Bone health over 50: calcium and vitamin D for bones, which osteoporosis supplements help, and preventing falls

What your bones need after 50: calcium, vitamin D and protein

Bone is broken down and rebuilt all the time, and after 50 (for women, after the menopause) the breaking down starts to win. Food and supplements supply the raw material. Exercise does the rest: it loads your bones and keeps you steady on your feet.

The UK osteoporosis guideline (NOGG) says at least 700 mg of calcium a day, preferably from food. For people with osteoporosis, NOGG says 800–2,000 IU of vitamin D a day may be appropriate. That’s a decision for your GP, not a reason to buy a 5,000 IU bottle. More on everyday doses is in our guide to vitamin D3 tablets.

Protein matters more than people expect. In NOGG’s review, higher protein intake went with better bone density in one trial and fewer hip fractures in observational studies. After a hip fracture, protein supplements cut infections and shortened hospital stays. Muscle loss is part of the same story, covered in our page on sarcopenia and protein after 60.

Calcium supplements: when they make sense

Most people can reach 700 mg from food. A pot of yoghurt, a glass of milk and a slice of cheese already get you most of the way. Our calcium and vitamin K2 guide has a fuller food list and compares carbonate with citrate.

NOGG suggests supplements mainly for people who can’t get enough calcium from food:

• people who are housebound or live in a care home;
• people with poor absorption, for example inflammatory bowel disease or after weight-loss surgery;
• anyone whose diet has little dairy or fortified food.

There’s one more group. If your GP prescribes an osteoporosis medicine, you’ll often be given calcium and vitamin D alongside it. Most trials of these medicines gave calcium and vitamin D together with the drug, and NOGG says people on treatment should have enough vitamin D.

Pick your situation:

Calcium tablets and the heart: what the evidence says

Some trial analyses from around 2010 found slightly more heart attacks in people taking calcium supplements. Other analyses found no link, and the debate went on for years.

NOGG has weighed it up. Its conclusion, at the highest evidence level: calcium and vitamin D supplements may increase the risk of kidney stones, but not of heart disease or cancer. In practice that means:

• get as much calcium as you can from food;
• take a supplement only for the shortfall, often 250–500 mg;
• split anything over 500 mg into two doses with meals;
• don’t stop a prescribed calcium tablet on your own; ask your GP first.

Vitamin K2 for bones: modest evidence

Vitamin K helps activate osteocalcin, a protein in bone. That’s why K2 often sits next to D3 in combination products. The evidence is mixed, according to NIH ODS:

• in Japan, MK-4 at 45 mg a day is used as an osteoporosis treatment, and a 2006 review of mostly Japanese trials found fewer fractures with it;
• 180 mcg a day of MK-7 for 3 years improved bone strength in post-menopausal women;
• later trials in older men and women found no effect on bone density.

NIH ODS concludes it is unclear whether any form of vitamin K lowers the risk of osteoporosis. K2 is optional. If you take warfarin, don’t start it without your doctor: vitamin K changes how warfarin works.

Preventing falls in older adults

Bone tablets can’t help much if you keep falling. That’s why the NICE falls guideline (NG249, April 2025, which replaced CG161) matters as much as any tablet. It covers everyone over 65, and people aged 50–64 at higher risk.

Your GP or nurse should ask whether you’ve fallen in the past year. NICE offers a full falls assessment if you fell and were injured, couldn’t get up on your own, blacked out, fell twice or more, or are frail. That assessment looks at:

• gait, balance and muscle strength;
• your medicines, especially sleeping tablets, antidepressants and other mind-acting drugs;
• lying and standing blood pressure and dizziness;
• eyesight (cataracts are referred), hearing, feet and footwear;
• bladder control, memory and mood, alcohol;
• osteoporosis risk.

What actually helps, according to NICE and NOGG:

1. A strength and balance programme. Progressive, tailored, run by a trained instructor. NOGG notes programmes of 3 hours or more a week work best.
2. A medicine review. Some medicines can be reduced or stopped. Bring a full list: our medicines list for your GP helps.
3. Regular eye tests. The NHS lists them in its top five tips.
4. A home hazard check, ideally by an occupational therapist: loose rugs, poor lighting at night, clutter on the floor, trailing dressing gowns and loose slippers.

Tick what’s already done at home:

Vitamin D and falls. NICE found too little evidence to take vitamin D specifically to lower the risk of falls. Take it for your bones and muscles at the NHS dose. NOGG warns against large one-off doses of 60,000 IU or more: they were linked to more falls and fractures.

If you do fall and aren’t hurt, the NHS advises getting up slowly: roll onto all fours, hold a sturdy chair with both hands and rise in stages. If you’re hurt or can’t get up, call for help, keep warm and change position about every 30 minutes. Tell your GP about any fall.

Fracture risk: FRAX and bone scans

NICE suggests a fracture risk assessment for all women from 65 and all men from 75. Younger people qualify if they have risk factors:

• a previous fragility fracture (a break from a fall at standing height or less);
• current or frequent steroid tablets;
• a history of falls or a parent who broke a hip;
• a body mass index below 18.5;
• smoking, or more than 14 units of alcohol a week.

Your GP uses FRAX (ages 40–90) or QFracture (ages 30–84) to estimate your 10-year fracture risk. A DXA bone scan comes next only if your risk is close to the treatment threshold. You can’t buy your way around this step: no supplement tells you whether you need treatment.

Alendronic acid and calcium: getting the timing right

Alendronic acid and similar bisphosphonates are absorbed only on an empty stomach. Calcium blocks their absorption. One NHS trust’s patient leaflet sets out the routine:

Leaflets differ slightly, so follow the one in your pack. Space magnesium out from bisphosphonates too, as our magnesium guide notes.

Who should be careful

• Kidney stones or kidney disease. Ask before taking calcium; see our page on supplements with kidney disease.
• Thiazide water tablets (bendroflumethiazide, indapamide) together with calcium and vitamin D can push blood calcium too high.
• Levothyroxine. Take calcium at least 4 hours apart.
• Warfarin. No K2 without your doctor.
• Several medicines at once. Write them all down before you buy anything, and point an unsure parent to our vitamin check.

How to choose bone supplements on iHerb

1. Work out your calcium from food first. Buy a supplement only for the gap.
2. Choose citrate if you take it between meals or use acid-reducing tablets; carbonate if you take it with food.
3. Check the elemental calcium per serving and the number of tablets in it.
4. For vitamin D, 10 mcg (400 IU) is the NHS dose. Add up D3 from every product you take.
5. K2 is optional, and never with warfarin unless your doctor agrees.
6. If you’re on an osteoporosis medicine, ask your pharmacist how to time everything.

More pages for this age group are in our 50+ section.