Assessment of Vitamin E Bone Mass Impacts and Implications for Hip Fracture Prevention and Optimal Post Fracture Recovery [2000-2026]
Ray Marks
.1OARC Clinical Research and Education Director, Ontario L3T 5H3, Canada
Correspondence: Ray Marks, OARC Clinical Research and Education Director, Ontario L3T 5H3, Canada. Email
[email protected]
Received: February 17, 2026 Published: February 28, 2026
Citation: Marks R. Assessment of Vitamin E Bone Mass Impacts and Implications for Hip Fracture Prevention and Optimal Post Fracture Recovery [2000-2026]. AOJ Emerg and Int Med. 2026;1(3):51–60.
Copyright: ©2026 Marks.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.
Abstract
Bone mass declines and related bone fracture risks and events, such as those that occur at the hip joint, have been topics of great interest for first responders and others for many decades. However, the means of preventing bone loss or the development of osteoporosis associated with fractures at any site while receiving more clinical attention has yet been quite limited and fragmented with no definitive consensus and warrants persistent attention. In particular, given the failure of medical approaches in general to build bone safely, or ensure optimal rapid healing of a fractured bone, a focus on the emergent numbers of high age often frail adults and their fracture risk and ensuing disablement who may benefit from vitamin E containing foods, and their possible promise for fostering optimal bone modeling, and averting bone resorption are quite compelling. As such, we conclude subject to further study, an optimal intake of vitamin E based nutrients may help maximize bone status as well as repair across all levels of prevention and in accord with the Haddon Matrix Injury Prevention Framework of those key pre injury, injury, and post periods where optimizing bone health is of the utmost clinical importance.
Keywords: Aging. Bone, Hip Fractures, Fracture Healing, Osteoporosis, Prevention, Rehabilitation, Vitamin E
References
1. Mehat MZ, Shuid AN, Mohamed N, et al. Beneficial effects of vitamin E isomer supplementation on static and dynamic bone histomorphometry
parameters in normal male rats. J Bone Min Metab. 2010:28(5);503-509.
2. Smith BJ, Lucas EA, Turner RT, et al. Vitamin E provides protection for bone in mature hindlimb unloaded male rats. Calcif Tissue Int.
2005;76(4):272-279.
3. Torbergsen AC, Watne LO, Wyller TB, et al. Micronutrients and the risk of hip fracture: case-control study. Clin Nutr. 2017;(2);438-443.
4. Rondanelli M, Faliva MA, Peroni G, et al. Focus on pivotal role of dietary intake (diet and supplement) and blood levels of tocopherols and tocotrienols in obtaining successful aging. International J Molecular Sci. 2015;16(10);23227-23249.
5. Zhang J, Hu X, Zhang J. Associations between serum vitamin E concentration and bone mineral density in the US elderly population. Osteoporos Int. 2017;28(4);1245-1253.
6. Brooks R, Kalia P, Ireland DC, et al. Direct inhibition of osteoclast formation and activity by the vitamin E isomer gamma-tocotrienol. International Journal of Vitamin Nutrition Research. 2011:81(6);358-367.
7. Guralp O. Effects of vitamin E on bone remodeling in perimenopausal women: mini review. Maturitas. 2014;79(4):476-480.
8. Hagan ML, Bahraini A, Pierce JL, et al. (2019) Inhibition of osteocyte membrane repair activity via dietary vitamin E deprivation impairs osteocyte survival. Calc Tissue Int. 2019;104(2);224-234.
9. Ilesanmi-Oyelere BL, Brough L, Coad J, et al. The relationship between nutrient patterns and bone mineral density in postmenopausal women. Nutrients. 2019;11(6).pii:E1262.
10. Viswanathan VK, Jain VK, Iyengar KP, et al. Evaluation of Vitamin E in Trauma and Orthopaedics: A Narrative Synthesis. Indian J Orthop. 2025;59(9):1364-1380.
11. Hampson G, Edwards S, Sankaralingam A, et al. Circulating concentrations of vitamin E isomers: association with bone turnover and
arterial stiffness in post-menopausal women. Bone. 2015:81;407-412.
12. Abdullah Sani N, Kamaruddin NA, Soelaiman IN, et al. Palm Tocotrienol activates the Wnt3a/β-Catenin Signaling Pathway, protecting MC3T3-E1 osteoblasts from cellular damage caused by dexamethasone and promoting bone formation. Biomedicines. 2025;13(1):243.
13. Fulgoni VL, 3rd, Keast DR, Bailey RL, et al. Foods, fortificants, and supplements: where do Americans get their nutrients? J Nutr. 2011:141(10);1847-1854.
14. Kurklu M, Yildiz C, Kose O, et al. Effect of alpha-tocopherol on bone formation during distraction osteogenesis: a rabbit model. J Orthop Traumatol. 2011;12:153-158.
15. Chin KY, Mo H, Soelaiman IN. A review of the possible mechanisms of action of tocotrienol - a potential antiosteoporotic agent. Curr Drug Targets. 2013;14(13):1533-541.
16. Abukhadir SS, Mohamed N, Makpol S, et al. Effects of palm vitamin R on bone-formation-related gene expression in nicotine-treated rats. Evid Based Complement Alternat Med. 2012;2012:656025.
17. Borhanuddin B, Mohd Fozi NF, Naina Mohamed I. Vitamin E and the healing of bone fracture: the current state of evidence. Evid Based Complement Alternat Med. 2012;2012:684510.
18.Torbergsen AC, Watne LO, Frihagen F, et al. Effects of nutritional intervention upon bone turnover in elderly hip fracture patients. Randomized controlled trial. Clin Nutr ESPEN. 2019;29:52-58.
19. Ferrucci L, Magaziner J, Shardell MD. Serum vitamin E concentrations and recovery of physical function during the year after hip fracture. J Gerontol A Biol Sci Med Sci. 2011;66(7):784-93.
20. Ramli ESM, Ahmad F, Kamaruddin NA, et al. Comparative bone-protective effects of tocotrienol isomers from palm and annatto in dexamethasone-induced Osteoporotic Male Rats. Int J Mol Sci. 2025;26(20):10206.
21. Ibrahim N', Mohamed N, Soelaiman IN, et al. The effects of targeted deliveries of lovastatin and tocotrienol on ossification-related gene expressions in fracture healing in an osteoporosis rat model. Int J Environ Res Public Health. 2015;12(10):12958-76.
22. Chin KY, Ima-Nirwana S. The effects of α-tocopherol on bone: a double-edged sword? Nutrients. 2014;6(4):1424-41.
23. Casati L, Pagani F, Limonta P, et al. Beneficial effects of δ-tocotrienol against oxidative stress in osteoblastic cells: studies on the mechanisms of action. Eur J Nutr. 2019.
24. Iwaniec UT, Turner RT, Smith BJ, et al. Evaluation of long-term vitamin E insufficiency or excess on bone mass, density, and microarchitecture in rodents. Free Radic Biol Med. 2013;65:1209-1214.
25. Li H, Cao W, Tao L, et al. The role of fat-soluble vitamins on bone metabolism and osteoporosis: a literature review. Ann Med. 2025;57(1):2533429.
26. Abdelkarem HM, Fadda LH, El-Sayed EM, et al. Potential role of l- arginine and vitamin E against bone loss induced by nano-zinc oxide in rats. J Diet Suppl. 2018;15(3):300-310.
27. Wu D, Wang H, Wang W, et al. Association between composite dietary antioxidant index and handgrip strength in American adults: data from National Health and Nutrition Examination Survey (NHANES, 2011- 2014). Front Nutr. 2023;10:1147869.
28. Zhuang R, Hou W, Zhang T, et al. Association between dietary vitamin E and osteoporosis in older adults in the United States. Front Endocrinol (Lausanne). 2024;15:1410581.
29. Wong SK, Chin KY, Ima-Nirwana S. The effects of tocotrienol on bone peptides in a rat model of osteoporosis induced by metabolic syndrome: the possible communication between bone cells. Int J Environ Res Public Health. 2019;16(18). pii: E3313.
30. Shuid AN, Mehat Z, Mohamed N, et al. Vitamin E exhibits bone anabolic actions in normal male rats. J Bone Miner Metab. 2010;28(2):149- 156.
31. Durak K, Sonmez G, Sarisozen B, et al. Histological assessment of the effect of alpha-tocopherol on fracture healing in rabbits. Int Med Res. 2003;31(1):26-30.
32. Paskalev MD, Goranov NV, Krastev SJ, et al. Antioxidant and bone healing effect of vitamin E in an experimental osteotomy model in dogs. Comp Clin Path. 2011;20(4):403-408.
33. Nizar AM, Nazrun AS, Norazlina M, et al. Low dose of tocotrienols protects osteoblasts against oxidative stress. Clin Ter. 2011;162(6):533-8.
34. Kasai S, Ito A, Shindo K, et al. High-dose α-tocopherol supplementation does not induce bone loss in normal rats. PLoS One. 2015;10(7):e0132059.
35. Norazlina M, Chua CW, Ima-Nirwana S. Vitamin E deficiency reduced lumbar bone calcium content in female rats. Med J Malaysia. 2004;59(5):623-30.
36. Savvidis M, Papavasiliou K, Taitzoglou I, et al. Postoperative administration of alpha-tocopherol enhances osseointegration of
stainless steel implants: an in vivo rat model. Clin Orthop Relat Res. 2020;478(2):406-419.
37. Mohamed N, Ahmed Abukhadir SS, Syed Hashim SA, et al. Vitamin E Improves cellular and structural bone histomorphometry in
an alcohol-induced osteoporosis rat model. pharmaceuticals (Basel). 2024;17(12):1730.
38. Abdul-Majeed S, Mohamed N, Soelaiman IN. The use of delta- tocotrienol and lovastatin for anti-osteoporotic therapy. Life Sci. 2015;125:42-48.
39. Suhaimi F, Muhammad N, Soelaiman IN. The effects of alpha- tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model. Clinics (Sao Paulo). 2012;67(9):1077-1085.
40. Turk C, Halici M, Guney A, et al. Promotion of fracture healing by vitamin E in rats. J Int Med Res. 2004;32(5):507-512.
41. Mohamad S, Shuid AN, Mohamed N, et al. The effects of alpha- tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model. Clinics (Sao Paulo). 2012;67(9):1077-1085.
42. Nazrun Shuid A, Das S, Mohamed IN. Therapeutic effect of Vitamin E in preventing bone loss: An evidence-based review. Int J Vitam Nutr Res. 2019;Mar:1-14.
43. Wong SK, Chin KY, Suhaimi FH, et al. The effects of vitamin E from elaeis guineensis (oil palm) in a rat model of bone loss due to metabolic syndrome. Int J Environ Res Public Health. 2018;15(9). pii: E1828.
44. Kohno K, Yamada W, Ishitsuka A, S et al. Tocotrienol-rich fraction from annatto ameliorates expression of lysyl oxidase in human osteoblastic MG-63 cells. Biosci Biotechnol Biochem. 2020;84(3):526-535.
45. Peng YL, Wang ZY, Wang XJ, et al. Lower risk of low bone mineral density in high vitamin E level in older people: a cross- sectional study. Clinical Nutrition ESPEN. 2024;61:316-21.
46. Shen CL, Yang S, Tomison MD, et al. Tocotrienol supplementation suppressed bone resorption and oxidative stress in postmenopausal osteopenic women: a 12-week randomized double-blinded placebo- controlled trial. Osteoporos Int. 2018;29(4):881-891.
47. Skalny AV, Aschner M, Tsatsakis A, et al. Role of vitamins beyond vitamin D 3 in bone health and osteoporosis. International Journal of Molecular Medicine. 2024;53(1):1;26(20):10206.
48. Magremanne M, Reychler H. Pentoxifylline and tocopherol in the treatment of yearly zoledronic acid-related osteonecrosis of the jaw in a corticosteroid-induced osteoporosis. J Oral Maxillofac Surg. 2014;72(2):334-337.
49. Shi WQ, Liu J, Cao Y, et al. Association of dietary and serum vitamin E with bone mineral density in middle-aged and elderly Chinese adults: a cross-sectional study. Br J Nutr. 2016;115(1):113-120.
50. Michaëlsson K, Wolk A, Byberg L, et al. Intake and serum concentrations of α-tocopherol in relation to fractures in elderly women and men: 2 cohort studies. Am J Clin Nutr. 2014;99(1):107-114.
51. Pasco JA, Henry MJ, Wilkinson LK, et al. Antioxidant vitamin supplements and markers of bone turnover in a community sample of nonsmoking women. J Womens Health (Larchmt). 2006;15(3):295-300.
52. Holvik K, Gjesdal CG, Tell GS, et al. Low serum concentrations of alpha-tocopherol are associated with increased risk of hip fracture. A NOREPOS study. Osteoporos Int. 2014;25(11):2545-54.
53. Mata-Granados JM, Cuenca-Acebedo R, Luque de Castro MD, et al. Lower vitamin E serum levels are associated with osteoporosis in early postmenopausal women: a cross-sectional study. J Bone Miner Metab. 2013;31(4):455-460.
54. Sun LL, Li BL, Xie HL, et al. Associations between the dietary intake of antioxidant nutrients and the risk of hip fracture in elderly Chinese: a case-control study. Br J Nutr. 2014;112(10):1706-1714.
55. Mulligan AA, Hayhoe RP, Luben RN, et al. Positive associations of dietary intake and plasma concentrations of vitamin E with skeletal muscle mass, heel bone ultrasound attenuation and fracture risk in the EPIC- Norfolk cohort. Antioxidants. 2021;10(2):159.
56. Chuin A, Labonté M, Tessier D, et al. Effect of antioxidants combined to resistance training on BMD in elderly women: a pilot study. Osteoporos Int. 2009;20(7):1253-258.
57 D'Adamo CR, Miller RR, Shardell MD, et al. Higher serum concentrations of dietary antioxidants are associated with lower levels of inflammatory biomarkers during the year after hip fracture. Clin Nutr. 2012;31(5):659-665.
58. Shen CL, Klein A, Chin KY, et al. Tocotrienols for bone health: a translational approach. Ann N Y Acad Sci. 2017;1401(1):150-165.
59. Norazlina M, Chua CW, Ima-Nirwana S. Vitamin E deficiency reduced lumbar bone calcium content in female rats. Med J Malaysia. 2004;59(5):623-630.
62. Thoen PS, Lindalen E, Nordsletten L, et al. Low wear with vitamin E- infused highly cross-linked polyethylene : 14 years' follow-up of a randomized radiostereometric analysis study. Bone Joint J. 2025;107- B(11):1182-1188.
63. Wan Hasan WN, Abd Ghafar N, Chin KY, et al. Annatto-derived tocotrienol stimulates osteogenic activity in preosteoblastic MC3T3-E1 cells: a temporal sequential study. Drug Des Devel Ther. 2018 ;12:1715-1726.
64. Johnson SA, Feresin RG, Soung do Y, et al. Vitamin E suppresses ex vivo osteoclastogenesis in ovariectomized rats. Food Funct. 2016:1628-1633.
65. Mohamad NV, Soelaiman IN, Chin KY. Effects of tocotrienol from Bixa orellana (annatto) on bone histomorphometry in a male osteoporosis model induced by buserelin. Biomed Pharmacother. 2018;103:453-462.
66. Smith BJ, Lucas EA, Turner RT, et al. Vitamin E provides protection for bone in mature hindlimb unloaded male rats. Calcif Tissue Int. 2005;76(4):272-279.
67. Wong SK, Chin KY, Ima-Nirwana S. The effects of tocotrienol on bonepeptides in a rat model of osteoporosis induced by metabolic syndrome: the
possible communication between bone cells. Int J Environ Res Public Health. 2019;16(18); pii: E3313.
68. Ruiz-Ramos M, Vargas LA, Fortoul Van der Goes TI et al, Supplementation of ascorbic acid and alpha-tocopherol is useful to preventing bone loss linked to oxidative stress in elderly. J Nutr Health Aging. 2010;14(6):467-472.
69. Norazlina M, Ima-Nirwana S, Abul Gapor MT, et al. Tocotrienols are needed for normal bone calcification in growing female rats. Asia Pac J Clin Nutr. 2002;11(3):194-199.
70. Vallibhakara SA, Nakpalat K, Sophonsritsuk A, et al. Effect of vitamin E supplement on bone turnover markers in postmenopausal osteopenic women: a double-blind, randomized, placebo-controlled trial. Nutrients. 2021;13(12):4226.
71. Fujita K, Iwasaki M, Ochi H, et al. Vitamin E decreases bone mass by stimulating osteoclast fusion. Nature Med. 2012:18(4);589-594.
72. Tennant KG, Leonard SW, Wong CP, et al. High-dietary alpha- tocopherol or mixed tocotrienols have no effect on bone mass, density, or turnover in male rats during skeletal maturation. J Med Food. 2017;20(7):700-708.
73. Lu Y, Yang Z, Duan J, et al. Associations of serum vitamins, carotenoids, and retinyl esters with risk of hip and spine fractures. Nutr Hosp. 2025;45(5):1016-1030.
74. Muhammad N, Luke DA, Shuid AN, et al. Tocotrienol supplementation in postmenopausal osteoporosis: evidence from a laboratory study. Clinics (Sao Paulo). 2013;68(10):1338-1343.
75. Kanchi MM, Shanmugam MK, Rane G, et al. Tocotrienols: the unsaturated sidekick shifting new paradigms in vitamin E therapeutics. Drug Discov Today. 2017;22(12):1765-1781.
76. Muhammad N, Luke DA, Shuid AN, et al. Two different isomers of vitamin E prevent bone loss in postmenopausal osteoporosis rat model. Evid Based Complement Alternat Med. 2012;2012:161527.
77. Zhang J, Munger RG, West NA, et al. Antioxidant intake and risk of osteoporotic hip fracture in Utah: an effect modified by smoking status. Am J Epidemiol. 2006;163(1):9-17.
78. Casati L, Pagani F, Maggi R,. Food for bone: evidence for a role for delta-tocotrienol in the physiological control of osteoblast migration. Int J Mol Sci. 2020;21(13):4661.
79. Mohamad S, Shuid AN, Mohamed N, et al. Therapeutic effect of vitamin E in preventing bone loss: an evidence-based review. Int J Vitam Nutr Res. 2019:1-14.
80. Radzi NFM, Ismail NAS, Alias E. Tocotrienols regulate bone loss through suppression on osteoclast differentiation and activity: a systematic review. Curr Drug Targets. 2018;19(9):1095-1107.
81. Chin KY, Ima-Nirwana S. The role of tocotrienol in preventing male osteoporosis-a review of current evidence. Int J Mol Sci. 2019;20(6). pii:E1355.
82. Ha H, Lee JH, Kim HN, et al. α-Tocotrienol inhibits osteoclastic bone resorption by suppressing RANKL expression and signaling and bone
resorbing activity. Biochem Biophys Res Commun. 2011;406(4):546-551.
83. Zhou P, Shao R, Wang H, et al. Dietary vitamin A, C, and E intake and subsequent fracture risk at various sites: A meta-analysis of prospective cohort studies. Medicine (Baltimore). 2020;99(35):e20841.
84. Feresin RG, Johnson SA, Elam ML, et al. Effects of vitamin E on bone biomechanical and histomorphometric parameters in ovariectomized rats. J Osteoporos. 2013;2013:825985.
85. Zakaria S, Mat-Husain SZ, Ying-Hwey K, et al. Vitamin E improved bone strength and bone minerals in male rats given alcohol. Iran J Basic Med Sci. 2017;20(12):1360-1367.
86. Pedrinolla A, Isanejad M, Antognelli C, et al. Randomised controlled trial combining vitamin E-functionalised chocolate with physical exercise
to reduce the risk of protein-energy malnutrition in predementia aged people: study protocol for Choko-Age. BMJ Open. 2023.
87. Shuid AN, Mohamad S, Muhammad N, et al. Effects of α-tocopherol on the early phase of osteoporotic fracture healing. J Orthop Res. 2011.
88. Haddon W Jr. The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. 1968. Inj Prev. 1999;5(3):231-235.
89. Yang J, Wang A, Shang L, et al. Study on the association between dietary habits, patterns and frailty of the elderly: a cross-sectional survey from communities in China. Clin Interv Aging. 2022;17:1527-1538.
90. Kochlik B, Stuetz W, Pérès K, et al. Associations of fat-soluble micronutrients and redox biomarkers with frailty status in the FRAILOMIC initiative. J Cachexia Sarcopenia Muscle. 2019;10(6):1339-1346.