Copper is a critical trace element implicated in bone metabolism. Copper is involved in both collagen synthesis and mineralization. Copper acts as a cofactor for lysyl oxidase, the enzyme that catalyzes collagen and elastin cross-linking in the bone extracellular matrix. Diminished activity of the enzyme subsequently interferes with bone formation.
Copper additionally governs osteoblast and osteoclast activity through the preservation of redox balance. Function of the superoxide dismutase antioxidant is dependent on the availability of copper. Excess oxidative stress can impair bone cell function, leading to heightened bone resorption and the ultimate development of osteoporosis.
Studies have consistently pointed toward low levels of dietary and circulating copper being linked with osteoporosis incidence and progression. The relationship between dietary and circulating copper and fracture risk appears especially strong, likely due to its role in enhancing bone structure integrity and preserving bone mineral density.
Encouraging appropriate copper intake to protect bone health, especially in vulnerable populations such as postmenopausal women and elite athletes, is supported by the literature. This relationship has been observed in a variety of contexts and populations, further solidifying the finding.
Nevertheless, a clear dose-response relationship has yet to be developed. The relationship may exhibit a U-shaped pattern such that excessive copper intake may be detrimental to bone structure and strength. Further research is needed to clarify the optimal intake for protecting against fracture and osteoporosis.
Other trace elements, including zinc and iron, exhibit overlapping biological mechanisms associated with osteoporosis, such as bone cell differentiation, collagen formation, and antioxidant activity. It is thus critical to monitor levels of these key trace elements to ensure bone turnover is adequately supported and regulated.
Ju Y, Xiong W, Pang Y, et al. The Association between Dietary and Circulating Copper Levels and Osteoporosis: a Scoping Review. Biol Trace Elem Res. 2026;204(5):3366-3375. doi:10.1007/s12011-025-04899-1
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