How Bones are Made

Thought of only as the rigid framework that supports the body, bones actually do much more and are a big player in many metabolic and hormonal systems.  Bone is a complex and constantly remodeling organ that requires far more than just calcium for good health.  Strong bones are a combination of both building strong bones, especially in our youth, and preserving bone while aging.

Think of bone as being similar to a concrete wall – with concrete and the internal metal scaffolding called rebar.  Concrete is very hard, but brittle.  The rebar gives a concrete wall its tensile strength to prevent cracking under pressure.  Similarly, calcium is like the concrete while a delicate internal structure similar to rebar is what gives bone its real strength to prevent breaking.  This internal bone scaffolding is called the “matrix”

Mature bone is made up from proteins and minerals.  About 60% of bone, by weight, is mineral, namely calcium and phosphorus.  The remaining 40% is the bone matrix and water.  The matrix is made up of proteins called collagen, which forms strong tissues throughout the body, including bone, tendons, cartilage and even skin.  In the bone matrix, collagen serves as the “rebar” scaffolding upon which minerals are laid down in an orderly fashion.  The precise patterns of bone matrix are oriented to reflect the external forces placed upon it, thus creating bones with elegant and logical patterns of matrix that provide the strength and flexibility to resist breakage.

Hormones play the largest role in turning on the machinery to either build or break down bone.  Estrogen, progesterone, testosterone, and growth hormone play the major role in stimulating the growth of new bone and/or slowing bone breakdown.  Other hormones such as parathyroid, thyroid, or the stress hormone cortisol, can cause bone to breakdown when present in excess.

Many nutrients play a role in the creation of a strong bone matrix and the proper deposition of calcium onto the matrix.  The process of bone formation requires an adequate and constant supply of minerals, such as calcium, magnesium, phosphorus, and potassium.

Vitamin D is necessary for the body to absorb dietary calcium from the intestine.  Vitamin C, also known as ascorbic acid, is essential for the formation of the collagen matrix.  Studies show that vitamin C contributes to increased bone mineral density by improving markers of bone turnover.  A bone specific protein called “osteocalcin” is responsible for binding calcium into a strong matrix that helps give strength and Vitamin K is necessary for the osteocalcin to function properly.

Vitamin K also protects against the build up of calcium in arteries by activating a protein in the artery wall that helps prevent calcium build up.  The Rotterdam Heart Study showed that adequate vitamin K, particularly the K2 subtype, lowered the risk of heart disease and calcification in the major arteries.

Other vitamins and minerals needed for metabolic processes related to bone include manganese, copper, boron, iron, zinc, Vitamin A and Vitamin B

Calcium and Fractures

Millions of Americans take calcium supplements in an effort to prevent thinning of the bones, but recent research is showing that extra calcium is not all that helpful in preventing fractures and may increase the risk of heart disease.  It seems that the extra calcium is not ending up in bone but rather settling in the arteries.

Despite being advised to take calcium for strong bones, there is scant evidence that it does any good unless one is markedly deficient in the first place.  A July 2015 study published in the British Medical Journal, “Calcium intake and bone mineral density: systematic review and meta-analysis”, concluded “Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in bone mineral density, which are unlikely to lead to a clinically significant reduction in risk of fracture.”

In February 2013 the US Preventative Task Force stated “the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men”

A 1997 study in women over the age of 65 showed no relationship between dietary calcium intake and fracture rate, while taking extra calcium actually led to more fractures!  (Cumming 1997)  On the other hand, some studies that examine elderly patients, such as those in nursing homes, have found that calcium supplements with vitamin D help increase bone density.

Calcium and the Heart

Three recent studies have caused alarm over the issue of calcium and heart disease.  First, from 2013 Journal of the American Medical Association (Xiao 2013) comes the conclusion that  “suggests that high intake of supplemental calcium is associated with an excess risk of cardiovascular disease death in men but not in women.”

Second, from the European Prospective Investigation into Cancer and Nutrition study (Li 2012), “increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise heart attack risk, should be taken with caution.”

And from the British Medical Journal (Bolland 2010) results show “Calcium supplements are associated with an increased risk of myocardial infarction.  As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population.  A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”

A reanalysis of data from the 2002 Women’s Health Initiative showed “the increased risk of cardiovascular events appeared largely due to calcium supplements” (Bolland 2011).

A Bone Health Plan

For strong bones, first start with good gut health and nutrition.  Get plenty of high quality protein, and fruits and vegetables that are rich in nutrients and anti-oxidants.  If you don’t get at least 800 mg/day of calcium in your diet, then taking a low dose calcium supplement makes sense, but don’t take more than necessary.  Of note, healthy bacteria that inhabit the gut make most of the beneficial Vitamin K2.  Taking a probiotic is an easy way to replenish beneficial gut bacteria.

Studies show that most Americans are deficient in Vitamin D and K2, and that supplementing helps build stronger bones and prevent fractures.  The only way to insure you have adequate Vitamin D is to get a blood test – then take enough to get ideal blood levels.  Recent reports consider a healthy Vitamin D level to be >50 nmol/L but many experts consider 70-100 nmol/L to be ideal.  Vitamin D3 is the type normally made in the skin and is recognized as the best form to supplement.  Vitamin K2 intake of at least 45 mcg/day appears adequate for bone and artery health.

Collagen peptides in the form of collagen powder has been shown to increase bone mineral density, perhaps through a signaling mechanism that anabolic growth including that of bone.  I recommend Great Lakes Collagen Powder 2 scoops daily.

A good quality multi-vitamin will help insure adequate amounts of the other vitamin and mineral co-factors.  I recommend either Ultra Preventive 2 Daily or Ultra Preventive EZ Swallow from Douglas Labs.  Both of these have 1000 units of D3 and the EZ Swallow also has 45mcg of K2 included.  Information on ordering directly from our physician account can be found here.

One of the most powerful tools to help keep strong bone is hormone replacement therapy (HRT), for both men and women.  The evidence just keeps growing that shows HRT prevents disease, including osteoporosis, and that bioidentical HRT is the most safe and effective treatment.   Similarly, treating hormone imbalances, such as high cortisol or low thyroid is critical for bone health.  Human growth hormone (HGH) is another bone promoting hormone that declines with aging and can be replaced directly with peptide secretagogues that stimulate HGH production.

Lastly, remember exercise builds strong bones.  Not so much the aerobic type such as walking, but more so the strength building exercises that build strong muscles.  Core exercises and activities such as yoga are particularly helpful.


Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado ( and Bellezza Laser Aesthetics (   Call (970) 245-6911 for an appointment or more information.

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