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

Skeletal Health Throughout Life

Osteoporosis is an age-related skeletal disorder of compromised bone strength, predisposing to an increased risk of fracture.[5] Modifiable determinants of adult bone health, to include nutrition, influence accrual of peak bone mass and size, and nutrition may have its greatest influence on adult bone health by affecting early skeletal growth.[6] Bone growth generally tracks at a consistent trajectory during youth until puberty, when bone turnover and nutrient demand markedly increase. Depending on the skeletal site, peak bone mass occurs by the end of the second or early in the third decade of life. Supported by sufficient nutrition, bone mass and bone turnover remain relatively stable in midlife. Despite metabolic demands during pregnancy and lactation for fetal bone growth, transient changes in maternal regional or systemic skeletal turnover are without enduring consequence on skeletal integrity.[7]

Menopause-related estrogen deficiency leads to an increase in bone remodeling. The rate of bone resorption exceeds formation, leading to micro-architectural deterioration and loss of both cortical and trabecular bone. Optimal nutrition can attenuate but not prevent age-related decline in bone strength seen in both women and men, although nutritional status can impact fracture risk with aging through nonskeletal risk factors (i.e., physical function associated with sarcopenia).

Nutrition supplies the required substrate for the cellular activity, tissue structure, and function of all components of bone. The noncellular bone tissue consists of minerals (i.e., calcium, phosphate, and magnesium), collagen, and noncollagenous proteins. Minerals strengthen the collagen-protein matrix while also serving as a source of important ions for bodily homeostasis. Thus, growth and maintenance of skeletal tissue requires provision of adequate nutrients during each stage of life[8] (Table 1).