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Nutritional Support as Part of the Management of Osteoporosis and Frailty in the Elderly: Challenges and Opportunities

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Geriatric Nutrition".

Deadline for manuscript submissions: 15 December 2026 | Viewed by 3764

Editor

Prof. Dr. Elaine Dennison

E-Mail Website
Guest Editor
1. MRC Lifecourse Epidemiology Centre, Faculty of Medicine, University of Southampton, University Road, Southampton SO17 1BJ, UK
2. School of Biological Sciences, Victoria University of Wellington, Wellington 6012, New Zealand
Interests: musculoskeletal aging; osteoporosis; epidemiology; cohort
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As a population, life expectancy is increasing, but this comes with challenges. Good nutrition is well-recognized as being central to good health in later life, with dietary calcium and protein particularly important for the maintenance of musculoskeletal health as we age. Despite this, many challenges occur in later life, including lost nutritional opportunities in hospital, anorexia of aging (especially in the context of cognitive decline), and limited access to good nutrition as a result of transport or financial difficulties. This Special Issue seeks to contribute to our understanding of these challenges and put forward strategies to mitigate the difficulties that older adults and their carers must navigate.

The purpose of this Special Issue is to provide an updated view on the challenges and opportunities around achieving adequate nutritional support in the management and rehabilitation for people with osteoporosis, frailty and sarcopenia. We welcome submissions of clinical studies, epidemiological studies, and current reviews (scoping reviews, systematic reviews, and narrative reviews).

Prof. Dr. Elaine Dennison
Guest Editor

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Keywords

  • nutrition
  • cognitive decline
  • older adults
  • hospitalization
  • protein intake
  • calcium intake
  • anorexia of aging
  • food security
  • support network

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Published Papers (5 papers)

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Research

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16 pages, 2288 KB  
Article
Vitamin K Status and Skeletal Fragility: Differential Associations of Osteocalcin Carboxylation States with Bone Strength, Geometry and Microarchitecture
by Deepti K. Sharma, Chloe Furst, Rebecca Bahnisch, Christopher Schultz, Manuela Rogers, Tim Cheok, Lucian B. Solomon, Stuart A. Callary and Boopalan Ramasamy
Nutrients 2026, 18(16), 2663; https://doi.org/10.3390/nu18162663 - 14 Aug 2026
Abstract
Background: The contribution of specific nutritional biomarkers to skeletal fragility remains poorly understood, in part because most studies include participants with metabolic conditions that obscure nutrient-specific effects. We aimed to examine incremental contribution of six pathway-specific nutritional biomarkers. Methods: In a prospective [...] Read more.
Background: The contribution of specific nutritional biomarkers to skeletal fragility remains poorly understood, in part because most studies include participants with metabolic conditions that obscure nutrient-specific effects. We aimed to examine incremental contribution of six pathway-specific nutritional biomarkers. Methods: In a prospective cross-sectional case–control design, 108 patients undergoing arthroplasty were enrolled (hip-fracture, n = 63; non-fracture, n = 45), and bone biopsies and blood specimens were collected intraoperatively. Circulating biomarkers reflecting vitamin K, one-carbon metabolism, antioxidant nutrients (vitamins E and C), protein and zinc status were measured. Bone outcomes included remodelling markers, trabecular microarchitecture and bone strength. Hierarchical regression was used to quantify the incremental contribution of nutritional biomarkers beyond clinical covariates with a priori outcome selection. Results: Bone remodelling markers did not differ between groups after covariate adjustment, indicating that fractures in this cohort were characterised by deficits in bone strength and quality rather than elevated systemic remodelling activity. Among six nutritional pathways tested, only vitamin K-dependent biomarkers showed consistent independent associations with bone outcomes, suggesting a degree of pathway specificity. Critically, carboxylated (cOC), undercarboxylated (ucOC) and fully uncarboxylated (unOC) osteocalcin fractions showed differential associations reflecting their distinct biological roles: cOC was independently associated with greater bone strength (section modulus, femoral neck width and cortical shaft thickness; p < 0.05) and lower trabecular separation (Tb.Sp); ucOC was associated with higher Tb.Sp (p = 0.004); and unOC was positively associated with cortical bone instability (buckling ratio, p = 0.003) and explained 17% of the variance in the bone resorption marker (p < 0.001), consistent with a shift towards bone loss. Vitamin K2-7 was negatively associated with hip axis length (p = 0.021). Conclusions: These findings identify vitamin K-dependent carboxylation as a mechanistically specific and modifiable factor associated with skeletal fragility beyond bone mineral density, with distinct skeletal consequences across osteocalcin carboxylation states. Full article
(This article belongs to the Special Issue Nutritional Support as Part of the Management of Osteoporosis and Frailty in the Elderly: Challenges and Opportunities)
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12 pages, 10761 KB  
Article
Comparable Protective Effects of Low- and High-Dose MK-7 on Bone Structure and Remodeling in a Rat Model of Osteoporosis Induced by Estrogen Deficiency and Glucocorticoid Exposure
by Hsin-Ju Chiang, Shu-Yuan Hsu and Steve Leu
Nutrients 2026, 18(10), 1605; https://doi.org/10.3390/nu18101605 - 18 May 2026
Viewed by 506
Abstract
Background: Estrogen deficiency and glucocorticoid exposure are major contributors to osteoporosis. Although menaquinone-7 (MK-7) exhibits osteoprotective effects, whether low-dose supplementation is comparable to high-dose treatment remains unclear. Methods: Female Sprague–Dawley rats were assigned to sham control (SC), ovariectomy plus dexamethasone (OVX+Dex), and OVX+Dex [...] Read more.
Background: Estrogen deficiency and glucocorticoid exposure are major contributors to osteoporosis. Although menaquinone-7 (MK-7) exhibits osteoprotective effects, whether low-dose supplementation is comparable to high-dose treatment remains unclear. Methods: Female Sprague–Dawley rats were assigned to sham control (SC), ovariectomy plus dexamethasone (OVX+Dex), and OVX+Dex treated with low-dose MK-7 (100 μg/kg) or high-dose MK-7 (20 mg/kg). Bone microarchitecture, histopathology, and serum bone turnover markers were evaluated. Results: OVX+Dex induced marked deterioration of trabecular bone microarchitecture, characterized by reduced bone volume and structural disruption. These changes were accompanied by increased osteoclast activity (cathepsin K), decreased osteogenic and extracellular matrix–related markers (cbfa-1, osteonectin, and biglycan), and downregulation of osteoprotegerin, indicating a pronounced imbalance in bone remodeling. Serum analysis further revealed reduced estradiol levels and alterations in circulating bone turnover markers, consistent with a dysregulated high-turnover state. Both low- and high-dose MK-7 significantly improved bone microarchitecture, restored remodeling-related protein expression, and partially normalized serum calcium-regulating hormones and bone turnover markers (all p < 0.05), with no significant differences observed between doses. Conclusions: MK-7 attenuates osteoporosis by restoring the balance between bone resorption and formation. Notably, low-dose MK-7 provides protective effects comparable to high-dose treatment, supporting its potential clinical utility. Full article
(This article belongs to the Special Issue Nutritional Support as Part of the Management of Osteoporosis and Frailty in the Elderly: Challenges and Opportunities)
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12 pages, 419 KB  
Article
Diet Quality Trajectories and Musculoskeletal Health Among the Oldest Old: Findings from the Hertfordshire Cohort Study
by Elaine M. Dennison, Faidra Laskou, Harnish P. Patel, Nicholas Fuggle, Kate A. Ward, Gregorio Bevilacqua and Leo D. Westbury
Nutrients 2026, 18(4), 569; https://doi.org/10.3390/nu18040569 - 9 Feb 2026
Viewed by 728
Abstract
Background: Few studies have examined changes in diet quality into old age, and related these changes to musculoskeletal outcomes. We examined this among Hertfordshire Cohort Study participants. Methods: In total, 178 individuals provided diet quality scores derived in 1998–2004, 2011 and 2017 (median [...] Read more.
Background: Few studies have examined changes in diet quality into old age, and related these changes to musculoskeletal outcomes. We examined this among Hertfordshire Cohort Study participants. Methods: In total, 178 individuals provided diet quality scores derived in 1998–2004, 2011 and 2017 (median age 64.0, 74.7 and 80.7) using principal component analysis of food frequency questionnaires; higher scores indicated healthier diets (more fruit and vegetables, oily fish and wholemeal bread, and less white bread, added sugar, full-fat dairy products, chips and processed meat). Pearson correlations between diet quality scores at each time-point were computed. Group-based trajectory modelling of diet quality scores was implemented; trajectory groups as predictors of musculoskeletal outcomes (history of hip/knee replacement, osteoporosis, fall in previous year, low grip strength, low gait speed) in 2017 were examined using logistic regression with age and sex included as covariates. Results: Diet quality showed moderate stability over time (0.64 < r < 0.74). Three trajectory groups were identified: low (29%), medium (51%), and high diet quality (20%). A higher diet quality group was related to greater odds (95% CI) of hip/knee replacement (1.85 (1.05, 3.26) per higher category); associations with other musculoskeletal outcomes were weak (p > 0.17). Conclusions: Weak associations were observed between diet quality trajectories and musculoskeletal outcomes. However, higher diet quality was related to increased likelihood of hip/knee joint replacement, potentially due to confounding by socioeconomic position. The stability of diet quality suggests individuals with poorer diets around age 65 are likely to maintain these patterns into old age and may benefit from targeted interventions. Full article
(This article belongs to the Special Issue Nutritional Support as Part of the Management of Osteoporosis and Frailty in the Elderly: Challenges and Opportunities)
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14 pages, 588 KB  
Article
Socioeconomic Status and Associations with Nutrition in Icelandic Community-Dwelling Older Adults: Results from the AGES-Reykjavik Study
by Kristín Elísabet Halldórsdóttir, Ólöf Guðný Geirsdóttir, Ólafur Ögmundsson, Pálmi V. Jónsson, Vilmundur Guðnason, Lenore J. Launer and Hrafnhildur Eymundsdóttir
Nutrients 2025, 17(20), 3231; https://doi.org/10.3390/nu17203231 - 15 Oct 2025
Viewed by 1177
Abstract
Objectives: The growing proportion of older adults underscores the importance of healthy aging. Maintaining good nutrition and physical activity are crucial for sustaining health. However, research on aging inequalities suggests that individuals with lower socioeconomic status (SES) may be at higher risk for [...] Read more.
Objectives: The growing proportion of older adults underscores the importance of healthy aging. Maintaining good nutrition and physical activity are crucial for sustaining health. However, research on aging inequalities suggests that individuals with lower socioeconomic status (SES) may be at higher risk for inadequate nutrition. The study examined associations between SES and nutrition in older community-dwelling adults in Iceland and whether the Sustainable Development Goals (SDGs) are being met in Iceland. Methods: Data from the AGES-Reykjavik study were used, and SES was grouped into four categories (low, medium-low, medium-high, and high), derived from education and occupation. Descriptive statistics were used to examine differences between groups, and logistic regression was used to explore associations with food and drink consumption. Results: Older adults with low SES were less likely to frequently consume vegetables, fruit, cod or saithe liver oil/pills, oatmeal or muesli, and cultured milk products, and they were less likely to meet nutritional guidelines. Higher SES was associated with greater alcohol intake. Conclusions: Older adults with low socioeconomic status are less likely to consume healthy food products than those with higher SES. As these individuals live independently, the findings highlight the need for targeted nutritional prevention and support to reduce health disparities, including potential risks such as insufficient vitamin D intake. Furthermore, the results suggest that the SDGs related to nutrition are not being met in Iceland, warranting monitoring and policy action. Full article
(This article belongs to the Special Issue Nutritional Support as Part of the Management of Osteoporosis and Frailty in the Elderly: Challenges and Opportunities)
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Review

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23 pages, 3141 KB  
Review
From Growth Trajectory to Functional Decline: Age-Contextualized Nutritional Strategies for Muscle Vulnerability. A Narrative Review
by Luisa Malaguarnera, Vincenzo Sortino, Sofia Surdo and Salvatore Piro
Nutrients 2026, 18(9), 1437; https://doi.org/10.3390/nu18091437 - 30 Apr 2026
Viewed by 901
Abstract
Muscle vulnerability occurs at both extremes of the human lifespan, although its biological significance differs substantially between developmental growth and late-life decline. During childhood and adolescence, insufficient muscle accretion reflects disruption of physiological anabolic trajectories driven by inadequate energy availability, inflammatory burden, endocrine [...] Read more.
Muscle vulnerability occurs at both extremes of the human lifespan, although its biological significance differs substantially between developmental growth and late-life decline. During childhood and adolescence, insufficient muscle accretion reflects disruption of physiological anabolic trajectories driven by inadequate energy availability, inflammatory burden, endocrine imbalance, or disease-associated catabolism. In older adults, muscle deterioration is characterized by anabolic resistance, neuromuscular remodeling, chronic low-grade inflammation, and hormonal decline, culminating in sarcopenia and loss of functional independence. The absence of harmonized diagnostic frameworks across age groups limits direct translational extrapolation. A lifespan-informed perspective distinguishing growth-supportive from function-preserving nutritional approaches is, therefore, required. This narrative review examines how major classes of nutritional bioactive interact with molecular pathways regulating skeletal muscle homeostasis in fragile populations across the lifespan. The analysis encompasses energy adequacy, protein quantity and quality, amino acid-dependent anabolic signaling, vitamin D status, lipid-derived mediators, redox-modulating phytochemicals, and micronutrients supporting mitochondrial bioenergetics. In pediatric contexts, nutritional interventions primarily aim to restore anabolic permissiveness within a structurally intact growth environment. In aging individuals, strategies focus on mitigating anabolic resistance through optimized protein intake, correction of micronutrient insufficiencies, and integration with resistance exercise to preserve functional capacity. This narrative review emphasizes the need to distinguish mechanistic rationale from clinically validated interventions, as improvements in molecular pathways do not consistently translate into meaningful functional outcomes. Full article
(This article belongs to the Special Issue Nutritional Support as Part of the Management of Osteoporosis and Frailty in the Elderly: Challenges and Opportunities)
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