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Bones have various roles: providing structure, protecting organs, anchoring muscles, and storing calcium. Bones are in a constant cycle of being broken down and reformed; this process, known as bone remodeling, requires sufficient levels of certain nutrients. Bone strength is dependent on bone density and quality. It is extremely important to eat foods that provide the right amount of calcium, vitamins, and protein.

Calcium is one of the main bone-forming minerals and approximately 99% of the body’s calcium is stored in the skeleton.1 The amount of calcium in your diet significantly affects bone health; a diet low in calcium contributes to reduced bone density, early bone loss, and an increased risk of fractures.

Vitamins are essential in maintaining bone strength and health. In addition to a balanced diet, regular exercise (including weight-bearing and muscle-strengthening exercise) is vital to avoid osteoporosis, a condition that causes bones to become weak and brittle.

Osteoporosis is the most common metabolic disease of the bones. More than 200 million people are affected by osteoporosis worldwide.1 Osteoporosis is a silent disease until it is complicated by fractures. Although osteoporosis is progressive, it can be prevented, diagnosed, and treated before fractures occur.2

Vitamin D

Since the body can create vitamin D from direct sunlight exposure, it is known as the ‘sunshine vitamin’. However, it can be difficult to get enough vitamin D through sunlight exposure, particularly during the winter months and for people who do not spend much time outdoors.

Vitamin D helps the body to absorb calcium. Adults should aim to have 400–800 IU of vitamin D daily. Good sources of vitamin D include oily fish, such as salmon, sardines, mackerel, trout, and tuna, as well as eggs, mushrooms, and fortified foods, such as milk and cereals.

Osteoporosis treatment has been found to work better if you have good vitamin D levels.

A study with 400 patients with osteoporosis found that people with osteoporosis were more likely to be deficient in vitamin D and that treatment with vitamin D over 8 weeks improved bone density indices and reduced the incidence of osteoporosis. The study suggested that continuous and regular treatment with vitamin D supplements, particularly in women and the elderly, may be extremely beneficial in the prevention and improvement of osteoporosis.3

Vitamin A

Vitamin A is a fat-soluble vitamin, which has influence in both osteoblasts (bone building cells) and osteoclasts (bone breaking down cells). Vitamin A is required for growth, reproduction, visual health, and the integrity of the immune system.4

Sources of vitamin D include retinol and beta-carotene; retinol can be found in meat and fish, whereas beta-carotene is found in dark green and orange fruits and vegetables.

Too much vitamin A (more than 10,000 IU per day) has been associated with lower bone density and fractures. A study with a cohort of 34,703 postmenopausal women found that vitamin A supplement users had an increased risk of hip fracture than non-users.5

Vitamin B12

Vitamin B12 is important for DNA synthesis and may affect bone formation. It has been associated with osteoblastic activity in clinical studies and cell culture. A study found that vitamin B12 deficiency is associated with a higher risk of developing osteoporosis.6

Vitamin B12 can be found in meat, fish, eggs, milk, and dairy products. Deficiencies in vitamin B, along with the consequent elevated homocysteine level, are associated with bone loss, decreased bone strength, and increased risk of fracture.

Vitamin C

Vitamin C is an essential vitamin that humans are not able to synthesise. Vitamin C is required for the formation of collagen, which is the foundation of bone mineralisation. Vitamin C can be found in broccoli, bell peppers, cauliflower, kale, oranges, lemons, papaya, and strawberries.

The most common reason for vitamin C deficiency is poor intake due to inadequate absorption. The association between vitamin C intake and bone density is complex and may be related to the interaction of other factors like smoking, estrogen use or hormonal therapy after menopause, calcium intake, and vitamin E intake.7

Animal studies showed that vitamin C deficient animals had impaired bone health due to increased osteoclast formation and decreased bone formation. Vitamin C supplementation resulted in the prevention of bone loss in several animal models of bone loss. Human studies generally showed a positive relationship between vitamin C and bone health, indicated by bone mineral density, fracture probability, and bone turnover markers. However, more studies are required to examine the relationship between vitamin C and bone health. 8

Vitamin K

Vitamin K is important in maintaining bone strength and preventing bone breakdown. Vitamin K helps attract calcium to the bone. Vitamin K may also have a protective role against age-related bone loss. Low levels of vitamin K are linked to low bone density and risk of fractures.

Foods that are rich in vitamin K include leafy greens, broccoli, Brussel sprouts, cabbage, kale, and spinach. Currently, there is insufficient evidence to determine the estimated average requirement for vitamin K. Studies exploring the relationship between vitamin K supplementation and fracture risk have found that the risk of fracture is decreased with supplements.9

Vitamin K can interfere with several medications, including blood thinners. As a result, as with any vitamin or supplement, it is important to speak to a healthcare professional before taking vitamin K supplements.

The relationship between vitamins, apart from vitamin D, on bone health is complex and appears to be affected by genetic factors, gender, menopausal status, hormonal therapy, smoking, and calcium intake.

As vitamin deficiencies are associated with compromised bone health, well-balanced and adequate nutrition should be prioritised in order to prevent adverse effects on bone health. Osteoporosis is considered to be a health priority worldwide and inflicts a heavy burden on the community. If you have concerns about your bone health or your risk of developing osteoporosis, speak to a healthcare professional. They may recommend calcium or vitamin D supplements. Always consult your doctor before taking any vitamins or supplements

References:

1. Pepa G and Brandi M. (2016). Microelements for bone boost: the last but not the least. Clin Cases Miner Bone Metab, 13(3): 181–5. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318168/

2. Cosman F, et al. (2015). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int, 26(7): 2045–7. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643600/

3. Shahnazari B, et al. (2019). Comparison of the effect of vitamin D on osteoporosis and osteoporotic patients with healthy individuals referred to the Bone Density Measurement Center. Biomol Concepts. Retrieved from: https://www.degruyter.com/document/doi/10.1515/bmc-2019-0005/html

4. Ahmadhieh H and Arabi A. (2011). Vitamins and bone health: beyond calcium and vitamin D. Nutrition Reviews, 69(10): 584–98. Retrieved from: https://academic.oup.com/nutritionreviews/article/69/10/584/1866761

5. Lim L, Harnack L, Lazovich D and Folsom A. (2004). Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women’s Health Study. Osteoporosis Internationational, 15: 552–9.

6. Tucker K, et al. (2005). Low plasma vitamin B12 is associated with lower BMD: the Framingham Osteoporosis Study. J Bone Miner Res, 20(1): 152–8. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/15619681/

7. Rondanelli M, et al. (2021). Evidence of a positive link between consumption and supplementation of ascorbic acid and bone mineral density. Nutrients, 13(3): 1012–27. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003869/

8. Chin K and Ima-Nirwana S. (2018). Vitamin C and bone health: evidence from cell, animal and human studies. Curr Drug Targets, 19(5): 439–50.

9. Rodriguez C and Curiel M. (2019). Vitamin K and bone health: a review on the effects of vitamin K deficiency and supplementation and the effect of non-vitamin K antagonist oral anticoagulants on different bone parameters. J Osteoporos. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955144/

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