The "good enough" trap
If you have osteopenia (thinner than normal bones) or osteoporosis, or take medicines that can weaken bones, such as long-term steroid tablets (Royal Osteoporosis Society, n.d.a), you have probably been prescribed Calci-D® (1,000 mg calcium + 1,000 IU vitamin D3, once a day) or Adcal-D3® (600 mg calcium + 400 IU vitamin D3, usually twice a day). These are an important foundation (Gregson et al., 2025).
But your skeleton is living tissue. As well as minerals, it needs a scaffold (protein), help steering calcium to the right place (vitamin K2) and a power source (muscle). This guide looks at what research suggests may add to standard care, always to be discussed with your GP.
Be clear about the evidence
Apart from calcium and vitamin D, none of the supplements below is currently recommended in UK osteoporosis guidance. Bone-strengthening medicines, such as bisphosphonates, remain the main treatment for osteoporosis (Gregson et al., 2025). Supplements are not a replacement for them.
Part 1: The calcium paradox and vitamin K2
Calcium in your blood does not automatically end up in bone. Researchers describe a "calcium paradox", where older adults can have weak bones and calcium build-up in their arteries at the same time (Vermeer and Theuwissen, 2011).
Vitamin K2 (MK-7) switches on proteins that help lock calcium into bone and may help keep it out of artery walls. In a three-year trial, 180 micrograms a day slowed age-related bone loss (Knapen et al., 2013) and reduced artery stiffness (Knapen et al., 2015) in women after the menopause. Read more in our vitamin K2 post.
⚠️ Taking warfarin?
Do not take a vitamin K supplement, or make big changes to your diet, without talking to your GP or anticoagulation clinic first (Royal Osteoporosis Society, 2021).
Part 2: The hidden scaffold – protein
Bone is not just mineral. Roughly a third of it is a protein framework, mostly a type of collagen, which gives bone the flexibility to bend rather than shatter.
As we age, our bodies get less efficient at using protein. A European expert group recommends that healthy older adults eat at least 1.0 to 1.2 g of protein per kg of body weight a day (Deutz et al., 2014). For someone weighing 70 kg, that is about 70 to 84 g a day. Food is the best source, such as fish, eggs, dairy, beans, lentils and tofu.
What about collagen supplements?
In one 12-month trial, 5 g a day of a specific collagen peptide product increased bone density at the spine and hip in 131 women with low bone density after the menopause (König et al., 2018). This is one trial, of one branded product, part-funded by its manufacturer, so results may not apply to other products. If you try collagen, look for "hydrolysed collagen peptides", as in the trial.
Part 3: Sarcopenia – the silent thief
Most hip fractures happen because of a fall, and falls are more likely when muscle strength fades with age. This loss of muscle is called sarcopenia.
Walking is great for your heart, but muscles also need strength work. The NHS recommends that adults over 65 do activities that improve strength, balance and flexibility on at least 2 days a week (NHS, n.d.a).
Creatine monohydrate is a well-studied supplement that is considered safe for long-term use in healthy people (Kreider et al., 2017). In a two-year trial in women after the menopause who did strength training, creatine increased lean muscle and helped maintain the shape of the hip bone, but did not change bone density (Chilibeck et al., 2023).
Part 4: At a glance
| What | Amount used in research or guidance | Evidence and cautions |
|---|---|---|
| Calcium + vitamin D | As prescribed | In UK guidance. Take with food (Gregson et al., 2025). |
| Vitamin K2 (MK-7) | 180 micrograms a day | Promising trials; not in UK guidance. ⚠️ Not with warfarin unless your GP agrees. |
| Protein | 1.0 to 1.2 g per kg a day | Expert recommendation. Food first. Check with your GP if you have kidney disease. |
| Collagen peptides | 5 g a day | One 12-month trial of a single branded product. |
| Creatine | 3 to 5 g a day | Helps muscle alongside strength training; no effect on bone density in a 2-year trial. Check with your GP if you have kidney disease. |
| Magnesium | No more than 250 mg a day from supplements | Helps calcium and vitamin D work (Royal Osteoporosis Society, n.d.b). Too much can cause diarrhoea (EFSA, 2006). |
| Omega-3 (EPA/DHA) | About 1 g a day | Evidence for bones is mixed (Dou et al., 2022). |
| Prunes | 50 g (5 to 6 prunes) a day | 50 g worked as well as 100 g at preventing bone loss over 6 months in women with osteopenia (Hooshmand et al., 2016). |
| Vitamin C + zinc | Under 1,000 mg vitamin C; no more than 25 mg zinc from supplements | Vitamin C is needed to make collagen. Most people get enough from food (NHS, n.d.b; NHS, n.d.c). |
Part 5: Food first
Vitamin C: your body needs it to make collagen, and the Royal Osteoporosis Society notes it is important for bone structure (Royal Osteoporosis Society, n.d.b). Fruit and vegetables are the best sources.
Before you start anything new, talk to your GP or pharmacist, especially if you take warfarin or another blood thinner, bisphosphonates or other prescribed medicines, or if you have kidney or liver disease, high calcium levels or a history of kidney stones.
The bottom line
Calcium and vitamin D are the foundation, not the whole building. Enough protein, strength exercise and, for some people, carefully chosen supplements may add further protection. The evidence for most extras is still developing, so take this guide to your GP and decide together what is right for you.
Calci-D® and Adcal-D3® are registered trademarks of their respective manufacturers.
References
Chilibeck, P.D. et al. (2023) 'A 2-year randomized controlled trial on creatine supplementation during exercise for postmenopausal bone health', Medicine & Science in Sports & Exercise. Available at: https://pubmed.ncbi.nlm.nih.gov/37144634/
Deutz, N.E.P. et al. (2014) 'Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group', Clinical Nutrition, 33(6), pp. 929–936. Available at: https://www.clinicalnutritionjournal.com/article/S0261-5614(14)00111-3/fulltext
Dou, Y. et al. (2022) 'Effect of n-3 polyunsaturated fatty acid on bone health: a systematic review and meta-analysis of randomized controlled trials', Food Science & Nutrition, 10. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/fsn3.2655
EFSA (2006) Tolerable upper intake levels for vitamins and minerals. Parma: European Food Safety Authority. Available at: https://www.efsa.europa.eu/sites/default/files/efsa_rep/blobserver_assets/ndatolerableuil.pdf
Gregson, C.L. et al. (2025) 'The 2024 UK clinical guideline for the prevention and treatment of osteoporosis', Archives of Osteoporosis, 20(1), p. 119. Available at: https://doi.org/10.1007/s11657-025-01588-3
Hooshmand, S. et al. (2016) 'The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women: a randomized, controlled trial', Osteoporosis International, 27(7), pp. 2271–2279. Available at: https://link.springer.com/article/10.1007/s00198-016-3524-8
Knapen, M.H.J. et al. (2013) 'Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women', Osteoporosis International, 24(9), pp. 2499–2507. Available at: https://pubmed.ncbi.nlm.nih.gov/23525894/
Knapen, M.H.J. et al. (2015) 'Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women: a double-blind randomised clinical trial', Thrombosis and Haemostasis, 113(5), pp. 1135–1144. Available at: https://pubmed.ncbi.nlm.nih.gov/25694037/
König, D. et al. (2018) 'Specific collagen peptides improve bone mineral density and bone markers in postmenopausal women: a randomized controlled study', Nutrients, 10(1), p. 97. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5793325/
Kreider, R.B. et al. (2017) 'International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine', Journal of the International Society of Sports Nutrition, 14, p. 18. Available at: https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0173-z
NHS (n.d.a) Physical activity guidelines for older adults. Available at: https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/
NHS (n.d.b) Vitamin C. Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-c/
NHS (n.d.c) Others – vitamins and minerals (zinc). Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/others/
Royal Osteoporosis Society (2021) Further food facts and bones. Available at: https://strwebprdmedia.blob.core.windows.net/media/v2pdyew4/ros-further-food-facts-and-bones.pdf
Royal Osteoporosis Society (n.d.a) Medicines that can increase your risk of osteoporosis and broken bones. Available at: https://theros.org.uk/information-and-support/causes-and-risk-factors/medicines-that-increase-your-risk/
Royal Osteoporosis Society (n.d.b) Other vitamins and minerals for bone health. Available at: https://theros.org.uk/information-and-support/bone-health/nutrition-for-bones/vitamins-minerals-and-nutrients/vitamins/
Vermeer, C. and Theuwissen, E. (2011) 'Vitamin K, osteoporosis and degenerative diseases of ageing', Menopause International, 17(1), pp. 19–23. Available at: https://pubmed.ncbi.nlm.nih.gov/21427421/
Join the Zero Jargon Health Community
Threads · Instagram · Facebook
Important medical disclaimer
The content provided in this blog post is for educational and informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your GP, psychiatrist or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Never start, stop or change a prescribed medicine without speaking to your prescriber first.
No comments:
Post a Comment