The clear hallmarks of ageing are creaky joints, stiff backs and brittle bones — but none of these need to be inevitable.
Although half of people over 55 in the UK and US show signs of arthritis, other regions such as Africa and Israel report far lower rates. Understanding how bones renew themselves is the first step toward keeping them strong for life.
BONES ARE ALIVE
Far from being lifeless scaffolding, bones are dynamic organs involved in metabolism, fat storage and insulin regulation. They are built from a collagen matrix (formed by vitamin C) into which calcium, magnesium and potassium are deposited. Throughout life, bone is broken down by osteoclasts and rebuilt by osteoblasts — but this process slows with age.
To maintain density, focus on:
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Weight-bearing exercise, such as walking, dancing or resistance training.
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Adequate protein, to stimulate collagen and bone matrix production.
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Vitamin D and B vitamins, which improve calcium absorption and prevent bone breakdown.
BISPHOSPHONATES: WORTH THE RISK?
Many people diagnosed with osteoporosis are prescribed bisphosphonates, drugs designed to slow bone loss. Yet research shows modest real-world benefits. A Finnish study published in the BMJ found that treating 1.86 million people over 50 would prevent only 343 hip fractures. Meanwhile, the drug would have failed to prevent 7 068 of them. That is a long, long way from preventing 32%, so how can the results be so poor and confusing?
Side effects (including oesophageal inflammation, jaw necrosis, femur fractures and arrhythmia) raise concern. Combined with acid-suppressing medication, bisphosphonates may lose all benefit.
THE VITAMIN D CONNECTION
Osteoporosis prevalence rises with latitude, confirming vitamin D's key role. This nutrient helps deposit calcium and magnesium into bone. Aim for 20–30 mcg daily and regular sunlight exposure; supplementation is essential in winter. Higher vitamin D levels can improve bisphosphonate response by sevenfold.
CALCIUM ISN'T ENOUGH
Despite marketing slogans, milk and calcium alone do not prevent fractures. Studies show that calcium without vitamin D offers little protection and may increase heart risk. The ideal intake is 800–1 000 mg daily, obtained from nuts, seeds, beans, and green vegetables. Supplementation should always include magnesium, zinc, boron, vitamin D and vitamin K — the latter found in spinach and Brussels sprouts, essential for calcium binding in bone.
PROTEIN AND AMINO ACIDS
Your skeleton's core is protein. Research by Dr Carlos Isales at Georgia Health Sciences University shows that amino acids help stem cells build bone instead of fat. Older adults with low protein intake are at greater risk of osteoporosis, as stem cells default to fat storage when deprived of amino acids.
B VITAMINS AND HOMOCYSTEINE
High homocysteine and low B12 levels correlate strongly with reduced bone density and higher fracture risk. Supplementing vitamin B12 and folate supports methylation, collagen integrity and bone regeneration.
MOVEMENT BUILDS BONE
Weight-bearing exercise remains one of the most effective strategies for preserving bone density. Even 2–3 sessions per week can increase bone mass by up to 10%. Resistance work for the upper body and vibration platforms (shown to boost hip and femur density) are especially beneficial.
Editor's note: Functional medicine now views osteoporosis as a metabolic condition involving chronic inflammation, hormonal imbalance and micronutrient deficiency rather than calcium loss alone. Emerging research links vitamin K2, boron and collagen peptides to improved bone microarchitecture. Low-level vibration therapy and red-light stimulation are being explored for bone regeneration support. Here is an article on Bone Density and Bone Strength.
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