The supplements we most commonly recommend — such as Vitamin D3, Omega-3s, CoQ10, and others — are primarily chosen for their well-established benefits for heart and brain health. These benefits are well understood and broadly discussed in our conversations about cardiovascular health.
However, exciting research suggests these same supplements may also play important roles in maintaining bone strength, density, and overall skeletal resilience.
Vitamin D₃
Vitamin D₃ is a workhorse when it comes to both heart health and bone protection. Vitamin D₃ enhances calcium absorption and bone mineralization. Meta-analyses demonstrate modest but significant improvements in bone mineral density (BMD) when measured at the lumbar spine and femoral neck. Supplementation is used to correct deficiency and can improve bone-mineral outcomes, especially in those who are clinically deficient.
Goal blood level Range: 50-70 ng/mL, common dosing range is 2000-5000iu daily of Vitamin D₃
Calcium
The conversation around calcium supplementation is always nuanced, with a focus on supplementation only to correct a dietary deficit. In other words, we want you to get the calcium you can from your diet, prior to taking a calcium supplement. Calcium is the primary mineral component of bone, so adequate calcium intake is foundational for healthy bone mass; however, trials of calcium supplements alone for fracture prevention show variable results. Benefits of supplementation are much more robust when combined with vitamin D₃.
Goal Range: For women >50 years old and men >70 years old, goal intake of 1200mg daily of calcium intake, supplement to food deficit.
Vitamin K₂ (menaquinone)
Vitamin K₂ (MK-7) is used along with Vitamin D₃ to ensure appropriate deposition of calcium in the bone instead of soft tissues. It also has a positive impact on insulin resistance. When it comes to bone health, Vitamin K₂ is another superstar! K₂ activates osteocalcin and other bone proteins our bodies need for bone mineralization. Randomized Controlled Trials and meta-analyses (the gold standards in research) on the use of Vitamin K₂ show improvement in BMD in the lumbar spine. Unsurprisingly, there is solid evidence for a synergistic effect when vitamin K₂ is combined with vitamin D₃.
Goal Range: Dosing range 180-200ugm daily.
Omega-3 fatty acids
Omega-3 fatty acids may exert a modest positive effect on bone health, potentially by reducing inflammation and promoting osteoblast activity, but human data is limited. There is no data suggesting any negative effects on bone health related to Omega-3 supplementation. Cold-water fatty fish, like salmon, are excellent sources of Omega-3!
Goal Range: Omega 3 level >5.5; Dosing depends on Apo E genetics, diet and baseline blood levels.
Ubiquinol / Coenzyme Q10
Animal models demonstrate that CoQ₁₀ (ubiquinol) reduces oxidative stress, supports osteoblast (bone-building) function and has demonstrated the ability to prevent bone loss. Human studies demonstrate that Ubiquinol supplementation increases the biomarkers of bone formation during strenuous exercise. Ubiquinol also has a beneficial effect on the mobilization of energy sources supporting a physiological advantage for skeletal muscles.
Goal Range: Dosing ranges 100-200mg daily
Berberine
In animal studies, berberine promotes osteoblast (bone-building cell) activity, blocks osteoclast (bone degraders) activity and protects against bone loss. Human clinical trials for osteoporosis are limited to early/small studies, but all signals point to the potential for bone protection.
Dose range: usually 500-1000mg daily (depends on blood sugar stability)
Creatine
By increasing muscle mass and strength (when combined with resistance training), creatine may indirectly benefit bone density via greater mechanical loading (i.e., more mass for the bone to carry around). Direct effects of creatine on bone density in older adults are mixed; some studies suggest benefit via changes in bone geometric properties when paired with exercise, but meta-analyses report inconsistent changes. In short, we are still learning about potential benefits for bone health, but there is mechanistic plausibility.
Dosing: Typically starting with 3-5gm daily
B Vitamins and/or Homocysteine Support
B vitamins influence homocysteine metabolism. Elevated homocysteine has been associated with higher fracture risk and lower bone density in observational studies. Testing homocysteine and B₁₂ levels and then treating to an optimal range is recommended for both heart/brain and bone protection.
Goal serum Range: Homocysteine <11 (generally)