Evidence Based

Osteocalcin Test: Serum Levels & How to Increase

Written by Biljana Novkovic, PhD | Reviewed by Ana Aleksic, MSc (Pharmacy), Matt Carland, PhD (Neuroscience) | Last updated:

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The osteocalcin test can point to bone problems HLA-B27

Osteocalcin is a protein that helps build and maintain bones. Low levels can increase your risk of diabetes, obesity, heart disease, and liver problems. Read on to learn more about the osteocalcin test, normal serum levels, and how to increase osteocalcin naturally.

Osteocalcin Test


The osteocalcin test measures the amount of osteocalcin in your blood.

Osteocalcin is a protein hormone produced in the bones. It binds calcium and helps build and heal bones. Osteocalcin also increases insulin production, adjusts blood sugar levels, stimulates testosterone production, and improves muscle strength and brain health [1, 2, 34, 5].

You shouldn’t take supplements containing biotin or vitamin B7 at least 12 hours before the test. Otherwise, you don’t need to prepare for the test in any special way.

Why Doctors Order It

Osteocalcin blood levels reflect the rate of bone turnover. Therefore, the osteocalcin test is useful for monitoring disorders that affect bone health, such as osteoporosis, primary and secondary hyperparathyroidism, cancer with bone metastasis, and Paget’s disease [6].

Your doctor may order the osteocalcin test to monitor how well bone-building therapy is working. It may also be used to diagnose any of the above-mentioned disorders, along with other blood markers.

Doctors use the osteocalcin test to monitor bone-building therapy or to diagnose bone disorders, along with other tests. Don’t take biotin for at least 12 hours before the test.

Osteocalcin Serum Levels

Normal Range

The levels of osteocalcin in your serum (the liquid part of the blood) are usually reported in ng/mL (nanograms per milliliter).

The normal range is 8 – 32 ng/mL.

Values under 8 ng/mL are considered low and values above 32 ng/mL are marked as high. The normal range may slightly vary from lab to lab.

Some labs give a different range for men, pre- and post-menopausal women.

How to Increase Osteocalcin

The strategies listed below can help you increase low osteocalcin levels and strengthen your bones.

1) Vitamin K

Vitamin K is necessary to activate osteocalcin in the body. A lack of vitamin K results in a lack of osteocalcin protein in the bones. Vitamin K deficiency is also associated with low bone mineral density and increased risk of fractures [7, 8].

A placebo-controlled study of 40 healthy young men showed that vitamin K supplements increased osteocalcin levels after just 4 weeks. This improved the body’s use of insulin (by reducing insulin resistance) and the maintenance of healthy glucose levels. These results were consistent with other clinical studies involving the use of vitamin K supplements by young males as well as older women and men [9, 10, 11].

An analysis of blood samples from 896 persons suggested that most people do not receive enough vitamin K from their diet. However, vitamin K can be taken as a supplement, to ensure that the body produces enough osteocalcin. The best type of vitamin K to take for this is vitamin K2, particularly the MK-7 type [12].

However, persons who are taking some types of blood-thinning medication (anticoagulants), such as warfarin, must be careful. There is a significant risk that some of these medications will become less effective if vitamin K2 in MK-7 form is taken as well, and so this combination is not advised [12].

Vitamin K activates osteocalcin and increases its blood levels. Go for vitamin K2 supplements, particularly MK-7, unless you are taking blood thinners.

2) Exercise

Osteocalcin levels are higher in people who are more physically active [13].

A link between more physical activity and higher osteocalcin levels has been found in 54 adolescents [14].

One hour of exercise, 3 times per week for 12 weeks, increased osteocalcin levels and bone mineral density in 29 women with osteoporosis (with an age range of 71 to 78) [15].

A study of 11 middle-aged men found that osteocalcin levels increased and remained at higher levels for several hours after a brief period of high-intensity exercise (4 sets of 4 minutes of cycling at nearly peak performance levels). This was also linked to increased insulin sensitivity [16].

There is also evidence that longer periods of less intense exercise can increase osteocalcin levels. A study involving 31 middle-aged subjects found a significant increase in osteocalcin levels after cycling for an hour, 3 to 4 days per week [17].

In a study of 39 obese but otherwise healthy young men, those who followed an 8-week program of exercise with four sessions per week had increased osteocalcin and leptin levels [18].

Regular exercise increases osteocalcin levels and supports bone health.

3) Diet/Calorie Restriction

In a study of 107 older, frail adults, osteocalcin blood levels increased on a calorie restriction diet [19].

In a study of 49 obese men, osteocalcin blood levels increased after weight loss [20].

However, in a study of 71 postmenopausal women, there was no link between weight loss and osteocalcin [21].

Finally, in 178 obese persons, high osteocalcin levels were associated with reduced body fat. However, osteocalcin levels actually decreased after weight loss [22].

Weight loss and calorie restriction may lower osteocalcin levels, which is beneficial for overweight people.

4) Vitamin D

Vitamin D directly stimulates osteocalcin production [23].

In a clinical trial of 76 obese but otherwise healthy menopausal women between the ages of 51 and 63, vitamin D supplements in combination with a calorie-restricted diet increased osteocalcin and improved insulin sensitivity, compared to diet alone [23].

Vitamin D helps produce osteocalcin in the body and increases bone strength.

5) Zinc

Zinc supplements increased osteocalcin levels in 22 shorter-than-average children. However, this has not been linked to more growth (height and weight) [24].

6) Manganese

Manganese supplements have been shown to increase osteocalcin levels, bone mineral density, and bone formation in rats [25].

Both zinc and manganese increase osteocalcin, while manganese may also strengthen the bones.

7) Olive Oil

A 12-month clinical trial of postmenopausal women with decreased bone mass (but without a diagnosis of osteoporosis) showed that an olive tree extract increased blood osteocalcin levels, leading to increased bone density in the spine [26].

The sustained consumption of an extra virgin olive oil-enriched Mediterranean diet increased osteocalcin levels in 42 elderly men with high risk of heart disease [27].

8) Omega-3 Fatty Acids

Omega-3 fatty acid supplements increased osteocalcin levels in rats. This may be beneficial to bones, but that link has not been demonstrated and so further studies are required [28].

Up your intake of olive oil and omega-3 fatty acids to increase your osteocalcin levels and bone density.

9) Ellagic Acid

Ellagic acid is found in many fruits and vegetables such as pecans, walnuts, pomegranates, raspberries, strawberries, and cranberries. It f1unctions as an antioxidant, preventing cell damage [29].

Ellagic acid increased osteocalcin in rats after tooth extraction [30].

10) Milk Thistle

The main component of milk thistle seeds is silymarin [31].

Silymarin increased osteocalcin, bone healing, and bone density in mice with bone fractures [32].

11) Icariin

Icariin is a flavonoid of the Epimedium plant/Horny Goat Weed.

A 24-month DB-RCT suggests that icariin may help prevent bone loss in postmenopausal women. Icariin maintained osteocalcin levels and prevented bone tissue loss [33].

Ellagic acid, milk thistle, and icariin may increase osteocalcin and prevent bone loss.

12) Insulin Therapy/Low Glucose

Type 1 diabetes can cause changes in the skeleton, especially when glucose levels are poorly controlled. Several studies have found that insulin therapy increases osteocalcin levels, leading to improved bone structure and flexibility in type 1 diabetes [34, 35].

13) Alendronate

Alendronate (Fosamax, Binosto) is a drug used to treat osteoporosis and Paget disease.

The use of alendronate in low doses is associated with increased osteocalcin and improved bone repair [36].

14) Teriparatide

Teriparatide is a parathyroid hormone used to treat osteoporosis [37].

In a study of older women with rheumatoid arthritis, long-term treatment with teriparatide (48 weeks) increased osteocalcin levels [38].

Since people with rheumatoid arthritis have a higher risk of osteoporosis, pre-treatment with teriparatide may be beneficial [38].

Alendronate and teriparatide are drugs that increase osteocalcin. They are used to treat osteoporosis.

15) Ibutamoren

Ibutamoren is a substance that increases growth hormone levels.

Elderly adults who received ibutamoren had increased osteocalcin levels, showing that this treatment has a positive effect on improving bone health in the elderly [39].

However, we recommend against taking ibutamoren without medical supervision until studies confirm its effecitivess and safety.

16) Stop Smoking

Smoking lowers osteocalcin levels by interfering with the genes that produce osteocalcin. This can lead to difficulties with bone healing, and can loosen teeth and dental implants by weakening bone tissue in the mouth and jaw (alveolar bone) [40].

Smoking can also decrease osteocalcin levels in saliva, which is associated with chronic gum inflammation (periodontitis). [41, 42].

Smoking lowers osteocalcin levels and slows bone healing.

17) Avoid Glucocorticoids

Glucocorticoids are steroid hormones that inhibit inflammation. They are frequently used to treat asthma and rheumatoid arthritis [43, 44].

However, glucocorticoids may also reduce osteocalcin in the bones, which may increase the risk of osteoporosis in people who take glucocorticoids regularly [45].

Reducing the dosage of glucocorticoids in 208 patients with rheumatoid arthritis led to improvements in osteocalcin levels and bone metabolism [45].

Glucocorticoids are steroid anti-inflammatory drugs that may reduce osteocalcin levels and increase the risk of osteoporosis in the long run.

18) Correct Iron Deficiency

There may be a link between iron deficiency and low osteocalcin.

In rats, iron deficiency reduced osteocalcin, lower bone mineral density, and reduced bone strength [46].

If your osteocalcin levels are low, check your iron levels to rule out deficiency as the culprit.


Skip this part if you are not interested in genetics and haven’t sequenced your DNA.

Two SNPs in the Osteocalcin Gene, BGLAP, may make you prone to high or low osteocalcin levels.


The ‘T’ variant of this gene is associated with higher osteocalcin levels, while the ‘C’ variant is linked to lower osteocalcin levels [47, 48].

In 5,561 older people, the ‘T’ variant of rs1800247 was associated with higher osteocalcin levels in women. In men, those with the ‘T’ variant had a higher risk of bone fractures [48].

However, in another study with 302 athletes, no relationship was observed between this variant and bone quality. This genetic variant may only be relevant in older people [49].

In another study of 5,647 people, those with the ‘C’ variant had a lower risk of high blood pressure (hypertension). This may be because osteocalcin improves insulin sensitivity and energy metabolism [50].


This variant is found close to the osteocalcin gene and may influence its production. In 998 women, the rs1543294 variant was associated with higher osteoporosis-related fracture risk [47].

Genetic variants in the osteocalcin gene (BGLAP) may increase your risk of having low or high osteocalcin levels, especially in old age.

Learn More


Your osteocalcin serum levels can reveal a bone disorder. Doctors may order the osteocalcin test to make a diagnosis, along with other blood markers. They also use it to monitor how well bone-building drugs are working. Don’t take niacin for at least 12 hours before the test.

The normal range of osteocalcin in the serum is 8 – 32 ng/mL.

If your levels are low and/or if your bones are weak, consider increasing your intake of vitamin K2, omega-3, and olive oil. Vitamin K is particularly important, as it is needed to activate osteocalcin in the body.

You should also get regular exercise and enough vitamin D, stop smoking, and lose weight if you are obese. Manganese, zinc, and milk thistle supplements may also help.

Irregular Osteocalcin Levels?

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About the Author

Biljana Novkovic

Biljana received her PhD from Hokkaido University.
Before joining SelfHacked, she was a research scientist with extensive field and laboratory experience. She spent 4 years reviewing the scientific literature on supplements, lab tests and other areas of health sciences. She is passionate about releasing the most accurate science & health information available on topics, and she's meticulous when writing and reviewing articles to make sure the science is sound. She believes that SelfHacked has the best science that is also layperson-friendly on the web.

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