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    "description": "Key PointsBone health requires total nutrition, because the integrity of bone tissue depends on the integrity of its cells, which (similarly to most other tissues) need a broad array of macro- and micronutrients. Additionally, calcium and protein play key roles, because the bulk of the bony material is made up of these substances.Bone turns over relatively slowly. Thus, the effects of inadequate nutrition on bone often are delayed, and the structural properties of bone tend to reflect past nutrition more than current intakes.Calcium is a threshold nutrient. The minimum daily requirement is the intake at which bony response plateaus. To reach this threshold, calcium intake should be 1500 mg/d both during growth and after age 50. With lifelong calcium intakes in this range, risk of osteoporotic hip and other nonspine fractures can be reduced by 30 to 50%.Vitamin D is predominantly produced in the skin. Recommended daily oral intakes are sufficient only to prevent the most extreme bony manifestations of vitamin D deficiency. Optimal vitamin D status is ensured by serum 25-hydroxyvitamin D [25(OH)D] values of 80 nmol/L (32 ng/mL) or more. Lower values are associated with impaired calcium absorption and increased osteoporotic fracture risk. Daily use of vitamin D may be as high as 4000 IU (100\u03bcg). For most elderly individuals, a daily oral dose of 1000 IU or higher is necessary to sustain adequate serum 25(OH)D concentrations.Protein, once thought to be potentially harmful to bone when ingested in large quantities, is now best understood as complementary to calcium. Together, the two nutrients provide the bulk constituents of bony material; to achieve the full benefit of either, the intake of the other must be adequate as well. Protein intakes that optimize bony response are uncertain but, from available data, appear to be above the current Recommended Daily Allowance (RDA; 0.8 g/kg of body weight).Although typical magnesium intakes are below the RDA (310 and 400 mg/d for women and men, respectively), there appear to be no skeletal consequences of the shortfall. Supplemental magnesium does not improve calcium absorption in individuals consuming typical diets and has no effect on calcium balance.Vitamin K, zinc, manganese, and copper are involved in various aspects of bone matrix formation, but it is not known whether deficiency of any of these contributes to the development or severity of typical osteoporosis.Recovery from hip fracture can be substantially improved with aggressive attention to the nutritional status of patients with hip fractures, with special emphasis on repairing the protein malnutrition that is common in such patients.", 
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