Calcium and Other Bone Builders

Don’t forget your vitamin D, as well

By Deborah Jeanne Sergeant

Calcium has earned a reputation as a bone builder and rightfully so. Found in dairy products, dark leafy green vegetables, salmon and tofu, calcium is the main stuff that bones are made of. However, it takes more than just adequate calcium consumption to build strong bones.

In addition to adequate calcium intake and supplementation, ranging from 1,000 to 1,200 mg. daily, depending upon age and gender, other minerals are necessary. Instead of taking it all at once, the calcium supplements should be taken in 400-500 mg. doses throughout the day with a meal.

“Calcium should be paired with D3 and K2,” said Laurel Sterling, registered dietitian, nutritionist and educator with Carlson Laboratories in Canastota. “They work together in helping the calcium get to the bones and teeth, versus staying in the soft tissue where you don’t want it to be. That leads to calcification of the blood vessels, which we don’t want. Magnesium is a major mineral to re-mineralize. Boron and strontium are some major players.”

Since skin exposure to sunlight for 20 to 30 minutes three times weekly generates enough vitamin D production in the body, most people who live in the North lack it during the winter. Obtaining a vitamin D blood test can reveal how much supplementation an individual needs. Reaching 800 international units (IU) of vitamin D should suffice.

Dietary sources of vitamin D include canned and fresh salmon, sardines and tuna; mushrooms; eggs, especially from pastured chickens; and fortified foods such as milk, cereal and oatmeal.

“K2 is in fermented soy products and other food sources we may not eat enough of,” Sterling said. “That should be looked at more through supplementation. The other minerals, you can get through food but you might not get enough. A general daily multivitamin may be good enough if it’s good quality. If someone has osteopenia or if they have osteoporosis, they’ll need an extra bone supplement.

“Magnesium is found in avocadoes, black beans, certain nuts. You can get magnesium in a lot of your foods.”

Lacey Roy, owner of Full Bodied Health in Syracuse, said that in addition to dairy, calcium-rich foods include dark leafy greens, like kale and spinach. She pairs calcium with magnesium and zinc for better absorption.

“If you eat a standard American diet, supplementation may make sense unless you’re more plant-based,” Roy said. “Not having animal protein for all three meals, you might not lack them.”

Kelly Springer, registered dietitian and owner of Kelly’s Choice Nutritional Company in Skaneateles, encourages food sources for nutrition. Since magnesium is often overlooked, she encourages consumption of avocados, nuts, seeds, ground flax and chia, along with whole grains.

“When we talk about getting in all the things our bodies need, these foods come in the perfect package so that combination of calcium, vitamin D and magnesium are key to bone health and making sure we have these in our meals through real foods,” Springer said. “We don’t need to think about buying these nutrients in a bottle. We can get them right through our food. When we eat foods like these, it helps reduce inflammation as well and it keeps our bones healthy and strong.”

Springer encourages clients to eat sufficient protein, fiber and whole produce for overall health, including bone health.

Susan E. Brown, PhD, clinical nutritionist and head of The Center for Better Bones and the Better Bones Foundation in East Syracuse, names 20 nutrients essential for bone health: calcium, phosphorus, magnesium, chromium, silica, zinc, manganese, potassium, strontium, vitamin D, vitamin C, vitamin A, copper, boron, vitamin B6, folic acid/folate (vitamin B9), vitamin B12, vitamins K1 and K2, essential fats and protein. The amount of supplementation varies, depending upon age, gender, other health issues and diet.

“What people are generally eating is way under the recommended daily allowance,” Brown said. “We always say that if you follow our belief system, everything you do for bone is good for the entire body. You can’t isolate bone from the rest of the body.”

In addition to a balanced diet and supplementation where necessary, she encourages people to limit sugar and processed foods. While a plant-based diet offers many benefits, it can contribute to fractures if not managed carefully.

“Too little protein will damage the bones,” Brown said. “Vegans have twice the fractures as non-vegans.”

Many medications can cause bone loss. Brown said that steroid medication such as prednisone causes 20% of all osteoporosis cases. She also listed antidepressants, proton pump inhibitors, and medication for seizures among the many medications that harm bone health. She also warned against tobacco use, excess alcohol and unmanaged stress as damaging to bones.

In addition to proper diet and moderate sun exposure, healthy bones also need exercise. Previously, experts believed that exercise builds only muscle. However, engaging in weight-bearing exercise also lays down bone.

“Impact exercise is great for bone health,” Brown said. “I interviewed Dr. Belinda Beck at The Bone Clinic in Queensland Australia. She has documented that post-menopausal women can rebuild bone with high-intensity, high-impact exercise. They work with trainers and lift substantial weights. They work up to very high weights. They build 5% to 10% bone mass. We know exercise is important. Any helps. But our guidelines are, if you build muscle, you will build bone.”

 Her organization hosts seminars and, in current times, webinars, on bone building diet and exercise. She advises mixing strength training with weight-bearing exercise for the best bone-building workout. Strength training might include lifting weights in the gym, using exercise bands or performing body weight exercises, like pull-ups, chin-ups, push-ups, squats and calf raises. Aerobic activity that is weight-bearing might include walking on a treadmill, running or cross-country skiing.

A primary health provider can provide guidance on taking supplements, exercised and, if applicable, recommend community resources to obtain a home fall risk assessment.