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Which supplements help bone density?

None adds much. Calcium raises bone density by about 1 to 2% in the first year and no further, and vitamin D on its own barely changes it; in 25,871 generally healthy adults aged 50 or older, vitamin D did not lower fractures. Grade A. Very high vitamin D doses even lowered wrist bone density in one trial. Supervised strength and impact training, enough food calcium and protein, and osteoporosis medicines when needed do more.

Last reviewed

How we grade evidenceEditorial policy

What the studies found

  • Grade A. Calcium: a small, one-time gain. In trials of people over 50, calcium pills gave gains of 0.7 to 1.8% in bone density that did not grow after the first year; calcium from food did about the same. The authors judged this unlikely to cut fractures meaningfully. (Tai 2015)
  • Grade A. Vitamin D alone: almost no change. Across 23 trials with 4,082 adults, it raised density only slightly at one hip site and nowhere else. In 311 healthy adults over 3 years, 4,000 or 10,000 IU a day left wrist bone density lower than 400 IU did. (Reid 2014; Burt 2019)
  • Grade A. Fractures: no clear drop. In 25,871 generally healthy adults aged 50 or older, 2,000 IU of vitamin D a day did not lower total, hip or other fractures. For calcium pills, the trials at lowest risk of bias (44,505 people) showed no effect at any site. (LeBoff 2022; Bolland 2015)
  • Grade C. Vitamin K and collagen: unconfirmed. A review of vitamin K trials found no evidence it changes bone density in women after menopause or people with osteoporosis. One trial in 131 women found 5 g of collagen peptides a day for a year raised spine and hip density slightly; it has not been repeated. (Mott 2019; König 2018)

Who should be careful

  • Count food and pills together: adults under 51 should stay below 2,500 mg of calcium a day, and those 51 and older below 2,000 mg. The body absorbs doses of 500 mg or less best, and pills may bring gas, bloating or constipation (NIH ODS). Higher supplemental intakes might raise kidney stone risk (NIH ODS).
  • Calcium carbonate blocks levothyroxine (thyroid hormone) taken within 4 hours, and calcium blocks quinolone antibiotics taken within 2 hours (NIH ODS).
  • The adult upper limit for vitamin D is 4,000 IU a day (NIH ODS). If you take warfarin, keep vitamin K intake steady and talk to your doctor before a supplement (NIH ODS).
  • See a doctor about a bone scan after a fracture from a minor fall, sudden back pain, or lost height. Don't stop or change a prescribed osteoporosis medicine on your own.

Try first

  • Strength and impact training, supervised. In 101 women with low bone mass, 8 months of twice-weekly heavy lifting and jumping raised spine density 2.9% while it fell 1.2% with home exercise, with one minor injury (Watson 2018).
  • Fall-prevention exercise cut the rate of falls by 23% in older people (59 trials, 12,981 people, high certainty) (Sherrington 2019).
  • Eat enough calcium and protein. Higher protein intake brought a small spine gain and no harm (Shams-White 2017).
  • If a scan shows osteoporosis, ask about medicine. In a Cochrane review of trials in women after menopause, the prescription drug alendronate lowered the risk of spine fractures by 45% (Wells 2008).

Sources

  1. Tai V, et al. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015. PubMed 26420598 · doi:10.1136/bmj.h4183
  2. Reid IR, et al. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. 2014. PubMed 24119980 · doi:10.1016/S0140-6736(13)61647-5
  3. Burt LA, et al. Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial. JAMA. 2019. PubMed 31454046 · doi:10.1001/jama.2019.11889
  4. LeBoff MS, et al. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. N Engl J Med. 2022. PubMed 35939577 · doi:10.1056/NEJMoa2202106
  5. Bolland MJ, et al. Calcium intake and risk of fracture: systematic review. BMJ. 2015. PubMed 26420387 · doi:10.1136/bmj.h4580
  6. Mott A, et al. Effect of vitamin K on bone mineral density and fractures in adults: an updated systematic review and meta-analysis of randomised controlled trials. Osteoporos Int. 2019. PubMed 31076817 · doi:10.1007/s00198-019-04949-0
  7. König D, et al. Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Study. Nutrients. 2018. PubMed 29337906 · doi:10.3390/nu10010097
  8. Watson SL, et al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018. PubMed 28975661 · doi:10.1002/jbmr.3284
  9. Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019. PubMed 30703272 · doi:10.1002/14651858.CD012424.pub2
  10. Wells GA, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008. PubMed 18253985 · doi:10.1002/14651858.CD001155.pub2
  11. Shams-White MM, et al. Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation. Am J Clin Nutr. 2017. PubMed 28404575 · doi:10.3945/ajcn.116.145110