Best Supplements to Strengthen Bones (9 min.)

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Osteoporosis is a major public health issue affecting bone health that is becoming more common in not only women but men as well. However, women specifically should be just as mindful of this condition as they are of heart disease and cancer.

According to the Centers for Disease Control and Prevention, at least 10 percent of women 50 years of age and older have osteoporosis of the hip. Fifty percent of women 50 and older and 25 percent of men will develop an osteoporotic fracture in their lifetimes. Unfortunately, in most cases, osteoporosis isn’t detected until the patient suffers a “fragility fracture” due to decreased bone density.

Cooper Clinic Platinum Preventive Medicine Physician Emily Hebert, MD, explains how to keep your bones strong and healthy.

What is Osteoporosis and How is it Detected?

Osteoporosis refers to the density or strength of the bones. From birth to your early 30s, you are building bone density. As you reach your mid-30s, bone density begins to decline. Loss of bone density is inevitable with age and not something that can be prevented. However, you can slow the decline of bone density, keeping your bones strong and healthy longer.

A bone densitometry scan (Cooper Clinic physicians use the DEXA scan) is most commonly used to measure the density of bones in the hips and lumbar spine on a scale. The World Health Organization sets benchmark scores to indicate osteopenia (pre-osteoporosis) and osteoporosis.

Factors that May Increase the Risk of Osteoporosis

• Dietary factors, including:
  • Low calcium intake—learn more about bone health through nutrition
  • Severe caloric restriction
  • Poor protein intake
• Gender – Women are at higher risk than men due to lower peak bone mass and smaller bones. Risk increases for men after age 70.
• Age – Bone growth slows and loss accelerates with age.
• Body size – Slim, thin-boned people have less bone to lose.
• Race
  • Caucasian and Asian women are at the highest risk while African-American and Hispanic women are at lower risk.
  • Caucasian men are at higher risk than African-American and Hispanic men.
• Family history – Risk increases if a parent had osteoporosis or suffered a hip fracture.
• Hormonal changes
  • Postmenopausal women with low estrogen
  • Premenopausal women with low estrogen due to extreme levels of physical activity or hormone disorders
  • Men with low testosterone
• Medical conditions – including hormonal or endocrine diseases, gastrointestinal diseases, rheumatoid arthritis, anorexia nervosa, HIV/AIDS and certain cancers
• Common medications taken long-term, including:
  • Proton pump inhibitors
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Thiazolidinediones, taken for diabetes

Lifestyle and Screening Recommendations for Strong Bones

To her female patients, Dr. Hebert recommends supplementing their diets with 2000 IU of vitamin D3. She suggests this level of vitamin D3 supplementation along with having a calcium-rich diet, including yogurt, low-fat milk, green leafy vegetables and cheese. If Dr. Hebert sees her patients are still deficient in calcium, she suggests a calcium citrate supplement, starting with a daily dose of 500 mg.

Technological advancements have made many screening procedures as minimally invasive as possible. Cooper Clinic recommends an osteoporosis/bone density scan for women beginning at age 40 and men beginning at age 60. If decreased bone density is detected, talk with your physician about changing your diet to ensure you are getting enough vitamin D and calcium and incorporating weight-bearing exercise into your daily routine to slow the progression of osteopenia or osteoporosis.

How to Keep Bones Strong and Healthy

Taking steps to keep bones strong and healthy is most important for young adults. It’s when you are young that you can create building blocks for good health.

Lifestyle Steps to Prevent or Slow Osteoporosis

Following is a summary of the lifestyle changes that help strengthen bones and minimize the risk factors associated with osteoporosis. Adopting these practices can improve your chances of avoiding—or slowing the progression of—osteoporosis.

• Engage in physical activity regularly, including:
  • Strength training with resistance exercises
  • Weight-bearing cardiovascular exercises such as walking (vs. cycling or swimming)
  • Exercises to improve balance and avoid falls
• Limit alcohol consumption, as alcohol decreases bone density.
• Do not smoke, as smoking decreases bone density.
• Maintain a healthy diet, including foods rich in calcium and protein.
  • Consider a Mediterranean diet composed mainly of vegetables, fruits, legumes, whole grains and olive oil, as well as daily servings of dairy, fish twice weekly or more, with red and processed meat only occasionally.
  • A review of observational studies found a 21 percent lower risk of hip fracture and higher bone mineral density in those adhering to a Mediterranean diet.
• Ensure a healthy vitamin D level.

Nutritional Supplements that Help Maintain Good Bone Health

Calcium

Ninety-nine percent of the calcium in the body is found in our bones, with the balance in our blood, extracellular fluid, muscle and other tissues. In addition to bone health, calcium has a role in dilation of the blood vessels to help decrease blood pressure, muscle contraction, nerve transmission and glandular secretions.

Calcium can be consumed in dark leafy greens, including spinach, kale, turnips and collard greens, as well as in soybeans and enriched grains. And, while there is a common perception that dairy is unhealthy due to its fat content, dairy products like cheese, yogurt and milk are important sources of calcium.

Here is the amount of calcium found in commonly eaten foods:

• 1 slice whole wheat bread: 30 mg
• 1 tablespoon Parmesan cheese: 55 mg
• 1 cup chopped cooked kale: 94 mg
• 1 cup cooked spinach: 245 mg
• 1 cup low-fat yogurt: 245-384 mg
• 1 cup cooked collard greens: 266 mg
• 1 cup (calcium-fortified) soy milk: 300 mg
• 1 cup non-fat milk: 316 mg
• 1-ounce cheddar cheese: 200 mg
• 1 cup plain Greek yogurt: 200 mg
• 1 cup plain yogurt: 296 mg
• 4 ounces extra firm tofu: 86 mg
• 1 cup (calcium-fortified) almond milk: 200 mg

While it is an essential nutrient, our bodies only need a certain amount of calcium to maintain healthy bones. Cooper Clinic Nutrition Department recommends that individuals obtain no more than 1500 mg of total calcium daily from food and calcium supplement sources. If your diet does not provide at least 1000 mg of calcium, a supplement may be necessary to meet your daily requirements. Premenopausal women should get about 1000 mg of calcium daily, ideally through diet rather than supplements.

When taking supplements to maintain an adequate daily calcium intake, consider the calcium citrate formulation, as it is better absorbed in the body than the more common calcium carbonate form. Cooper Complete recommends taking Calcium Citrate on an empty stomach—first thing in the morning, mid-afternoon or before bed at night—as this ensures the supplement is not competing for absorption with calcium consumed through meals.

Each two-tablet daily serving of Cooper Complete Calcium Citrate contains 500 mg of elemental calcium from calcium citrate.

Collagen 

Accounting for 30 percent of its protein, collagen is the most abundant protein in the body and is a primary building block of bones, cartilage, tendons, ligaments, muscles and skin. Bone tissue is comprised of protein and collagen and is strengthened by calcium and other minerals.

A 12-month study of 131 postmenopausal women aged 46–80 demonstrated collagen supplementation increased bone mineral density of the lumbar spine and the femoral neck.

Cooper Complete Collagen Complex contains three clinically studied and patented Type I and Type II collagen peptides, along with vitamin C (100 mg), magnesium (135 mg) and hyaluronic acid (40 mg).

Magnesium

With 60 percent of the body’s magnesium stored in the bones, individuals who don’t get enough magnesium are at increased risk of osteoporosis. Magnesium is a component of bone and is involved in the cellular activity of building bones. It is also the hormone that regulates calcium levels.

One large cohort study of postmenopausal women found that supplementation can increase bone mineral density in women with an inadequate magnesium intake. Because calcium can reduce the absorption of other minerals when taken at the same time, it is recommended that magnesium and calcium be taken separately.

Magnesium is also essential to the enzymes that produce and metabolize vitamin D. Higher intake amounts are associated with reduced risk of vitamin D deficiency.

Each Cooper Complete Magnesium Glycinate vegetarian capsule contains 120 mg of elemental magnesium and is well absorbed without significant laxative effects.

Vitamin D

Vitamin D is essential for bone health as it helps our bodies absorb calcium. However, with vitamin D deficiency, the body will not absorb all the calcium it ingests. One study found that no more than 15 percent of the calcium consumed is absorbed among subjects deficient in vitamin D.

Fatty fish and fish liver oils are the best dietary sources of vitamin D, while smaller amounts are found in canned salmon with bones, cheese and egg yolks. And, though the kidneys can convert natural sunlight to vitamin D, adding a vitamin D supplement to your daily regimen reduces the risk of damage or skin cancer from sun exposure.

The Cooper Complete Nutritional Supplement line includes standalone vitamin D supplements with 25 mcg (1000 IU) and 125 mcg (5000 IU) in softgel form and 25 mcg (1000 IU) in liquid form—all best absorbed when taken with a meal containing fat.

Next time you see your doctor, ask to have your vitamin D levels tested to know if you have a vitamin D deficiency.

Below is a summary of the Recommended Dietary Allowance (RDA) for each of the nutrients reviewed above.

Recommended Dietary Allowance (RDA) for Bone Health Supplements
Nutrient	Age Range	RDA
Calcium	19-50 51+	600 IU (15 mcg) 800 IU (20 mcg)
Collagen	Not Established	Not Established
Magnesium	31+	320 mg
Vitamin D	1-70 71+	600 IU (15 mcg) 800 IU (20 mcg)

It is always important to consult your physician before adding any new supplement to your regimen. Your physician understands your health profile best, so talk with them about which supplements are best for you and any medical conditions you may have.

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Cooper Complete June 17, 2024