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synergy · 1
The idea that older people should eat less protein is a mistaken belief, and it harms two things at once: the bone framework and muscle. Bone density and muscle mass already decline together, and they jointly set the risk of falling, so they should be managed together.
cofactor · 5
Calcium is the building material for bone, but absorption has a ceiling: above roughly 500 mg at once, the share absorbed falls, so supplements should be taken with meals and in divided doses. Food comes first and supplements only fill the gap; take too much at once and little of the extra is absorbed.
Vitamin D decides whether the calcium you eat can be absorbed. On the NIH Office of Dietary Supplements tiers, a 25(OH)D below 30 nmol/L (12 ng/mL) is deficiency, 30–50 nmol/L may be inadequate, and 50 nmol/L (20 ng/mL) or more is enough for most people. When vitamin D is deficient, calcium absorption drops clearly, and taking more calcium keeps little of it.
Bone is not just mineral: its framework is collagen, and collagen is made from protein. The PROT-AGE consensus advises 1.2–1.5 g of protein per kilogram of body weight a day for people over 65 with an acute or chronic illness, spread so that every meal has enough; how it is spread across meals is easier to overlook than the total.
Vitamin K2 governs where calcium goes: osteocalcin and matrix Gla protein both need gamma-carboxylation to work, the first fixing calcium into bone and the second keeping it out of artery walls. The mechanism is clear, but the evidence from randomized trials with fractures as the endpoint is still early.
Magnesium plays a supporting role in bone health, but it cannot be left out: the US Recommended Dietary Allowance is 320 mg a day for adult women and 420 mg for men. It takes part in forming bone mineral crystals (hydroxyapatite) and is a cofactor in activating vitamin D; without enough of it, both calcium and vitamin D work less well.
depletes · 1
↮GERD
Long-term acid suppression with proton pump inhibitors (PPIs), usually for more than a year, may reduce the absorption of calcium and B12 and can cause low blood magnesium (the subject of an FDA safety communication in 2011); observational studies see a slightly higher fracture risk in long-term users. People who need long-term acid suppression can review bone health, calcium and vitamin D with their doctor, and whether the dose can be lowered or stopped.
regulates · 7
↔Bone
Osteoporosis is an imbalance in bone rebuilding: bone is removed faster than it is laid down, bone mass falls, the bone's fine structure breaks down, and bone becomes fragile. The FRAX tool combines age, body mass index (BMI), a parent's hip fracture, smoking, drinking, glucocorticoid use and other factors with bone density to estimate the chance of fracture over the next 10 years (Kanis 2008), which doctors use to decide on treatment.
Perimenopause and the first years after menopause are when women lose bone fastest, most of all in the spine. Menopausal hormone therapy slows bone loss, but whether to use it and when to start depend on age, time since menopause and other risks, and are for the woman to decide with her doctor. So bone risk is best assessed around the time of menopause.
Heavy training makes bone stronger along the lines of load. In the LIFTMOR randomized trial (Watson 2018), 101 postmenopausal women with low bone mass did closely supervised high-intensity resistance and impact training twice a week for 30 minutes; after 8 months lumbar-spine bone density rose 2.9%, while the control group doing low-intensity exercise at home lost 1.2%. It was done in people with low bone mass under supervision, so get a professional assessment before starting on your own.
After menopause estrogen withdraws, and the pair of signals that balance bone breakdown against bone building (RANKL and OPG) tips toward breakdown, so bone is resorbed faster than it is formed. For bone, menopause is not just getting older; it is a predictable period of faster loss that can be addressed early.
Vertigo makes falls more likely, especially in older people, and one fall can cost far more than the dizziness itself. Repositioning maneuvers make the vertigo of benign paroxysmal positional vertigo (BPPV) clear up sooner; whether that goes on to prevent falls and fractures has not been tested directly.
Osteoporosis in men is often overlooked. Bisphosphonates, calcium, vitamin D and strength training apply to men just the same, and if testosterone really is low, it should be assessed as hypogonadism; osteoporosis is not a women-only condition.
Blood calcium is held tightly at about 2.2–2.6 mmol/L by a negative-feedback loop: when intake is low, parathyroid hormone draws calcium out of bone to make up the difference. So an abnormal blood calcium says nothing about whether you eat enough; it means the control system itself has gone wrong (the parathyroid glands, the kidneys or certain tumors), which needs a doctor. How your bones are doing is judged by bone density.