Nutrition & Bone Health: Selective Literature Review

"A generalization from the literature, without a formal metaanalysis, may be that we need adequate supplies of both vitamin D and calcium to obtain significant reductions in nonvertebral fractures (especially hip fractures), and that those effects may be seen only in those persons who have insufficient vitamin D or calcium (or both). In addition, persons need to consume an overall healthful diet that meets all nutrient requirements. Protein for fracture prevention and healing and plenty of fruit and vegetables for overall health are of particular importance. A well-rounded diet is important, and evaluation of one element or vitamin does not give the whole story. [emphasis added.]

So where does that leave clinicians? The best public health recommendation would be that people should consume an overall healthful diet including adequate consumption of both calcium and vitamin D. This meta-analysis highlights the importance of not  segmenting nutrition into heterogeneous populations and isolated nutrients. Bone is not just calcium, and calcium does not function in isolation.

Source: JW Nieves, R Lindsay
Calcium and fracture risk (editorial)
Am J Clin Nutr. 2007 Dec;86(6):1579-80.


Today, I'm publishing the "sifted" results of several literature searches I conducted during the past two weeks.

HA Bischoff-Ferrari, B Dawson-Hughes, J A Baron, PBurckhardt, R Li, DSpiegelman, B Specker, JE Orav, JB Wong, HB Staehelin, E O’Reilly, DP Kiel, and WC Willett
Calcium intake and hip fracture risk in men and women: a metaanalysis of prospective cohort studies and randomized controlled trials
Am J Clin Nutr 2007;86(6):1780–90.
Full article (PDF)

JZ Ilich and JEKerstetter
Nutrition in Bone Health Revisited: A Story Beyond Calcium
J Am Coll Nutr 2000;19(6):715-737.
Full article (PDF)

(Note: Though this review is 9 years old, it led me to other valuable research and review articles and has been cited by many so I'm including it here. All other resources have been published within the past 6 years.)

SA New and DJ Millward
Calcium, protein, and fruit and vegetables as dietary determinants of bone health
Am J Clin Nutr 2003;77(5):1340 - 1341.
Letter to Editor

SA Lanham-New
Fruit and vegetables: the unexpected natural answer to the question of osteoporosis prevention?
Am J Clin Nutr 2006;83(6):1254-1255.
Editorial with detailed reference list & links
Full article (PDF)

CJ Prynne, GD Mishra, MA O'Connell, GMuniz, MA Laskey, L Yan, APrentice and F Ginty
Fruit and vegetable intakes and bone mineral status: a cross-sectional study in 5 age and sex cohorts
Am J Clin Nutr 2006;83(6):1420-1428.
Full article (PDF)

J-P Bonjour
Dietary Protein: An Essential Nutrient For Bone Health
J Am Coll Nutr 2005;24,(90006):526S-536S
Full article (PDF)

A Devine, IM Dick, AF Islam, SS Dhaliwal and RL Prince
Protein consumption is an important predictor of lower limb bone mass in elderly women
Am J Clin Nutr 2005;81(6):1423 - 1428.
Full article (PDF)

RP Heaney and DK Layman
Amount and type of protein influences bone health
Am J Clin Nutr 2008;87(5):1567S - 1570S.

Full text (PDF)

JW Nieves
Osteoporosis: the role of micronutrients
Am J Clin Nutr 2005;81(5):1232S - 1239S.

Full article (PDF)

RK Rude, FR Singer, and HE Gruber
Skeletal and Hormonal Effects of Magnesium Deficiency
J Am Coll Nutr 2009; 28(2):131 - 141.

FA Tylavsky, LA Spence and L Harkness
The Importance of Calcium, Potassium, and Acid-Base Homeostasis in Bone Health and Osteoporosis Prevention
J Nutr 2008;138(1):164S - 165S.

Full article (PDF)

SA Lanham-New
The Balance of Bone Health: Tipping the Scales in Favor of Potassium-Rich, Bicarbonate-Rich Foods
J Nutr 2008;138(1):172S - 177S.

Full article (PDF)


Because of my practice area (neuroscience), I've been focused on brains and neglecting bones -- at least in terms of the evidence for best practice. Collecting these resources wasn't too difficult (thank you, OVIDSP databases and Google Scholar) and reading them has been very interesting, informative and even surprising. I hope you find some of these resources helpful, too.

In my next post (currently in draft stage) I'll be sharing evidence and practical guidelines on how a plant-based diet can build and maintain healthy bones.


Other Greens & Berries posts on nutrition and bone health:

Nutrition in Bone Fracture Prevention & Healing: Part 1
Nutrition in Bone Fracture Prevention & Healing: Part 2
Nutrition in Bone Fracture Prevention & Healing: Part 3