The Use of Vitamins and Minerals in Skeletal Health

American Association of Clinical Endocrinologists and the American College of Endocrinology Position Statement

Daniel L. Hurley, MD, FACE; Neil Binkley, MD, FACE; Pauline M. Camacho, MD, FACE; Dima L. Diab, MD, FACE, FACP, CCD; Kurt A. Kennel, MD, FACE; Alan Malabanan, MD, FACE, CCD; Vin Tangpricha, MD, PhD, FACE


Endocr Pract. 2018;24(10):915-924. 

In This Article

Abstract and Introduction


The desire to maintain health, including bone health, into old age has led to almost one-half of the population and 70% of older adults in the United States[1] and up to 26% in Europe[2,3] using dietary supplements. Dietary supplements allow for randomized controlled trials (RCTs) that can assess a single nutrient. However, in nutrient studies, it is difficult to account for the impact of food and food fortification on skeletal outcomes. The ability to accurately quantify the effect of an individual nutrient on bone health is confounded by methodological issues and the time lag to assess outcomes. Multiple challenges exist to define what constitutes optimal nutrition for bone health. As stated by Dr. Robert Heaney, "…the Institute of Medicine (IOM) makes recommendations concerning intakes of something like nineteen essential nutrients … for virtually all of them, there are still major unresolved questions … most fundamental, what is normal?".[4] Challenges in defining nutritional adequacy are related in part to study design. Baseline nutrient assessment can also be challenging due to variability in daily food consumption. Furthermore, the interactions between nutrients in food, rather than provision of a single nutrient as a supplement, may have important effects. Finally, it seems implausible that a single nutrient amount is optimal for all individuals, regardless of gender, age, ethnicity, body size, and comorbidities. Thus, it is unrealistic to expect systematic reviews or meta-analyses to provide a simple "one size fits all" definition of optimal nutritional status for skeletal health. Nonetheless, clinicians are commonly asked for advice regarding proper nutrient intake to maintain health. Recognizing that additional data are sorely needed, the aim of this position statement is to outline our current understanding of optimal nutrition to maximize bone gain, minimize bone loss, and reduce fragility fracture risk until future studies provide more clarity.