and the mineral appears to strengthen the connective tissue matrix by cross‐linking collagen strands.nih. Proc. 1984.2008).. How to Stop It. Clin. 222. A concentration of silica is found in the areas of active bone mineralization. Chen. Nutr. Med. URL (abstract): http://www. hair. Trace Elem. London/Sydney: Pan Books. ISBN: 1558171711
Susan E. 407–413. Estimates of trace element intakes in Chinese farmers. Since up to 80% of the food we consume today is processed — compared with a mere 10% at the turn of the century — silica consumption has dramatically declined in just a few generations.ncbi.28.. How to Prevent It. J. but as nutrition educator Betty Kamen reports. et al. Apr 26 [Epub ahead of print]. Bone collagen is reported to increase with silica supplementation. 1988. 1987. Overall. Massachusetts. Fed. NY 13057 www.2008). silica plays an important role in initiating the calcification process. R.28. Bae. nails. 29. Res. including the arteries. URL (abstract): http://www. E. World‐wide projections for hip fracture. 1999.

. et al. Nutr.21. T. and to date no RDA for manganese has been established. URL: http://jn. 2007. manganese is a trace element that can profoundly affect bone health.com
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. R. zinc is needed to produce the matrix of collagen protein threads upon which the bone‐forming calcium–phosphorus compound is deposited. E. J. 1990..gov/articlerender.28.. Report. It’s essential for bone healing. and a deficiency prevents full absorption of calcium. 53 Johtatsu.org/cgi/content/full/75/5/887 (accessed 05.betterbones. M.. 2000.. 122 (7):1576–1581.fcgi?tool=pubmed&pubmedid=18299716 (accessed 05. P. et al. J.. 197–201.
Jugdaohsingh. 52 Hambidge. et al. 31 (12).nih.25(OH)2D(125) response to low calcium (LC) diet (D). Yet for a long time it was one of the most overlooked nutrients. Clin. Am. Hendricks. 790–791.ajcn.nlm. Mild — but still clinically significant — zinc deficiency is widespread and far‐reaching in its effects. Am. Zinc and senile osteoporosis.nih. 130 (5). Nutr. while in women it was bananas and string beans!50 Return to table
Key minerals for bone health — zinc
In bone metabolism.
Susan E. Proper calcium absorption also depends on zinc. 41 (3). Nutr. Ger.2008).2008). Soc.13.2008).25‐dihydroxycholecalciferol to calcium depletion in rats.nutrition. J.. Kidney Int. authorities have seen fit to lower zinc requirements. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse.ncbi. Nutr. 1992. URL: http://jn. 1987. K.2008).gov/pubmed/6655182 (accessed 05.51 Low levels in the body have been closely linked with osteoporosis.org/cgi/reprint/122/7/1576 (accessed 05.2008)..53 Return to table
Key minerals for bone health — manganese
Like zinc and copper. 66. URL (abstract): http://www. 358. Clin. URL: http://www.52 The 2–3 grams of zinc found in the body act as a co‐factor in over 200 enzymatic reactions that are instrumental in maintaining not just the health of our bones. 31. Brown.13. URL: http://www. NY 13057 www.. S. Serum concentrations of trace elements in patients with Crohn’s disease receiving enteral nutrition. J. 51 Kimmel. J. Human zinc deficiency.org/cgi/content/full/130/5/1344S (accessed 07. and increased amounts are found at the sites of bone repair.nutrition. Dietary silicon and absorption. 887–893. Atik. It’s also necessary for the production of enzymes that degrade and recycle worn‐out bits of bone protein. but for optimal system‐wide functioning. Nutr.. Zinc nutritional status modulates the response of 1. 2002. 1983. Teller. Zinc and inflammatory bowel disease.pubmedcentral.
20 Key bone‐building nutrients — an overview
silica in American men’s diets was found to be beer and bananas.13. Biochem. It’s unfortunate that in the face of declining intake and growing deficiencies of zinc in the American diet. 75 (5). 1344S–1349S. Zinc (Z) nutritional status modulates the 1. et al.

J. Chem. Dietary standards for manganese: Overlap between nutritional and toxicological studies. 57 Freeland–Graves. Apparent absorption and retention of Ca. J. Hallfrisch. J. 91 (2).ncbi. 1990. Chem. Schwartz. 117 (1). 55 Raloff. Med. such as getting too much calcium. iron. Soc.54 It appears manganese intake can vary widely depending on basic food choices… 199.com
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.2008). 1986.ncbi.gov/pubmed/1991931 (accessed 05. et al. 96‐101. Manganese and magnesium utilization of humans as affected by level and kind of dietary fat. 59 Slemenda. A prospective study of clinical data using photon absorptiometry. L. we now know that intake of manganese is greatly reduced when whole grains are replaced in the diet with foods made from refined flour..55 This gives us pause because grain products constitute nearly 40% of our daily manganese intake. 1987. et al. “Role of manganese in bone metabolism. For example.. C. 128 (2).. Am. Clin. 43 (3).nutrition.nutrition.. “Manganese requirements of humans.13.org/cgi/reprint/117/1/48 (accessed 05. DC: Am.13.56 Other dietary patterns can inhibit the absorption of manganese. ed. J. J. Proc. Reasons for boning up on manganese. URL (abstract): http://www. J. Brown. What’s more. Am. Mg. manganese deficiency is relatively easy to address and dietary sources are extremely safe. et al. Nutr. 1998. Ricketts.nih. 368S–371S.nlm.
Susan E.gov/pubmed/2294827 (accessed 05.] Science News. 56 Pennington. URL: http://jn.ajcn. 1991. copper aids in the formation of collagen for bone and connective tissue and contributes to the mechanical strength of bone collagen fibrils — the long thin strands of proteins that cross‐link to one another in the spaces around cells.58 Osteoporotic changes in bone can be brought about by manganese deficiency..13. et al. URL: http://jn. ed. P. Soc. 1988. & Saltman. or zinc. 48–55. 112 (2). URL (abstract): http://www.” In Nutritional Bioavailability of Manganese. Cu. J. Med. Fed. Beverages (particularly tea) contribute about 20%. et al. which appears to increase bone breakdown while decreasing new bone mineralization. Nutr.2008).org/cgi/content/full/128/2/368S (accessed 05. R.2008). B. Mineral balances of men and women consuming high‐fiber diets with complex or simple carbohydrate. 1987. Diet.” In Nutritional Bioavailability of Manganese. 179–183.
20 Key bone‐building nutrients — an overview
One reason cited for this lack of an RDA in the past was that scientists weren’t really sure what people’s typical manganese intakes were. ISBN: 0841214336.org/cgi/reprint/43/3/444 (accessed 05. Assoc. Keys. 1850.. Mn. 444–445..2008). 44. Total Diet Study nutritional elements 1982–1989.. J. 58 Strause. Res. and vegetables less than 20%. & Young. C. NY 13057 www… 60 Reginster. Washington. but we do know that by virtue of a copper‐containing enzyme called lysyl oxidase. et al. Washington. C. 337–338.59 Blood levels of manganese of severely osteoporotic women were found in a Belgian study to be just one‐fourth those of non‐osteoporotic women their same age. 1987.13. of the 25 variables studied..nlm. Keys. 1985. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. C.13.Y. Zn from a diet containing bran..nih.
Greger. DC: Am. phosphorus. J. Sci. 1986. 16. [Review. only manganese was significantly different between the two groups. 130. Intern. copper is an essential trace mineral that has only recently been found to play an important role in bone health maintenance.57 In recent decades research has uncovered the special role manganese plays as a co‐factor in the formation of bone cartilage and bone collagen. Return to table
Key minerals for bone health — copper
Like manganese. This role is still not fully understood. ISBN: 0841214336.. Trace elements and postmenopausal osteoporosis: A preliminary study of decreased serum manganese. as well as in bone mineralization. Nutr. Predictors of bone mass in perimenopausal women.2008).60 Fortunately. J. URL: http://www.betterbones. Ann.

65 Pennington. The nutritional and metabolic effects of boron in humans and animals. copper excretion from the body is increased on a diet high in sugar. 1986.E. URL (abstract): http://www. 1988.ncbi.fasebj.nlm. 66 (1–3). Mineral content of food and total diet: The Selected Minerals in Foods Survey.. 1987. Lead researchers now consider boron important in the utilization and metabolism of calcium and vitamin D. 1999.2008). F. J. URL (abstract): (accessed 05. URL: http://www.. Effect of dietary boron on mineral. 1988. et al.13. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. et al.63 Some researchers have suggested that even lactose (milk sugar) could interfere with copper metabolism.2008). vitamin D.com
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. Diet.13.gov/pubmed/3722652 (accessed 05. 62 Turnlund.2008). B.13. Personal communication with Dr.67
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Strain. URL (abstract): http://www.
20 Key bone‐building nutrients — an overview
Copper also helps inhibit bone resorption through a copper‐ and zinc‐containing antioxidant called superoxide dismutase. Shils et al. Brown.66 Though results have been somewhat mixed and the mechanisms have yet to become clear. Pennington.nih. “Copper.13. Susan Brown. & Young. This antioxidant neutralizes superoxide radicals produced by the bone‐ breakdown cells called osteoclasts during bone resorption.. 1986. Med. Biol. and dairy.61 And as with so many other minerals. M.. 1995. 1987. estrogen.2008). 135‐41.2008). 876–891. J. URL: http://jn. et al. 1986. 241. 394–397. it’s not surprising that copper is among the minerals most often deficient in the American diet. F. magnesium..64 With our penchant for sugar. 1917–1918. Strause.
Susan E. The body requires boron for proper metabolism and utilization of various bone‐building factors.2008). Pennington. Res.13. refined flour. 241–252. 64 Strain. including calcium. other sweeteners like fructose. 1982 to 1984. 63 Hallfrisch.nih.. pp. J. J. FASEB J. Trace Elem. 67 Neilsen. 1 (5). 116 (1). 1979. estrogen. Assoc. NY 13057 www.nih. S. as with manganese. especially among women with low magnesium intake. Evidence of dietary copper and zinc deficiencies.13. J. as well as important for overall hormonal balance.. L. making high dairy intake less than ideal for copper utilization. and testosterone metabolism in postmenopausal women. 1991. et al.nlm. J. Raloff. ed.62 and refined flour. 227–235.nutrition. J.ncbi. Hypotheses. JAMA. 1996. Nielsen. Again. Baltimore: Lippincott Williams & Wilkins. J. J. 27 (4). Nutr. inadequate copper levels have been associated with the development of osteoporosis. Effects of long‐term dietary manganese and copper deficiency on rat skeleton.. 333–338. 1998. A reassessment of diet and osteoporosis — possible role for copper.. studies overall show that boron has a mineral‐conserving and estrogen‐enhancing effect. et al.nlm. L.gov/pubmed/10050922 (accessed 05..ncbi. URL (abstract): http://www. J. and perhaps testosterone. 86 (7).gov/pubmed/3067062 (accessed 05.org/cgi/reprint/1/5/394 (accessed 05. 66 Samann.org/cgi/reprint/116/1/135 (accessed 05.betterbones. Klevay.65 Return to table
Key minerals for bone health — boron
Boron is another element on our list of 20 key nutrients that has been discovered only in recent years to be essential to bone health. Am.” in Modern Nutrition in Health and Disease.

whereas diets high in potassium reduce it. is directly associated with overall higher bone mineral density and less bone loss72 — all the more motivation for us to renew our “5–10‐a‐day” pledge!73 (See my blog post on how to measure your daily pH balance and track potential bone loss.com
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. and legumes has resulted in significantly decreased potassium intake. et al. J. 1994. Clin. Nutr.13.2008). Bone Miner. 73 Demigné. veggies. Preventing and Reversing Osteoporosis: What You Can Do About Bone Loss — A Leading Expert’s Natural Approach to Increasing Bone Mass. J. and nuts.nutrition.nih..org/cgi/content/full/81/5/1232S (accessed 05. URL: http://www. 2005.04.nejm. The acid–base hypothesis: Diet and bone in the Framingham Osteoporosis Study. 304.
Susan E. Dietary potassium conserves calcium after menopause. Nutr. vegetables. Eur. NEJM. Protective effects of high dietary potassium: Nutritional and metabolic aspects. particularly in the form of fruits and vegetables. J.68 Return to table
Key minerals for bone health — potassium
I like to call potassium the hidden bone guardian. 72 Tucker. but potassium’s service to bone health is less well appreciated. Abstract M362. 2001. 40 (5). URL (abstract): http://www. et al. A. C. K. Yet we know that higher potassium intake. 81 (5). 231–237.) Return to table
Gaby. 1232S–1239S. Res.gov/pubmed/11842948 (accessed 05. Brown. CA: Prima Publishing. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. S476.org/cgi/content/full/134/11/2903 (accessed 05. 70 Nieves. 2002. URL: http://jn. 1).. Roseville.. 2004. K. Excessive boron in the supplemental form can be toxic. Nutr.13.. but there’s no need to restrict boron from our food sources. as the role it plays along with sodium in maintaining critical fluid balance is widely known.. potassium prevents too much calcium from being excreted in the urine. 1776–1781. et al. Am.13.69 Diets low in potassium increase net urinary calcium loss. NY 13057 www. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. 1994. J. 71 Davies. dietary potassium can offset the excretion of absorbed calcium to such an extent that eating one medium baked potato or one large banana can conserve about 60 mg of calcium!71 Supplemental potassium in the form of potassium salts such as potassium bicarbonate and potassium citrate can also help decrease urinary loss of calcium. 2903–2906. there are places in the world where people consume as much as four times this amount. 17 (Suppl.ncbi. The transition in our diet in recent generations to one that is lower in fruits.nlm. In fact. This guardianship role relates mainly to the ability of certain alkalinizing potassium compounds to neutralize the bone‐depleting acids that are produced during everyday normal metabolic processes.. 130 (125).. In maintaining the acid–alkaline balance in our bodies.70 In fact. et al.2008).2008). J. and this could in part account for a lower osteoporosis rate among vegetarians. we know that our ancestors consumed much more of this nutrient than most of us do today.ajcn. URL (abstract): http://content.. Osteoporosis: the role of micronutrients.
20 Key bone‐building nutrients — an overview
Though RDA’s for boron have yet to be established. 134 (11). A. without adverse effects. It’s easy enough to consume as much as 10 mg per day with a diet plentiful in fruits.org/cgi/content/abstract/330/25/1776 (accessed 06.2008). or read my full article on testing markers of bone resorption. ISBN: 0761500227 69 Sebastian.betterbones.

et al. J. 244–248.gov/pubmed/16846022 (accessed 05. making them more resistant to breakdown. URL: (abstract): http://www.20. dairy foods. 857‐864.gov/pubmed/16188508 (accessed 03.nih. et al. Expert Opin. 78 Maggio. and again. 77 Newton.13. The cause and correction of low blood vitamin C concentrations in the elderly. URL (abstract): http://www.nih.1517/13543784. Review. 76 Kawaguchi. Strontium has a high affinity for bone and is thought to play a critical role in bone health.) In the periodic table you will find strontium below calcium and it belongs to the same chemical family as calcium and magnesium. strontium adds strength to these tissues.75 Return to table
Key vitamins for bone health — vitamin A
Vitamin A plays an essential role in the development of osteoblasts. 2006.77 Overall. 1994.. 1985. A. naturally in drinking water. low vitamin A levels are associated with osteoporosis and increased risk of fracture.. Very high‐dose (several hundred‐milligram dose) synthetic strontium ranelate (Protelos) has been developed in Europe as a prescription osteoporosis medication and is used for the purpose of both halting bone breakdown and enhancing new bone formation.02. strontium is capable of replacing a small proportion of calcium in the calcified crystals of bone and teeth.
20 Key bone‐building nutrients — an overview
Key minerals for bone health — strontium
Strontium is a mineral that naturally exists and is present in small amounts in our food and water. Brown. the bone‐building cells that lay down new bone. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. In fact. J. which results in poor bone growth. Methods Mol. Reginster. Brazil nuts. Drugs.betterbones.. Strontium also appears to draw extra calcium into the bone.ncbi. 135–148. because of its similarities. 330. 2006.2008).7. with 99% of this located in the bones and teeth. Biol.com
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.2009). D. Bone. It tends to migrate to the sites where active remodeling is taking place and promotes mineralization of the bones and teeth.. Strontium ranelate: A new paradigm in the treatment of osteoporosis. Investig. NY 13057 www.857 (accessed 05. Generation of osteoblasts and chondrocytes from embryonic stem cells. The typical daily diet is thought to provide from as little as 1 mg to more than 10 mg strontium. et al.nlm.Y.2008). As it appears.nlm.76 A deficiency in vitamin A also limits calcium absorption and metabolism. milligram quantities and is considered a natural and beneficial bone nutrient.com/doi/abs/10.13. There are about 320 mg of strontium in the body. 2004.78
Gaby.74 Dietary strontium is consumed in very small. 38 (2).ncbi. H.expertopin. 13 (7).
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Susan E. (This stable mineral form of strontium found in food and water should not be confused with the radioactive form of strontium that is produced by nuclear reactors or by explosion of nuclear weapons. Low levels of carotenoids and retinol in involutional osteoporosis. http://www. It is found in most plant foods.

o Subgroup: Retinol — also referred to as “preformed vitamin A. I. Cairns. 129. et al. H. More than 600 carotenoids have been identified to date. or more of a hindrance to bone health. et al. or retinoid forms — to 5000 IU per day. Abstracts of the 12th International Carotenoid Symposium. Clin. 2003. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Mercadante. URL (abstract): http://www. H. but this relates only to the active forms of vitamin A. Rev. URL (abstract): http://www.. Barker.2008). 770–778.22.. 62 (4).nlm.gov/pubmed/15018484 (accessed 05. E.” Invited Lecture 2. 1998.nih.. are dietary precursors to the active forms of vitamin A in the body.nih. Carotenoids.22. J. and include retinol. Enzymol. Meth. E. & Tee. & Hertz–Picciotto… 2003. & Blumsohn.betterbones. 1995. Natural sources of carotenoids from plants and oils. fat‐soluble pigments found principally in deeply‐colored plant foods.
20 Key bone‐building nutrients — an overview
On the other hand. Nutr. Ann. with retinoids and carotenoids being the two main categories. 845–850.. J. Is vitamin A consumption a risk factor for osteoporotic fracture? Proc. Intern. Am.nlm. M. Australia. Symanski.. H. retinoids are a smaller class than the carotenoids.000 IU per day. sometimes referred to as provitamins.. “New carotenoids: Recent progress.80 But in the meantime. alcohol.. J. Soc. Ong. and pregnancy history.. 1995.” retinol is regarded as the main active form for vitamin A in the body. Vitamin A: Is it a risk factor for osteoporosis and bone fracture? Nutr.
Macdonald.
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Ribaya–Mercado. & Hertz–Picciotto. 1992.. Nutritional associations with bone loss during the menopausal transition: Evidence of a beneficial effect of calcium. 425–438. J. 1047–1058. Macdonald. or retinoids.. among others. retinal.ncbi. Melhus.gov/pubmed/17972437 (accessed 05.com
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.2008). Brown. fat‐soluble forms of vitamin A that are available for immediate use in the body. 2007. Carotenoids — a large class of natural.. & Blumsohn. et al. preformed vitamin A. such as liver. A. 79. Am. 155–165. 1998. J.81
Ribaya–Mercado. 2004. Derived from animal sources. 2004.. 141. A. smoking. which makes liver a good dietary source of this vitamin. This is still well below the known tolerable upper limit (UL) of preformed vitamin A — around 10. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. H. et al. 65 (10). It is found naturally in some animal tissues. I. J. NY 13057 www.


Retinoids — natural. A. there is some controversy as to whether high vitamin A intakes are actually helpful. Barker. M.. we recommend limiting intake of supplemental vitamin A — that is. Melhus. E. & Blumberg. What do we mean by “preformed” vitamin A? There are many forms of vitamin A. The jury is still out on how — or even if — excess vitamin A intake actually increases risk of osteoporosis and bone fracture..
Susan E.. Med. 213. and retinoic acid.ncbi. Symanski.79 Some studies suggest high vitamin A can be bone‐damaging. and fruit and vegetable nutrients and of a detrimental effect of fatty acids. A. Blood lead levels in relation to menopause. & Blumberg. Nutr. 07/18–23/1999. 2007. Epidemiol. 142–167.

” amounts over 25. Cancer. is a precursor that is safely stored in our body fat and liver. Natl.2009).
Today.. Cancer Inst. high intake of beta‐carotene is generally not of concern. 2005.ncbi. In turn. supplementing with both the above‐described forms of vitamin A is a wise move for bone health.25. again. several dozen hormones are produced by the adrenal glands. and HCl in turn is necessary for calcium absorption. 2008. where it gets converted into active vitamin A forms as needed.
A full description of the hundreds of forms and functions of vitamin A is beyond the scope of this article.25. and contain useful. URL: http://jnci. several of which aid in maintaining proper mineral balance within the body. Brown. linked high‐dose beta‐carotene supplements to increased risk of lung cancer among smokers — but the opposite seems to be the case among nonsmokers!82 Though there may be different thoughts on what constitutes “high‐dose beta‐carotene. T. Beta‐carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers: A meta‐analysis and evaluation of national brands. however.
20 Key bone‐building nutrients — an overview
o
Subgroup: Beta‐carotene — the most well‐known plant precursor source of active vitamin A. • B6 is necessary for adrenal functioning. Science is always evolving. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. Some recent research has. which. Here are a few aspects of the work it does for us: • B6 is necessary for hydrochloric acid (HCl) production by the stomach. so here are a few key points to remember:

• • •
• •
Most of the vitamin A in our diets comes from plants in the form of beta‐carotene. Touvier. storing or eliminating any extra.org/cgi/content/full/97/18/1338 (accessed 02. 113 (1). the primary form of active vitamin A.betterbones. M. J. G. URL (abstract): http://www.000 IU are typically considered to be in the higher range..
Susan E. nontoxic amounts of both forms as part of supplement regimen. can be toxic if consumed at very high levels. & Bepler. Return to table
Key vitamins for bone health — vitamin B6 (pyroxidine)
Vitamin B6 is another nutrient that plays an important but indirect role in bone metabolism. but our Better Bones products have been well‐formulated based on current nutritional research.com
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. 150–157. 97 (18).oxfordjournals. NY 13057 www.nlm. Thanks to an inbuilt mechanism that shuts off our body’s conversion of beta‐carotene into retinol when levels are adequate. et al.
Tanvetyanon. Our bodies can convert beta‐carotene into active vitamin A when needed. Dual association of beta‐carotene with risk of tobacco‐related cancers in a cohort of French women.2009). 1338–1344. for the approximately 44% of the US population that under‐consume vitamin A in their food.nih.gov/pubmed/18429004 (accessed 02. Retinol.

Evidence of subclinical deficiencies in various segments of the population and possible consequences thereof. 17 (2). thus. ISBN: 015578689X. Chem. Chem. It also contributes to the development of heart disease.2008). or simply as vitamin B9. 84 Azuma. Pharmacol.

Studies indicate that inadequate vitamin B6 intake is widespread among all population groups. Pharmacol. referred to sometimes as folate (its related anion form). Res. 85 Kishi. Vitamin B6 revisited. S.83 B6 is also a necessary co‐factor in the enzymatic cross‐linking of collagen strands. Deficiency of vitamin B6 in women taking contraceptive formulations.. 2000. et al. In one study. In addition. oral contraceptives. which increase the strength of connective tissue. Commun. et al… Homocysteine is a metabolite of the amino acid methionine. 437–440. and many others function suboptimally without a sufficient amount of this nutrient. URL (abstract): http://www.ncbi. et al. along with folic acid. Pathol. as do other common B6 antagonists such as yellow dye #5 (food coloring).nlm. more than 50 enzyme systems are directly dependent on vitamin B6.nih. 1990. Apparent deficiency of vitamin B6 in typical individuals who commonly serve as normal controls.. NY 13057 www.13. NY: Harcourt Brace Jovanovich. Brown.
20 Key bone‐building nutrients — an overview
• • B6 is a factor in the breakdown of homocysteine. their ability to prevent homocysteine build‐up. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. Azuma. 283–293. URL (abstract) http://www. which tends to increase in postmenopausal women.nih. Pathol. et al.85 Return to table
Key vitamins for bone health — folic acid and folate — forms of the water‐soluble vitamin B9
Folic acid is another one of the B vitamins. 86 Botto & Yang.gov/pubmed/6385307 (accessed 05.13.com
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.gov/pubmed/877413 (accessed 05.. Commun. Res. W. 1976. 1976.. 1984.. As a result. helps prevent build‐up of homocysteine in the body. 343–348.2008).13. and keep inflammation at bay.84 One of the factors contributing to this problem is the relative instability of vitamin B6. which interferes with collagen cross‐linking and leads to defective bone matrix and osteoporosis. J.betterbones. higher animal protein intake creates an increased demand for B6. J. detoxify adequately. J.ncbi.nih. 1977.2008). 14 (2). 66 (12). storage. The Science of Human Nutrition.nlm. H. Med. and preparation.gov/pubmed/940965 (accessed 05. J. an amino acid linked with inflammation and increased fracture risk. The most notable role folate and folic acid play in bone health is in the detoxification of homocysteine.nlm.ncbi. Brown. Anywhere from 5–50% of any given population (varying by geographic region and ethnicity) may have genetic variants that impact their ability to optimally metabolize folate and. all of the 21 “normal American students” studied over a two–week period were found to be functionally deficient in B6. All in all. URL (abstract): http://www. B6. Afr.
Susan E. which is destroyed by light and heat.86
Serfontein. and certain other drugs and alcohol. much of it is lost in food processing.

nih.. p. women experience a reduced capacity to process homocysteine appropriately. 89 Matteini. vitamins B6.gov/IS/pr/2000/000802.gov/pubmed/3260008 (accessed 05.nlm. S. 458. Markers of B‐vitamin deficiency and frailty in older women. The average US intake is only about half the RDA.nlm. et al. Brown.2008).
Susan E. Tufts nutritional epidemiologist Katherine Tucker concluded that B12 deficiency may be more widespread than previously thought. R. ISBN = 0849337240 88 Carmel. The proper processing of homocysteine requires folic acid.87 Osteoblasts. J. Health Aging.2008). 70–75.betterbones. 2006.com
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.17. In older folks. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. according to the USDA website. Deficiency of folic acid is an extremely common problem in many parts of the world where diets of refined foods predominate.2008). A. and Sports Nutrition. FL: CRC Press. but is abundant in animal protein.
20 Key bone‐building nutrients — an overview
Homocysteine is a compound produced as a by‐product of the metabolism of the amino acid methionine.88 Vitamin B12 deficiency anemia has been associated with osteoporosis. 90 B12 deficiency may be more widespread than thought. but excess blood levels can accumulate as a result of genetic or nutritional factors. Researchers suggest that around the time of menopause. URL: http://www. Kohlstadt.90 Vitamin B12 is not found in plants.gov/pubmed/18443711 (accessed 05. NEJM. the body’s bone‐ building cells. Yet vitamin B12 deficiency in the US may be largely linked not so much to inadequate meat.ars. are at special risk for drug‐induced folic acid deficiency. ed.nih. Normally. B12.ncbi. The problem may lie with inadequate stomach acid. URL (abstract): http://www. I. Supplementing with folic acid has been found to improve this homocysteine processing problem. with nearly 40% of the US population “flirting” with marginal B12 status. NY 13057 www. poultry and fish intake — the foods that supply the majority of dietary B12 — but to problems with intestinal absorption. It is not known whether this is a universal trait or one found only in more developed countries. Nutr. which is required to cleave the vitamin from the animal proteins to which it is tightly bound in food sources. homocysteine gets recycled as another substance or eliminated. as well as users of alcohol and long‐term users of anticonvulsant medications. require an adequate supply of B12. 12 (5): 303–308. or their ability to function properly will be compromised. 2008. and folic acid (B9) have all been recently added to our list of important bone‐protective nutrients. Cobalamin and osteoblast–specific proteins. Excess homocysteine promotes both osteoporosis and atherosclerosis. In Scientific Evidence for Musculoskeletal.ncbi. Boca Raton.89 Following careful analysis of the Framingham Offspring Study in 2000.13. Return to table ====
Key vitamins for bone health — vitamin B12 (cobalamin)
Because of their role in the detoxification of homocysteine. 319 (2). Women taking oral contraceptives or estrogen replacement. Bariatric. and having low serum levels of vitamin B12 has also been associated recently with odds of frailty in older women. the problems with B12 absorption could be due
Brown.06. Of interest is that researchers have found intestinal malabsorption to be a problem among the young and the old alike. Bone nutrition. et al.htm (accessed 06. URL (abstract): http://www.usda. 1988.

N Y Acad.com
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. vitamin C appears to stimulate the cells that build bone. 1986. Even so. 2008. Regulation of steroid hormone metabolism requires L–ascorbic acid.nlm. Mag. 48 (8). Even though the RDA’s for vitamin C are a very minimal 90 mg for men and 75 mg for women. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse.. including the late Nobel laureate. After all. Microbiology. The complete coenzyme B12 biosynthesis gene cluster of Lactobacillus reuteri CRL1098. • In addition to its role in collagen formation. 93 Goralczyk.91 B12 is also one of the few vitamins biosynthesized by the “friendly” flora in our intestines. 81–93. which play a vital role in bone health93 — especially during perimenopause and menopause. can be very helpful! Return to table ====
Key vitamins for bone health — vitamin C
Vitamin C is involved in a great variety of complex and interrelated metabolic processes.92 Though production in the human intestines is not believed to occur to an extensive degree.ncbi. URL (PDF): http://www. Brown.
Susan E. et al. 1992. R..betterbones. 2000.pdf (accessed 06. J. NY 13057 www. • Vitamin C assists in the formation of collagen. J. 349–351.2008). F. when ovarian production of these hormones slows. 154 (Pt 1). vegetarians are strongly suggested to ensure adequate B12 intake — a high‐quality daily supplement formulated to deliver the most highly bioavailable forms of key bone nutrients.nih. for instance in the rumen of cows. Here are three ways in which it is essential for healthy bones. serving as a support structure for mineral deposits and giving bone its resilience. it makes up about 30% of our bones.usda. such as those offered in our Better Bones programs.17. • A third role for vitamin C and bones is in the synthesis and optimal functioning of adrenal steroid hormones. Tucker speculates that the problem could be resulting from the overuse of antacid tablets. 669. bone mineral is laid down over a protein matrix called collagen. great numbers of Americans do not even consume this amount! Many well‐qualified scientists. Ann.. URL (abstract): http://www. Are you vitamin B12 deficient? Ag. and enhance vitamin D’s effect on bone metabolism. Freudenheim. enhance calcium absorption. believe recommended levels are extremely low. Linus Pauling. there is still a lot for us to learn about both B12 synthesis and absorption processes. the B12 we get from animal sources originally derives from bacterial production. and that our health
McBride.gov/is/AR/archive/aug00/vita0800.ars. Res. et al.
20 Key bone‐building nutrients — an overview
to a loss of active acid‐secreting cells in the stomach as we age. Sci. et al. As described in our article on the nature of healthy bones.gov/pubmed/18174128 (accessed 05..2008).22. But in younger adults. Collagen is abundant in the connective tissue of cartilage and bone — in fact. 92 Santos.. and it is safe to say that maintaining healthy gut flora is one way to encourage adequate vitamin B12 status as well as promote good bone health.

• Vitamin D increases kidney absorption of calcium and phosphorus and carries them into the blood. L.com
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would be greatly served on many levels by a much higher intake per day. patients are encouraged to strive for an intake of 2000–3000 mg per day to recover and preserve bone health. URL: http://jn.. Inadequate levels of vitamin D have now been associated with numerous types of cancer. In young children. and the bones and teeth become soft and poorly mineralized. 2005. Inadequate levels of vitamin D also directly affect bone as it causes a condition known as secondary hyperparathyroidism. 1986.2008). & Davison. Recently there has been a veritable explosion of research on vitamin D’s beneficial effects throughout the body. ISBN: 0870710966 95 Holick. the body cannot properly absorb calcium without vitamin D. which stimulates a loss of matrix and minerals.
Pauling.org/cgi/content/full/135/11/2739S (accessed 05.13.13. M. The vitamin D epidemic and its health consequences. URL: http://www.
Susan E. from childhood to old age. which results in growth retardation and the bone deformity condition known as rickets. Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease‐Specific Biomarkers of Vitamin D Sufficiency. 332‐337. Nutr. OR: Oregon State University Press. Vitamin D insufficiency in North America. Brown. 2005. K. In adults. J. Hanley. But for decades both the prevalence and implications of vitamin D deficiency have been grossly underestimated.. How to Live Longer and Feel Better. High prevalence of vitamin D inadequacy and implications for health. M.ncbi. Corvallis. URL: http://jn. J. Mayo Clin.org/cgi/content/full/135/2/332 (accessed 05. Return to table
Key vitamins for bone health — vitamin D
This amazing vitamin serves as the body’s great regulator of calcium and phosphorus metabolism in three major ways: • Vitamin D mobilizes calcium and phosphorus for release from bone in the presence of parathyroid hormone. 135 (11).betterbones.2008). in turn increasing the risk of osteoporosis and fractures.. 2739S–2748S. vitamin D deficiency results in a type of bone‐softening adult rickets.nutrition. a deficiency causes poor mineralization of the collagen matrix. D.95 A simple test can quickly tell you and your healthcare provider whether you have sufficient stores of vitamin D — don’t hesitate to ask for this important test — your lifelong health depends on it! Simply with respect to bone health. • Vitamin D promotes intestinal absorption of calcium and phosphate.94 At the Better Bones Center. known as osteomalacia.gov/pubmed/16529140 (accessed 05.2008).13. Nutr. NY 13057 www. 353–373.nih. Proc. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. Adequate vitamin D nutrition is crucial at every stage of our lives. 135 (2).nutrition.. 81 (3).nlm. and more as individual need is determined. 2006. Holick.

gov/pubmed/2203964 (accessed 05.com/altmedrev/. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. 2008. MedlinePlus: Low levels of vitamin D spell trouble for breast cancer patients.. A recent study.nih. Healthday.ncbi. Rev. J.2008). propensity to fall. JAMA.17.13.thorne. and chronic pain..betterbones..nih. Rev. URL: http://www. showed that women with adequate blood levels of vitamin D at diagnosis had a much better outcome and much less metastases of their breast cancer than did those who were vitamin D‐deficient at diagnosis. Nutr.com/altmedrev/.2008). Relationship between serum parathyroid hormone levels.99 Most importantly. Alt. URL: http://abcnews.gov/pubmed/18065599 (accessed 06.” This is especially true during the dark days of winter. 1997. URL: http://www.. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse..nih.17. diabetes.nejm. 337 (10). NEJM.02. Dawson–Hughes. as the Better Bones Center recently documented in Alternative Medicine Review. for years it has been known that osteopenia. 2005.101
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20 Key bone‐building nutrients — an overview
cardiovascular disease. and calcium intake. and needless fractures are linked with low levels of vitamin D. the more adequate the state of vitamin D nutrition. S. 101 Brown.pdf (accessed 06.org/cgi/content/full/337/10/670 (accessed 06. 2007. 294 (18).ncbi. Steingrimsdottir. 13 (1). 98 Bischoff–Ferrari. 670‐676. stroke. Vitamin D and fracture reduction: An evaluation of the existing research. 878–883. 2008. A. 1780–1790. various clinical trials support this amazing fracture‐reduction capacity of adequate‐ dose vitamin D. rheumatoid arthritis. Am. vitamin D sufficiency.2008). 99 Dawson–Hughes. et al. URL: (http://www. 86 (6). H.ncbi. in fact.28.100 And indeed.nlm. More aggressive breast cancer linked to vitamin D deficiency. et al. Med. 2005. URL: http://jama.
Susan E. 323 (13). adequate‐dose vitamin D is now proven to reduce fractures significantly.ama‐assn. URL (abstract): http://www.. Recently. Nearly two decades ago one prominent osteoporosis researcher concluded that. B. Dawson‐Hughes.2008).fulltext/13/1/6.nlm..gov/medlineplus/news/fullstory_64701.28. 1990. Comparisons of estimated economic burden due to insufficient solar ultraviolet irradiance for the United States.2008).2008). for example.98 We now know that women of all ages can actually halt bone loss.04.2008). Med. 100 Grant. et al. Brown. Calcium intake and hip fracture risk in men and women: A meta‐analysis of prospective cohort studies and randomized controlled trials. URL (PDF): http://www. B. mental illness. URL: http://content.gov/pubmed/16159309 (accessed 06.nlm. 2008.pdf (accessed 06. 81 (6).] 2008.. 2336‐2341.thorne. L. 1276–1286. et al.2008). Clin. Uses of vitamin D in clinical practice. Alt. NEJM. and even increase their bone density over the course of the year by consuming adequate calcium and getting adequate amounts of vitamin D — the “sunshine vitamin. Photochem. B.04. et al. osteoporosis. three major vitamin D researchers estimated that 50–60% of all osteoporotic fractures are due to insufficient vitamin D. 97 [No author listed.org/cgi/content/full/294/18/2336 (accessed 06..97 Also. NY 13057 www.nlm. Photobiol.go. hypertension.96 The newly identified link between low vitamin D status and cancer has drawn particular attention. ABC News: Low vitamin D may mean worse breast cancer. macular degeneration.2008). et al.17.. Grayson. periodontal disease. in general.fulltext/13/1/21. 1990. URL (abstract): http://www. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. J.html (accessed 05. 13 (1). multiple sclerosis.nih.com/Health/OnCallPlusBreastCancerNews/story?id=4866328&page=1 (accessed 05. the less bone loss among the elderly.

Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. Our wondrous capacity to produce vitamin D internally appears to decrease with age. showed a reduction in falls of 49% and 72% with just 800 IU supplemental vitamin D. 863–876.medscape. Robert Heaney has demonstrated. Advances in the therapy of osteoporosis.gov/pubmed/16274368 (accessed 05. multiple‐dose study. Geriatr. DC: National Institute on Aging. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: A 3‐year randomized controlled trial. J. 343‐351. 1881. in fact. J. 55 (2). Nutr. vitamin D’s effects across all body tissues are far‐reaching throughout our lives.. et al.2008). it’s important to understand that as a hormone vitamin D exists in both more active and less active states. 1986.. 234–239. 18 (2). Invest. 103 Broe. 9 (11). known as 1. however. et al. Bone Miner. and elderly people in even the world’s sunniest places are especially prone to low levels of in vitamin D.2008).2008). 1979. R. H.gov/pubmed/12568412 (accessed 06.nih. 2003. 2008.105 What’s interesting. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. K. J.2008). Am.nih. Flicker. Relationships between usual nutrient intake and bone mineral content of women 35–65 years of age: Longitudinal and cross‐sectional analysis. 44 (6). Bischoff.nlm.org/articles/view/109516 (accessed 05.. Bischoff‐Ferrari. The most active metabolite of vitamin D. Am. Geriatrics Soc. A higher dose of vitamin D reduces the risk of falls in nursing home residents: A randomized. 2006. including calcium absorption.2008). Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients. for example.ama‐assn..gov/pubmed/18195202 (accessed 05. as calcium expert Dr.13. with many varied forms and myriad biological functions. Today. NY 13057 www. It is this active vitamin D hormone that mediates the many biological effects of vitamin D. 2005. less than 10% of our dietary calcium may be absorbed!104 Our ability to absorb calcium via the intestines is.2008). URL (abstract): http://www. in the absence of activated calcitriol. Soc… URL: http://www. 37–49. many of which we have yet to explore and describe. Vitamin D is a very complex substance. Am. Freudenheim. J. Two recent clinical trials. is that intestinal calcium absorption was 65% higher when blood levels of vitamin D averaged 34 ng/mL — we now know this level approaches only
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Susan E.nlm. URL: http://www. directly related to our blood levels of this active form of vitamin D. M. et al.13. 104 NIH.13. 729–736.. 1994. 1990.jci. Part VIII. et al. It is converted to more active states within the body on an as‐needed basis..betterbones. J. For example.04.com/viewarticle/553365 (accessed 06.. et al. Med.. Res. Effects of vitamin D and calcium supplementation on falls: A randomized controlled trial.. H.
20 Key bone‐building nutrients — an overview
Although we refer to vitamin D as a vitamin. While we consume small amounts of vitamin D in our diet. URL: http://www. J. J.org/cgi/content/full/166/4/424 (accessed 05. Brown.13.103 If for this reason alone. URL: http://www.13.2008).ncbi.25‐dihydroxyvitamin D. 168 (1). 2007.. 103–108. Washington. Effects of ergocalciferol added to calcium on the risk of falls in elderly high‐risk women. is produced by our kidneys and in other tissues from less active precursors. most of our vitamin D supply is produced by our bodies upon exposure to sunlight. et al. Regarding its pivotal role in mineral metabolism. URL http://www. Consensus statement.ncbi. it is really a pre‐hormone which is transformed into a hormone in the body. But again. Med.ajcn. Supplemental vitamin D has now been repeatedly shown to help improve muscle mass and strength and thus help in the prevention of falls. Clin. 64 (3). Clin.org/cgi/reprint/44/6/863 (accessed 05. Int. 53 (11). it is vital that older people obtain higher amounts of vitamin D through their food or supplementation. or calcitriol.102 Several studies have shown a rapid reduction in falls among the elderly with administration of even 800 IU vitamin D. Another fascinating thing about vitamin D is that it directly nourishes muscles.ncbi. Arch. 105 Eufemio. et al. Ger..nih. L.04. Gallagher. URL: http://archinte.

04.. Even though vitamin D deficiency is common and vitamin D toxicity is rare. A. Calcium absorption varies within the reference range for serum 25–hydroxyvitamin D. see also our other articles: o Vitamin D: an old bone builder takes on new importance o Vitamin D: its benefits are more than ever imagined Return to table
Key vitamins for bone health — vitamins K1 and K2
While vitamin K is best known for its role in blood clotting.000 IU/day is absent in the literature.109 So let’s follow Dr. URL (summary): http://www.
20 Key bone‐building nutrients — an overview
the barest minimum needed to ensure system‐wide health. we need not worry about getting too much vitamin D from our body’s own internal production.1. URL: http://www. For most people. et al.org/cgi/content/full/73/2/288 (accessed 06.1517/14656566.107 Nevertheless. and evidence of toxicity in adults consuming more than 10. Gaby’s lead and delve a little deeper into its role in bone health. J..
Susan E. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. Am. Nutr. Nutr. it is this theoretical risk that made so many so leery of vitamin D supplementation for so long. 1994. R.com
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. this is strictly a theoretical concern. as this is the current (albeit outdated) “safe upper limit” set by US Food and Nutrition Board. supplemental vitamin D can have toxic effects. but more ideally. • For a comprehensive overview of this exciting new research. John Cannell. Am. since our body simply stops producing vitamin D when levels are adequate. URL: http://www. 1–12. J. Efficacy and safety of vitamin D intake exceeding the lowest observed adverse effect level. J.2008). Testing is easy. 9 (1). Vitamin K is required for the synthesis of osteocalcin. the bone protein matrix upon which calcium crystallizes… 42–146. 109 Gaby. 2003. 108 Vieth. without it bone would be
Heaney. and one of the most powerful tools there is to work with to achieve bone health. et al. 107 Cannell. et al. Review.2008). Brown.jacn.) It’s also of note that at extremely high levels. many people will need more than 2000 IU vitamin D daily to achieve this minimum adequate blood level. you may also wish to visit the Vitamin D Council website. • For further reading on vitamin D.108 Today we know precisely what levels in the blood are needed for optimal bone health: a minimum of 34 mg/mL. at least 50–60 mg/mL.22. Clin. at the Center for Better bones.04.betterbones. Pharmacother. Luckily. this nutrient also plays an important part in the maintenance of healthy bones. we recommend everyone have their vitamin D level tested using the 25(OH)D blood test.com/doi/abs/10. a nonprofit organization founded and directed by Dr.2008). Alan Gaby has suggested that vitamin K is as important to bone as calcium. Thus. In reality.106 (For more about this.expertopin.9. Coll.. R. see my blog entry on vitamin D and calcium.. Osteocalcin provides the structure and order to bone tissue.ajcn. Diagnosis and treatment of vitamin D deficiency.107 (accessed 05. Noted nutrition authority Dr.org/cgi/content/full/22/2/142 (accessed 06. NY 13057 www. 2008. 73 (2). 2001. it is important to get professional guidance and testing before supplementing at levels greater than 2000 IU per day. 22 (2). 288–294. Expert Opin.

Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age.22. 1989. 16 (10). Metab. Tsukamoto. Y. Endocrinol. 9 (1). Z.2008). Biochem. Int..pubmedcentral. L. Just as vitamin K is central to bone formation. 171– 172. 1268–1269. H. 18 (4). Electrochemical detection of depressed circulating levels of vitamin K1 in osteoporosis. URL (abstract): http://www. Endocrinol. 2001.2008).111 Vitamin K is not a single nutrient. 1988. 60 (6). Vitamin K levels fall during recovery from fracture.22. Blood. Effect of vitamin K2 (menaquinone–7) in fermented soybean (natto) on bone loss in ovariectomized rats. Tissue Int. Essentials of Clinical Nutrition. so it appears to play an important role in fracture healing.
20 Key bone‐building nutrients — an overview
fragile and easily broken. Molecul.13.2008). or MK–7.nlm.. Calcium. which is found in plant‐based foods.2008). Metab.. Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women. Yamaguchi.nlm. M. Yamachuchi. URL (abstract): http://www.nih.. Testing for vitamin K1: An osteoporosis “risk factor. 2007.22. longer lasting. 2006. 228 (1–2).2008).22. URL (abstract): http://www. Feldman.ncbi. & Ma. Postmenopausal osteoporosis CA‐47 study with vitamin K2.
Susan E. L.nih.14. NY 13057 www.112 The more we learn about K. which are produced by bacteria in fermented foods and to some minor extent in our intestinal tracts. Vitamin K also aids in the binding of calcium to the bone matrix110 — in essence. et al.com/content/klu/mcbi/2001/00000228/F0020001/00383053 (accessed 05..22. The two main groups that occur naturally are phylloquinone.. Takemura. the more we see how it takes on various forms and roles in the body.gov/pubmed/3998071 (accessed 05. et al. Metab.gov/sites/pubmed/14506950 (accessed 05.nih. URL (abstract): http://www. Braam. 19. it serves as the “glue” that binds calcium onto the skeleton. 113 Schurgers. URL (abstract): http://www.ncbi. et al. 731.nih. Bone Min.com/content/xgyn1c0mkl6frhen/ (accessed 05. 3279–3283. 23–29. J. 1985. Inhibitory effect of menaquinone–7 (vitamin K2) on osteoclast–like cell formation and osteoclastic bone resorption in rat bone tissues in vitro. [Prevention of osteoporosis by foods and dietary supplements. Clin. and it appears that this nutrient is actually drawn from the rest of the body to the site of fracture to speed fracture healing. But a new wave of research is now focusing on K2 — in particular the subset of K2 known as menaquinone–7. M.. This research documents the superior ability of MK‐7 over K1 to enhance both bone and heart health. 14–15. 17 (1).2008). In combination with vitamin D and calcium. URL (abstract): http://www. Intake of fermented soybean (natto) increases circulating vitamin K2 (menaquinone–7) and gamma‐carboxylated osteocalcin concentration in normal individuals. 1971. but the name given to a group of vitamins of similar composition. 2000.gov/pubmed/17012826 (accessed 05. 2007. Rev. But vitamin K2 is more bioavailable. Clin. M. J. 108 (8).. Osteoporos.nlm. et al. Philadelphia: F. Davis Co.ingentaconnect. both vitamins K1 and K2 increase bone quality. J. To date most of the research has been done on K1.113 Getting enough of the K2 forms of this
Wright. and the menaquinones. 21–26.betterbones.. A. and provides for greater increase in bone strength. 73 (1).nih.ncbi. (Jpn.. 111 Hart.nlm.2008). Bone Miner. URL: http://www.).ncbi.14. 963–972.” Int.gov/pubmed/17158229 (accessed 05. 39–49 (9). PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. Clin..] Clin. Brown. Calcif. 2003. or K1. URL (abstract): http://www. Nutr..springerlink. Cellul.com
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. or K2.ncbi. J. 1998.nlm. E. particularly green leafy vegetables. 18 (78). et al. Vitamin K‐containing dietary supplements: Comparison of synthetic vitamin K1 and natto‐derived menaquinone‐7. A. J.gov/articlerender.fcgi?tool=pubmed&pubmedid=17287908 (accessed 05. ISBN: 0803634315 Tomita.gov/pubmed/10874601 (accessed 05. 216–222.2008). “Kinnotsubu honegenki”: A fermented soybean (natto) with reinforced vitamin K2 (menaquinone‐7)] [In Japanese. 112 Knapen. et al..nih.

Vitamin K: The coagulation vitamin that became omnipotent.de/index. sulfa drugs. including those of cartilage and bone. and indeed. impaired fat absorption.
Cranenburg. and they are essential components of all membranes. Fatty acids also play multiple roles in bone structure. 2007. E. long‐term use of antibiotics can lead to vitamin K deficiency. 115 Krasinski. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. URL: http://www. just as they require certain vitamins and minerals. possibly by reducing production of pro‐inflammatory molecules called prostaglandins. Brown. and water. and certain liver diseases. culprits in vitamin K inadequacy include the freezing of foods. read my article on vitamin K — the overlooked bone builder and heart protector.114 (Read more about vitamin K research at the Better Bones Foundation. et al. rancid and hydrogenated fats. Am. EFA’s increase calcium absorption from the gut.com
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.. Fats are required for proper calcium metabolism. such as warfarin (Coumadin).17. radiation. and for everyday energy production. J. function. proteins. 120–125..ajcn. Nutr. To learn more. 41.. By compromising this process. URL (PDF): http://www. in part by enhancing the effects of vitamin D. for the maintenance and functioning of the brain. In fact. Thrombos. 98 (1). the role omega‐3 fatty acids play in countering inflammation is arguably their most bone‐critical mission.13. Return to table
Other key nutrient for bone health — essential fatty acids (EFA’s)
Conventional wisdom tells us we should cut the fat in our diet.115 Aside from oral antibiotic and anticoagulant use. et al.) Aside from getting K through dietary sources.
Susan E.2008). David Horrobin. But what we are just beginning to appreciate is that our bodies require more of certain fats. These fatty acids are essential for nerve functioning. These fats are called essential fatty acids because they are not produced by the body and must be consumed in the diet or by supplementation. Clin.php?id=1268&pii=th07070120&no_cache=1 (accessed 06. As explained by essential fatty acid researcher Dr.
20 Key bone‐building nutrients — an overview
vitamin has been found to be especially important for healthy bones in patients being treated with oral anticoagulants. too much of the wrong kinds of fat can be detrimental to bone health by decreasing calcium absorption.schattauer.betterbones. and development. On average. They also regulate and reduce urinary excretion of calcium. S. hormone production. 70–75. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. mineral oil laxatives. vitamin K can also be produced in the body by certain beneficial intestinal bacteria.2008). fiber. Haemostasis. NY 13057 www.org/cgi/reprint/41/3/639 (accessed 05. 1985. we Americans consume more than one‐third of our calories as fat.

the situation with protein is somewhat of a paradox — similar to that with fats. and protein is a major building block for bone. Return to table
Kruger. URL: http://www. S. Nutr.2008). While adequate protein intake is certainly necessary. 36 (2–3). Lipid Res. M. 117 Dawson–Hughes. D. too much is detrimental.betterbones. if not adequately balanced with alkalizing compounds of minerals like calcium. 773–779. B.116 Return to table
Other key nutrients in bone health — protein
When it comes to bone nutrition. including some high‐carb. While some protein is essential.nih.com
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. see my article on acid‐alkaline balance. the average person in the US consumes far too much protein in the form of meat and dairy products. which is not surprising since bone calcification must take place in the presence of a type of fat known as phospholipids. possibly by fomenting collagen synthesis.
20 Key bone‐building nutrients — an overview
EFA’s have also been found to increase calcium deposition in bone. Am. Prog. J. Finally. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Clin. magnesium.ajcn. but nutrient‐dense veggies like sweet potatoes and carrots. roughly one‐third to one‐half of our bone is living organic protein matrix! Protein malnutrition debilitates bone.org/cgi/content/full/75/4/773 (accessed 05. and essential fatty acids: A review. In this case the loss results from an increased acid load which our bodies must buffer daily by drawing calcium and other alkalizing mineral compounds from the bones.13. 2002. osteoporosis. For more information on chronic low‐grade metabolic acidosis. Not that either of these foodstuffs are bad per se — we just need to remember to balance them with plenty of alkalizing fruits and vegetables. & Harris. URL: http://www. Brown. potassium — can likewise lead to bone loss.2008). Calcium metabolism.nlm. Yet over‐consumption of dietary protein (think Atkins diet) — again. 131–151.. This excess animal protein intake leads to a state known as chronic low‐grade metabolic acidosis (CLGMA). Protein is beneficial for intestinal absorption of calcium..117 By weight. & Horrobin..ncbi. which actually washes calcium out of the body.. 1997. PhD • Center for Better Bones 605 Franklin Park Drive • East Syracuse. and can be a significant problem among the elderly in Western countries. essential fatty acids appear to improve bone strength.
Susan E.22. NY 13057 www. 75 (4).gov/pubmed/9624425 (accessed 05.

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