Bones and vitamin D after 60: what actually works

Bone density starts dropping slowly and without a single symptom — most people find out only when something breaks. The good news is that bone still responds to load and nutrition in your seventies, just more slowly than muscle does. Here is what is worth doing, in numbers.

What happens to bone as you age

Bone is living tissue that is constantly broken down and rebuilt. Until roughly age 30 you build more than you lose; after that the balance flips. In women the loss accelerates in the first 5–10 years after menopause, often 2–3% per year in the spine. In men it is slower, around 0.5–1% per year, but it speeds up after 70 as well.

The practical consequence: a hip fracture after 65 is not just a fracture. Roughly half of people never return to their previous level of independence. So the goal is both stronger bone and a lower chance of falling in the first place.

Vitamin D: how much and how

Vitamin D does not build bone by itself. It lets your gut absorb calcium — without it you take up about 10–15% of the calcium you eat, with it 30–40%. Pushing calcium while your D is low is wasted effort, and the reverse is true too.

• Dose: for people over 65 the usual recommendation is 800–1000 IU (20–25 µg) per day, all year round, not only in winter.
• Upper limit without medical supervision is 4000 IU per day. Mega-doses such as 50,000 IU once a month are not better; in several trials they were linked to more falls, not fewer.
• Take it with a meal containing fat — absorption is noticeably better alongside eggs, cheese, fish or a spoon of oil than on an empty stomach.
• Sun will not cover winter. From October to March the sun sits too low for skin to make any vitamin D at these latitudes. On top of that, skin after 65 produces roughly half as much as it did at 25.

The blood test to ask for is 25(OH)D. Below 30 nmol/L (12 ng/mL) is a true deficiency; the target is above 50 nmol/L (20 ng/mL). One recheck after 3 months of supplementing is enough — there is no reason to test every couple of months.

Calcium and protein

Calcium from food first, supplements only if you cannot get there by eating. The target is 1000–1200 mg per day, split across 3 meals, since you absorb no more than about 500 mg at a time.

• 200 ml of milk or kefir — about 240 mg
• 150 g of yoghurt — about 200 mg
• 30 g of hard cheese (one slice) — about 250 mg
• 100 g of sardines with the bones — about 350 mg
• 30 g of almonds — about 75 mg

Protein matters just as much, because a third of bone mass is collagen. Count on 1.0–1.2 g per kilogram of body weight daily, with 25–30 g per meal — that is roughly 120 g of chicken, 150 g of fish, 200 g of cottage cheese, or 3 eggs plus a yoghurt. Below 20 g per meal the building response barely switches on.

Training that actually builds bone

Walking is excellent for your heart and your head, but walking alone does not raise bone density — the force is simply too small. Bone needs load beyond what it is already used to.

Strength, 2–3 times a week

1. Squat or loaded sit-to-stand from a chair — 3 sets of 6–8 reps
2. Romanian deadlift or hip hinge — 3 x 6–8
3. Press (bench press, or push-ups with hands elevated) — 3 x 8–10
4. One-arm row — 3 x 8–12 per side
5. Loaded carries, 3 x 30 metres, total load 20–30% of body weight

The last two reps have to be genuinely hard, otherwise bone gets no signal. Spend the first 4 weeks lighter while you learn the movements, then add 2.5 kg once you hit the top of the rep range in all three sets. The whole session fits in 40 minutes.

Impact loading

If you have no diagnosed osteoporosis and your joints tolerate it: 20–50 hops per day, in sets of 10 with about 10 seconds between them. If hopping is too much, do heel drops holding a support — 3 sets of 10, landing firmly on the heel.

Balance, 10 minutes three times a week

• Single-leg stand, 3 x 30 seconds per leg, one finger on the wall for safety
• Tandem walking (heel to toe), 4 x 10 metres
• Standing up from a chair without using your hands, 3 x 10

If you have confirmed osteoporosis, avoid deep spinal flexion under load and sharp twisting — weighted sit-ups and loaded rotations are unnecessary risk here.

When to see a doctor

• Women from 65 and men from 70 — a DXA bone density scan, even with no complaints
• Any fracture after age 50 caused by a fall from standing height
• Losing more than 4 cm of height compared with your younger years, or sudden severe back pain without injury (a possible vertebral fracture)
• Corticosteroid treatment for longer than 3 months, thyroid disease, coeliac disease, or previous stomach surgery
• Before taking more than 2000 IU of vitamin D per day, especially with kidney disease, kidney stones, sarcoidosis, or diuretic treatment
• If you stumble often or feel unsteady walking — the cause is frequently vision, medication or blood pressure rather than bone

The short version

• 800–1000 IU of vitamin D daily all year, taken with a meal containing fat; above 4000 IU only under medical supervision.
• 1000–1200 mg of calcium from food across three servings, plus 1.0–1.2 g of protein per kilogram per day.
• Strength training 2–3 times a week, 3 sets of 6–10 reps, with the last two reps hard.
• Add 20–50 hops a day and 10 minutes of balance work three times a week.
• Get a DXA scan from 65 (women) or 70 (men), and immediately after any fracture from a standing-height fall.