https://www.nytimes.com/2024/07/22/well/eat/bones-strength-calcium-vitamin-d.html


July 22, 2024


As we age, our bodies break down more bone tissue than they build. This can increase the risk of osteoporosis, a condition defined by weak, brittle bones, which can make them more susceptible to breaks and fractures. And for older adults, the results can be devastating — broken or fractured bones may give way to lengthy hospital or nursing home stays, long-term disability or even death.

The prime time to build bone is during adolescence, when the body is growing and devoting more resources to the task. And while your age, gender and genetics play significant roles in bone health, there are ways to slow bone loss in midlife and beyond. Exercise is a major part of this, but your diet is a big player, too, said Dr. Bess Dawson-Hughes, a professor and senior scientist at the U.S.D.A. Nutrition Center at Tufts University.

Here are some nutrients to prioritize to keep your bones healthy as you age.

Calcium

When you don’t get enough calcium from food, your body will pull the mineral from your bones, which can make them weaker, said Sue Shapses, a professor of nutritional sciences at Rutgers University. Your ability to absorb calcium from food declines as you age too, she said.

According to the National Institutes of Health, women ages 19 to 50 need 1,000 milligrams of calcium each day, and 1,200 milligrams if they’re 51 or older. Men ages 19 to 70 need 1,000 milligrams, or 1,200 milligrams if they’re older.
Experts say that, if possible, it’s best to meet these recommendations with your diet rather than with supplements. Dairy products like milk and yogurt are excellent sources of calcium, said Connie Weaver, a research professor at San Diego State University who studies how diet influences bone health. One cup of low-fat Greek yogurt, for example, contains about a quarter of the calcium most people need in a day, she said.

Other calcium-rich foods include beans; tofu; calcium-fortified plant milks; small bone-in fish like sardines; and leafy green vegetables like kale and collard greens.

The Facts Behind 5 Supplements

Collagen. Collagen, is one of the most abundant proteins in the body and helps form our skin, bones, muscles, tendons and ligaments. As we age, we naturally start reducing its production. Some studies show that taking collagen supplements can reduce signs of aging, increase bone density and improve joint, back and knee pain. But many of these studies are small and funded by the companies behind such products, increasing the opportunity for bias. Certain products also have flaws that reduce the likelihood of their efficacy: Topical creams, for example, are unlikely to make it into the deeper level of the skin where collagen is produced.

Magnesium. Though low levels of magnesium have been associated with various sleep disorders, the evidence for the benefits of taking it for better sleep in supplemental form is thin. In fact, most people already have sufficient levels of the mineral, which helps support immune health, blood sugar regulation, and nerve and muscle function. Magnesium is easy to get in foods including nuts, greens, seeds, beans, yogurt and fish.

Vitamin B6. This essential nutrient is involved in a number of chemical reactions that are important for the proper functioning of the immune and nervous systems. As with the other essential vitamins, the body cannot produce B6 on its own, so you can only get it from foods (such as tuna, salmon, chickpeas, poultry, dark leafy greens, bananas, oranges, cantaloupe and nuts) or supplements. Most healthy adults get more than enough vitamin B6 from their diets alone, so B6 supplements are generally not needed.

Melatonin. The hormone is released by our brains as it starts to get dark outside, making us sleepy. Taking it in supplement form tricks your body into feeling like it’s nighttime. Experts urge people to consult their doctor before taking melatonin, as the supplement does not address underlying health problems, like anxiety and sleep apnea, that may disrupt sleep and require treatment. Lifestyle changes that experts say help us sleep better, from limiting alcohol consumption to exercising regularly, should also be considered first.

Vitamin D. Our bodies need this vitamin for the gut to absorb calcium, which bones need to grow and stay healthy. But a large study in the United States reported that vitamin D pills taken with or without calcium have no effect on bone fracture rates and a host of other ailments like cancer and cardiovascular disease. Even so, some people, including those with conditions like celiac and those who are deprived of sunshine, however, may find the supplements useful.
If you can’t meet your calcium needs with food alone, taking a calcium supplement can help, Dr. Weaver said. Just make sure you don’t exceed the recommended amount, Dr. Dawson-Hughes added. More is not always better, and excess calcium won’t provide extra protection for your bones.

Vitamin D

Vitamin D, which is crucial for maintaining strong bones because it helps your body absorb calcium from food, is synthesized in the skin after it is exposed to the sun’s ultraviolet B rays. But the skin’s ability to do this synthesizing declines with age, Dr. Dawson-Hughes said.

Certain vitamin D-rich foods can help make up for that loss. These include rainbow trout, salmon, canned tuna, mushrooms, egg yolks and milk, in addition to foods and drinks that are fortified with the vitamin, like some orange juices, plant milks and cereals.
Those between the ages of 1 and 70 need 600 IU (international units) per day, and those 70 and older need 800 IU daily. But it’s challenging for most people to reach those requirements with food alone, Dr. Shapses said.

It’s also not clear if turning to a vitamin D supplement will help with bone health. Recent research suggests that vitamin D supplements do not reduce the risk of fractures, so experts recommend consulting a doctor, who can advise if vitamin D supplements are right for you.

Protein

Several studies in older adults have linked higher protein consumption with stronger bones. Protein makes up about half of bone volume and is essential for replacing bone when it is lost.

But since protein plays two roles in the body — helping to absorb calcium in the gut and to excrete it in urine — you need to maintain sufficient levels of both protein and calcium for good bone health, said Shivani Sahni, an associate professor at Harvard Medical School.

In one 2021 study of more than 7,000 older adults in senior living centers in Australia, for instance, those who consumed 3.5 servings of dairy (which is high in both calcium and protein) per day for two years had 33 percent fewer fractures than those who consumed only two servings per day. That’s similar to the effect of some osteoporosis drugs that are intended to reduce fracture risk, the study’s authors noted.
Federal guidelines say that most adults need 0.36 grams of protein per pound of body weight per day. For a 185-pound person, that translates to 67 grams of protein each day. But some evidence suggests that adults 65 and older might benefit from slightly more protein — closer to 0.45 to 0.54 grams per pound per day, or 84 to 101 grams per day for an 185-pound person.

Protein-rich foods include Greek yogurt, salmon, beef, chicken, eggs, almonds, milk and lentils.

Other Vitamins and Minerals

Diets that incorporate a variety of fruits and vegetables, like the Mediterranean and DASH diets, can help support bone health, too, Dr. Sahni said. The beneficial nutrients and plant compounds can help protect our cells from damage, further preventing or slowing the progress of osteoporosis, she said.

Leafy greens, fruits, nuts and legumes, for example, are rich in magnesium and potassium, which both support healthy bones. "Increasing the variety of foods you consume is one of the best ways to influence your bone health," said Kelsey Mangano, an associate professor at the University of Massachusetts, Lowell, who studies nutrition and musculoskeletal aging.

Prunes and blueberries have also been linked to bone health in older women. In a 2022 study of 235 postmenopausal women, for instance, those who ate four to six prunes per day for one year were less likely to lose hip bone mineral density than those who ate none. Another small trial of 13 postmenopausal women found that those who consumed 17.5 grams of freeze-dried blueberry powder (equivalent to three-quarters of a cup of blueberries) per day for six weeks retained more bone calcium than they did during the weeks they didn’t consume the powder.

Dr. Weaver, who was an author on the blueberry and prune studies, said that although the blueberry study had few participants, the results were "statistically significant and about a quarter as effective as hormone replacement therapy, but without the side effects."
But, she added, it’s hard to say if these benefits were a result of the fruit itself, the fiber or something else, like the gut microbiome of the person eating the fruit. "There’s a lot to be learned," she said.

Your diet alone won’t be enough to prevent bone loss. You still need to combine it with exercise, Dr. Mangano said. Adults 65 and older should aim for at least 150 minutes of moderate aerobic activity each week (such as brisk walking or bike riding), as well as incorporating balance activities and at least two days of muscle-strengthening workouts, according to the Centers for Disease Control and Prevention.

"Exercise and a nutrient-rich diet with adequate calcium, vitamin D and protein are the foundation stones for healthy bones," Dr. Shapses said. They’ll work together to benefit "multiple organs in the body," she said, "but especially bone."

Nikki Campo is a freelance writer in North Carolina.
Take Care of Your Bones



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