Which supplements help osteoporosis?
Vitamin D first, then calcium if food falls short. Most other bone nutrients come from food. But one vitamin found in many multivitamins may make bones more likely to break if you have too much.
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What are the best supplements for osteoporosis?
Vitamin D is the one to take. The NHS says to get it from sunlight in summer and a supplement in winter. Your doctor may prescribe it all year round.
Calcium comes next, but food comes first. The NHS says to eat plenty of calcium-rich food, and take a calcium supplement if your doctor prescribes it.
The rest of the shelf usually isn’t needed. With a balanced diet, the Royal Osteoporosis Society (ROS) says in most cases, you will not need other bone supplements.
| Supplement | UK advice | How much |
|---|---|---|
| Vitamin D | A supplement in winter. Your doctor may prescribe it all year. | 10 micrograms a day. Your doctor may advise 20. |
| Calcium | Food first. A supplement if your doctor prescribes it. | 700mg a day. Your doctor may advise around 1,000mg. |
| Magnesium | Food usually covers it. | From supplements, 400mg or less a day is unlikely to harm. |
| Vitamin K | Some evidence it may help. Food usually covers it. | From supplements, 1mg or less a day is unlikely to harm. |
| Vitamin A | Don’t have too much. | After the menopause, or an older man: no more than 1.5mg a day from food and supplements. |
Sources: NHS; ROS: vitamin D; ROS: calcium; NHS: magnesium; NHS: vitamin K; NHS: vitamin A
More isn’t stronger. Topping up past what you need is like pouring fuel into a full tank.
The ROS says extra calcium or vitamin D is unlikely to improve your bone strength. Past the safe limit, too much can harm.
Your next step: check you take vitamin D, then check your food for calcium.
How much vitamin D for osteoporosis?
Most adults need 10 micrograms (400 IU) a day. From October to early March, the sun in the UK is too weak to make enough.
At risk of osteoporosis, or on a bone medicine? Your doctor may advise 20 micrograms a day. If they suggest a different amount, the NHS says follow their advice.
- Below 10 microgramsBelow 10. Most people need 10 a day from October to early March.
- 10 up to 100 micrograms10 for most. Your doctor may advise 20.
- Above 100 microgramsNHS: more than 100 could be harmful.
Too much over a long time can build up calcium in your blood. That can weaken bones and damage the kidneys and heart.
D3 is thought to be slightly more effective than D2. Some D3 is made from lamb’s wool, so check the pack if you’re vegan.
Add up the vitamin D in every supplement you take. More on the upper limit: can you take too much vitamin D?
Do calcium supplements help osteoporosis?
Paired with vitamin D, a little.
A Cochrane review of 53 trials looked at women past the menopause and men over 65. Vitamin D alone was unlikely to prevent fractures. With calcium, it slightly cut hip and other fractures.
| Older people living | Hip fractures per 1,000 a year | With calcium and vitamin D |
|---|---|---|
| At home | About 8 | About 7 |
| In a care home or other institution | About 54 | About 45 |
Source: Cochrane
Most adults need 700mg of calcium a day. At risk of osteoporosis, or on a bone medicine? Your doctor may advise around 1,000mg.
Food can usually cover it: milk, cheese, yoghurt, broccoli, cabbage and sardines. Not spinach, though. The ROS says the body can’t digest its calcium very well.
Need a top-up? Calcium carbonate and calcium citrate are both good for your bones. Calcium supplements can cause constipation, diarrhoea or feeling sick.
The NHS says 1,500mg or less a day is unlikely to cause any harm. Above that, the ROS warns of stomach pain, diarrhoea and kidney stones.
Worried about your heart? The ROS says there’s not enough evidence to prove calcium supplements raise heart attack risk.
Check your food first, then see calcium and vitamin D tablets.
Do magnesium, vitamin K or prunes help bones?
Magnesium helps calcium and vitamin D work properly. Adults aged 19 to 64 need 300mg a day (men) or 270mg (women), which food should cover. See calcium and magnesium.
Vitamin K is important for bone building. The NHS says there’s some evidence it may help keep bones healthy.
On warfarin? Don’t take vitamin K supplements.
Prunes have one good trial. In 235 US women past the menopause, eating 50g a day for a year kept more hip bone density. It fell 1.1% without prunes and 0.3% with them.
The trial measured density, not broken bones. Women on 100g a day saw no clear gain, and 41% of them dropped out.
The vitamin to watch is vitamin A. Some research suggests more than an average of 1.5mg a day over many years may make bones more likely to break when you’re older.
Many multivitamins and fish liver oils contain it. Eat liver every week? The NHS says don’t take supplements that contain vitamin A.
Can I take supplements with osteoporosis medicine?
Yes, and your doctor may add them. Bone medicines stop or slow damage to your bones, or speed up building new bone. Calcium gives your bones the strength and hardness they need, and vitamin D helps your body absorb and use it.
Timing matters with alendronic acid, a common bone medicine. Take it on an empty stomach with tap water, before food, drinks or other medicines. Not with milk.
Starting the bone medicines zoledronate or denosumab? You’ll often have a vitamin D test first, and low levels are treated before you start.
Before you add a bone supplement
- Take 10 micrograms of vitamin D a day in autumn and winter, or the amount your doctor advises.
- Eat calcium-rich food every day, such as milk, cheese, yoghurt, broccoli and sardines.
- Add up the vitamin D and calcium in every supplement you take.
- Keep calcium from supplements to 1,500mg a day or less, and vitamin D to 100 micrograms or less.
- Check multivitamins and fish liver oil for vitamin A. Skip them if you eat liver every week.
- On alendronic acid? Tell your doctor about any calcium, iron, magnesium or zinc supplement.
Sources: NHS; ROS; NHS: vitamin A; NHS: alendronic acid
On prescribed calcium? Take the number of tablets your doctor advises. The ROS says let your doctor know if you stop.
Never stop or change a prescribed medicine without your prescriber.
Supplements are one part. The NHS also lists weight-bearing, strength and balance exercise. See strength training for older adults.
When to speak to a GP
Osteoporosis usually has no obvious symptoms until a bone breaks. Speak to a GP if:
- You think you may be at risk of osteoporosis and you’re worried.
- You have back pain that isn’t getting better after a few weeks, or your spine becomes curved or hunched.
- You have kidney stones, kidney disease, high blood calcium or a gut condition, or you’re at risk of heart disease. Cochrane says get advice before calcium and vitamin D.
- You’ve recently had a fall or injury and the pain isn’t getting better. Ask for an urgent GP appointment or call 111.
- You have severe pain after a fall or injury, can’t put weight on your leg, or have tingling or loss of feeling in your hip or leg after an injury. Call 999 or go to A&E.
Questions to ask your GP:
- Should I take 10 or 20 micrograms of vitamin D?
- Does my food give me enough calcium?
- Is my multivitamin safe for my bones?
- How should I time my supplements around my bone medicine?
Had a bone blood test? See bone health blood results.