Importance of nutrients and minerals in maintaining bone health (by A. Thangaroopan)

Your bones and their role are often overlooked. We take their function for granted, and often do not think about how we have to work to keep them healthy so they can continue to fulfill their role. These roles include:

• Support – provide a frame for the attachment of muscles and other tissue
• Movement – the attached muscles use the bones as levers for movement
• Protection – they help protect vulnerable organs and tissue
• Mineral storage – serve as a storage site for many essential minerals ex. calcium, etc.
• Blood cell production – the marrow inside certain bones is the site of blood cell production
• Energy storage – lipids (such as fats) are stored in marrow as an energy reservoir

There are a number of important nutrients and minerals for bone health. The most well known is calcium and vitamin D. But there are various nutrients such as vitamin K, vitamin C, and other minerals and trace minerals such as magnesium, boron, zinc, manganese, copper, and silicon which are also essential for maintaining bone health. Table 1 shows the recommended dietary allowance for the various nutrients and minerals.

Calcium is found in such foods as dairy (milk, cheese, etc.), green leafy vegetables (broccoli, cabbage, kale), tofu, nuts (almonds), fish in which you eat the bones, etc. [3]. Calcium is the most well-known mineral involved in building of bone structure. Over supplementation of this mineral can be harmful and cause such things as kidney stones, and myocardial infarctions (heart attacks) [3].

Vitamin D can be produced by the body from sunlight! So get outside when possible at anytime of the year in that sunlight! Dietary sources of this nutrient include fatty fish such as tuna, salmon, and mackerel, and fortified foods such as cereal, dairy, orange juice, etc., beef liver. It plays an important role in helping the body absorb calcium, and also with bone resorption and bone mineralization.
Vitamin K is found in such food sources as fish, liver, meat, eggs, green leafy vegetables (kale, spinach, romaine lettuce, lettuce), vegetables (brussel sprouts, cabbage, broccoli, cauliflower), prunes [3]. This vitamin is an important cofactor involved in the process of producing hormones responsible for bone generation and normal bone turnover to keep it healthy and strong.

Vitamin C is found in many foods. Some sources include citrus fruits (lemon, orange, lime), tomato, green and red peppers, kiwi, strawberries, mango, pineapple, watermelon, vegetables (broccoli, brussel sprouts, cauliflower), green leafy vegetables (spinach, cabbage) [3]. Vitamin C plays a major role in collagen formation, stimulating cells in bone formation, and healing (including bone healing), calcium absorption, and affects vitamin D in bone metabolism.

Magnesium is found in fruits (avocado, banana, raspberries, figs), green leafy vegetables (spinach, kale), nuts and seeds (almonds, cashews, peanuts), seafood (mackerel, tuna, salmon), vegetables (broccoli, cabbage, green beans, asparagus, brussel sprouts), raisins, kidney beans, lentils, dark chocolate [3]. Magnesium is important for the absorption and metabolism of calcium, and in many enzyme reactions that promote bone health from such things as thyroid function, converting vitamin D to active vitamin D, calcium deposition in bones, etc.

Boron is an essential element in plants, and its through this source that the general population acquires this mineral. Boron is found in such foods as prunes, plums, grapes, pears, kiwis, beans, tomato, carrots, nuts, seeds, lentils, leafy vegetables, raisins, dried apricots, and avocados, etc. [3, 4]. Boron stabilizes cell membranes and modulates membrane transport mechanisms [2]. It has anti-inflammatory, anti-neoplastic, and hypolipidemic effects [1,2]. It regulates sex hormones, and protects against oxidative stress, and improves brain electrical activity, cognitive performance, and short-term memory in elders [2]. Boron also stimulates bone growth and bone metabolism, it activates 1,25(OH)2D3 production (which increases bone mineralization) [1] and improves magnesium absorption [2]. Trabecular bone microarchitecture and cortical bone strength depend on sufficient boron intake.

Zinc, manganese, and copper are typically not deficient in the Standard American Diet (SAD), so supplementation is not typically necessary for bone health, and in fact may be harmful in the case of long-term over-supplementation [3]. But it may be of benefit based on the needs of the body, for example in times of infection, zinc supplementation can help.

Zinc is found in such foods as meats, shellfish, legumes (such as lentils chickpeas, etc), seeds, nuts, eggs, dairy, whole grains. Vegetarians and older individuals are more likely to be deficient and may benefit from dietary changes or supplementation [3]. Zinc is necessary to create the matrix on which calcium and phosphorous is deposited to build bone structure. It is also used to produce enzymes which degrade and recycle old bone proteins.

Manganese is found in oatmeal and bran cereals, whole wheat bread and brown rice, nuts (such as almonds and pecans), pineapples, beans and legumes (such as lima beans), green leafy vegetables (such as spinach), mollusks (clams, oysters, mussels), dark chocolate, cinnamon, and tea [3]. Manganese is a co-factor in bone cartilage and bone collagen formation, and also in bone mineralization.
Dietary copper is found in meats (especially organ meats), seafood (oysters and lobsters), dark leafy greens, shiitake mushrooms, nuts, grains, and cocoa products [3]. Copper is involved in an enzyme which aids in the formation of collagen and for bone and connective tissue, contribute to bone strength, and works with zinc to reduce resorption of bone.

Dietary silica is found in many sources such as whole grain bread and pasta, oats, cucumbers, flaxseed, banana, spinach, mango, and even in beer! (don’t overdo it!) [3]. Silicon helps start the bone mineralization process, and so is important in maintaining strong and flexible bone.

Osteoporosis

Osteoporosis is a disease process characterized by low bone mass due to loss or low production, and it affects millions worldwide [5, 6, 7]. The lifetime risk for women is thought to be 40-50%, and for men it is 13-22% [6]. In the US there are 2 million osteoporotic fractures annually [6].
Non-Pharmacologic options:

• Regular exercise (impact type 20-40mins), weight management (BMI<24), fall prevention, smoking cessation (increases risk of osteoporosis by 50% [10]), and improve dietary intake of protein (meats, fish), calcium (yogurt, broccoli, salmon, tofu, almonds, leafy greens, etc.), supplements of vitamin D (400 IU/day), calcium (800-1200mg/day), magnesium (400-800mg/day), boron (3-5mg/day) , reduce alcohol (<2/day) and caffeine <4/day) [5].

With an aging population, incidences of bone disease will increase. This represents a significant burden on quality of life, society and its health and healthcare. Quite often, the focus will be on more commonly associated minerals mentioned earlier such as calcium and phosphorus. However, it is important to keep in mind that there are many things required for maintaining bone health, and there are a number of other key minerals involved which do not get as much attention but are just as vital to overall bone health. It is essential that every individual has an adequate intake of these minerals to maintain their bone strength, which allows them to significantly improve their quality of life. Talk to your naturopathic doctor or other healthcare providers about how you can help improve and maintain your bone health for years to come.


Common Nutrients for Bone Health: Recommended Dietary Allowance (Median Intake)[3]

Nutrient: 

• Vitamin D: 600-800 IU (150-300 IU)
• Calcium: 1000-1200 mg (735 mg)
• Magnesium: 320-420 mg (243 mg)
• Silicon: 40 mg for bone health (21 mg)
• Vitamin K: 90-120 µgm (70-80 µgm)
• Boron: 3 mg for bone health (1 mg)
• Vitamin C: 75-90 mg (103 mg)
• Copper: 0.9 mg (1.1 mg)
• Zinc: 8-11 mg (9.6 mg)
• Manganese: 1.8-2.3 mg (2.8 mg)

References:

1. Zofkova I, Davis M, Blahos J. Trace elements have beneficial, as well as detrimental effects on bone homeostasis. Physiol Res. 2017 Jul 18;66(3):391-402. Epub 2017 Feb 28. Review. PMID: 28248532  
   
2. Pizzorno L. Nothing Boring About Boron. Integr Med (Encinitas). 2015 Aug;14(4):35-48. Review. PMID: 26770156  
   
3. Price CT, Langford JR, Liporace FA. Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet. Open Orthop J. 2012;6:143-9. doi: 10.2174/1874325001206010143. Epub 2012 Apr 5. PMID: 22523525
   
4. Higgs J, Derbyshire E, Styles K. Nutrition and osteoporosis prevention for the orthopaedic surgeon: A wholefoods approach. EFORT Open Rev. 2017 Jun 23;2(6):300-308. doi: 10.1302/2058-5241.2.160079. eCollection 2017 Jun. PMID: 28736622 
5. Hanley DA. CTC 2019 Compendium of Therapeutic Choices. Ottawa: Canadian Pharmacists Association; 2018. Chapter 85, Osteoporosis; p1279-1298. 
6. Li G, Thabane L, Papaioannou A, Ioannidis G, Levine MA, Adachi JD. An overview of osteoporosis and frailty in the elderly. BMC Musculoskelet Disord. 2017 Jan 26;18(1):46. doi: 10.1186/s12891-017-1403-x. Review. PMID: 28125982  
7. Osteoporosis. Fast facts. [Internet]. 2018 [cited 2018 Nov 4]. Available from: https://osteoporosis.ca/about-the-disease/fast-facts/  
8. Hoffman D. Medical Herbalism: The Science and Practice of Herbal Medicine. Rochester, Vermont: Healing Arts Press, 2003. Chapter 19, The Musculoskeletal System; p408-430.

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