Bone Health Supplement Guide

    Medical disclaimer

    This guide is a general-health document for adults 18 or over. Its aim is strictly educational. It does not constitute medical advice. Please consult a medical or health professional before you begin any exercise-, nutrition-, or supplementation-related program, or if you have questions about your health.

    This guide is based on scientific studies, but individual results do vary. If you engage in any activity or take any product mentioned herein, you do so of your own free will, and you knowingly and voluntarily accept the risks. While we mention major known interactions, it is possible for any supplement to interact with other supplements, with foods and pharmaceuticals, and with particular health conditions.

    Examine.com does not assume liability for any actions undertaken after visiting these pages, and does not assume liability if one misuses supplements. Examine.com and its Editors do not ensure that unforeseen side effects will not occur even at the proper dosages, and thereby does not assume liability for any side effects from supplements or practices hosted under the domain of Examine.com.

    Examine.com does not make any representations, recommend or endorse any specific tests, products, procedures, opinions, or other information that may be mentioned on the website. Reliance on any information provided by Examine.com, Examine.com employees, guest writers, editors, and invitees of Examine.com, or other visitors to Examine.com is solely at your own risk.

    How to use

    The Examine team has been publishing research on nutrition and supplementation since March 2011. Drawing from all we’ve learned, we’ve designed this Supplement Guide with two aims in mind: helping you decide which supplements are right for you, based on the scientific evidence, and helping you integrate these supplements into synergistic combos.

    Primary supplements have the best safety-efficacy profile. When used responsibly, they are the supplements most likely to help and not cause side effects.

    Secondary supplements may provide substantial benefits, but only in the right context. A secondary option is not for everyone and not a first pick, but if you read the entry and find that you meet the criteria, consider adding the supplement to your combo.

    Promising supplements have less evidence for their effects. They could work or be a waste of money. Keep them in mind, but think twice before adding them to your combo.

    Unproven supplements are backed by tradition or by mechanistic, animal, epidemiological, or anecdotal evidence, but not yet by convincing human trials. At this point, they are not good candidates for your combo.

    Inadvisable supplements are either potentially dangerous or simply ineffective, marketing claims notwithstanding. Do not add them to your combo. At best, they’ll be a waste of money; at worst, they can cause you harm.

    Now that you’ve learned of various supplements worthy of your consideration, you’ll learn to integrate them into synergistic combos. You’ll discover a core combo (composed of the most important and least controversial supplements) and several specialized combos. Each specialized combo is optimized for a specific population. The simplest way to formulate your own combo is to combine the core combo with the specialized combo that best fits your situation, needs, and primary health goal.

    Then comes the FAQ, in which we cover common questions that may arise when selecting and combining supplements. With all this, you should be able to identify and assemble the supplement combo best suited to your objective.

    Introduction

    Your bones are more complex than is commonly assumed. They are composed of minerals (mainly calcium, magnesium, and phosphorus) attached to a structural matrix made of proteins (collagen and glycoproteins) and function as an endocrine organ (i.e., they produce hormones such as osteocalcin).[1]. Unlike your visible hair and nails, bones are alive; they are continuously being broken down and built back up in a process called remodeling (or bone turnover), for maintenance and for repair after injury and daily wear. This is how bones adapt to stressors, which explains why exercise, especially resistance training, can increase bone mineral density (BMD).[2][3][4][5]

    If your BMD is low, you suffer from osteopenia (literally, “poor bone”). If your osteopenia worsens to the point that your bones become brittle, it becomes an illness, called osteoporosis (literally, “porous bone”). Osteoporosis is more common in (postmenopausal) women than in men, but men are not immune.

    The risk of osteoporosis varies by location; in general, in the northern hemisphere, the further north you go, the higher the risk.[6] The incidence of fractures varies greatly by country, but on average, approximately 50% of women aged 50 and older are at risk of fractures.[6] In 2010, it was estimated that 53.2% of women and 20.7% of men aged 50 and older in the UK would sustain a fracture before the end of their lives.[7] In 2010, an estimated 43.4 million adults aged 50 and older in the U.S. had osteopenia and 10.2 had osteoporosis (at the femoral neck or lumbar spine).[8]

    Rate of osteoporosis of the femoral neck or lumbar spine in the U.S. in 2010 (%)

    AGE50s60s70s80s
    WOMEN6.812.325.734.9
    MEN3.43.3510.9

    Reference: Wright et al. J Bone Miner Res. 2014.[8]

    Osteoblasts and osteoclasts are large cells on the bone surface. Osteoblasts synthesize and mineralize bone, whereas osteoclasts break down bone, causing minerals to be reabsorbed into the bloodstream.

    If osteoclasts are too active or numerous, BMD decreases, leading to osteoporosis. Conversely, if osteoclasts are not numerous or active enough, BMD increases, leading to the rare, inherited condition called osteopetrosis (literally, “stone bone”). You might think that osteopetrosis makes bone more resilient, but no — osteoporosis[6] and osteopetrosis[9] both increase the risk of fractures.[10][11]

    Interestingly, osteoclast activity is increased by inflammatory signaling. This may be why smoking, heavy alcohol consumption, and inflammation-linked diseases (such as diabetes and rheumatoid arthritis) are risk factors for osteoporosis, especially in older people.[12][13][14][15]

    Conversely, estrogen decreases osteoclast activity while increasing the number and activity of osteoblasts. This explains why after menopause, when estrogen levels decline significantly, the rate of osteoporosis becomes so much worse in women than men.[16]

    The interactions among genetics, age, sex, exercise, nutrition, supplementation, and other factors (some of which are still unknown to us) make bone health a complex topic. On the bright side, it also makes supplement synergy possible because some supplements can serve as building blocks (protein, calcium, magnesium), and some play supporting roles. For example, vitamin D helps your intestines absorb calcium, whereas vitamin K helps shuttle calcium from the bloodstream to the bones, thus improving bone health as well as cardiovascular health.

    Combos

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    Primary Supplements

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    Secondary Supplements

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    Promising Supplements

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    Unproven Supplements

    Inadvisable Supplements

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