Is Bone Health Only About Calcium? Vitamin D, Exercise and Diet
Drinking milk alone is not enough for healthy bones. How calcium, vitamin D, protein, exercise and lifestyle protect your bones.
Short answer: No, bone health is not only about calcium. Strong bones need calcium together with vitamin D (so calcium can be absorbed), enough protein, regular weight-bearing exercise, and avoiding smoking and heavy drinking. Drinking milk alone is not enough, and taking high-dose supplements on your own is not recommended.
Dr Ahmet Şadi Kılınç, Orthopaedics and Traumatology Specialist, Bahçeşehir, Istanbul
“I drink plenty of milk for my bones, is that enough?” I hear this often in clinic. Calcium is the main mineral of bone, but bone health is a puzzle and calcium is only one piece. In this article I explain the other building blocks.
I also explain it in a short video, in Turkish: watch on YouTube.
What is bone made of?
Bone has two components that give both hardness and flexibility: minerals (mainly calcium and phosphate), making up about two thirds of bone, and a network of the protein collagen that gives it flexibility and strength. Bone is living tissue that is broken down and rebuilt throughout life, and this renewal needs more than one ingredient.
The building blocks of bone health
1. Calcium. The main building material. Adults generally need around 1000 to 1200 mg a day. Sources include milk, yoghurt, cheese, kefir, small fish eaten with bones such as sardines, almonds and dark green leafy vegetables. A glass of milk has about 300 mg.
2. Vitamin D. Needed for calcium to be absorbed from the gut. If vitamin D is low, calcium does not reach the bone well even when you take plenty. Sunlight is the main source, but deficiency is common in people who cover up, in older adults and in winter. It is diagnosed with a blood test and the supplement dose should be decided by a doctor.
3. Protein. The organic part of bone is protein. Too little protein, especially in older age, increases bone loss and fracture risk. Meat, fish, eggs, dairy and pulses are good sources.
4. Movement. Bone gets stronger when it is loaded. Walking, running, climbing stairs, skipping and resistance exercise maintain or increase bone density. Swimming and cycling are good for the heart but are less effective for bone than walking and resistance work.
5. Other vitamins and minerals. Magnesium, vitamin K and zinc also play a role in bone metabolism. A varied, balanced diet usually covers them.
6. Lifestyle. Smoking, heavy alcohol, a lot of salt and fizzy drinks, long-term cortisone use and being very underweight can speed up bone loss.
Do collagen supplements work?
Collagen is an important part of bone structure. However, evidence that collagen supplements taken by mouth improve bone density or reduce fractures is currently limited. The approaches with strong evidence are enough calcium, vitamin D, protein and exercise. If you consider collagen, remember that it does not replace these basics.
When should osteoporosis be suspected?
Osteoporosis progresses silently, and often the first sign is a fracture. A bone density scan should be discussed if:
- You are a woman after menopause or over 65, or a man over 70
- There is a family history of hip fracture or osteoporosis
- You have had a fracture from a low-energy fall
- You have lost noticeable height or have a stooped back
- You take long-term cortisone or certain hormone drugs and medicines
- You have low vitamin D, coeliac disease, or thyroid or parathyroid disease
If osteoporosis is diagnosed, treatment is planned by a doctor, and medicines that support bone formation or reduce bone breakdown are used when needed.
For children and teenagers
Peak bone mass is reached around age 25 to 30. The better the “bone bank” is filled in childhood and adolescence with dairy, protein, sunlight and regular sport, the safer you are in later life. For children, see our article on bone development in babies and children.
If you have had a fracture
Needs for calcium, vitamin D and protein also rise while a fracture heals. Read how fractures heal in how does a broken bone heal, and see our Fracture and Dislocation Treatment page.
In short
Milk is good for bones, but not enough. Alongside calcium you need vitamin D, protein, regular weight-bearing exercise and a healthy lifestyle. Have your blood levels checked before taking supplements and decide the dose and duration with your doctor. If you have questions about your bone health, you can book an appointment.
This article is for general information and does not replace an examination.
Frequently asked questions
Is bone health only about calcium?
No. Alongside calcium you need vitamin D, protein, regular weight-bearing exercise and a healthy lifestyle.
How much calcium do I need each day?
Adults generally need around 1000 to 1200 mg a day. Getting it from food is preferred; whether a supplement is needed is for your doctor to decide.
Why is vitamin D important for bones?
It allows calcium to be absorbed from the gut. If vitamin D is low, the calcium you take does not reach the bone well.
Do collagen supplements strengthen bone?
Evidence that collagen taken by mouth increases bone density is currently limited. The methods with strong evidence are calcium, vitamin D, protein and exercise.
Which exercises are best for bones?
Weight-bearing and resistance exercises such as walking, light jogging, climbing stairs, skipping and strength training.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.