The correct nutrition to support good bone health is essential at all stages of life. In this article we cover the main vitamin and mineral nutrients that you will find most commonly referred to in respect of beneficial bone health. These nutrients are applicable from pregnancy through to old-age.
As we age reduced bone density risks such as Osteoporosis increase and a good diet and appropriate exercise are vital. This article also covers nutrition for bone health and growth in the early years and at the end we provide our health professionals osteoporosis booklet in pdf form. We also cover the importance of ‘synergy’ between certain vitamins and minerals where suitable intakes of two nutrients jointly support their beneficial health effects.
Bone Density and Ageing
Reduced bone density, once considered a problem for the older female, is now shown to be a condition impacting on both males and females and often occurring at a younger age than previously considered.
Peak bone mass is estimated to be between the ages of 20 to 30 years. As we age, a gradual decline of bone mineral density occurs, with an increased rate of loss frequently experienced as we approach our fifties, and beyond. Both men and women are at risk of reduced bone density, however women experience an increased rate of loss after the menopause due to hormonal changes.
Bone is a dynamic tissue
Although the length and shape of bone does not normally change after ossification (bone formation) is complete, bone tissue is continually being remodelled and replaced when damaged throughout life. Indeed our bone is a dynamic tissue that is continuously being broken down and restructured.
Osteoblasts are the bone forming cells which secrete collagen and other constituents of bone tissue and continue to lay down osteoid (bone matrix) for mineralization. Remodelling of bone is carried out by the osteoclasts, which are responsible for absorption and removal of bone. A fine balance of osteoblast and osteoclast activity maintains normal bone structure.
Factors affecting bone health
Certain factors can affect this delicate balance that provides good bone structure health – illness, diet, lack of exercise or certain medications are all good examples. Fortunately for the healthy individual this positive bone structure balance is maintained, providing healthy and strong bones.
Diet throughout life is of paramount important for bone health. Whilst a diet deficient in important nutrients (for bone health) is often cited as a reason for decreased bone health a diet high in protein, saturated fats, alcohol, salt and separately impaired digestive function can negatively impact on the absorption of nutrients important for healthy bones.
Exercise throughout life is very important for our bones. And a sensible exercise regime needs to be maintained (or undertaken) as we age and osteoporosis becomes a greater risk. Regular and gentle walking is often cited as an excellent example – you don’t need to maintain any form of ‘aggressive’ exercise to support bone health.
Those undertaking reduced levels of physical exercise or the less mobile are unfortunately at particular risk for reduced bone renewal and remodelling.
Sunlight is equally important for bone health (and health in general) and this fact is fortunately gaining greater public recognition. Sunlight is needed to provide our main supply of Vitamin D, which is mostly made in our skin by exposure to sunlight; Vitamin D plays a pivotal role in bone health as it contributes to the maintenance of normal bones. Naturally one should always be mindful of not getting too much sun.
Bone Health from Preconception and Childhood Onward
Bone health starts at preconception with emerging evidence pointing to the importance of good nutrition in the mother prior to conception itself. Recently released research in the fields of nutrigenomics and epigenetics indicate how important the right nutrients are from the earliest stages of life.
The nutrients that we discuss in this article which most typically are calcium, magnesium, vitamins D and K are so relevant to bone growth and health at all stages of life. In pregnancy the mother-to-be needs excellent levels of appropriate nutrition for her foetus and herself. And post birth this remains the case into breastfeeding and the diet of the child.
For example vitamin D is needed for normal growth and development of bone in children. For children one consequence of not having enough vitamin D is it can cause their bones to soften and can lead to rickets (a bone development disease in children). Calcium is essential for making the baby’s bones and teeth. Increased amounts (above the recommended daily allowance) of Calcium may be needed for women during pregnancy and lactation.
What is Osteoporosis?
Osteoporosis is defined as a decreased bone mass with deterioration of the structure of the bone, resulting in increased fragility of bones and resultant fractures. ‘Osteopenia’ is defined as a reduced bone mass due to inadequate synthesis; bone mass density, however, is not sufficiently low to be classified as osteoporosis. More details can be found in our pdf below.
Bone Health Nutrition
Suitable levels of calcium, magnesium, vitamin K and vitamin D are the four main vitamin and mineral nutrients that you will find most commonly referred to in respect of beneficial bone health.
Magnesium is an essential mineral with nearly 70% of the body’s supply located in the bones. Magnesium aids in bone growth and is necessary for the proper functioning of muscles. Magnesium also helps promote the absorption and metabolism of other minerals and vitamins in our body and importantly regulates the transport and metabolism of calcium.
Magnesium has the permitted health claim of contributing to the maintenance of normal bone and teeth. For good natural food sources of magnesium see the list at the end of this article.
Vitamin K is a ‘fat-soluble’ vitamin that is an important co-factor to proteins which are essential for the bone building process. There are two naturally occurring forms of vitamin K and these are ‘K1’ and ‘K2’. Vitamin K has the permitted health claims of contributing to normal blood clotting and the maintenance of normal bones.
Vitamin K1 is the form most commonly consumed in the diet and found in green vegetables such as spinach, kale, broccoli etc. Vitamin K1 is now coming toward the fore in terms of fighting Osteoporosis as the vitamin keeps our blood vessels from calcifying, whilst helping our bones retain calcium and develop appropriately.
Vitamin K2 content in food is more ‘elusive’ the best sources being fermented foods such as ‘natto’, cheese and sauerkraut. The ‘action’ of vitamin K2 in our body is to go straight to bones, vessel walls and tissues (but not the liver). Vitamin K2 like K1 is recognised as being beneficial towards osteoporosis.
When it comes to taking a supplement comprising vitamin K we would always recommend that it contains vitamin K in the form of K2. Vitamin K2 is the most bio-effective supplement form of this vitamin.
Vitamin K2 & Osteoporosis
Recent Japanese trials have indicated that vitamin K2 can reverse bone loss and in some cases increases bone mass in people with Osteoporosis. The evidence of further Japanese studies were pooled and the trial evidence shows that vitamin K2 supplementation produces a 60% reduction in vertebral fractures and an 80% reduction in hip and other non-vertebral fractures.
So how does vitamin K, and in particular vitamin K2, lead to bone health and the fight against Osteoporosis? Without being too scientific this is the process:
> Osteoblasts are cells responsible for bone formation
> Osteocalcin is a protein produced by our Osteoblasts
> Osteocalcin is utilised within our bones as an integral part of the bone-forming process
> Osteocalcin must be ‘carboxylated’ before it can be effective in the bone forming process
> Vitamin K functions as a ‘co-factor’ for the enzyme that catalyzes the ‘carboxylation’ of Osteocalcin
> Vitamin K2 has been found to be far more effective in this process than Vitamin K1
Separately recent research over a three year period indicated that ’Three-year low-dose menaquinone-7 (Vitamin K2) supplementation helps decrease bone loss in healthy postmenopausal women’ The research appears to demonstrate that supplements of natural vitamin K2 (menaquinone-7) prevent bone loss and improve bone strength in post-menopausal women. A study abstract of the research comments:
“We have investigated whether low-dose vitamin K2 supplements (menaquinone-7, MK-7) could beneficially affect bone health. Next to an improved vitamin K status, MK-7 supplementation significantly decreased the age-related decline in bone mineral density and bone strength. Low-dose MK-7 supplements may therefore help postmenopausal women prevent bone loss.” (link below).
Vitamin D is a very important nutrient in respect of bone health, due to its role in the maintenance of bone structure. It is essential for the absorption of minerals such as calcium, magnesium and phosphorus, resulting in an integral role in the mineralisation of bones and teeth. Vitamin D is essential for the uptake and distribution of calcium and promotion of bone mass.
Vitamin D has the permitted health claims of contributing to the maintenance of normal bones, the utilisation of calcium and phosphorus and normal blood calcium levels. Calcium and vitamin D are needed for normal growth and development of bone in children.
Vitamin D is mostly made in our skin by exposure to sunlight. Hence Vitamin D is termed ‘the sunshine vitamin’ and to put it bluntly – no sunshine, not enough Vitamin D. As we age our body does not convert vitamin D from sunlight as easily; hence government advice that those over 65 years take vitamin D supplements.
In a supplement form vitamin D is available as ‘D2’ and ‘D3’; metabolism of these nutrients is undertaken differently, and vitamin D3 is considered to offer increased bioavailability. When it comes to supplementing with vitamin D we would always recommend vitamin D3 and it is the only form we use in our supplement formulas.
The following foods are good natural sources of vitamin D: salmon, mackerel, tuna, sardines, milk, eggs, beef, liver and Swiss cheese.
Calcium is an important mineral in bone formation; it is important in the development of bones throughout childhood and teenage years and assisting in achieving a peak bone mass essential for maintaining bone density as we age. Calcium levels remain an important consideration for those with a reduced intake of dietary calcium.
Recent research has raised concerns with calcium supplementation and the potential for cardio vascular problems, particularly for men. When looking at supplementing with calcium we would not recommend the common calcium carbonate supplements which are not soluble in the hcl acid of the stomach. High doses are therefore likely to increase the risk of kidney stones and arterial calcification. Further details on this topic are to be found in our pdf below.
Calcium has the permitted health claims ‘calcium is needed for the maintenance of normal bones and teeth’. ‘Calcium and vitamin D are needed for normal growth and development of bone in children.’ For good natural food sources of calcium see the list at the end of this article.
The Synergy of Nutrients
Vitamin D contributes to the normal absorption & utilisation of calcium and phosphorus, and the action of vitamin D in supporting the two minerals underlines the importance of both vitamin D levels for bone health and it is also a good example of nutritional ‘synergy’. In this case calcium is recognised as being important for bone health yet with inadequate intake of vitamin D (in this example) the positive effect of the calcium will be more limited.
Separately, evidence suggests enhanced benefits for bone health by ensuring combined and good levels of both vitamins D and K2. This would seem logical as vitamin D supports bone development by absorbing calcium whilst it would appear that vitamin K2 has an important role in ‘directing’ the calcium to our skeleton; this has the added benefit of preventing the calcium being deposited where it is not wanted (e.g. the arteries).
A recent study on the combined roles of vitamin D and K2 on slowing the progression of arterial calcification would seem to support this ‘synergistic’ scenario between the vitamins. It would also indicate the importance of vitamin K for those ingesting good levels of vitamin D and calcium – as, apart from the perceived beneficial role in bone health, without the K2 the calcium is potentially more likely to increase arterial calcification.
(Further details on arterial calcification are to be found in our pdf below).
Additional Nutrients for Bone Health
There are other nutrients popularly associated with supporting bone health for example Omega 3 which is found in fish and seafood and can be obtained in supplement forms such as fish and krill oils. Omega 3 is also frequently taken by people for joint support too, however there are no ‘permitted’ health claims for Omega 3 in respect of bone or joint health (there are permitted health claims for heart and vision health etc.).
Omega 3 ‘essential fatty acids’ contain the beneficial ‘DHA’ (Docosahexaenoic Acid) and ‘EPA’ (Eicosapentaenoic Acid). It has been suggested that the Omega 3 fatty acids appear to increase calcium absorption from the gut and this would be beneficial to bone health. Research has also looked at the relationship and relevance of the ‘Omega 3 / Omega 6’ ratio in many modern diets, with the preponderance typically being Omega 6 fatty acids. This ratio may have many negative health impacts including on bone health.
Vitamin C and the minerals Zinc and Manganese all additionally have the permitted health claims of ‘contributing to the maintenance of normal bones’ and this again highlights the need for a healthy, balanced and varied diet.
Many people seeking to support good bone health, particularly women in their fifties onward, also consume a diet with good levels of ‘Soy Isoflavones’; these nutrients are also available in a supplement form. Soy isoflavones are a flavonoid, the structure of which is believed to mimic the hormone oestradiol working as a hormonal balancer. Foods rich in the plant phyto-oestrogens such as pulses, beans and soya are believed to assist in maintaining the hormonal balance which when disrupted can contribute to greater risks of osteoporosis in women post menopause.
Menopause and Osteoporosis
Post-menopausal women are particularly at risk of bone density loss / osteoporosis, and unfortunately this often leads to bone fractures. Prior to menopause oestrogen is important for bone health and there is a direct relationship between the lack of oestrogen during perimenopause and menopause (and beyond) and the greater risk of Osteoporosis. We have a good article specifically on this topic on our blog and the link is below.
Supplements for Bone Health
There are of course multi-vitamin and mineral supplements available specifically formulated for supporting bone health. We would recommend those comprising the key nutrients we have discussed: Vitamins K2 and D3, plus the minerals calcium and magnesium. Also bear in mind our comments regarding calcium supplementation.
Always consult with your doctor, a suitably qualified health practitioner, or directly with a reputable supplement company if you have any queries regarding choosing a supplement to take. The supplements should always be tailored to your age, gender and with relevancy to any pre-existing medical conditions.
Vegetarians and Vegans
Vegetarians, Vegans and those on restricted diets should be mindful that they are getting good levels of the relevant nutrients for bone health. Where common rich natural food sources are typically dairy, fish and meat (for example) and these are not present suitable alternatives need to feature in the diet or consideration for inclusion in a supplement form.
This is important at all stages of life for such groups of people and none more so than during pregnancy. The Vegan and Vegetarian Societies, for example, provide lots of helpful information on this topic available online.
We can see that the common sense approach to good health throughout life is key to also maintaining good bone health. A sensible and varied diet rich in fruit and vegetables, sensible and regular exercise and getting outdoors for emotional nourishment and vitamin D. A balanced diet is always so important for all aspect of health, and the examples in this article demonstrate the need for ‘synergistic’ nutrients in the diet so that their beneficial effects are maximised.
Good natural food sources: Calcium & Magnesium
In general, rich natural food sources of calcium include low fat dairy products, dark green leafy vegetables, broccoli, canned fish with bones, cottage cheese, cooked dried beans, peas, tofu, grains, brown rice, seeds (sesame, sunflower), nuts (hazel, almond, Brazil, walnut, pistachio) and seaweeds.
Magnesium is widely distributed in foods, being found chiefly in fresh, green vegetables. Other excellent sources include raw, un-milled wheat germ, soya beans, milk, whole grains, seafoods, figs, corn, apples and oil-rich seeds and nuts, especially almonds. Fish, garlic, tofu, peaches, apricots and lima beans are also good sources.
However magnesium is easily depleted from our diet by food processing, cooking and food refining techniques.
If you have any questions regarding this article or any other health matters please do contact us on 01684 310022 (Monday to Friday 9.00am to 5.00pm).
Now University: Improving Bone Health in Postmenopausal Women
Springer: Abstract; Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women
Cytolpan Blog: Vitamin K2 – For Cardiovascular Health, Fighting Cancers and Osteoporosis?
Cytolpan Blog: Menopause and Osteoporosis
You can also download the PDF document with the following link (sorry – it may not work for every browser): Cytoplan Osteoporosis Leaflet.pdf