Build & Maintain: Strong Bones

A report published in 2021 by the Centers for Disease control (CDC) showed that the incidence of osteoporosis in American adults 50 and older was nearly 13 percent, while prevalence of osteopenia, low bone mass that can lead to osteoporosis, was 43 percent. Women experienced higher rates of both osteopenia and osteoporosis. The report also showed that the prevalence of osteoporosis has increased specifically among women over the last decade.¹

To know how to best support bone health, it’s important to understand exactly what bone is. Most people tend to think of bones as hard and inflexible, but they are not. Bone is dynamic living tissue composed of a mineral matrix (calcium, phosphorous, magnesium, silica, etc.) and a non-mineral matrix made mostly of protein, namely collagen. The minerals make bones hard and dense, while the proteins provide flexibility. Without protein, bones would become too brittle and break, and without minerals, bones would become too soft and lose their density. In optimal health, your bones have just the right balance of minerals and protein to maintain their strength, density, and flexibility.

There are many nutrients crucial to bone health, some of which haven’t even been identified yet. Some of these nutrients may come from food, but for various reasons, we often don’t get optimal amounts of important bone-building nutrients from food alone. For this reason, you may consider implementing a supplement plan to support bone health. Age-related bone loss begins in our forties, so this is the time to start thinking of giving your bones a little extra support.²

Vitamin D

Without optimal levels of vitamin D, your body cannot properly absorb calcium, an important bone-building mineral. In addition to helping the body absorb this mineral, it also ensures that calcium is delivered to the bones. Vitamin D deficiency leads to decreased calcium absorption and ultimately the release of calcium from the bones in order to maintain circulating calcium concentrations in the body.³

A meta-analysis of observational studies published in 2019 that included 39,141 participants found that higher blood levels of vitamin D were associated with lower risks of any fracture and hip fracture specifically; each 10 ng/mL increase in vitamin D levels was associated with a seven percent lower risk of any fracture and a 20 percent lower risk of hip fracture.⁴ Studies have shown that a combination of vitamin D and calcium help maintain bone density and reduce the risk of hip fractures,⁵ however, the amount of vitamin D is critical. In one study, researchers found that women taking 1,000 IU of vitamin D daily maintained their bone density, while those taking only 400 IU lost bone density over one year.⁶

Vitamin K2

This oft-forgotten nutrient plays a crucial role in bone health (vitamin K2 supplements are an approved treatment for osteoporosis in Japan).⁷ Vitamin K—specifically vitamin K2—is necessary for the activation of the proteins osteocalcin and matrix Gla. Once activated, osteocalcin holds calcium to the bone and matrix Gla ensures that calcium is delivered from the blood to the bones, and not deposited in places where it shouldn’t be, like the arteries. In vitro, vitamin K2 has been found to enhance the production of bone-building osteoblasts, while inhibiting the production of osteoclasts, the cells responsible for breaking down bones. It’s also been shown to enhance the activity of vitamin D in the bones.⁸

One three-year long study including 244 postmenopausal women found that daily supplementation of 180 mcg of MK-7, a form of vitamin K2, significantly decreased age-related decline in both bone mineral density and bone strength.⁹

Other important bone-building nutrients include magnesium, part of the mineral-protein matrix that regulates the transport of calcium to bones; calcium, the most abundant mineral in the bones and one that is easily depleted from our bodies; and vitamin C, essential for the production of collagen, the most abundant protein in the bone matrix. Zinc, copper, strontium, silicon, and boron are also important bone-building nutrients; many of these can be found in combinations formulated specifically for bone health.

Brand new research is also showing that the tocotrienols (family of E vitamins) can help reduce bone loss in postmenopausal women,¹⁰ while animal research is finding that the antioxidant quercetin has a balancing effect on bone metabolism, promoting bone building while inhibiting bone loss, and increases bone mineral density.^{11 12}

Build & Maintain: Healthy Muscle Mass

From around age 30 onward, we begin to lose 3 to 8 percent of muscle mass each decade.¹³ Loss of muscle mass and strength can lead to frailty, falls, and broken bones—and is one of the leading causes of loss of mobility and independence in older adults. These supplements have been shown to maintain muscle synthesis and reduce muscle loss related to aging.

Branched-chain amino acids (BCAAs)

BCAAs are a group of amino acids—leucine, isoleucine, and valine—that are essential for muscle growth and suppressing the breakdown of muscle.¹⁴ L-leucine in particular plays a central role in muscle production. One study found that L-leucine supplements, combined with protein, helped increase muscle production in older men (average age 75) almost to the same level as in young men (average age 20).¹⁵ Whey protein is one of the best sources of BCAAs, particularly leucine, and is quickly absorbed and utilized by the muscles, giving them the nutrients they need to stop muscle breakdown and shift to growth and repair.^{16 17 18}

Another option is a multi-amino acid supplement containing the nine essential amino acids. Studies have found that amino acid supplements stimulate muscle production in both older and younger subjects.¹⁹ One study of older adults found that daily multi amino acid supplements led to significant increases in muscle and strength after as little as six months.^{20 21}

EPA & DHA

The omega-3 fats EPA and DHA are well known for their cardiovascular and brain-health benefits and they may also protect against muscle loss. Research is finding that these omega-3s can increase muscle size and strength in healthy older people, as well as reducing the loss of muscle mass. It appears that EPA and DHA are incorporated into muscle cells where they can enhance muscle protein synthesis, decrease muscle breakdown, and improve muscle cell mitochondrial function.²²

One study including healthy older men and women (60 to 85 years) found that six months of supplementing 1.8 grams of EPA and 1.5 grams of DHA lead to a significant increase in lean muscle mass and gains in muscle volume and strength. The study authors concluded that, “Fish oil-derived n-3 PUFA [omega-3] therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.”²³

Other nutrients to consider for maintaining muscle health include vitamin D, which plays an important role in maintaining muscle strength and preventing falls in older people; collagen peptides, which can help increase muscle strength in older people;²⁴ and the Ayurvedic herb shatavari, which may improve muscle function in postmenopausal women.²⁵

In addition to creating a bone and muscle health supplement routine, it is critical to eat a nutrient-dense diet that includes plenty of quality protein (such as 100% grassfed meat and dairy products from pastured animals, wild-caught fish, and nuts) as well as healthy fats (such as butter from grassfed cows, olive oil, coconut oil, and avocados). And maybe most importantly of all—regular physical movement, because after all, if you want to keep on moving… you have to keep moving!

References

1. Sarafrazi N, PhD, Wambogo EA, PhD, MS, MPH, RD, and Shepard JA, PhD. “Osteoporosis or Low Bone Mass in Older Adults: United States, 2017-2018, NCHS Data Brief No. 405, March 2021 https://www.cdc.gov/nchs/products/databriefs/db405.htm
2. Laird E, Ward M, McSorley E, et al. “Vitamin D and Bone Health; Potential Mechanisms.” Nutrients. 2010 Jul; 2(7): 693-72 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257679/
3. Laird E, Ward M, McSorley E, et al. “Vitamin D and Bone Health; Potential Mechanisms.” Nutrients. 2010 Jul; 2(7): 693-72 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257679/
4. Yao P, Bennett D, Mafham M, et al. Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(12):e1917789. doi:10.1001/jamanetworkopen.2019.17789
5. Prentice RL, Pettinger MB, Jackson RD, et al. Health risks and benefits from calcium and vitamin D supplementation: women’s health initiative clinical trial and cohort study. Osteoporosis International, 2013;24:567-580.
6. Macdonald HM, Wood AD, Aucott LS, et al. Hip bone loss is attenuated with 1000 IU but not 400 IU daily vitamin D3: a 1-year double-blind RCT in postmenopausal women. Journal of Bone and Mineral Research, 2013; 28:2202-2213.
7. Celia Rodríguez-Olleros Rodríguez, Manuel Díaz Curiel, "Vitamin K and Bone Health: A Review on the Effects of Vitamin K Deficiency and Supplementation and the Effect of Non-Vitamin K Antagonist Oral Anticoagulants on Different Bone Parameters", Journal of Osteoporosis, vol. 2019, Article ID 2069176, 8 pages, 2019. https://doi.org/10.1155/2019/2069176
8. Koshihara Y, PhD, Hoshi K. “Vitamin K2 Enhances Osteocalcin Accumulation in the Extracellular Matrix of Human Osteoblasts In Vitro.” Journal of Bone and Mineral Research, Dec 4, 2009;12(3): 431-438  https://doi.org/10.1359/jbmr.1997.12.3.431
9. Knapen, M.H.J., Drummen, N.E., Smit, E. et al. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporos Int 24, 2499–2507 (2013). https://doi.org/10.1007/s00198-013-2325-6
10. Shen C-L, Mo H, Dunn DM and Watkins BA (2021) Tocotrienol Supplementation Led to Higher Serum Levels of Lysophospholipids but Lower Acylcarnitines in Postmenopausal Women: A Randomized Double-Blinded Placebo-Controlled Clinical Trial. Front. Nutr. Dec 24, 2021 8:766711. doi: 10.3389/fnut.2021.766711
11. Wong SK, Chin K-Y, and Ima-Nirwana S. “Quercetin as an Agent for Protecting the Bone: A Review of the Current Evidence.” Int J Mol Sci. 2020 Sep; 21(17): 6448. doi: 10.3390/ijms21176448
12. Yue-Yue Huang, Zi-Hao Wang, Li-Hui Deng, Hong Wang, Qun Zheng, "Oral Administration of Quercetin or Its Derivatives Inhibit Bone Loss in Animal Model of Osteoporosis", Oxidative Medicine and Cellular Longevity, vol. 2020, Article ID 6080597, 21 pages, 2020. https://doi.org/10.1155/2020/6080597
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23. Gordon I Smith, Sophie Julliand, Dominic N Reeds, David R Sinacore, Samuel Klein, Bettina Mittendorfer, Fish oil–derived n−3 PUFA therapy increases muscle mass and function in healthy older adults, The American Journal of Clinical Nutrition, Volume 102, Issue 1, July 2015, Pages 115–122, https://doi.org/10.3945/ajcn.114.105833
24. Zdzieblik, D., Oesser, S., Baumstark, M., Gollhofer, A., & König, D. (2015). Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: A randomised controlled trial. British Journal of Nutrition, 114(8), 1237-1245. doi:10.1017/S0007114515002810
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