My wife recently discovered she has osteopenia, which is a step away from osteoporosis. It was a shock because she’s young, eats well, takes supplements, and exercises. But after looking closely at her diet and exercise habits, I realized there were some key things missing. So, I decided to share the five most important things anyone needs to know to keep their skeleton healthy throughout life. Let’s break it down. (Based on the teachings of Dr. Dave Clayton)

Understanding Bone Density Scans

First, let’s look at my wife’s bone density scans. Six years ago, the first scan showed a Z-score but no T-score. The Z-score compares your bone density to others of the same age and sex. A Z-score of about -1 meant she was in the bottom 20% for her age group, which is a red flag for osteopenia.

Fast forward six years, and the numbers got worse. Her Z-score dropped to -1.6. More importantly, her T-score, which is used to diagnose osteoporosis, came in at -2.3. A T-score of -2.5 or lower indicates osteoporosis, so she was right on the edge. This was the wake-up call to make serious changes to her diet, exercise, and supplementation to rebuild bone before the risk of fractures became too high.

The Building Blocks of Bone Health

Healthy bone is built on calcium and phosphate. Everything we do should focus on getting these minerals into the bone and keeping them there.

Vitamin D: The Calcium Absorber

Vitamin D’s main job in bone health is to help your body absorb calcium and phosphate from your intestines. Without enough vitamin D, you only absorb about 10% of the calcium you eat. Vitamin D helps create proteins that actively pull calcium and phosphate from your food into your bloodstream. Studies show vitamin D can increase calcium absorption by up to four times.

For maintaining healthy bone levels, 800 IU of vitamin D daily is a common recommendation, but taking 1,000 or 2,000 IU is also fine. Vitamin D stores well in your body, so you can take a larger dose once a week or even monthly if that’s easier to remember.

Calcium: How Much Do You Really Need?

Dietary calcium is vital. While older advice suggested 1,500 mg daily, more recent research indicates that around 700-750 mg is likely sufficient for most people. The average American diet provides about 700 mg of calcium daily, meaning many people might not need much extra from supplements.

If you do supplement, one 500 mg calcium capsule a day might be enough, depending on your diet. Focusing on calcium-rich foods like dairy, leafy greens, and fish is ideal. Taking too much calcium can be harmful. Excess calcium that isn’t used for bone can end up in your arteries, kidneys (leading to stones), or cause abdominal pain, increasing the risk of heart attack and hospitalizations.

Vitamin K2: The Calcium Director

This is where vitamin K2 comes in. It acts like a traffic director for calcium in your bloodstream. Vitamin K2 activates two key proteins: osteocalcin, which helps lay down bone matrix, and Matrix GLA protein, which prevents calcium from depositing in arteries and other soft tissues.

Vitamin K2 deficiency is common, affecting about a third of adults and over half of older adults. This deficiency increases the risk of not just osteoporosis but also kidney disease, diabetes, osteoarthritis, and even all-cause mortality.

Getting about 100 micrograms (mcg) of vitamin K2 daily is a good target. Some studies show benefits with as little as 20-30 mcg. While vitamin K1 is found in leafy greens, direct dietary sources of K2 are limited. Natto, a Japanese fermented soybean dish, is one of the richest sources. Supplements are also readily available.

The Power of Combining Vitamins D and K2

It’s not enough to just take these vitamins separately. Research shows a significant benefit when vitamin D and K2 are taken together.

Doing Nothing: Bone density continues to decline.
Vitamin D Alone or K2 Alone: Bone loss may stop in the short term, but bone density doesn’t increase.
Vitamin D and K2 Together: Bone density significantly increases, with studies showing a 5-7% improvement in just a few months.

This combination approach helps absorb calcium efficiently and directs it to the bones while keeping it away from arteries.

Potassium: The Unsung Hero for Bone Alkalinity

Phosphate is as important as calcium for bone structure. It also plays a critical role in maintaining the body’s pH balance. Most American diets are acidic due to coffee, soda, processed foods, and high salt intake.

When the body is too acidic, it tries to buffer this acid load. One way it does this is by pulling phosphate from bone. When phosphate leaves the bone, calcium often follows, leading to weaker bones and increased risk of kidney stones and arterial calcification.

Potassium salts are basic and can help neutralize this acid load. Supplementing with potassium can immediately alkalize the body, reducing the need to pull minerals from bone. Studies show that potassium supplementation can improve bone formation markers (like osteocalcin) by over 10% and reduce bone breakdown markers by 8% in just weeks. This helps keep calcium and phosphate in the bone where they belong.