Manganese is an essential trace mineral that plays a significant role in bone health. Its involvement in the skeletal system is scientifically validated by its role as a cofactor for enzymes essential in bone formation and maintenance, such as glycosyltransferases, which are involved in the synthesis of proteoglycans necessary for the formation of healthy cartilage and bone matrix. Manganese also contributes to the synthesis of connective tissue components and supports metabolic processes related to bone mineralization.

Several studies have shown that manganese deficiency can lead to impaired bone growth and skeletal abnormalities, particularly in animal models. Human studies are more limited, but observational research indicates that individuals with low dietary manganese intake might be at increased risk for bone demineralization and osteoporosis. The malate form of manganese (manganese malate) is used in supplements to potentially enhance its absorption, though there is limited direct research comparing its efficacy to other forms.

However, while manganese is critical for bone health, deficiency is rare in populations with varied diets, and excessive supplementation can be toxic. Therefore, manganese (including manganese malate) is included in some bone-support supplements, but the direct evidence for its supplementation (outside of correcting deficiency) in bone health is moderate, justifying a mid-level evidence rating.