Look to Food, Not Supplements, for Bone Health : General malnutrition is not uncommon in the United States, especially in patients older than 65 years.

Magnesium

Inadequate magnesium is associated with decreased parathyroid hormone. Epidemiologic studies suggest a positive association between increased magnesium intake and BMD. But data from the Women's Health Initiative found that high magnesium intake was not protective of BMD.

The bottom line for patients is to eat foods that contain magnesium, including whole grains, vegetables, and nuts. There are no data to support the use of magnesium supplements, Dr. Binkley said.

Caffeine

It's been widely assumed that caffeine is harmful to bone because it leads to increased urinary calcium loss. But several studies have shown that decreased calcium absorption is actually what occurs. “The gist is that for each cup of coffee that we drink, there is a calcium loss of about 5 mg. What does that mean? It means that we need to put about 2 tablespoons of milk in our coffee,” Dr. Binkley said.

The effect of other caffeinated beverages on calcium absorption is largely negligible. The bigger issue is that soft drinks have replaced milk in the average American's diet. “What we've done is taken good food and replaced it with carbonated water. The problem is not what they contain but what they don't.”

Protein

One study of elderly patients found that patients getting protein supplements were less likely to have fractures. In fact, those with higher protein intake and adequate calcium had the best outcomes, suggesting that there may be a synergistic effect between protein and calcium. There's no need to restrict protein after hip fractures.