Do You Need Calcium and Vitamin D Supplements for Bone Health?
Do You Need Calcium and Vitamin D Supplements for Bone Health?
TL;DR
Most people don't need calcium supplements. Dairy, bones (bone broth), and leafy greens provide enough. Vitamin D from sun is ideal. Supplement if deficient (test first). But bone health requires more than calcium and D: adequate protein, saturated fat, thyroid function, and weight-bearing exercise. PUFAs impair calcium absorption and bone formation. Fix that first.
Your doctor says your bone density is low.
She prescribes calcium and vitamin D. Maybe a bisphosphonate drug if it's really bad.
You take them. For months. For years.
Your bones don't improve much. Sometimes they get worse.
The supplements aren't fixing the problem. Your metabolism is broken.
Bone health is like building a house. Calcium is bricks. But you also need foundation, frame, and workers. PUFAs fire the workers.
What Bones Actually Need
Bones aren't just calcium. They're living tissue that constantly remodels.
Components of healthy bones:
- Calcium (mineral structure)
- Phosphorus (mineral structure)
- Collagen (protein matrix that holds minerals)
- Vitamin D (helps absorb calcium)
- Vitamin K2 (directs calcium to bones, not arteries)
- Magnesium (needed for calcium metabolism)
- Boron (supports bone formation)
Hormones needed:
- Thyroid hormone (regulates bone turnover)
- Growth hormone (builds bone)
- Sex hormones (estrogen, testosterone protect bones)
- Parathyroid hormone (regulates calcium)
Mechanical stress:
- Weight-bearing exercise creates signals for bone building
- Bones respond to load by getting stronger
How PUFAs Damage Bones
They suppress thyroid function. Low thyroid slows bone formation. Your bones don't rebuild as fast as they break down. Osteoporosis develops.
They cause inflammation. Chronic inflammation increases osteoclast activity (cells that break down bone). More breakdown, less formation.
They impair protein synthesis. Damaged gut from PUFAs means poor protein absorption. You can't make collagen matrix. Bones become brittle.
They reduce sex hormones. PUFAs lower testosterone in men. Lower estrogen effectiveness in women. Both sex hormones protect bone density.
They impair nutrient absorption. Leaky gut and inflammation reduce absorption of calcium, magnesium, vitamin D, and other bone nutrients.
Calcium: Food vs. Supplements
Best food sources:
- Dairy (milk, cheese, yogurt): 300mg per cup of milk
- Bone-in fish (sardines, salmon): 200-400mg per serving
- Bone broth: varies, but significant if bones are cooked long
- Leafy greens (kale, collards): 100-200mg per serving
Needs:
- Adults: 1000-1200mg per day
- Postmenopausal women: 1200mg per day
From food:
- 3 cups dairy = 900mg
- 1 serving sardines = 300mg
- Total: 1200mg easily
Supplements:
- Calcium carbonate (needs stomach acid to absorb)
- Calcium citrate (absorbs better, doesn't need acid)
Problems with supplements:
- Can cause constipation
- May increase heart disease risk (calcium deposits in arteries)
- Doesn't fix poor absorption from gut issues
- Crowds out other minerals (iron, zinc, magnesium)
Better approach: Eat dairy. Drink bone broth. Fix your gut so you absorb calcium properly.
Vitamin D: Sun vs. Supplements
Vitamin D functions:
- Helps absorb calcium from gut
- Regulates immune function
- Supports mood
- Needed for hormone production
Best source: Sun
- 15-30 minutes of midday sun on arms and legs
- Makes 10,000-25,000 IU
- Can't overdose from sun
- Free
Supplement needs:
- Test first (25-OH vitamin D)
- Optimal: 40-60 ng/mL (some say 50-80 ng/mL)
- Deficient: Below 30 ng/mL
If supplementing:
- Vitamin D3 (cholecalciferol), not D2
- 2,000-5,000 IU per day if deficient
- Take with fat (fat-soluble vitamin)
- Retest after 3 months
Don't megadose blindly. Too much vitamin D can cause hypercalcemia (too much calcium in blood). This actually harms bones and kidneys.
What About Vitamin K2
K2 directs calcium to bones instead of soft tissues (arteries, kidneys).
Food sources:
- Natto (fermented soybeans): highest source, 1000mcg per serving
- Grass-fed butter and ghee: 15mcg per tablespoon
- Egg yolks from pasture-raised chickens: 30mcg per yolk
- Hard cheeses: 75mcg per ounce
- Liver: 5-10mcg per serving
Needs:
- 90-200mcg per day
From food:
- Butter, eggs, cheese, meat from grass-fed/pastured animals
- Most people get 10-50mcg per day (low)
Supplement:
- MK-4 or MK-7 forms
- 100-200mcg per day if not eating natto or grass-fed dairy regularly
Important for:
- People taking high-dose vitamin D
- People with cardiovascular disease (prevents arterial calcification)
- Postmenopausal women (bone protection)
The Thyroid-Bone Connection
Thyroid hormone regulates bone turnover.
Hypothyroidism (low thyroid):
- Slows bone formation
- Bones don't rebuild fast enough
- Osteoporosis develops slowly
Hyperthyroidism (high thyroid):
- Increases bone breakdown
- Bones break down faster than they rebuild
- Osteoporosis develops quickly
Optimal thyroid function:
- Balanced bone formation and breakdown
- Healthy bone density maintained
Fix thyroid function first. Eliminate PUFAs. Support with adequate carbs. Then worry about calcium supplements.
Weight-Bearing Exercise
Bones respond to mechanical stress. No stress = weak bones.
Best for bones:
- Walking (weight of body loads bones)
- Strength training with weights
- Running or jumping (impact loading)
- Dancing, hiking, stairs
Not enough:
- Swimming (no impact)
- Cycling (seated, no impact)
- Yoga alone (good for balance, not bone loading)
How much:
- Strength train 2-4x per week
- Walk daily
- Progressive overload (gradually increase weight)
Bones build in response to load. Give them load.
What About Osteoporosis Drugs
Bisphosphonates (Fosamax, Boniva, Reclast):
- Slow bone breakdown
- Increase bone density on scans
- But create brittle bones (quality is poor)
- Side effects: jaw osteonecrosis, atypical fractures
- Don't fix root cause
Prolia (denosumab):
- Monoclonal antibody that stops bone breakdown
- Works differently than bisphosphonates
- Rebound fractures if stopped
- Doesn't fix root cause
Our take: These drugs have a place for severe osteoporosis with fracture risk. But they should be last resort, not first line.
Try first:
- Eliminate PUFAs
- Optimize thyroid
- Eat adequate protein (1g per pound body weight)
- Strength train
- Get vitamin D to optimal range
- Eat calcium-rich foods
Give this 6-12 months. Retest bone density. Many people improve without drugs.
Protein Matters More Than You Think
Bones are 50% protein (collagen). Not just calcium.
Low protein:
- Can't make collagen matrix
- Bones are porous and brittle
- Fracture easily even with normal calcium
Adequate protein:
- 0.8-1g per pound body weight
- Higher for elderly (1-1.2g per pound)
- From meat, eggs, dairy, fish
- Collagen/gelatin helpful (bone broth)
Many elderly people with osteoporosis are simply under-eating protein. They restrict meat because they're not hungry (low thyroid suppresses appetite).
Fix metabolism, appetite returns, protein intake increases, bones improve.
FAQ
Q: I'm lactose intolerant. How do I get calcium? A: Hard cheese is low lactose. Bone-in fish (sardines, canned salmon). Bone broth. Leafy greens (though absorption is lower). Lactose-free milk if needed. Or supplement calcium citrate.
Q: Can I take too much calcium? A: Yes. Above 2,000mg per day can cause constipation, kidney stones, and arterial calcification. Stick to 1,000-1,200mg from food primarily. Supplement only if dietary intake is low.
Q: What about magnesium for bones? A: Also important. Needed for calcium metabolism. Get from dark chocolate, nuts (if tolerated), leafy greens, meat. Or supplement magnesium glycinate 300-400mg per day if deficient.
Q: How long until bone density improves? A: Bones remodel slowly. Expect 6-12 months minimum. Retest DEXA scan after 1-2 years of metabolic optimization and strength training. Don't expect fast results. Focus on preventing further loss while slowly rebuilding.
This isn't medical advice. I'm not your doctor. Work with your healthcare provider for bone health management.
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