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We all know that calcium and vitamin D are essential for healthy bones. Osteoporosis prevention also requires magnesium, zinc, and vitamin K. But the missing link in bone health for many people is vitamin C.

Everybody knows that calcium and vitamin D are essential for healthy bones and preventing osteoporosis. The word is getting out about magnesium, zinc, and vitamin K. But for many women over 50 (and some men, too) the missing link for preventing fractures is vitamin C.

Here are seven facts about vitamin C and healthy bones everyone needs to know.

1. Your body does not require an enormous amount of vitamin C for basic health

The recommended daily intake of vitamin C for healthy people is 75 mg a day for women and 90 mg a day for men. Children need up to 65 mg a day and infants up to 50 mg a day. A little extra won't hurt. Any healthy person can get the minimum daily requirement for C from a single serving of citrus. There are situations in which 10 to 20 times the minimum daily intake of the vitamin is helpful, when you first get a cold, for instance, but anything over 2,000 mg per day just gets expelled with urine and stool. Very-high dosing of vitamin C is only possible by IV. You don't need high doses of vitamin C to ward off osteoporosis.

2. Even though the minimum requirement for vitamin C is not very high, a lot of people don't get it

In the US, the NHANES survey found that 31 percent of Blacks did not get adequate vitamin C. Deficiencies were also noted in 12 percent of Hispanics. White men had a deficiency rate of seven percent, and white women had a deficiency rate of five percent. Adults between the ages of 19 and 40 also tended to be deficient in their intake of C.

Outside the US, vitamin C deficiency is more common. A study in the UK found that 16 percent of women and 25 percent of men were vitamin C-deficient. In Latin America, vitamin C deficiency is a greater problem among the elderly than other segments of the population. Anyone on a "tea and toast" diet is likely to be deficient in the vitamin, and deficiency is also more common in smokers.

3. Vitamin C is essential for the production of collagen, which provides the scaffolding on which bones place minerals

One of the main symptoms of severe vitamin C deficiency is bone pain. Problems with making collagen also cause bleeding gums and sores on the skin. These symptoms go away in two weeks or less if you simply get the vitamin C you need. Damage to bone, however, takes a lot longer to repair.

4. The amount of vitamin C you need for bone health is greater than the recommended daily intake

There have been over 50 clinical studies of the benefits of vitamin C for bone health. Most of the studies find that you need about 300 mg of C a day to have a significantly lower risk of fractures. That's about three servings of fruit every day. Different studies find different levels of benefit in different bones, but vitamin C seems to make its most significant difference in preventing compression fractures of the spine. This is the osteoporosis that causes you to lose height as you get older and that causes back pain.

It's better that you get your fruit before a meal than after. The relatively small amount of fructose in fresh fruit and pure fruit juice activates your liver to deal with other sugars more efficiently, that is, if you don't consume more than about 25 grams of fructose in 12 hours. This means you need to spread out your fruit juice throughout the day. The most beneficial way to get your fruit is at the beginning of every meal, just a small serving. It's enough C without too much sugar.

5. Vitamin C seems to be especially protective of bone health in people of Asian heritage

Studies of vitamin C and osteoporosis have found benefits of getting more C for both men and women over the age of 50 in Korea. Vitamin C and beta-cryptoxanthin together are linked to better bone health in a study from Japan. Relatively few vegetables contain large amounts of beta-cryptoxanthin. These include butternut squash, chili peppers, tangerines, papaya, sweet red peppers, rose hips, sweet pickles, carrots, kumquats, sweet corn, oranges, and orange juice. There also has been a study that found that Korean women who eat more vegetables, including pickles, and who get more vitamin C have lower loss of bone mineral mass and lower risk of osteoporosis.

6. Vitamin C makes the biggest difference when you are in your fifties and then again when you are in your seventies

An American study called NHANES found that vitamin C offered the most benefits for preventing early-onset osteoporosis in women in their fifties, and then again for women and men in their seventies. People over 70 tend to have poor diets that are deficient in vitamins in general, but relatively young women may have problems with iron overload that are addressed by vitamin C.

7. You need regular, small amounts of vitamin C, not huge, occasional doses of vitamin C

Researchers set out to determine if vitamin C could be a magic bullet to reverse bone mineral loss. They gave a group of women 10,000 mg of vitamin C every day to see if bones could heal in just eight weeks. They didn't. Getting a little vitamin C three times a day for all of your adult life, however, may cut your risk of compression fractures in the spine by about half and your risk of hip fractures by about a third.

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  • Photo courtesy of SteadyHealth

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