4 top supps for stronger bones

Kamal Patel is a director of Examine.com, the research-based resource on supplementation and nutrition, and a nutrition researcher with an MPH and MBA from Johns Hopkins University. He is based in San Francisco, California.

The human body contains 206 bones and they serve far more purpose than simply allowing you to move and protecting your organs. They also make red and blood white cells and store minerals, so healthy bones are essential for optimal health. Here’s four supplements that can help improve bone density and strength.

1 Calcium
This element is one of the major mineral components of bone. A diet low in calcium will put you at risk for many bone disorders late in life because low calcium levels are associated with osteopenia and osteoporosis, diseases characterized by dangerously low bone density.

Milk, dark leafy greens, and cheese are all foods with high levels of calcium so eating plenty of these foods will render calcium supplementation unnecessary, and it should be noted that higher dietary levels of calcium do not necessarily confer a protective effect. If you think you need to increase calcium consumption then you should introduce calcium-rich foods into your diet before considering supplementation. Not only is it cheaper, but healthier and tastier as well.

Calcium can affect the absorption of several pharmaceuticals, such as bisphosphonates, levothyroxine, tetracycline or quinolone antibiotics, and may otherwise interact with some drugs such as diuretics, which increase calcium levels, or digoxin. Excess calcium levels – usually via supplementation of high doses in addition to the diet – have been linked to increased risk for cardiovascular incidents related to hypercalcemia.

How to take it If you need to supplement calcium then it’s worth noting that whey and casein protein powder will provide around 20% and 40% of your recommended dietary allowance per scoop, respectively. Calcium should be supplemented with a meal. Excess calcium may cause constipation. If this occurs, reduce the calcium dose or consider vitamin D supplementation in addition to calcium.

2 Magnesium
Like calcium, magnesium is an important dietary mineral and a major component of bones.
Most people do not get enough magnesium through their diet and a deficiency is associated with bone loss, whereas high magnesium levels are associated with significantly higher bone mass in old age. Magnesium is safe, effective, and commonly paired with calcium in one supplement, making it an ideal base supplement for bone health.

Fibrous vegetables and nuts are particularly high in magnesium, as is dark chocolate and coffee. People with diets high in these foods do not need to supplement magnesium. Magnesium can interfere with the absorption of several pharmaceuticals, including calcium channel blockers (CCBs), bisphosphonates, and quinolone and tetracycline antibiotics, unless taken two hours before or four hours after such drugs.

How to take it Magnesium can be supplemented through magnesium citrate, magnesium tartrate, magnesium diglycinate, and magnesium gluconate. Magnesium oxide is not recommended for supplementation because it can cause intestinal discomfort and diarrhea and has less bioavailability than other forms.

The standard dose for magnesium is 200mg of elemental magnesium, though doses of up to 400mg can be used. Elemental magnesium content is found on the supplement label. It is the amount of magnesium in the supplement, excluding other compounds that may be included. Magnesium gluconate should be taken with a meal to increase the absorption of the supplement, but other forms of magnesium can be taken either with food or on an empty stomach.

3 Vitamin D
Vitamin D is a general health supplement, and it also helps bones stay dense and strong. High levels of vitamin D are associated with improved bone mineral density. This is especially important for older people. Vitamin D increases the rate at which minerals accumulate in bones, leading to greater overall growth.

Vitamin K can improve the effects of vitamin D at bone cell level when the two supplements are taken together, and vitamin D can increase the absorption of calcium from the intestines. If you are outside frequently and live near the equator, you may not need to supplement vitamin D due to enough synthesis on exposed skin from the sun. People with darker skin tones will require more sun exposure than lighter skinned people to get the same amount of vitamin D.

How to take it To supplement vitamin D, take 2,000IU per day in the form of vitamin D3. It should be supplemented alongside a meal containing dietary fat sources for improved absorption. There are suggestions that it can impair sleep so it may be prudent to take vitamin D in the morning.

4 Vitamin K
Vitamin K is a fat-soluble vitamin which is synergistic with vitamin D for bone formation.
Supplementation does not increase bone density because it increases the rate at which minerals accumulate in the bone so it actually increases bone size. Vitamin K can protect bones from fracturing, which is particularly important for older people, for whom falls can be very damaging.

How to take it The optimal dose for vitamin K is 1,000mcg, which is much higher than the recommended daily intake (RDI) in many countries. As with vitamin D, vitamin K should be supplemented alongside a meal containing dietary fat sources for improved absorption.

Vitamin K can be supplemented through vitamin K1 (the plant form) and vitamin K2 (the animal form). Vitamin K2 is actually a series of molecules, designated by labels like MK-4 and MK-7. Vitamin K1 and vitamin K2 MK-7 are both recommended over vitamin K2 MK-4. To supplement vitamin K1, take 1,000mcg. To supplement vitamin K2 MK-7, take 200mcg. Do not supplement vitamin K if you are taking warfarin or any blood-thinning medication.

Supplement stacking
The base supplements for bone health are vitamin D (2,000 IU) and vitamin K (up to 1,000mcg K1, or 200mcg MK-7), taken with the first meal of the day. Calcium (500mg) and magnesium (200–400mg) should only be supplemented after a dietary evaluation. Track what you eat for a week, taking note of calcium and magnesium levels in your food.

Compare your magnesium intake with the recommended daily intake for your gender and age. If you are getting 80-100% of your RDI on average, you do not need to supplement calcium or magnesium. Calcium and magnesium should only be supplemented if dietary modifications to improve calcium and magnesium levels are not an option.