As the global population of people aged 80 years and older continues to rise, there is an increased focus on understanding how dietary factors can impact their overall health, particularly related to musculoskeletal conditions. A recent study published in Clinical Nutrition ESPEN has scrutinized the relationship between protein, calcium, and vitamin D intake with body composition and the incidence of fractures in the oldest-old community-dwelling individuals. This article delves into the findings and their implications for dietary guidelines and interventions targeted at this vulnerable age group.


For the oldest-old, maintaining independence often hinges upon the preservation of bone mass and muscle strength. Diet has long been considered a cornerstone for such preservation, with particular emphasis on nutrients like protein, calcium, and vitamin D. However, the effect of these nutrients on bone density and the risk of fractures in individuals over the age of 80 remains a debated topic among researchers and clinicians.

The study, “Relationship of protein, calcium and vitamin D consumption with body composition and fractures in oldest-old independent people,” published on January 26, 2024, under DOI 10.1016/j.clnesp.2023.12.008, also available under the identifier S2405-4577(23)02234-9, aims to shed light on this pertinent issue. Conducted by Flávia Kurebayashi and colleagues at the Paulista Medical School of the Federal University of São Paulo, Brazil, this cross-sectional observational analytic study includes a cohort of 159 independent individuals aged 80 or older.


Participants were selected after ensuring their chronic diseases were under control according to scientific guidelines. The data collection utilized a one-day food record (FR) assessed by Avanutri software (version 4.1) to evaluate nutrient intake. A critical measure in the study was the assessment of body composition and bone densitometry via whole-body Dual Energy X-ray Absorptiometry (DXA). Additionally, the prevalence of morphometric vertebral fractures was appraised through conventional X-ray.

Results and Discussion

The findings revealed that the mean calcium intake was significantly below the recommended dietary allowance (RDA) at 834.6 ± 374.7 mg/day, as was the vitamin D intake at 6.1 ± 24.3 μg/day. Despite the use of supplements to bridge this nutritional gap, intake levels highlight a concern for this nutrient-dependent age group. Protein intake appeared more robust at an average of 72.9 ± 26.8 g/day.

A startling 48.4% of participants exhibited low muscle mass, 45.3% were diagnosed with osteoporosis, and 24.7% had experienced vertebral fractures. The analysis also indicated an association between dietary protein intake and body composition and bone mineral density, although not directly with fracture incidence. Alarmingly, individuals with fractures were more likely to be obese with low muscle mass compared to their non-obese counterparts.

While numerous studies have described the protective effect of protein against bone mass loss, the results herein suggest a nuanced role of dietary protein that cannot be ignored. The lack of statistically significant association with fractures does not diminish the importance of protein for body composition and bone health but rather calls for a more differentiated understanding of the interplay between diet and skeletal integrity.

It is worth noting that these correlations exist in an age group that is not only contending with advancing years but also the challenges of managing chronic conditions. Optimal protein, calcium, and vitamin D intake might be crucial in delaying or preventing the decline in musculoskeletal health.

Implications and Conclusion

This study’s findings resonate with the need for comprehensive dietary interventions tailored for the oldest-old. Although various nutrients were examined, protein emerged as significantly correlated with key aspects of musculoskeletal health. This insight could inform future nutritional guideline developments, emphasizing protein’s relevance for maintaining an independent lifestyle in advanced age.

Flávia Kurebayashi et al. call for more in-depth research to refine our understanding of the nutritional needs of the oldest-old. Considering the study’s cross-sectional design, a long-term longitudinal study might present clearer causal relationships between nutrient intake and health outcomes in this demographic.


Kurebayashi, F. et al. (2024). Relationship of protein, calcium and vitamin D consumption with body composition and fractures in oldest-old independent people. Clinical Nutrition ESPEN, 59, pp. 398-403. DOI:10.1016/j.clnesp.2023.12.008.

For further investigation, the reader is encouraged to consult the following additional resources:
1. Fielding, R. A. et al. (2011). Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. Journal of the American Medical Directors Association, 12(4), pp. 249-256. DOI: doi.org/10.1016/j.jamda.2011.01.003.
2. Rizzoli, R. et al. (2018). Nutrition and bone health: turning knowledge and beliefs into healthy behaviour. Current Medical Research & Opinion, 30(sup2), pp. 131-141. DOI:  doi.org/10.1185/030079908X291967.
3. Bischoff-Ferrari, H. A. et al. (2012). A pooled analysis of vitamin D dose requirements for fracture prevention. New England Journal of Medicine, 367(1), pp. 40-49. DOI: doi.org/10.1056/NEJMoa1109617.
4. Houston, D. K. et al. (2010). Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. American Journal of Clinical Nutrition, 87(1), pp. 150-155. DOI: doi.org/10.3945/ajcn.2008.26427.
5. Kanis, J. A. et al. (2019). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International, 30(1), pp. 3-44. DOI: doi.org/10.1007/s00198-018-4704-5.


1. Nutrition Older Adults
2. Bone Health Dietary Intake
3. Protein and Fracture Risk
4. Calcium and Vitamin D
5. Musculoskeletal Aging