Sources of Magnesium : Chocolate, green leafy vegetables such as spinach , legumes, milk, yogurt and milk products, nuts, seeds, whole grains, and hard water.
It is added to some fortified breakfast cereals and foods. Phosphorus is a mineral contained in each cell in our body. Most phosphorus is in the bones and teeth, and some is in your genes. Your body needs phosphorus to make energy and to carry out many important chemical processes. Phosphorus then builds up in the blood and can affect bone health and worsen kidney disease, and it might increase the risk of death.
Consuming less phosphorus and eating more foods containing calcium might help prevent the side effects of high phosphorus levels in people with severe chronic kidney disease. Sources of Phosphorus: Cereals, dairy products, eggs, fish, meat, poultry, legumes lentils, kidney beans, peas , nuts, and grains bread, tortillas, brown rise, oatmeal , and vegetables such as potatoes and asparagus.
Your body needs potassium for almost everything it does, including proper kidney and heart function, muscle contraction, and nerve transmission. People who have high intakes of potassium from fruits and vegetables seem to have stronger bones. Eating more of these foods might improve your bone health by increasing bone mineral density a measure of bone strength.
Getting too little potassium can increase blood pressure, deplete calcium in bones, and increase the risk of kidney stones. The diets of many people in the United States provide less than recommended amounts of potassium. Even when food and dietary supplements are combined, total potassium intakes for most people are below recommended amounts. Sources of Potassium : Avocados, bananas, beans, broccoli, cereals, dried apricots, lentils, milk and yogurt, nuts, soybeans, orange juice, prunes, raisins, spinach, and tomatoes.
Zinc is found in cells throughout the body. It helps the immune system fight off invading bacteria and viruses. The body also needs zinc to make proteins and DNA, the genetic material in all cells. During pregnancy, infancy, and childhood, the body needs zinc to grow and develop properly. Zinc also helps wounds heal and is important for proper senses of taste and smell. Most people in the United States get enough zinc from the foods they eat.
However, certain groups of people are more likely than others to have trouble getting enough zinc:. Sources of Zinc : Beans, eggs, fortified cereals, legumes, milk and dairy products, , poultry, red meat, poultry, fish and seafood crab, lobsters, oysters , and whole grains. As a service to our readers, American Bone Health provides access to our library of archived content. Please note the date of the last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Share on facebook. Share on twitter. Share on linkedin. Share on email. Share on print. BMD significantly increased in all three treatments compared to the control group. Between the three diet groups, a significant effect of phylloquinone or MK-7 on BMD remained only at the lumbar spine not at hip and total body after controlling for serum vitamin D and calcium intake. Overall, the positive influence on BMD was attributed to the combined effect of diet and lifestyle changes associated with the intervention, rather than with an isolated effect of phylloquinone or MK-7 Even if phylloquinone and menaquinones have different effects on bone health, there is only limited evidence to suggest that supplementation with one form of vitamin K, rather than the other, would be more effective in preventing age-related bone loss in humans, especially since the body can convert phylloquinone into menaquinone The US National Osteoporosis Foundation does not support the use of vitamin K supplements because the evidence of effectiveness in the prevention of osteoporosis and fracture is too limited and because their use may cause serious adverse effects in individuals at risk of blood clots and those taking blood-thinning medications Both vitamin A deficiency and excess can negatively affect skeletal health.
Vitamin A deficiency is a major public health concern in developing nations where it is the leading cause of preventable blindness. Early animal studies demonstrated that both vitamin A deficiency and excess at critical periods of development caused bone abnormalities due to impaired osteoclastic and osteoblastic activities Very high intakes of vitamin A as retinol from animal sources, fortified food, and supplements can be toxic.
In animals, vitamin A toxicity hypervitaminosis A is associated with poor bone growth, loss of bone mineral content, and increased rate of fractures However, there is some concern that long-term vitamin A intakes at levels not much higher than the RDA have a negative effect on bone 23 , , Methods to assess vitamin A intake and status are notoriously unreliable , and concerns regarding the potential impact of habitual high vitamin A intakes on bone health may require measuring vitamin A status using sensitive markers of body stores At this time, striving for the recommended dietary intake RDA of vitamin A see Table 1 is an important and safe goal for optimizing skeletal health.
We often discuss the mineral aspect of bone, but the organic matrix is also an integral aspect of bone quality and health. Type I collagen fibers twist around each other in a triple helix and become the scaffold upon which minerals are deposited. Vitamin C ascorbic acid is a required cofactor for the hydroxylation of lysine and proline during collagen synthesis by osteoblasts In guinea pigs, vitamin C deficiency is associated with defective bone matrix production, both quantity and quality Unlike humans and guinea pigs, rats can synthesize ascorbic acid on their own.
Using a special strain of rats with a genetic defect in ascorbic acid synthesis Osteogenic Disorder Shionogi [ODS] rats , researchers can mimic human scurvy by feeding these animals a vitamin C-deficient diet Ascorbic acid-deficient ODS rats have a marked reduction in bone formation with no defect in bone mineralization More specifically, ascorbic acid deficiency impairs collagen synthesis, the hydroxylation of collagenous proline and lysine residues, and osteoblastic adhesion to bone matrix In observational studies , vitamin C intake and status are inconsistently associated with bone mineral density and fracture risk In addition, data from observational studies with a prospective design i.
An analysis of data from elderly adults mean age, 75 years followed for about 17 years in the Framingham osteoporosis study showed an inverse relationship between total dietary plus supplemental intake of vitamin C and the risk of hip fracture or non-vertebral osteoporotic fracture. However, the association ceased to be significant after adjusting for the confounding effect of potassium intakes Another analysis of a younger sub-cohort 4, adults; mean age, However, an inverse relationship was reported between plasma concentrations of ascorbic acid and risk of hip fracture in men but not in women A double-blind , placebo -controlled trial was performed with the premise that improving the collagenous bone matrix will enhance the efficacy of mineral supplementation to counteract bone loss Sixty osteopenic women 35 to 55 years of age received a placebo comprised of calcium and vitamin D 1, mg calcium carbonate and IU vitamin D or this placebo plus CB6Pro mg vitamin C, 75 mg vitamin B 6 , and mg proline daily for one year.
In contrast to controls receiving calcium plus vitamin D alone, there was no bone loss detected in the spine and femur in the CB6Pro group A link between homocysteine and the skeleton was first noted in studies of hyperhomocysteinemia , a metabolic disorder characterized by exceedingly high concentrations of homocysteine in the plasma and urine.
Individuals with hyperhomocysteinemia exhibit numerous skeletal defects, including reduced bone mineral density BMD and osteopenia Moreover, in vitro and animal studies suggest that elevated homocysteine concentrations might decrease bone quality and increase bone resorption through various mechanisms, including i inhibiting the expression of lysyl oxidase, an enzyme involved in stabilization of collagen fibers; ii stimulating osteoclast formation and activity; and iii reducing bone blood flow reviewed in The effect of more subtle elevations of plasma homocysteine on bone health is more difficult to demonstrate, and observational studies in humans report conflicting results , Some report an association between elevated plasma homocysteine and fracture risk , while others find no relationship Folate , vitamin B 12 , and vitamin B 6 help regulate circulating homocysteine concentrations; thus, efforts to reduce plasma homocysteine concentrations by meeting recommended intake levels for these vitamins may benefit bone health In addition, because vitamin B 6 is a cofactor for lysyl oxidase, vitamin B 6 deficiency may limit collagen cross-linking and reduce bone strength A few intervention trials evaluating the homocysteine-lowering effect of B-vitamins on bone health outcomes have been conducted.
The results showed no significant difference between treatment and placebo on the risk of skeletal fracture. Compared to placebo, daily consumption of 2 mg folic acid, 25 mg vitamin B 6 , and 0. Supplementation with B vitamins also failed to increase the time before the first fall and to prevent the age-related decline in physical performance and handgrip strength Finally, a pooled analysis of data from two randomized controlled interventions — the Norwegian Vitamin Trial NORVIT; 3, participants and the Western Norway B Vitamin Intervention Trial WENBIT; 3, participants — showed no difference in risk of hip fracture during trials mean, 3 years or extended follow-ups mean, 10 years between participants assigned to receive either folic acid 0.
During the extended follow-ups, there was a significant increase in hip fracture risk in groups supplemented with vitamin B 6 compared to groups without vitamin B 6. However, this result should be considered with caution because these trials conducted in subjects with coronary heart disease were not designed or powered to assess bone fracture incidence It is important to note that the available data on the effects of lifestyle factors on bone health come primarily from observational studies ; thus, interpretation of associations is limited by potential confounding.
Specifically, factors that are associated with the exposure and have an effect on the outcome under study may not always be identified and accounted for i. For example, a study may find that coffee consumption is associated with lower bone mineral density BMD ; however, because smoking is often associated with coffee consumption, smoking may have confounded distorted the observed association between coffee intake and risk of low bone mass.
Several meta-analyses have been conducted to assess the relationship between cigarette smoking and bone health. After pooling data from a number of similar studies, there is a consistent, significant reduction in bone mass and increased risk of fracture in smokers compared to non-smokers The effects were dose-dependent and had a strong association with age. Beyond the direct effect of tobacco, unhealthy lifestyle habits and low body weight present in smokers may also contribute to the negative impact on bone health , Additionally, smoking leads to alterations in hormone e.
The deleterious effects of smoking on bone appear to be reversible. Recent meta-analyses of prospective cohort studies found a significant association between cigarette smoking and risk of hip fracture in current but not in former smokers , Thus, efforts to stop smoking are likely to benefit many aspects of general health, including bone health. Chronic light alcohol intake is associated with higher bone density and lower bone loss over time This level of intake translates to one drink per day for women and two drinks per day for men, with one standard drink containing 10 g of ethanol.
At the other end of the spectrum, chronic alcoholism has a documented negative effect on bone and increases fracture risk Alcoholics consuming to g of ethanol per day have low bone mineral density , impaired osteoblastic activity, and metabolic abnormalities that compromise bone health , In addition, a meta-analysis of 18 prospective cohort studies , including more than 3.
Moderate alcohol consumption The results of early controlled studies in humans indicated that coffee and caffeine consumption decreased the efficiency of calcium absorption, resulting in a loss of about 4 to 6 mg of calcium per cup of coffee , This effect could be offset by as little as one or two tablespoons of milk There is little evidence to suggest detrimental effects of coffee on bone health in populations with adequate calcium intakes Results from observational studies that examined associations between coffee intakes and bone mineral density have been mixed Two meta-analyses of observational studies reported no significant associations between coffee intake and risk of hip fracture , Current evidence is scarce to suggest that coffee consumption could increase the risk of bone loss and fracture.
Physical activity is highly beneficial to skeletal health across all stages of bone development. Regular resistance exercise helps to reduce risk of osteoporotic fracture for two reasons: It both directly and indirectly increases bone mass, and it reduces falling risk by improving strength, balance, and coordination Physical activity increases bone mass because mechanical forces imposed on bone induce an adaptive osteogenic bone-forming response.
Bone adjusts its strength in proportion to the degree of bone stress 1 , and the intensity and novelty of the load, rather than number of repetitions or sets, matter for building bone mass Exercise recommendations for adults to maintain bone health are listed in Table 2.
Finally, the ability of the skeleton to respond to physical activity can be either constrained or enabled by nutritional factors. For example, calcium insufficiency diminishes the effectiveness of mechanical loading to increase bone mass, and highly active people who are malnourished are at increased fracture risk , Thus, exercise can be detrimental to bone health when the body is not receiving the nutrients it needs to remodel bone tissue in response to physical activity.
Micronutrients play a prominent role in bone health. The emerging theme with supplementation trials seems to be that habitual intake influences the efficacy of the intervention. In other words, correcting a deficiency and meeting the RDAs of micronutrients involved in bone health will improve bone mineral density BMD and benefit the skeleton see Table 1.
To realize lasting effects on bone, the intervention must persist throughout a lifetime. At all stages of life, high impact and resistance exercise in conjunction with adequate intakes of nutrients involved in bone health are critical factors in maintaining a healthy skeleton and minimizing age-related bone loss.
There is no consensus regarding supplementation with calcium and vitamin D in older adults as a preventive strategy against osteoporosis , falls, or fractures. Although low dietary vitamin K intake is associated with increased fracture risk , randomized controlled trials have generally not supported a direct role for vitamin K supplementation in fracture risk reduction.
The other micronutrients important to bone health phosphorus, fluoride, magnesium, potassium, sodium, and vitamin C have essential roles in bone, but clinical evidence in support of supplementation beyond recommended levels of intake to improve BMD or reduce fracture incidence is lacking.
Many Americans, especially the elderly, are at risk of deficiencies for several micronutrients Striving for the recommended dietary intakes of nutrients that are critical for bone health is an important and safe goal for optimizing skeletal health and limiting age-related bone loss. Originally written in August by: Giana Angelo, Ph.
Updated in November by: Barbara Delage, Ph. Reviewed in December by: Connie M. Weaver, Ph. The update of this article was supported by a grant from Pfizer Inc. Textbook of medical physiology. Philadelphia: W. Saunders; Heaney RP. Bone biology in health and disease. Modern Nutrition in Health and Disease. The relative contributions of age and years since menopause to postmenopausal bone loss.
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BMC Med. Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis. Dietary sources of manganese include cereals, nuts, pineapples, beans, mollusks clams, oysters, mussels , dark chocolate, cinnamon, and tea.
Excessive intake of manganese is associated with cognitive disorders in adults and children [ 78 , 79 ]. In spite of this information, some daily multi-vitamins provide mg of additional manganese. The Recommended Daily Allowance of copper is 0. However, dietary copper is available in a wide variety of foods including meats, seafood, nuts, grains, and cocoa products.
The average American consumes 1. Strontium is another nutritional supplement that should be questioned as a bone health product. Strontium is not an essential nutrient and it displaces calcium in bone [ 81 ]. Strontium has gained attention for bone mineralization in part because it increases bone density as measured by x-ray tests and DXA Scan [ 82 , 83 ].
However, this effect is partly caused by the strontium itself because strontium is a heavier element than calcium. Strontium is considered an alkaline earth metal with an atomic weight of That makes it much heavier than calcium and it replaces natural calcium in bone.
This gives the DXA scan a denser appearance because strontium absorbs the x-rays [ 83 ]. The x-ray absorbing properties of strontium gave rise to its use in early color television tubes so that x-rays would be absorbed by the strontium and prevent irradiation of viewers [ 84 ]. Strontium also accumulates in the body and remains there long term [ 82 ]. Therefore, strontium may need more evaluation before it becomes a routine treatment of osteoporosis. Nutritional needs for bone health can be met with proper food choices.
Regular exercise is also important for bone health. Modest amounts of zinc supplementation may be appropriate for vegetarians and for older individuals. However, routine supplementation with zinc, manganese, copper and other metals is generally unnecessary, and excessive supplementation may be harmful. Supplementation with strontium should also be questioned until long-term risks and benefits are better understood. The authors thank Kenneth J. Koval, M. Haidukewych, M. National Center for Biotechnology Information , U.
Journal List Open Orthop J v. Open Orthop J. Published online Apr 5. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC.
Abstract Osteoporosis and low bone mineral density affect millions of Americans. Common Nutrients for Bone Health. Open in a separate window. Table 2 Nutrient and Dietary Sources.
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