Everyone is concerned about what they eat but do not always think beyond the calories. Many nutrients are essential for overall health. A recent paper published in Osteoporosis International reviewed the role of nutrition in bone health based on information from almost 200 scientific articles (Nieves JW. Skeletal effects of nutrients and nutraceuticals, beyond calcium and vitamin D. Osteoporos Int. 2012 Nov 14). The good news in this paper is that a diet that is good for your bones is likely to be beneficial to your overall health.
Nutrition plays an important role in the treatment and prevention of osteoporosis in adults. Calcium and vitamin D play a clear role in bone health. In cases of low dietary intake of calcium, supplementation may be needed, but the first choice is to consume calcium from foods. Your skeleton is made mostly of calcium. If not enough calcium is consumed each day, your body will take calcium from the skeleton, resulting in bone loss. Vitamin D is needed to help absorb calcium. In most individuals, vitamin D supplementation is needed to meet the daily requirements of this important vitamin. Many papers have discussed the role of vitamin D in overall health.
Many individuals will use nutritional products (nutraceuticals) with the goal of improving their health. Popular products that are purchased for bone health include soy compounds, black cohosh, red clover and Dehydroepiandrosterone (DHEA). However, these products have been evaluated in several studies and their benefit to the skeleton remains to be proven. Potential safety issues must be recognized when these nutraceutical or “natural products” are taken in amounts that exceed dietary recommendations.
Several studies show that higher fruit and vegetable intakes may relate to stronger bones. However, studies to evaluate the skeletal effect of individual components of these foods (flavonoids, carotenoids, omega-3-fatty acids, and vitamins A, C, E and K) do not always show a benefit. Given limited data, it would be better to get these nutrients from fruits and vegetables rather than from supplements. Fruits and vegetables are also important in the prevention of many other diseases.
Taking B vitamins may reduce fracture risk by lowering homocysteine levels in the blood, but the overall skeletal benefit of each individual B vitamin is unknown. All we know is that high blood levels of homocysteine increase fracture risk. Food sources of most B-vitamins (except B-12) include whole grains, fortified cereals, soybeans, dark green leafy vegetables, and nuts. These are all foods that will also improve overall health. Vitamin B12 is found in fish, some meats, cheese, eggs and fortified foods.
Many people wonder if they need to take a magnesium supplement. This is likely only required in persons with low magnesium levels, people with poor diets or with gastrointestinal disease. Data are very limited for the role of nutritional levels of trace elements such as boron, strontium, silicon and phosphorus in bone health. What we do know is that a nutrient rich diet, with adequate fruits and vegetables, will generally meet skeletal needs in healthy individuals. For most healthy adults, supplementation with nutrients other than calcium and vitamin D may not be required, except in those with chronic disease and the frail elderly with poor diets.
Clearly for patients with osteoporosis or with a high risk for fracture, a good healthful diet is important, but it will not replace a medication proven to prevent fractures.
Helen Hayes Hospital serves as the osteoporosis resource center for all of New York State. For further information about osteoporosis visit our website at www.NYSOPEP.org. For a bone density test or to see one of our physicians please call 845-786-4318. For information on our Research Studies please call 845-786-4804.
Jeri Wanzor Nieves, PhD
Associate Professor of Clinical Epidemiology and Nutrition
Director, New York State Osteoporosis Prevention and Education Program
Clinical Research Center
Helen Hayes Hospital