Vastly underdiagnosed and undertreated, osteoporosis is a significant public health concern. It is characterised by weakened bones, increasing the risk of fractures, particularly in the hip, spine, and wrist.¹ As pharmacists, understanding the intricacies of osteoporosis and the importance of essential bone nutrients is crucial in guiding patients towards better bone health.

CRITICAL IMPORTANCE OF CALCIUM

Calcium is a vital mineral for bone health, but it is important to note that because the human body cannot produce calcium on its own, the only way to obtain it is through dietary intake. This underscores the importance of ensuring adequate calcium consumption through diet or supplements. Foods rich in calcium include dairy products, leafy green vegetables, and fortified foods. However, many individuals may not consume enough calcium daily, making bone health supplements essential.¹

5 ESSENTIAL BONE NUTRIENTS

1. Calcium: The cornerstone of bone health, calcium is necessary for maintaining strong bones and teeth. It is crucial for the prevention and management of osteoporosis. Dairy products, almonds, broccoli, kale, canned salmon with bones, sardines, and soy products like tofu are good sources of calcium.²
2. Vitamin D: Essential for the absorption of calcium in the gut, without adequate vitamin D, the body cannot absorb calcium effectively, regardless of dietary intake. Sun exposure and foods like fatty fish and fortified dairy products are good sources of vitamin D.²
3. Magnesium: Magnesium supports calcium levels and plays a role in the activation of vitamin D, which is necessary for calcium homeostasis. It is found in foods such as nuts, seeds, whole grains, and green leafy vegetables.³
4. Vitamin K2: This vitamin ensures that calcium is deposited in the bones and not in soft tissues, reducing the risk of cardiovascular issues. Vitamin K2 is found in fermented foods and animal products.⁴
5. Vitamin C: Essential for collagen formation, vitamin C supports joint health and the structural integrity of bones. Citrus fruits, berries, and vegetables like bell peppers are rich in vitamin C.⁵

RISK FACTORS AND PREVENTION

Osteoporosis is influenced by several non-modifiable risk factors, including age, gender, and family history. Women are more susceptible to bone loss than men, with one in three women over the age of 50 likely to experience osteoporotic fractures. Menopause and certain medical conditions, such as diabetes and rheumatoid arthritis, also increase the risk.^1,2

PREVENTIVE MEASURES

• • Healthy diet: Ensure a balanced diet with adequate intake of calcium, protein, vitamin D, vitamin K, and other essential nutrients.¹
  • Regular exercise: Weight-bearing and resistance exercises strengthen bones.¹
  • Avoiding harmful habits: Smoking and excessive alcohol consumption are risk factors for osteoporosis.¹
  • Medical assessment: Regular check-ups and bone density tests, especially for those with risk factors.¹

REFERENCES: 

1. International Osteoporosis Foundation. (2024). World Osteoporosis Day Toolkit. 
2. Bone health: Tips to keep your bones healthy. Mayo Clinic. 3 December 2022. Available from: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060#:~:text=Include%20plenty%20of%20calcium%20in%20your%20diet.&text=The%20recommendation%20increases%20to%201%2C200,soy%20products%2C%20such%20as%20tofu. 
3. Rondanelli M, Faliva MA, Tartara A, Gasparri C, Perna S, Infantino V, Riva A, Petrangolini G, Peroni G. An update on magnesium and bone health. Biometals. 2021 Aug;34(4):715-736. doi: 10.1007/s10534-021-00305-0. Epub 2021 May 6. PMID: 33959846; PMCID: PMC8313472. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313472/. 
4. Maresz K. Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health. Integr Med (Encinitas). 2015 Feb;14(1):34-9. PMID: 26770129; PMCID: PMC4566462. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/#:~:text=An%20adequate%20intake%20of%20vitamin,of%20calcium%20on%20the%20walls. 
5. Malmir H, Shab-Bidar S, Djafarian K. Vitamin C intake in relation to bone mineral density and risk of hip fracture and osteoporosis: a systematic review and meta-analysis of observational studies. British Journal of Nutrition. 2018;119(8):847-858. Available from: https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/vitamin-c-intake-in-relation-to-bone-mineral-density-and-risk-of-hip-fracture-and-osteoporosis-a-systematic-review-and-metaanalysis-of-observational-studies/E1229B088231CD96AE676352030F428B.