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Introduction
If you have ever nursed a broken arm or leg back to health, you’ll know that bones – despite their
appearance – are living tissue that continually rebuild. If we don’t protect our bones, and joints, the
bones become thinner and more fragile, making them more likely to break (or fracture). What makes
matters worse, is the fact that bone loss takes place ‘silently’ and progressively (i.e. it keeps getting
worse over time) and there are usually no symptoms until the first fracture occurs.
A joint is the connection between two bones. Joints and their surrounding structures allow you to bend
your elbows and knees, wiggle your hips, bend your back, turn your head, and wave your fingers to say
bye-bye – usually without giving it a second thought. Smooth tissue, called cartilage and synovium, and a
lubricant called synovial fluid cushion the joints so bones do not rub against each other.
Looking after your bone and joint health is the best defence against musculoskeletal pain and is great for
the long-term prevention of common bone and joint conditions such as osteoporosis, osteoarthritis, low
bone mass and sport injuries. Dietary supplements can be a part of this regime but are not intended to
replace medication where this is indicated or prescribed by your doctor.
A closer look at osteoporosis and osteoarthritis
Osteoporosis and osteoarthritis are the most common and severe bone and joint conditions. Poor
nutrition, lack of exercise, being overweight and a genetic predisposition might increase your risk of
developing these conditions.
In its most severe form, osteoporosis manifests in the thinning of the bones seen mostly in post-
menopausal women and older people, causing weak and easily broken bones, especially of the hip,
spine and wrist. When bone loss outpaces the growth of new bone, bones become porous, brittle
and prone to fracture and can cause severe disability.
In women, osteoporosis usually occurs after menopause when levels of hormones, which help keep
bones strong, are reduced. Genetic factors largely determine whether an individual is at a heightened
risk of developing osteoporosis. In addition, poor nutrition, lack of weight-bearing exercise, smoking
and excess alcohol intake all have a negative effect on bone health.
Approximately one out of three women over 50 will have a fracture due to osteoporosis (a higher
incident rate than breast cancer) as will one out of five men over 50 (higher than prostate cancer).
Osteoporosis is a silent disease with no symptoms until a fracture occurs. Measuring bone mass or bone
density is the best predictor of osteoporosis. However, the real key to management of the disease is
prevention.
Osteoarthritis, on the other hand, is characterised by the progressive degeneration of the body’s
cartilage that cushions and protects joints. The incidence of osteoarthritis increases with age and
women are more likely to develop this condition. However, osteoarthritis is also a lifestyle-related
disease – it is more prevalent in people who are overweight or obese and people leading a sedentary
lifestyle without regular exercise. Joint injuries and bone deformities may also increase a person’s risk.
Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become
severe enough to make daily tasks such as carrying out normal work, difficult.
The following symptoms are usually associated with osteoarthritis: pain, stiffness, swelling and limited
mobility in the affected joint. Pain is aggravated by activity and relieved by rest. It is not uncommon to
hear the grating or crunching sound of bones rubbing together when the joint is moved. If several of
these symptoms are present, it’s time to see your doctor for a physical examination, which might include
X-rays and blood tests.
Nutritional info
The right combination of nutritional supplements, combined with a healthy lifestyle, can help you keep
your bones and tissue healthier for longer.
• Calcium is one of the most important minerals and electrolytes in the body and is
essential for the development of healthy bones and teeth. Bones use calcium as
building material.
• Calcium is used for the treatment and prevention of low calcium levels and resulting bone conditions including osteoporosis (weak bones due to low bone
density), rickets (a condition in children involving softening of the bones), and
osteomalacia (a softening of bones involving pain).
• Calcium is also important to support other critical bodily functions like controlling
your blood pressure, maintaining your heart beat, stimulation of hormone secretions and clotting of blood.
• Calcium is lost daily in the urine, sweat and faeces. It should therefore be replaced
in adequate amounts to maintain a positive calcium balance. 99% of calcium is stored in bones and teeth and if calcium intake is insufficient it is taken from these stores.
• Excessive intake of protein, salt and caffeine may lead to an increased excretion of
• Calcium absorption is inhibited to a certain degree by fibre in the diet, so try taking
your calcium when you are having a low-fibre meal.
• Calcium may interfere with the body’s ability to use certain antibiotics like
tetracycline − use calcium two hours before or after taking the tetracycline.
• If you are using a bisphosphonate drug like Fosamax or Actonel for osteoporosis,
do not take the calcium supplement in the morning as it will interfere with the
absorption of the medication.
• A person’s recommended daily intake of calcium may be influenced by their dietary
intake, gender, age, pregnancy, breastfeeding or menopause.
• Most Western diets contain insufficient calcium to meet daily requirements,
containing in the region of 500 to 600 mg/day. This means that most individuals get
only half of the calcium they need from their food. If you don’t get enough calcium
from food you need to take a supplement.
• The recommend daily calcium intake is as follows:
Total recommended bio-available* calcium intake per day
Calcium per day (mg)
Children and adolescents (1 to 13 years old) Replacement Therapy)Post-menopausal women NOT on HRT *‘Bio-availability’ of a substance is what is available of the ingested dose after digestion and is absorbed systemically. By definition, when something is administered intravenously, its bio-availability is 100%. Consult your doctor or paediatrician before giving infants and children any calcium supplementation.
• When choosing a calcium supplement it is important to know what the bio-
available (elemental) calcium content of the supplement is.
• Calcium intake of below 500 mg per day leads to accelerated bone loss that can
cause osteoporosis and subsequent fractures.
• The bio-availability of calcium carbonate and calcium phosphate is the highest
at 40%; calcium citrate is about 24% bio-available, calcium lactate and calcium gluconate <15%. • Calcium carbonate is best taken with meals.
• Calcium citrate is better absorbed than most other calcium products, but less bio-
available and requires higher dosages. It can be taken any time of the day.
• Individuals taking medications that decrease stomach acid like proton pump
inhibitors or H2-blockers should use calcium citrate supplements.
Possible
• Certain calcium supplements may cause bloatedness, constipation and a slight
unwanted
increase in kidney stones. If simple measures such as increased fluid and fibre
effects &
intake as well as exercise do not solve the problem, another form of calcium should interactions
• Gastritis may be caused if calcium carbonate is taken between meals – this can
stimulate rebound acid production in the stomach.
• Patients suffering from any of the following conditions must consult their doctor
before taking calcium supplements: hyperparathyroidism, sarcoidosis, kidney
failure or kidney stones and certain types of cancer.
• Calcium may interact with amongst others, the following medications:
Alendronate, blood pressure medications, cholesterol-lowering agents, Digoxin, certain diuretics, Metformin, Phenytoin and certain antibiotics. Consult your healthcare practitioner before taking calcium supplements in conjunction with these medications.
• It is highly recommended to take a vitamin D supplement, preferably vitamin D3
(cholecalciferol), with calcium supplements for improved absorption of the calcium into bones.
• If you need to take an iron supplement as well, take your calcium supplement
either two hours before or after the iron supplement to ensure proper absorption of both • When starting supplementation increase the dose gradually.
• Milk and other dairy products are the most readily available dietary sources of
calcium. Other good food sources of calcium include some green vegetables, like broccoli, curly kale and bok choy; canned fish with soft, edible bones (the calcium’s in the bones!) such as sardines, pilchards and salmon; nuts – especially Brazil nuts and almonds; some fruits such as oranges, apricots and dried figs.
• Calcium supplements are usually divided into two doses daily in order to increase
absorption. It’s best to take calcium with food in doses of 500 mg or less.
GLUCOSAMINE
• Glucosamine is naturally present in the shells of shellfish, animal bones and bone
marrow. It is also present in some fungi.
• Glucosamine is commonly used to support the structure and function of joints and
is also typically used by people suffering from osteoarthritis.
• Glucosamine plays a role in building and maintaining cartilage, tendons and other
connective tissues in the body by acting as a building block for these materials and inhibiting enzymes that destroy cartilage. Glucosamine works by preventing the cartilage destruction, joint pain, swelling and loss of flexibility in a natural way and without harmful side effects. • The recommended dosage is 1 500 mg/day.
• Commonly sold forms of glucosamine are glucosamine sulfate, glucosamine
hydrochloride, and N-acetylglucosamine (NAG). Glucosamine is often sold
in combination with other supplements such as chondroitin sulfate and
methylsulfonylmethane (MSM).
• The body absorbs glucosamine well.
Possible
• Stomach upsets and diarrhoea.
unwanted
• Glucosamine should be used with caution if you have a shellfish allergy, peptic
effects &
ulcer, diabetes or asthma and in those taking non-steroidal anti-inflammatory interactions
medication, certain cancer medications, certain diuretics, diabetes medication e.g. Insulin, or Warfarin.
• Always tell your doctor if you are using a dietary supplement or if you are thinking
about combining a dietary supplement with your conventional medical treatment.
VITAMIN D
• The body’s ability to absorb calcium into the bones depends on vitamin D, a fat
soluble vitamin. A deficiency of Vitamin D can lead to rickets (softening of the
bones).
• Vitamin D ensures the correct renewal and mineralisation of bone tissue, promotes
a healthy immune system and muscles, and is required for the regulation of calcium and phosphorus in the body.
• Vitamin D is consumed in the diet and produced in the skin by the UV rays in
• Vitamin D is important for bone and muscle development, functioning and
preservation and reduces the rates of bone loss in older women.
• Vitamin D insufficiency has been implicated as a contributing factor in a growing
number of important chronic diseases including type 2 diabetes, cardiovascular disease, selected cancers, and autoimmune diseases as well as infections, and to increased mortality.
• A vitamin D dosage depends on the serum 250HD (vitamin D) concentration, BMI, sun exposure and other unidentified factors.
Recommended Vitamin D intake
Individuals who get regular, effective sun exposure, and with normal BMI (Body Mass (IU – International Unit)Index – i.e. a ‘normal BMI’ means you have a healthy bodyweight)Individuals who have an obese BMI, have osteoporosis, limited sun exposure, and malabsortion of Vitamin D**In these and other high-risk individuals it is recommended to measure the serum 250 HD level – ask your doctor about this.
Possible
• Vitamin D is generally well tolerated when taken in recommended amounts.
unwanted
Side effects of taking too much vitamin D include weakness, fatigue, sleepiness, effects &
headache, loss of appetite, dry mouth, metallic taste, nausea and vomiting.
interactions
• Pregnant or breastfeeding women should consult a doctor before taking a
vitamin D supplement.
• Consult your doctor before taking vitamin D if you are taking the following
medication: oestrogen, Corticosteroids, Digoxin, Atorvastatin, calcium channel blockers, anti-convulsant medication, certain cancer medication, INH and Thiazide diuretics, antacids, Calcipotrine and Cholestyramine.
• Also consult your doctor before taking vitamin D if you have a peptic ulcer, high
blood levels of calcium or phosphorus, heart or kidney diseases, diabetes, TB, sarcoidosis, histoplasmosis or hyperparathyroidism.
• Pharmacological (high) doses of vitamin D supplementation should only be done under a doctor’s supervision.
• Cod liver oil, fatty fish and egg yolk are good sources of Vitamin D.
Suggested lifestyle changes
Adopting a healthy lifestyle and using the tips below, can go a long way in protecting your bones and
joints from everyday wear and tear.
• Enjoy a balanced, nutritious diet including adequate protein, and plenty of fresh fruits and vegetables
for both bone and general health benefits.
• Safeguard a healthy body weight, as being underweight is a strong risk factor for osteoporosis
(BMI < 18.5 kg/m2) and being overweight (BMI >25 kg/m2) increases the risk of osteoarthritis. (The unit of measurement for BMI, namely kg/m2, is derived from the formula used to calculate one’s body mass index: your body mass divided by the square of your height.) • Weight-bearing exercise (e.g. walking, running, gym, strength training, dancing) helps build bone mass and strength in the young, maintains bone density in adults, and slows down bone loss in the elderly.
• Avoid smoking as it hampers the work of bone-building cells and increases the risk of fracture.
• Avoid excessive alcohol consumption, as high intakes (more than 2 standard units per day) have been
linked to increased risk of hip and other osteoporotic fractures.
• Use salt and caffeine in moderation, as these can promote calcium loss from the body, especially if
• Omega-3 fatty acids are particularly beneficial for your joints. Omega-3s promote healthy joints and
may assist in reducing joint pain and swelling in people with arthritis. You can get omega-3 by taking an omega-3 fish-oil capsule. Salmon contains omega-3 fatty acids and is also a good source of calcium. Other sources of omega-3s include cold-water fish such as mackerel, tuna and sardines. Want to know more?
For more information on bone health, we suggest you visit www.iofbonehealth.org.
You can also consult the sources listed below.
Patel et al., 2012. Calcium effects on vascular endpoints. Nutrition & Metabolism, vol. 9, no. 24. ttp://www.nutritionandmetabolism.com/content/9/1/ D CtRDRIfV, Calcium, Medicine Io: Dietary Reference Intakes for Calcium and Vitamin D. The National Academies Press; 2011.
Bailey et al., 2010. Estimation of total usual calcium and vitamin D intakes in the United States. Journal of Nutrition, vol. 140.
Price Charles T, Langford, JR and Liporace FA, 2012. Essential Nutrients for bone health and a review of their availability in the Average North American diet. The Open Orthopaedics Journal, 6: 143-149.
Dawson-Hughes, et al. 2010. IOF position statement: Vitamin D recommendation for older adults. International Osteoporosis Foundation and National Osteoporosis Foundation 2010.
Herrero-Beaumont, et al., 2007. Glucosamine Sulphate in the Treatment of knee osteoarthritis symptoms. Arthritis & Rheumatism, vol. 56, no. 2.

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