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


As defined by the World Health Organization and the Food and Agricultural Organization of the United Nations, fortification refers to "the practice of deliberately increasing the content of an essential micronutrient, that is, vitamins or minerals in a food, irrespective of whether the nutrients were originally in the food before processing or not, so as to provide a health benefit with minimal risk to health".[106] Food fortification has the advantage of delivering essential nutrients to large segments of the population without requiring radical changes in food consumption patterns. Foods used as fortification vehicles vary from country to country, but they generally include cereals and cereal-based products, milk and dairy products, fats and oils, tea and other beverages, and condiments. Certain types of fortification are more accurately called enrichment when micronutrients lost during processing are added back to food.

Debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals, and this is true also for skeletal health. Given the study limitations limiting our current knowledge, provision of excess nutrients beyond their threshold of benefit may not produce a greater response. 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.