No Bones About It: How Nutrition Supports Bone Health

When a patient walks into your clinic after a fracture or comes to you struggling with osteoporosis, you know the rehabilitation process goes beyond exercise alone. It requires a holistic approach—where nutrition and physical activity both play essential roles in recovery and long-term bone health.

While exercise like aerobic activity and strength training is crucial for stimulating bone growth and improving overall strength, it’s equally important to ensure that the body has the proper nutrients to build and maintain bone density. Building and maintaining strong bones is a bit like constructing a house—exercise provides the framework, but without the right materials from nutrition, the structure won’t be as strong. 

Providing clear guidelines on proper nutrition lays the foundation for helping patients build and maintain bone health. Let’s take a closer look at the key nutritional elements you can recommend to support your patients’ long-term bone strength and recovery.

Calcium: The cornerstone of strong bones

Calcium is widely recognized as a key mineral for bone formation. For adults under 50, the recommended daily intake is 1,000 mg. To put that into perspective, an 8-ounce glass of milk contains around 300 mg of calcium, while 8 ounces of yogurt offers about 400 mg. 

Beyond dairy, fish with bones, such as sardines or canned salmon, can also provide calcium when eaten regularly. Some vegetables contain calcium, but the presence of oxalates or phytates can reduce their bioavailability—the ability of the body to absorb and utilize the nutrient. For instance, spinach has a bioavailability of about 5 percent for calcium, meaning only a small portion of the calcium present is absorbed. While plant-based options can contribute, this reduced bioavailability may require careful planning to ensure adequate intake.

Fortified foods, like calcium-enriched tofu or juices, can help you meet your daily needs, offering over 250 mg per serving. While it’s best to get calcium from your diet, supplementation is often necessary to hit your target intake, especially when food sources fall short. By encouraging a variety of calcium-rich foods, you can help your patients strengthen their bones for the long term. Food sources of calcium include:

• Milk
• Yogurt
• Cheese
• Sardines
• Salmon
• Calcium-fortified tofu
• Calcium-fortified juice
• Kale
• Turnip greens

Encouraging patients to consume a variety of calcium-rich foods is a simple but effective way to support bone health over the long term, especially as part of a comprehensive rehabilitation plan.

​​Vitamin D: Your body’s assistant for calcium absorption

Vitamin D supports bone health by helping the body absorb calcium from the digestive system. It also aids in maintaining proper blood levels of calcium and phosphorus, which are crucial for bone mineralization and overall strength.

Getting enough vitamin D can be more challenging than calcium, especially since it isn’t found in many foods naturally. While fortified foods such as milk and cereals provide some vitamin D, the options are limited. These challenges are amplified for individuals with dietary restrictions, like those who follow a plant-based diet or are lactose intolerant. This makes finding alternative ways to meet vitamin D requirements all the more important.

For adults under 50, the recommended daily amount is 600 IU (15 mcg). One of the unique aspects of this nutrient is that the body can synthesize it through skin exposure to sunlight. It is recommended to get 5-30 minutes of sun exposure during the “solar noon” window, which occurs daily between 10 a.m. and 4 p.m.² If the goal is to get the recommended dose of vitamin D, it is advised not to use sunscreen during this time, as sunscreens with an SPF of 8 or greater can block vitamin D synthesis.

When advising patients on sun exposure, it’s important to educate patients and emphasize caution due to the link between excessive UV exposure and skin cancer. Most people do not apply sunscreen uniformly, so some vitamin D synthesis may still occur even when sunscreen is used.

Even with this natural method of production, it’s important to be aware of potential barriers to adequate synthesis. Factors like limited sun exposure, living in northern climates, and skin pigmentation can affect how much is produced, raising the risk of deficiency. Great food sources of vitamin D include:

• Fatty fish (salmon, trout)
• Fortified milk
• Fortified cereals
• Maitake and portobello mushrooms

Magnesium: A key player in bone health

Magnesium contributes to bone health by supporting the production of parathyroid hormones and the active form of vitamin D. Despite its importance, nearly half of Americans don’t meet the recommended daily intake of 320-420 mg, according to data from the National Health and Nutrition Examination Survey.³

Given magnesium’s vital role in bone health, it is crucial to educate your patients on the benefits of incorporating magnesium-rich foods into their diets. Helping patients meet their magnesium needs can enhance the effectiveness of other key nutrients like calcium and vitamin D, strengthening the foundation for healthier bones. Food sources of magnesium include:

• Pumpkin seeds
• Almonds
• Cashews
• Spinach

Boron: The up-and-coming mineral

Boron is the new kid in the blood. Although it’s classified as a trace mineral, meaning the body only requires small amounts, its role in human nutrition is becoming more apparent. Research suggests that boron may be important for bone growth and formation by potentially affecting osteoblast (formation of bone) and osteoclast (breakdown of bone) activity.⁴ 

Incorporating boron into a balanced diet can be an easy and effective way to support bone health. Prunes, for example, are a great source of boron. Research shows that consuming just five prunes per day may help reduce bone loss in postmenopausal women, making boron-rich foods a simple addition to a bone-healthy diet.⁵ Food sources of boron include:

• Prunes
• Avocados
• Raisins
• Peaches
• Coffee (while not a significant source, it can still contribute to your intake)

Supporting your bones: When supplements are necessary

If a diet doesn’t provide enough of these key nutrients, then strategic supplementation may be needed to help meet daily requirements. Supplements can be particularly beneficial for individuals with dietary restrictions, absorption issues, or increased nutrient needs due to age or certain health conditions. For example, an older adult may need more vitamin D due to reduced skin synthesis.

When choosing supplements, it’s crucial to understand that not all forms of a nutrient are absorbed by the body in the same way. This is where the concept of bioavailability becomes important—the degree to which the body can absorb and effectively use the nutrient provided in the supplement. Choosing a form of supplement with higher bioavailability ensures that you’re getting the most benefit from it.

Here’s a quick guide to common supplements, their recommended doses, and considerations to keep in mind when incorporating them into your routine:

While supplements should never replace a nutrient-rich diet, they can help maintain bone health, particularly when a patient’s food intake isn’t meeting their nutritional needs. Recommending supplements with higher bioavailability can ensure their bodies absorb and use nutrients effectively.

Help patients take control of their bone health

Nutrition is a vital part of bone health, and helping patients understand the importance of essential nutrients like calcium, vitamin D, magnesium, and boron can significantly improve their long-term outcomes. By guiding them toward a balanced diet and appropriate supplementation, you can support their efforts to prevent conditions such as osteoporosis and promote overall bone strength and resilience.

Ensuring that patients meet the recommended intakes for these key nutrients is essential to supporting healthy bones. For those whose diet falls short, carefully chosen supplements can effectively bridge the gap, promoting optimal bone health.

If you want to dive deeper into debunking diet trends, understanding supplements, and identifying nutrition myths, check out our Medbridge course Say No to the Faux: Dubious Diet Trends, Tests, and Supplements. As healthcare providers and advocates, you’ll learn how to guide patients away from questionable practices, offering science-based recommendations for better health.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299926/
2. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-281. doi:10.1056/NEJMra070553
3. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
4. https://ods.od.nih.gov/factsheets/Boron-HealthProfessional/
5. De Souza MJ, Strock NCA, Williams NI, et al. Prunes preserve hip bone mineral density in a 12-month randomized controlled trial in postmenopausal women: the Prune Study. Am J Clin Nutr. 2022;116(4):897-910. doi:10.1093/ajcn/nqac189