Nutrients for Bone Health – Beyond Calcium and Vitamin D

If you’ve read the blog posts on Osteoporosis and Plant Based Diets and Bone Health you might be keen to find out which specific nutrients can support the health of your teeth and bones. Here we highlight the key nutrients for bone health, although the importance of a healthy diet and lifestyle cannot be over-estimated when it comes to the health of your skeleton.

Bones and Calcium

Calcium is the most abundant mineral in your body; most of it is in our bones and teeth. Our bones undergo constant remodelling as part of bone formation and maintenance. As we age, our bones tend to lose more calcium than they retain, which increases the risk of osteoporosis. This is especially common among postmenopausal women due to the hormonal changes that occur around the time of the menopause.

Getting sufficient calcium is important, but high doses of calcium do not prevent fractures.

Some of the best plant sources of calcium are:

• Green vegetables such as kale, lettuce, rocket and broccoli. Green leafy vegetables are also a rich source of vitamin K1, which affects osteoblasts and osteocalcin metabolism (1).
• Beans such as chickpeas, black beans and green peas.
• Whole grains such as quinoa, amaranth and oats.
• Dried fruit such as figs, apricots and raisins.
• Nuts and seeds such as chia seeds, tahini, almonds and hazelnuts.
• Soy foods such as edamame beans, tofu and tempeh.

Magnesium

Magnesium is important for the utilisation of calcium and bone formation (2). Foods containing magnesium include green vegetables, pumpkin seeds, tahini, cacao, bananas, sea vegetables, almonds, hazelnuts and alfalfa sprouts.

Vitamin D3

Vitamin D plays an important part in protecting bones as it is needed for the body to absorb calcium. The best source of vitamin D is sunlight. Spending some time in the sun every day with skin exposed is recommended, but take care not to burn. In the UK supplementation is recommended from September until March.

If you take vitamin D supplements, it’s worth getting your blood levels checked periodically to ensure that you are not overdosing.

Vitamin K2 and D3

Supplementing with vitamin K2 and D3 has been shown to have positive effect on bone mineral density (3,4).

Osteoporosis is one of the chief complications of anorexia nervosa. Supplementing anorexic patients with vitamin D3 or vitamin K2 prevents the further decrease in bone mineral density (5).

Vitamin B12

Impaired vitamin B12 status negatively affects bone mineral density (6). Pernicious anaemia, caused by either inadequate intake of vitamin B12, or insufficient absorption, is a risk factor for osteoporosis. Studies have found that B12 deficiency is especially a risk factor among older women. 

As vitamin B12 is only found in an absorbable form in animal foods vegans and vegetarians may need to supplement or eat foods fortified with it.

Boron and Bone Health

Boron plays an important role in calcium metabolism and growth and maintenance of bone tissue. Studies suggest that supplementing with 3mg a day of boron is beneficial for bone health (7).

Zinc and Bone Health

Zinc plays a role in the growth and maintenance of healthy bones. Serum zinc levels have been found to be lower in patients with osteoporosis compared with controls. Zinc supplementation may improve bone mineral density (8). 

Protein – is needed for a healthy bone matrix. Plant sources of protein include tofu, tempeh, lentils, beans, peas, quinoa, amaranth, nuts, seeds and nut butters.

Gut Microbiome and Bone Health

It is becoming increasingly clear that the gut, and specifically the microbiome, may affect bone health by modulating bone resorption and bone formation. The gut microbiota also affect vitamin D3 levels and calcium absorption.

There are many factors that affect the gut microbiota including age, sex, genetics, immune status, geography, diet, prebiotics, probiotics,, living conditions, diseases and drugs (9,10,11).

Probiotic supplements are one way to improve the balance of gut organisms. Fermented foods such as yoghurt, kefir, miso, natto, kombucha, kimchi and sauerkraut are also valuable sources of probiotics that can be included daily in the diet.

Soy Isoflavones and Bone Health

Soy isoflavones and soy protein may have positive effects on bone metabolism and may inhibit bone loss (12,13,14).

Multi-Nutrients and Bone Health

Menopausal women at risk of osteoporosis or untreated osteopenia were given a food product enriched with calcium, vitamin D, vitamin K, vitamin C, zinc, magnesium, L-leucine and a probiotic (Lactobacillus plantarum 3547) for 24 weeks. Compared to the control group the women eating the enriched food showed a significantly increased bone mass. They also maintained their bone mineral density while the control group had decreased bone mineral density by the end of the study (15).

Other nutrients needed for healthy bones include: the B vitamins, vitamin C, vitamin E, manganese, biotin and the essential fats.

For a delicious bone building superfood salad recipe see post Quinoa Salad with Tahini Dressing.

References

1. Bone Rep. 2020 Apr 26;12:100274. The effects of vitamin K-rich green leafy vegetables on bone metabolism: A 4-week randomised controlled trial in middle-aged and older individuals. Sim M et al.

2. Steroid Biochem Mol Biol. 2019 Oct;193:105400. Anabolic effects of vitamin D and magnesium in aging bone. Erem S et al.

3. Calcif Tissue Int. 2020 May;106(5):476-485. Effect of Low-Dose Vitamin K2 Supplementation on Bone Mineral Density in Middle-Aged and Elderly Chinese: A Randomized Controlled Study. Zhang Y et al.

4. Keio J Med. 2003 Sep;52(3):147-50. Treatment with vitamin D3 and/or vitamin K2 for postmenopausal osteoporosis. Iwamoto J et al.

5. Clin Calcium. 2018;28(7):979-986. [Body weight and bone/calcium metabolism. Bone and calcium metabolism in anorexia nervosa]. Hotta M.

6. Am J Clin Nutr. 2014 Jul;100 Suppl 1:469S-75S. Bone nutrients for vegetarians. Mangels AR

7. J Trace Elem Med Biol. 2020 Jun 6;62:126577. Pivotal role of boron supplementation on bone health: A narrative review. Rondanelli M et al.

8. Biol Trace Elem Res. 2020 May 25. Is Zinc an Important Trace Element on Bone-Related Diseases and Complications? A Meta-analysis and Systematic Review from Serum Level, Dietary Intake, and Supplementation Aspects. Ceylan MN et al.

9. Curr Osteoporos Rep. 2020 Jun;18(3):273-284. Are Probiotics the New Calcium and Vitamin D for Bone Health? Rizzoli R et al.

10. Aging Clin Exp Res. 2019 Jun;31(6):743-751. Nutritional influence on bone: role of gut microbiota. Rizzoli R.

11. Curr Osteoporos Rep. . 2015 Dec;13(6):363-71. Prebiotic and Probiotic Regulation of Bone Health: Role of the Intestine and its Microbiome. McCabe L et al.

12. J Nutr Sci Vitaminol. 2019;65(4):335-342. Anti-Osteoporotic Effect of Soy Isoflavones Intake on Low Bone Mineral Density Caused by Voluntary Exercise and Food Restriction in Mature Female Rats. Yanaka K et al.

13. 2020 Jul 9;12(7):2043. The Combination of Soy Isoflavones and Resveratrol Preserve Bone Mineral Density in Hindlimb-Unloaded Mice. Tousen Y et al.

14. Food Funct. 2020 Jan 29;11(1):544-551. Is soy protein effective in reducing cholesterol and improving bone health? George KS et al.

15. 2020 Jul 24;12(8):E2203. A Dairy Product to Reconstitute Enriched with Bioactive Nutrients Stops Bone Loss in High-Risk Menopausal Women without Pharmacological Treatment. Morato-Martinez M et al.