Essential Nutrients for Bone Health: Calcium, Magnesium, Vitamin D, and Vitamin K

OPTIMIZE BONE HEALTH—YOUR PLAN TO PREVENT OSTEOPOROSIS FRACTURES.

As men and women age, they lose bone density and the risk for debilitating fractures increases. Several preventative measures will help to maintain strong bones and prevent the risk of fractures. The two most important factors for bone health are activity and nutrition.

Activity Builds Bone Strength

Bones need vibration to stay strong. Send a healthy fit adult to the space station in outer space, and they risk losing a lifetime of bone density in just a few months; now you know why they have a mini gym in the space lab for astronauts.

Bones need physical stress to stay strong, not surprisingly, weight bearing exercises (walking, running, elliptical machine use) and strength training (weight lifting, Pilates) are fantastic for your bones. Taking bone nutrients (calcium, vitamin D, etc) alone is not enough to maintain bone density.

Are you getting enough activity? Most experts recommend walking 10,000 steps daily (as measured on a pedometer). This is equivalent to walking about 3 miles every day.

Bone Nutrition

Your bones need four primary nutrients to stay strong and prevent fractures: calcium, magnesium, vitamin D, and vitamin K (plus trace elements found in a high quality multivitamin). My favorite pill that contains all four is OsteoForce. For details on bone nutrition, keep reading:

Bone Nutrition Outline

  • How much Calcium do you need?
  • What is the best type of Calcium supplement? Are some absorbed and tolerated better than others?
  • Should you always take Calcium with Magnesium?
  • How much and what type of Magnesium do you need?
  • How much Vitamin D do you need?
  • Do you need to check a Vitamin D level?
  • What if you get Vitamin D, but you don’t get Vitamin K?
  • Why do you need vitamin K?
  • How much Vitamin K do you need for your bones and arteries?
  • What are food sources for vitamin K?

Calcium:

  1. How much Calcium do you need? Calcium needs vary by lifestyle. If you do everything right, you will do well with only 800 mg of calcium daily, but if you do most things wrong, 1,500 mg daily will keep you from fracturing later in life. I recommend that you select one of the choices that best matches your lifestyle:
    1. You do everything right and you need 800 mg of calcium daily: meaning you get 45 minutes of weight bearing exercise 5-6 days per week, you lift weights 2-3 times per week, you don’t smoke, do not drink more than 1-2 servings of alcohol at a time, you get at least 1,000 IU of vitamin D and 500 mcg of vitamin K daily, you do not eat excessive animal protein or salt (>10 ounces meat-poultry-fish daily, >2,000 mg salt daily), and you eat at least 5 cups of fruits and vegetables every day. Sadly, this is only about 5% of Americans.
    2. You do most things wrong, or, you already have osteopenia or osteoporosis and thus you need 1,500 IU of vitamin D daily: you don’t exercise; you get excessive amounts of alcohol, tobacco, animal protein, and/or salt; and you don’t get your 5 cups of fruits and vegetables every daily. This is about 20-30% of Americans today.
    3. Most often, you are somewhere in between and you should get 1,000 to 1,200 mg of calcium daily.

    Once you know your calcium requirements, calculate how much calcium you get from food. See the table below. To simplify it, think of plain yogurt at 400 mg of calcium per cup. Milk, calcium-fortified soy milk, almond milk, & orange juice all have 300 mg of calcium per cup. Green leafy veggies (except spinach) have 100 mg per cup. Beans have 100 mg per cup. On a typical day (not a good or bad day), how much calcium do you get through your food?

Food Item Calcium content (mg)

Non-Fat Yogurt (8 ounces)                               415

Non-Fat Cow’s milk (8 ounces)                         300

Soy & Rice milk (Calcium fortified-8 ounces) 300

Orange juice, calcium fortified                           300

Soy beans (edamame, 1 cup)                             261

Sardines in tomato sauce (3.5 ounces)             240

Broccoli, cooked (1 cup)                                      175

Kale, and other cooked greens  (1 cup)            100-150

Seaweed (dry Hijiki or Wakame)                      100-160

Tofu (1/2 cup)                                                      130

Navy beans (1 cup, cooked)                                128

Garbanzo beans (1 cup)                                        80

Almonds (1 ounce)                                                 75

Carrots (1 cup)                                                       35

Brown rice (1 cup), or oatmeal cereal, (1 cup)   20

Whole wheat bread (1 slice)                                  20

Now that you know your calcium requirement and your dietary intake, you can calculate how much calcium to add daily to meet your needs. If your dietary intake is lower than your requirement, either add more calcium rich foods daily or take a supplement.

What is the best type of Calcium Supplement?

  • Protein-bound calcium or calcium chelate (e.g. calcium malate chelate or calcium glycinate chelate) are by far the best absorbed and cause little to no gastrointestinal symptoms.
  • Calcium carbonate is the worst type of calcium as it may contain lead, must be consumed with food, has limited absorption, and causes constipation.
  • Calcium citrate is normally lead-free, but has limited absorption and can cause constipation.

Should you always take Calcium with Magnesium?

Absolutely. Please keep three facts in mind:

  • Most people are magnesium deficient
  • Taking calcium blocks magnesium absorption
  • Magnesium is critical for hundreds of health issues, in particular blood pressure and blood sugar control, preventing constipation & muscle cramps, plus preventing fatal cardiac arrhythmias.

So yes, if you take calcium, you should take it with magnesium. Many high quality calcium supplements come with calcium and magnesium in a 2:1 to 3:1 ratio, which is an excellent choice.

  • My favorite form of calcium and magnesium is OsteoForce, with a nice protein-bound form of calcium & magnesium, plus extra vitamin D and vitamin K. If you already get your vitamin D and vitamin K from other sources, then try our Calcium Malate Chelate and Magnesium Malate Chelate aiming for a 2:1 ratio.

Magnesium.

  • How much Magnesium do you need? Most people need about 400 mg daily. If you aim for 800 mg of calcium daily, then 300-400 mg of magnesium should be enough for you. If you aim for 1500 mg calcium daily, then 500-750 mg of magnesium is needed.
  • Does the type of Magnesium matter? Absolutely! There are many different types of magnesium, and the most common is magnesium oxide, which is a cheap form that often causes gastrointestinal distress (typically this is the type used to clean out your bowel before surgery or a colonoscopy). The best absorbed and best tolerated would be a protein bound form of magnesium, or the second best choice would be magnesium citrate.

Vitamin D.

Vitamin D is essential for calcium absorption and bone mineralization.

  1. Vitamin D also impacts many critical aspects of health and proper intake is associated with reducing the risk of cancer, auto-immune disease, heart disease, and many other health issues.

How much vitamin D do you need? (See Get Your Vitamin D for details)

  1. Most people need at least 1000 IU of vitamin D3 (cholecalciferol) daily. As we age, or if we have other health issues (bone density loss, auto-immune disease, cancer risk) then some people may need 2000 to 3000 IU daily. Talk to your medical provider before taking more than 2000 IU daily long term, although if your level is low, typically people take 5,000 IU daily for 2-3 months to bring their levels back to normal before continuing on 2,000 IU daily long term.

Vitamin D facilitates the absorption of calcium, helping to support healthy and strong bones. It also promotes bone mineralization. Get regular sun exposure (about 20-30 minutes a day is adequate), and take 2,000 IU of vitamin D per day – look for supplements that provide D3 (cholecalciferol) rather than D2 (ergocalciferol).

Should you check your Vitamin D level with a blood test?

  1. If you have complicated medical problems, such as gastrointestinal problems, osteopenia or osteoporosis, auto-immune disease, cancer, then yes I suggest you check a level to ensure you are between 40-70.
  2. Healthy people getting the dosages recommended above do not require this, although I check this at least once in all my patients to ensure they are at optimal levels. Absorption rates vary substantially and at times I am surprised how low some of my patient’s levels are.

Do you need to take Vitamin K with Vitamin D?

  1. There are theoretical concerns that adding vitamin D, which helps calcium absorption, to a vitamin K deficient person will increase arterial calcification. As there is a great deal of scientific merit behind this concern, I think it is critical to meet your vitamin K needs if you take vitamin D.

Vitamin K.

Why do you need Vitamin K?

  1. Vitamin K was first identified to be essential for normal clotting, otherwise one might bleed to death after a minor cut.
  2. Over time, we now realize that vitamin K is also essential for bone and artery health. Without vitamin K, bones lose calcium and arteries become stiff and hard as they cannot get rid of calcium from their arterial walls.

How much Vitamin K do you need for your bones and arteries?

The minimum for proper clotting is around 100 mcg per day (90mcg for women, and 120 mcg for men). Yet for your bones and arteries, they function much better with at least 250 mcg of Vitamin K daily, and most experts in this field suggest that for optimum function you get 1,000 mcg daily. If you eat 1 cup of cooked greens, that provides ~1000 mcg of Vitamin K daily, while 1 cup of broccoli, onions, or beets provides about 250 mcg of Vitamin K.

Ten Years Younger options for Vitamin K:

  1. -OsteoForce: 250 mcg Vit K/tablet
  2. -Multivitamin with joint or arthritis support: 775 mcg Vit K/pack once daily
  3. -Multivitamin with bone support: 1000 mcg with 1 pack taken twice daily
  4. -Vitamin D 2000 IU daily with 200 mcg Vit K

Vitamin K Content in Food:

 

Food Content Measure mcg of K1
Kale, cooked, drained 1 cup 1,062
Collards, cooked drained 1 cup 1,059
Spinach, cooked(or ~7 cups raw) 1 cup 889
Beets, cooked 1 cup 697
Broccoli, cooked 1 cup 220
Brussels sprouts, cooked 1 cup 219
Onions, raw 1 cup 207
Parsley 10 sprigs 164
Cabbage, cooked(or ~ 3 cups raw) 1 cup 163
Asparagus, cooked 1 cup 144
Lettuce, iceberg 1/4 head 33

Comments

  1. Glad it was helpful. Keep in mind the combination of weight bearing activity (such as walking) and these bone nutrients are not just good for your bones, but good for many aspects of your life.

    To Your Health!
    Steven Masley, MD

  2. Dr Masley, would speak about mk4 and mk7. please? I am healthy, 68, post mastectomy 3 yrs, take arimedex, make best choices[ veggies, exercise almost daily, no smoke, rarely 2oz wine etc] and have an osteoporotic fem neck. it is on the side I favored the past 2 years due to an injured knee[ used trek poles to keep walking and thus took weight bearing off that hip, I can now see]. In summation, I also have sleep disturbance and wake often. aim for better sleep, and arimedex works against that, but I also hear mk7 does as well. I take melatonin, do my resperate at bed, and do increasingly better. it’s a long slow one tho;-) I grow kale and have it in my smoothie daily. and think I am pretty pro active in general. am a retired chiro.
    thanks for your information offers;-)

  3. Susan, This is an important questions as mk4 and mk7 are forms of Vitamin K, specifically vitamin K2.
    Green leafy veggies provide K1, which is good for your heart and bones.
    Vitamin K2 comes from fermented cheese and natto (fermented soy paste), and appears to be more powerful than K1, especially for your arteries and bones. Your body also converts a small amount of K1 to K2, but nothing compared to the amount that can be taken as a supplement.

    There are a dozen Japanese studies showing that Vitamin K2 (in particular in the MK7) is helpful for treating osteoporosis in dosages approaching 45 mg per day. Compared to dietary intake, this is a massive dosing schedule. So clearly talk to your doctor for dosing advice and whether this is a good therapy choice for you.

    I don’t know of any literature that suggests that vitamin K affects your sleep in any significant way, although Arimedex has many side effects, poor sleep being just one. In light of your history of breast cancer, I’d error more on the cautious side when considering vitamin K therapy, as nobody has likely studied its impact on breast cancer, certainly not that I know of.
    To Your Health!
    Steven Masley, MD

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  7. Hello Doctor

    This was a very helpful webpage. Accept my thanks from heart. I have been recently diagnosed of osteopenia, and loss of cartilage in knees making ugly sound and yes little pain in knee area. My calcium level is very low.

    I have started taking medicines. I am 31. I have been asked to stop coffee but its hard. I take usualy 2-3 cups of strong coffee. Can you suggest on coffee? And how much time shall medicines take to bring me back on my healthy feet? Can cartilage be created again?

  8. You have a complicated story, and having osteopenia at 31 is not usual. You’ll need to see an expert in person to get good medical advice.
    Generally speaking, cartilage loss and bone loss are not related.
    Coffee pulls calcium out of bones, but tea does not, so try drinking tea more often.

    To Your Health!
    Steven Masley, MD

  9. If Calcium blocks Magnesium absorption, why do you recommend taking them together? thanks

  10. My husband has had two emboli in his lungs and clotted from his knees to just below his renal veins. He has to be on blood thinners the rest of his life. He is currently taking two shots of lovenox(sp?) a day. It is a 2/3 dose because he has innumerable arterial veinous malformations in his brain Nine of them have already bled. I am looking for a good calcium product but I am having a difficult time finding one that doesn’t have vitamin K. The docs are wanting to switch him to Coumadin(SP?). Any suggestions?

  11. I would suggest adding a protein-bound form of both calcium and magnesium. We have both in our store as an example: http://tenyearsyounger.pwcstores.com/product/calcium-malate-chelate) and (http://tenyearsyounger.pwcstores.com/product/magnesium-malate-chelate).

    Always aim for a 2:1 Calcium to Magnesium), plus vitamin D and skip vitamin D until your doctor tells you it is ok to resume it.
    I wish you the best of health!
    Steven Masley, MD

  12. Paul,
    If you take calcium without magnesium, it will block the magnesium update from your food. If you take both together in a 2:1 or 3:1 ratio, you will block a small quantity of magnesium absorption, but with that amount of magnesium, you will still absorb ample magnesium.
    Hope that helps.
    Steven Masley, MD

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