Public health messaging about bone health has focused overwhelmingly on calcium. This focus has led to calcium supplementation becoming one of the most widely used supplements in older adults, despite evidence that calcium supplements at high doses may increase cardiovascular risk. More importantly, the singular focus on calcium has obscured the reality that calcium alone cannot be incorporated into bone without the cofactors that direct it into the bone matrix rather than into soft tissues including arterial walls.
Vitamin K2: The Calcium Traffic Controller
Vitamin K2 activates two critical proteins: osteocalcin, produced by bone-building osteoblasts, which binds calcium into the hydroxyapatite matrix of bone; and matrix Gla protein, produced by vascular smooth muscle cells, which prevents calcium from depositing in arterial walls. Without adequate K2, calcium absorbed from food or supplements is less efficiently incorporated into bone and more likely to accumulate in soft tissues. Dietary K2 sources are limited: natto, aged hard cheeses, egg yolks, and chicken liver are the primary sources.
Magnesium and Bone Crystal Structure
Magnesium is incorporated into the crystal structure of hydroxyapatite, the mineral component of bone, and influences the size and structural integrity of bone crystals. Magnesium deficiency is associated with reduced bone mineral density and increased fracture risk. Multiple epidemiological studies have found that higher dietary magnesium intake is independently associated with higher bone density in both pre- and post-menopausal women. Pumpkin seeds, dark leafy greens, and dark chocolate are the best food sources.
- Vitamin D: required for calcium absorption from the gut; supplement 1,000 to 2,000 IU from October to March at minimum
- Vitamin K2: eat fermented dairy (aged hard cheese), egg yolks, and chicken liver regularly
- Magnesium: eat dark leafy greens, pumpkin seeds, and dark chocolate daily
- Protein: adequate intake of 1.6g per kilogram body weight supports the collagen matrix of bone
- Exercise: particularly resistance training and impact activities, is the primary stimulator of bone remodelling; dietary support without mechanical loading is insufficient