Today's article is going to focus on what nutrients make for stronger bones and higher bone density. This is not only critical for our aging population but is often time an overlooked aspect of health in the 20-40s age group. The younger the adult the more likely the person is to ignore their bone health until it is already too late and they have already begun to lose some amount of bone density. This importance is made obvious when we consider the lifetime risk for any bone fracture is 40-50% for women and 13-22% for men.  The reality is that bone metabolism (breakdown) over time is a very complex subject that requires multiple nutritional factors to be addressed in order to offset the progression of bone loss. Calcium supplementation alone (which is what the majority of Americans do) has shown to not be enough in the fight against slowing the metabolism (breakdown) of bones.
Let's discuss some risk factors. These risk factors can help a person identify if they are at risk for having low bone density. The ethnic background most commonly effected by bone loss are Caucasians followed closely by those of Asian decent. It is still unclear why these two backgrounds show higher prevalence of both osteopenia and osteoporosis. People over age of 50 are also at higher risk of having low bone density as well. Women are more commonly affected than men which is explained by changes in hormone levels. This change is the drop in estrogen levels during menopause. Estrogen has the ability to help keep calcium in bone. When a body no longer has the same amount of estrogen circulating the body it also loses this bone protective benefit. Smokers have also been associated with much higher levels of bone density loss than non-smokers.
Four key nutrients that are absolute necessary for optimal bone health (as well as other processes within the body) are Vitamin D, Calcium, Magnesium, Boron.
Boron is an important vital trace mineral that is critically important for normal bone growth and bone density. A recent study showed that areas of the world where boron intakes are usually 3 to10 mg, the estimated incidence of joint health issues ranges from 0 to 10%. Bone appears to be stronger in individuals who supplement with boron. This is a drastic difference from areas where boron intakes usually are 1.0 mg or less/day, the estimated incidence of joint health issues ranges from 20% to 70%. 
Next is calcium. This is easily the most talked about nutrient when it comes to bone health. Calcium makes up a large portion of ones bone composition. It is critical for both density and healthy bone aging. Calcium carbonate is effective and is the least expensive form of calcium. This is the form most commonly found in the cheap calcium products you see at department stores. It is best absorbed with a low-iron meal (such as breakfast). Calcium carbonate is not absorbed well in people who also take a specific medication for gastroesophageal reflux (called a proton pump inhibitor or H2 blocker). Unlike calcium carbonate, which must be taken with meals to ensure optimal absorption, the calcium citrate form are highly absorbable and can be taken with or between meals. Even when calcium citrate and carbonate are given with meals, the citrate variety is better absorbed .
Vitamin D is another important nutrient for optimal bone health (as well as a plethora of other health issues). Study after study has shown that people with low vitamin D levels are also associated with lower bone mass as well as a much higher risk of bone fracture at an older age. Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and to prevent hypocalcemic tetany. It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts [1,2]. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults . Together with calcium, vitamin D also helps protect older adults from osteoporosis.
Last but not least is Magnesium. Although bone health is supported by many factors, most notably calcium and vitamin D. However, some evidence suggests that magnesium deficiency may be an additional risk factor for postmenopausal osteoporosis . This may be due to the fact that magnesium deficiency alters calcium metabolism and the hormones that regulate calcium . Several human studies have suggested that magnesium supplementation may improve bone mineral density . In a study of older adults, a greater magnesium intake maintained bone mineral density to a greater degree than a lower magnesium intake . Diets that provide recommended levels of magnesium are beneficial for bone health, but further investigation on the role of magnesium in bone metabolism and osteoporosis is needed.
Unfortunately not many people supplement with all four of these vital nutrients. By supplementing with just one it is very similar to showing up to a battlefield with only half of your army.
I hope this articles helps show the importance of each nutrient and the importance of supplementing ones bone health. Hopefully with this knowledge everyone can get a jump on the prevention of bone metabolism.
- Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
- Cranney C, Horsely T, O'Donnell S, Weiler H, Ooi D, Atkinson S, et al. Effectiveness and safety of vitamin D. Evidence Report/Technology Assessment No. 158 prepared by the University of Ottawa Evidence-based Practice Center under Contract No. 290-02.0021. AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality, 2007.
- Staub DA. Calcium supplementation in clinical practice: review of forms, doses, and indications. Nutr Clin Pract. 207;22:286-96.
- Newnham RE. Essentiality of boron for healthy bones and joints. Environ Health Perspect. 1994;102(Suppl 7):83-85.
- Johnell O, Kanis JA. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005; 16: S3–S7.
- Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. National Academy Press. Washington, DC, 1999.
- Elisaf M, Milionis H, Siamopoulos K. Hypomagnesemic hypokalemia and hypocalcemia: Clinical and laboratory characteristics. Mineral Electrolyte Metab 1997;23:105-12.
- Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999;69(4):727-36.