AACE statement questions efficacy of dietary supplements for bone health

A healthy diet that includes adequate consumption of calcium, vitamin D and protein is more effective for bone health maintenance than vitamin and other supplements, according to a position statement released by the American Association of Clinical Endocrinologists.

“Given the study limitations limiting our current knowledge, provision of excess nutrients beyond their threshold of benefit may not produce a greater response,” Daniel L. Hurley, MD, FACE, associate professor of medicine in the division of endocrinology, diabetes, metabolism and nutrition at Mayo Clinic and president of AACE, and colleagues wrote in the statement. “Three critical nutrients for bone health are calcium, vitamin D and protein, and diets that are inadequate in one may well be inadequate in other nutrients important to skeletal health. Otherwise, optimal nutritional status for bone health is best obtained by consuming a healthful diet and will likely not be met by single nutrient supplementation.”

Calcium is best obtained from food sources, as low-calcium diets can increase the risk for osteoporosis and fractures at all ages. However, the authors recommend total calcium intake of no more than 1,200 mg to 1,500 mg per day. Use of calcium supplements should be weighed against regular calcium consumption from food and only to reach the recommended threshold.

Other minerals such as phosphorous/phosphate, magnesium and fluoride have varying degrees of importance in bone health, according to the authors.

Although failing to get enough phosphate can negatively affect bone mineralization, the mineral is present in many foods and insufficiency is unlikely, they wrote. Additionally, excessive phosphate consumption can harm bone health, especially if calcium intake is low or renal function is compromised.

Magnesium consumption, which aids in calcium and potassium homeostasis, is lower than recommended in nearly half of the U.S. population, but evidence is lacking for the benefits of supplementation, according to the authors. Additionally, fluoride is found throughout the food chain and is therefore not a clear candidate for supplementation.

Boron is a still misunderstood mineral when it comes to bone health, although it has positive effects on vitamin D, estrogen and renal retention of calcium, according to the authors. Although boron supplementation is not recommended, its presence in foods like fruits, leafy vegetables and nuts makes it an accessible mineral and one that may have ancillary benefits for bone health.

Vitamin D is another important factor in bone health, according to the authors, but controversy surrounding the definition of vitamin D insufficiency and high vitamin D distorts how effective supplementation may be. Even if vitamin D is mostly obtained through exposure to ultraviolet B radiation and not food, the authors do not recommend “huge single doses of vitamin D” and advise individual consideration for addressing low or high vitamin D levels.

Along with vitamin D, vitamins A, K, E and C all have varying degrees of effect on bone health, but the authors do not recommend supplementation, especially as some are naturally occurring in a normal diet.

Protein has a beneficial interaction with calcium in bone health and can help decrease fracture risk. The authors, therefore, emphasize the importance of “adequate protein intake” as a necessary protective measure in bone health.

In a similar vein, they addressed trace elements, which are part of the growth, development and maintenance of bone and other body tissues. Despite this important role, trace elements in over-the-counter supplements have not been studied enough long term to recommend their use in improving bone health and reducing fracture risk.

One strategy the authors recommend for the consumption of a balanced diet for optimal bone health is food fortification, which can provide bone health-positive nutrients to more people without changing consumption behavior. In the meantime, there is more work to be done in determining the optimal approach to bone health, especially since requirements vary from person to person, they wrote.

“As clinicians, we are frequently asked for advice regarding proper nutrient intake to maintain health,” Hurley said in a press statement. “However, there are varying factors to consider when defining nutritional adequacy for optimal bone health, such as food consumption and interactions between nutrients and food, and therefore, additional studies are needed to provide more clarity.” – by Phil Neuffer

Disclosures: Hurley reports no relevant financial disclosures. Please see the statement for all other authors’ relevant financial disclosures.

A healthy diet that includes adequate consumption of calcium, vitamin D and protein is more effective for bone health maintenance than vitamin and other supplements, according to a position statement released by the American Association of Clinical Endocrinologists.

“Given the study limitations limiting our current knowledge, provision of excess nutrients beyond their threshold of benefit may not produce a greater response,” Daniel L. Hurley, MD, FACE, associate professor of medicine in the division of endocrinology, diabetes, metabolism and nutrition at Mayo Clinic and president of AACE, and colleagues wrote in the statement. “Three critical nutrients for bone health are calcium, vitamin D and protein, and diets that are inadequate in one may well be inadequate in other nutrients important to skeletal health. Otherwise, optimal nutritional status for bone health is best obtained by consuming a healthful diet and will likely not be met by single nutrient supplementation.”

Calcium is best obtained from food sources, as low-calcium diets can increase the risk for osteoporosis and fractures at all ages. However, the authors recommend total calcium intake of no more than 1,200 mg to 1,500 mg per day. Use of calcium supplements should be weighed against regular calcium consumption from food and only to reach the recommended threshold.

Other minerals such as phosphorous/phosphate, magnesium and fluoride have varying degrees of importance in bone health, according to the authors.

Although failing to get enough phosphate can negatively affect bone mineralization, the mineral is present in many foods and insufficiency is unlikely, they wrote. Additionally, excessive phosphate consumption can harm bone health, especially if calcium intake is low or renal function is compromised.

Magnesium consumption, which aids in calcium and potassium homeostasis, is lower than recommended in nearly half of the U.S. population, but evidence is lacking for the benefits of supplementation, according to the authors. Additionally, fluoride is found throughout the food chain and is therefore not a clear candidate for supplementation.

Boron is a still misunderstood mineral when it comes to bone health, although it has positive effects on vitamin D, estrogen and renal retention of calcium, according to the authors. Although boron supplementation is not recommended, its presence in foods like fruits, leafy vegetables and nuts makes it an accessible mineral and one that may have ancillary benefits for bone health.

Vitamin D is another important factor in bone health, according to the authors, but controversy surrounding the definition of vitamin D insufficiency and high vitamin D distorts how effective supplementation may be. Even if vitamin D is mostly obtained through exposure to ultraviolet B radiation and not food, the authors do not recommend “huge single doses of vitamin D” and advise individual consideration for addressing low or high vitamin D levels.

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Along with vitamin D, vitamins A, K, E and C all have varying degrees of effect on bone health, but the authors do not recommend supplementation, especially as some are naturally occurring in a normal diet.

Protein has a beneficial interaction with calcium in bone health and can help decrease fracture risk. The authors, therefore, emphasize the importance of “adequate protein intake” as a necessary protective measure in bone health.

In a similar vein, they addressed trace elements, which are part of the growth, development and maintenance of bone and other body tissues. Despite this important role, trace elements in over-the-counter supplements have not been studied enough long term to recommend their use in improving bone health and reducing fracture risk.

One strategy the authors recommend for the consumption of a balanced diet for optimal bone health is food fortification, which can provide bone health-positive nutrients to more people without changing consumption behavior. In the meantime, there is more work to be done in determining the optimal approach to bone health, especially since requirements vary from person to person, they wrote.

“As clinicians, we are frequently asked for advice regarding proper nutrient intake to maintain health,” Hurley said in a press statement. “However, there are varying factors to consider when defining nutritional adequacy for optimal bone health, such as food consumption and interactions between nutrients and food, and therefore, additional studies are needed to provide more clarity.” – by Phil Neuffer

Disclosures: Hurley reports no relevant financial disclosures. Please see the statement for all other authors’ relevant financial disclosures.