Your customers have probably seen commercials about foods advertised to promote strong bones, usually milk and breakfast cereals fortified with calcium. Your savvier customers may know there is more to the story than calcium, but many may not know how to properly support bone density throughout their life to ensure good bone health in more vulnerable years. Here is what you need to know to point them in the right direction.

Calcium Needs a Helping Hand“It’s important to recognize that bones are a living tissue in the body,” says Robin Rogosin, VP of product development & corporate responsibility for LifeSeasons, based in Lewisville, TX. “Bone is constantly being broken down and rebuilt and that means there is a requirement that every day we get nutrition that helps maintain the optimal health of our bones.”

Lara Niemann, marketing director, Americas for Gelita USA based in Sergeant Bluff, IA, explains that bones are made up of calcium crystals (and other minerals) in a bone collagen matrix. You can’t have one without the other. “Just like a bridge: If it was made only of concrete, it would collapse,” she says. “For stability, it needs a steel frame to which the concrete clings. In humans, the concrete corresponds to the calcium, and the steel frame to the Type I collagen to which the calcium adheres.”

If bone tissue is constantly being broken down by osteoclasts and built back up by osteoblasts, how does one ensure that the right nutrients get to where they are needed? Taking calcium alone certainly doesn’t cut it. “We know that calcium is an essential component of the bone matrix, but relatively little calcium passes from the gut into the blood stream, passively,” says Jamie Langston RN, BSN, CCAP, CCRP, chief research officer, LifeSeasons. This is what makes nutrients likevitamin Dandmagnesiumso vital.

“Without vitamin D, calcium can’t be absorbed and used by the body at all,” says Rogosin. Vitamin D can enhance the absorption of calcium by 65%, meaning that without this vitamin, a majority of calcium consumed, either through food or supplements, would get excreted (1). Our main source of vitamin D is sunlight and Rogosin explains that bone issues became more common during the industrial revolution when people were working long hours in dark, dingy factories rather than the fields, significantly reducing their exposure to the sun.

Additionally, magnesium is crucial to proper calcium absorption because it converts vitamin D into its active form (2). Low serum magnesium often coincides with low serum vitamin D. So even if vitamin D exposure is sufficient, one cannot guarantee its full potential without enough magnesium. Unfortunately, this is a mineral that people do not typically get enough of in their diets. So while calcium is ubiquitous in the food supply, the deficiency of vitamin D creates an imbalance in our bodies that makes calcium more abundant than magnesium. This has the potential to cause heart problems, specifically atherosclerosis, which is when calcium accumulates in the arteries.

Magnesium can also support osteoblast formation, which builds bone material back up after osteoclasts break them down as part of the bones’ healthy lifecycle (1). While vitamin D allows calcium to be absorbed by the body,vitamin K2helps guide calcium out of the blood — where it can accumulate — into bone. Chris Speed, SVP of global sales and marketing with NattoPharma based in Edison, NJ, explains that vitamin K2 accomplishes this by activating Matrix Gla Protein (MGP), inhibiting calcium from depositing in arteries and soft tissues. In turn, he says, K2-activated osteocalcin binds calcium to the bone mineral matrix. Both MGP and osteocalcin are vitamin K-dependent proteins.

“Few vitamins are better paired than vitamins K2 and D3,” says Speed. “While K2 is required to activate these K-dependent proteins, D3 is needed for the creation of these proteins. So ideally, vitamin K2 would be taken in tandem with calcium and vitamin D3.”Methylsulfonylmethane (MSM), an organic sulfur compound well known for its joint support properties, is also beneficial for bone health, promoting the production of osteoblasts and having a synergistic relationship with other vitamins and minerals.

“The synergistic effects of MSM with other vitamins and minerals may be due to its high sulfur content. Recently published data indicate that OptiMSM, a brand of MSM manufactured by Bergstrom Nutrition, acts as a sulfur donor,” explains Rodney Benjamin, director of research and development and technical support for Vancouver, WA-based Bergstrom Nutrition. “Sulfur is necessary for many enzymatic processes and proper protein synthesis. Sulfur-containing metabolites merge in their functioning with Omega-3 and -6 fatty acids, minerals such as selenium, copper, zinc and magnesium, vitamins C and E and antioxidants such as proantocyanidins.”

It’s not unusual to find products with Microcrystalline Hydroxyapatite (MCH), which is an excellent option to get a broad spectrum of minerals. “MCH complexes refer to whole-bone concentrates from natural sources (typically bovine) that contain naturally-occurring calcium, as well as a variety of other bone-supporting minerals naturally found in bone tissue, such as magnesium and phosphorous,” explains Neil Levin, senior nutrition education manager at NOW Health Group, based in Bloomingdale, IL. “MCH also has specialized nutrients such as osteocalcin (a calcium-binding protein), collagen, and various growth factors such as IGF-I and IGF-II. Compared to some other forms of calcium, MCH has shown better bioavailability and absorption in numerous studies. MCH is a whole bone matrix — including the protein (collagen), minerals, and other components of living bone tissue — and so contains far more cofactors needed to build the same kind of matrix in our own bodies than any combination mineral formula would.”

It is still important, however, even with MCH products, for them to contain vitamin K2 and D as well as other supportive minerals to enhance the efficacy of the products further.

Collagen is Abundant and Abundantly ImportantCollagen makes up a huge portion of our bodies, crucial to the composition and health of our skin, joints and yes, bones. As Niemann mentions earlier, collagen holds together the calcium and other minerals that give our bones strength. Collagen for its part gives the bones the necessary elasticity and flexibility that allows us to put our bodies through the ringer of life. Type I collagen specifically, comprises our skin and bones.

Niemann explains that supplementing with collagen is about stimulating the production of collagen. Gelita’s proprietary Type I collagen, FORTIBONE, “Stimulates osteoblast (collagen production) and reduces the activity of osteoclasts (collagen degradation),” she explains. “In this way it increases the formation of the extracellular bone matrix, which is the essential framework for calcium mineralization.”

Niemann adds, “FORTIBONE regulates the degenerative processes that affect bones by reducing osteoclast-based protease production. Thus, these specific Bioactive Collagen Peptides make bones more stable and elastic and help to reduce bone loss or fragility fractures.”

There are different approaches to collagen ingredients. For example, Gelita uses a specific peptide profile to stimulate collagen production in the desired areas. They do this for bone health, skin health and joint health. Neocell, a Nutranext company, based in Sunrise, FL, supplies a hydrolyzed collagen. “[This] is a process where the collagen molecules are broken down into smaller particles by a natural enzyme process, which may promote better absorption,” explains Susan Piergeorge, nutrition education manager for the firm. What makes these ingredients ideal is that they are easily integrated into products. For example, Neocell’s collagen powder is odorless and tasteless, allowing one to mix into food and drink.

Others do a more holistic approach, using bone broth which is typically derived from the bones of chickens and sometimes bovine, providing a wider spectrum of collagen types. Foods rich in collagen should be the priority but adding supplements over time is beneficial, says Jordan Rubin, co-founder of Ancient Nutrition, based in North Palm Beach, FL. “The best way to get sufficient amounts of collagen is to eat collagen-rich foods, such as bone broth, grass-fed beef, chicken, eggs and wild-caught fish to support your body’s production of this vital protein,” he explains. “However, particularly as people age, I also recommend protein powder made from bone broth in addition to a collagen protein supplement, preferably with a variety of collagen sources (since different types of collagen support different parts of the body). High-quality supplements like these can provide the body with additional collagen as the body begins to produce less over time.”

What’s interesting is the potential for nutricosmetic products to be utilized to support bone health because Type I collagen is found both in the skin and bones. Of course, this depends on the collagen material used in the formula. LifeSeasons, for example, uses a collagen derived from chicken as well as other bone supportive ingredients in a product called Beau-T.

“If your hair, skin and nails are healthy, it means the tissues inside your body are also healthy,” says Rogosin. “I broke my arm really seriously a couple of years ago and I’ve had three surgeries to help repair it and I’m just getting ready to have the plates removed from my arm, so I have a lot of experience with bone building and trying to get my arm healed. [Beau-T] is one of the products I used during my healing process because I really felt that tissue support and all the ingredients that include collagen really were incredibly helpful during that process. It has chicken collagen with all the types in it and it also has biotin, MSM and horse tail, which provides silica.”

This provides an opportunity to cross-merchandise other bone support products that contain magnesium, vitamin D and vitamin K2 to complement the nutricosmetic product and get the best results.

Supportive Herbs and Plant-based OptionsRogosin explains that the importance of herbs for functions such as bone health, is nutritive. For example, horse tail provides silica, an important mineral for proper bone health. “Silica is a naturally occurring element necessary for the production of collagen and glycosaminoglycan, two structural compounds important for the health of skin and joints,” says Levin. “Silica is also an important component of hair and nail health.”

Another is stinging nettle, which Rogosin says is a good source of calcium and magnesium, silica, and boron as well as vitamins C, D and K. Herbs and sources of vitamins and minerals derived from plants are an important consideration for vegans and vegetarians and therefore an important option to stock on your shelves. Options like MCH and collagen are exclusively derived from animals which might make it hard for vegans to find a good bone support product and they might need one more than most. Some other unique plant-based sources of bone supportive minerals and vitamins are kelp and red algae.

“Kelp is a large, leafy seaweed belonging to the brown algae family that grows in ‘forests’ in the colder waters of the world’s oceans,” says Levin. “Kelp is known for containing the trace minerals found in sea water. Trace minerals are needed for healthy body processes and structures, including the support of normal enzymatic activities promoting bone formation and retention.”

NOW manufactures a mineral blend derived from red algae harvested off the coasts of Ireland and Iceland called Aquamin. “Aquamin is a vegetarian source of bioavailable calcium and magnesium with over 70 additional important trace minerals,” says Levin. “Though technically a calcium carbonate, the calcium matrix in this plant material is quite different from that in rock powders. Research indicates that Aquamin is a multi-mineral complex that may support proper bone mineralization.”

The company incorporates this red algae product into a variety of formulas because it has advantages over other mineral sources. “There is more elemental calcium (over 30%) in this plant material than in calcium citrate (up to 21%), along with lower levels of lead and other heavy metals plus a bonus of magnesium and trace minerals,” explains Levin. “This allows us to keep the size of our tablets and capsules smaller, while adding the calcium, a little magnesium, and some trace minerals from a clean plant source.”

Herbs can also be beneficial for bone health in less direct ways but also support more vulnerable populations in important ways.

Bone Density Through the YearsThere are a variety of factors that can be detrimental to bone health. Often, these factors coincide with age. “Peak bone density occurs in our 30s, with slight declines following over the next 20 years or so,” explains Levin. “A sedentary lifestyle, especially if away from sunlight, could erode calcium reserves in the bones at any age. An acidifying diet (versus a healthy alkalinizing diet) may actually strip calcium from bones in an attempt to raise the pH in the body to maintain appropriate healthy levels. Hormones are also important, and post-menopause is a key time for bone repair and remodeling to decline, affecting healthy maintenance.”

Women experience a decline in estrogen while men experience a decline in testosterone. Both have an impact on bone health. Estrogen inhibits bone resorption, slowing the breakdown of bone tissue by killing the proteins responsible — osteoclasts — and protecting osteoblasts, which build bone up. So, once women experience a significant drop in estrogen, bone resorption increases through the increased production of osteoclasts while osteoblast production drops as well, not allowing the bone to repair itself (3). This puts them at a significantly higher risk of osteoporosis. Certain supplement formulas and ingredients that support the health of women going through menopause can therefore support their bone health as well, ideally with the addition of other important nutrients.

“Some of the ingredients we’re talking about in terms of menopause include phytoestrogens, which are plant materials with estrogen-like activity and they bind with estrogen receptor sites,” says Rogosin. These include herbs like alfalfa, red clover, black cohosh and soy isoflavones.

“Multiple scientific studies worldwide have demonstrated that women who come from cultures that consume diets high in phytoestrogens experience less post-menopausal bone loss than their counterparts in other cultures,” she adds. “Including herbs rich in phytoestrogens is a very important component of a program designed to maintain or improve bone density.”

For men, the loss of testosterone affects their bone health. Both men and women have estrogen, but men have it in smaller amount and instead their primary sex hormone is testosterone. Langston explains that osteoporosis is less likely in men because of a great bone density to begin with but over time, the decline in bone density between men and women becomes equal. While women experience a severe drop in estrogen between 48 and 55 years of age, men’s testosterone declines between 65 and 70 years of age.

“In their fifties, men do not experience the rapid loss of bone mass that women have in the years following menopause,” Langston explains. “By age 65 or 70, however, men and women lose bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes.”

“It is estimated that up to 30% of men with osteoporotic vertebral fractures have low testosterone levels,” says Langston. While the relationship is clear, the reasons are not entirely clear but it is notable that testosterone does convert to estrogen to build bone mass (4). Herbs that can support testosterone products include tribulus, longjax, muira puama, maca and fenugreek.

In some cases, the decline in bone health can be the result of medication such as proton pump inhibitors and glucocorticoid steroids as well as poor lifestyle choices. There is a lot of opportunity in the bone health category for incorporating various supportive ingredients and formulas as well as cross-merchandising with other supplement categories by helping customers understand the big picture.WF

References1. S. Krawiec. “Synergy in the Bone Aisle.” WholeFoods Magazine. supplements/synergy-in-the-bone-aisle/, Accessed July 1, 2018. 2. S. Krawiec. “Change of Heart.” WholeFoods Magazine., Accessed July 1, 2018. 3. “How Estrogen Impacts Your Bone Health And What You Can Do About It.”, Accessed July 1, 2018. 4. “Male Osteoporosis: Bone Mass Matters.” https://www., Accessed July 1, 2018.

Published in WholeFoods Magazine August 2018