Keep your Bones Young and Strong

The clear hallmarks of ageing are creaky and aching joints and reducing bone mass. For some people, decreasing bone mass leads to osteoporosis, which is usually discovered when a fracture occurs. Four-fifths of fractures occur after the age of 50 and the risk becomes quite significant from 70 onwards.

Most people think of bones as something rather ‘dead’ – simply the scaffolding on which to hang the rest of the body. Bones are made from a matrix of collagen, produced by vitamin C, into which bone-building minerals such as calcium, magnesium and potassium are deposited. Although they seem the strongest and most enduring part of us, our bones are in a constant flux, endlessly being destroyed and re-created. Cells called osteoclasts are the bone destroyers, whereas the osteoblasts create new bone – but age slows down this sequence of destruction and renewal.

Strategies for improving bone-mass density either focus on stimulating growth, helping to push minerals into the bone, or on preventing its breakdown. Weight-bearing exercise – such as walking – combined with eating sufficient protein, for example, stimulates bone growth. Getting enough vitamin D helps calcium to be absorbed into the bone, while the hormone oestrogen and drugs called bisphosphonates inhibit bone breakdown. B vitamins assist your body’s methylation, and keep your homocysteine level ideal, which also helps to inhibit bone breakdown. The usual drugs offered are bisphosphonates but they are remarkably ineffective.

The amount of vitamin D you have in your blood may also play a major role. Not only does research show that 75 per cent of people on bisphosphonates don’t respond at all if they have the kind of low levels very common in the UK (below 50 nmol/l) but also getting double that amount would mean that you would be seven times more likely to have a favourable response to the drug.1 It only costs your doctor a small amount – a fraction of the cost of a drug prescription– to have your vitamin D levels tested, but if your doctor doesn’t want to test you, you can do it yourself at

Vitamin D is vitally important for bone health

Osteoporosis becomes more common as you move north, suggesting a link between sunlight (which produces vitamin D in the body) and this condition. The vital role of vitamin D is well known. It helps deposit calcium and other minerals into the bones’ collagen structure. Numerous studies have shown that the combination of vitamin D – at a daily intake of around 20–30mcg a day, along with 1,000mg-plus of calcium – improves bone mass density and reduces the risk of fractures.

It is certainly possible make all the vitamin D you need from sun, depending on how near the equator you are, the season and your skin colour. In the UK, 20 to 30 minutes a day in the summer, with as much of your skin exposed as you are comfortable with, will keep you healthy. But between October and March the sun will provide very little and getting enough from your diet is challenging. Few would be prepared to eat the three portions of oily fish a week and at least half a dozen eggs it would require. So to get the 30mcg that many experts now recommend as the minimum, you will need supplements. You get vitamin D drops providing 25mcg per drop. One or two of these a day can really boost your vitamin D levels. They are well worth trying for a couple of months if you do have muscle or joint pain, or osteopenia or osteoporosis.

Just taking calcium isn’t the answer

‘Bones are made of calcium, and milk is rich in calcium, so drink milk to strengthen bones.’ It’s a good story, but it’s very misleading. A recent review of studies giving calcium supplements finds that calcium alone doesn’t significantly reduce risk of fractures in postmenopausal women2 unless vitamin D is also given, and it doesn’t increase bone mass density in children either. Marion Nestle, Professor of Nutrition at New York University, has long campaigned for good food and has also exposed the vested interests behind junk food. She is one of a growing number of experts who point out that there is no clear correlation between rates of osteoporosis and calcium intake from milk.3

Another recent study found that calcium alone, or even with vitamin D, slightly raised the risk of a heart attack,4 while a third study found that getting more than 750mg was a waste of time. But such studies rarely consider the vitamin D levels of the patients, when low levels are linked with a greater risk of heart attack. What is more, giving a single mineral or vitamin is rarely effective.

In relation to calcium, your diet should provide around 800–1,000mg. The average intake is 900mg, because most people have a lot of dairy products. If you don’t have dairy products but do eat seeds, nuts and beans on a regular basis you should still achieve 800mg calcium plus other bone-friendly minerals such as magnesium. To get the ideal 1,000mg intake means supplementing a further 100–200mg, which is what should be in your daily multivitamin–mineral.

Some nutritionists recommend getting 1,200–1,500mg of calcium later in life, which means supplementing a further 400–700mg of calcium in total. There’s nothing wrong with this provided you also supplement the co-factor bone-building nutrients, which include magnesium, zinc, boron and vitamin D.

A good multivitamin–mineral should provide these, plus at least 40mcg of vitamin K. This often-forgotten vitamin helps bone formation by stimulating a protein called osteocalcin, which also fixes calcium into the bone. Leafy green vegetables such as spinach, Swiss chard and Brussels sprouts are rich in vitamin K and are also good sources of calcium and magnesium. There are also bone-friendly formulas that might be worth taking as well to ensure you get the optimal levels for bone support.

If you do have decreased bone mass density or any joint degeneration disease, taking a good multivitamin–mineral twice a day, and an extra supplement that contains all the bone-building nutrients, is a good idea.

Because collagen is made from vitamin C, we also recommend a daily intake of 1,800mg taken twice a day in divided doses. The most absorbable forms of calcium and magnesium are citrate, ascorbate and malate. These are always best taken twice with food. Also, avoid fizzy drinks, which contain phosphoric acid and caffeine, both of which leach calcium from bones. And don’t drink lots of coffee – one cup a day is enough.

The homocysteine connection

One important discovery that few people are aware of is the link between homocysteine, low B12 levels and bone and joint health. High homocysteine is an indicator of poor methylation, which is one of the critical anti-ageing processes. Over the last five years, there have been more and more studies linking high homocysteine and low B12 levels to an increased risk of fractures, osteoporosis and decreased bone mass density. Your homocysteine level predicts both your risk of osteoporosis and bone mass density, especially in women.5

Vitamin B12 levels, essential for keeping homocysteine down, decrease as you age, because it becomes increasingly poorly absorbed. A high homocysteine level means poor methylation, and both methylation and B12 are needed to build bone. In studies, lowering homocysteine by giving extra B12 plus folic acid to those over 65 reduced their risk of fractures.6 It looks as if homocysteine actually damages bone by encouraging its breakdown and interfering with the collagen structure that holds bone together.7

Bones are metabolically active

The essential structure of your body and your bones is protein, which is found in meat, fish and eggs as well as beans, chickpeas, lentils, nuts and seeds.

There’s some disagreement about how much protein you need for healthy bones. Ongoing research by Dr Carlos Isales, an endocrinologist at the Georgia Health Sciences University in the US suggests that getting the correct amount and type of amino acids – which are the building blocks of protein – helps to stimulate bone building by affecting the stem cells. This also lowers fat production, high levels of which can be a problem when the diet is low in protein.

Official figures in both the US and the UK suggest that about a third of patients over 65 eat a diet that is both calorie and protein deficient. That, Isales explains, encourages the stem cells in your bone marrow to make fat rather than bone. ‘Fat is the cheapest thing for your body to make,’ he says ‘so making fat is the default.’

Eating a low-GL diet and therefore keeping your insulin levels down, is another important key to bone health.The insulin you produce after a meal doesn’t only clear sugar but, among other things, it also triggers the ‘clasts’ in your bones to start building, because you’ve got the resources to do so – making bone uses up a lot of energy. That starts a whole sequence: the ‘blasts’ go to work as well, and that releases a hormone called osteocalcin into the bloodstream that stimulates insulin production from the B cells in the pancreas. This suggests that ensuring the natural rhythm of bone creation and destruction might also help to maintain a healthy metabolism.

The fitness factor

The importance of weight-bearing exercise for maintaining strong bones was brought vividly home when the first astronauts returned from space with seriously weakened bones after only a short period of weightlessness. Weight-bearing exercise can be as simple as walking, dancing or gardening. You can increase your bone mass by 5–10 per cent with just two or three weight-bearing exercise sessions a week.

The drawback to just relying on weight-bearing exercise is that it’s usually concentrated on the lower part of the body. Therefore, it’s best to add some resistance training that uses your upper body muscles too. Amazingly, you can maintain and build a significant amount of upper-body muscle in just five minutes three times a week. See my report on how to do this.


To keep your bones young:

  • Eat more nuts, seeds and beans – high in bone-friendly minerals.
  • Eat oily fish (salmon, mackerel, herring, sardines) at least three times a week for extra omega-3 and vitamin D.
  • Exercise every day, including some weight-bearing, joint-stretching, back-strengthening and muscle-building exercises.
  • Make an effort to lose weight if you are overweight .

In terms of supplements:

  • Check your homocysteine level. If it is high (above 9mcmol/l) supplement high-dose B6, B12 and folic acid
  • Take a twice-daily multivitamin–mineral that provides at least 15mcg of vitamin D, 40mcg of vitamin K, 100–400mg of calcium, 150mg of magnesium and 1mg of boron; plus 1,000mg of vitamin C and an omega-3 supplement twice a day.

To find out more read my book The 10 Secrets of Healthy Ageing.


  1. Research presented by Professor Richard Bockman chief of endocrinology at Weill Cornell Medical Collge in New York at the Endocrine Society’s 93 annual meeting in Boston June 2011
  2. M. Spangler, et al., ‘Calcium supplementation in postmenopausal women to reduce the risk of osteoporotic fractures’, American Journal of Health-System Pharmacy, 2011;68(4):309–18
  3. M. Nestle., ‘Eating made simple: How do you cope with a mountain of conflicting diet advice?’, Scientific American, 2007 Aug 8;
  4. M.J. Bolland, et al., ‘Calcium supplements with or without vitamin D and risk of cardiovascular events: Reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis’, British Medical Journal, 2011 Apr 19;342:d2040. doi: 10.1136/bmj.d2040
  5. C.G. Gjesdal, et al., ‘Plasma total homocysteine level and bone mineral density’, Archives of Internal Medicine, 2006;166:88–94; see also R.R. Maclean, et al., ‘Homocysteine as a predictive factor for hip fracture in older persons’, New England Journal of Medicine, 2004;350:2042–9; See also J.B. Van Meurs, et al., ‘Homocysteine levels and the risk of osteoporotic fracture’, New England Journal of Medicine, 2004;350:2033–41; See also M. Hermmann, et al., ‘The role of hyperhomocysteinemia as well as folate, vitamin B6 and B12 deficiencies in osteoporosis: A systematic review’, Clinical Chemistry Laboratory Medicine, 2007;45(12):1621–32; see also Z. Krivosíková, et al., ‘The association between high plasma homocysteine levels and lower bone mineral density in Slovak women: The impact of vegetarian diet’, European Journal of Nutrition, 2010;49(3):147–53
  6. Y. Sato, et al., ‘Effect of folate and mecobalamin on hip fractures in patients with stroke’, Journal of the American Medical Association, 2005;293:1082–88; see also Z. Ouzzif, et al., ‘Relation of plasma total homocysteine, folate and vitamin B12 levels to bone mineral density in Moroccan healthy postmenopausal women’, Rheumatology International, 2010 Jul 31. [Epub ahead of print]; Z. –Ouzzif, et al., [20676649];
  7. R. Thaler, et al., ‘Homocysteine suppresses the expression of the collagen cross-linker lysyl oxidase involving IL-6, Fli1, and epigenetic DNA methylation’,Journal of Biological Chemistry, 2011;286(7)5578–88