As interest in longevity and regenerative medicine grows, so does curiosity around supplements that promise to support healthy aging. Cocoa flavanols (naturally occurring plant compounds (aka phytonutrients) found in cacao) have attracted particular attention for their potential cardiovascular, cognitive, and antioxidant benefits. But when it comes to bone health and fracture prevention, the evidence tells a more nuanced story.
At ReCELLebrate, we believe longevity care should always be guided by evidence—not trends, marketing claims, or assumptions. That’s why well-designed clinical trials matter. One such study, recently published in the Journal of Bone and Mineral Research, examined whether cocoa extract supplementation or daily multivitamin use could meaningfully reduce fracture risk in older adults.
The results were clear—and instructive.
Why Bone Health and Fracture Prevention Matter in Longevity Medicine
Fractures are not simply “broken bones.” In older adults, they often represent a potentially catastrophic turning point; leading to reduced mobility, loss of independence, chronic pain, and all too often increased mortality. Hip fractures in particular are associated with significant long-term health consequences and shorter life expectancy from that point, forward.
From a longevity perspective, fracture prevention is about far more than bone density alone. It reflects the health of interconnected systems: skeletal integrity, muscle strength, balance, neuromuscular coordination, inflammation, and cellular repair capacity.
This complexity is exactly why fracture prevention has proven so challenging, but a crucial point for longevity seekers.
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The COSMOS Trial: A Real-World Test of Cocoa Extract Supplementation
The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) is one of the largest and most rigorous nutrition trials conducted in older adults. Over 21,000 participants, women aged 65 and older and men aged 60 and older, were followed for an average of 3.6 years.
Participants were randomly assigned to receive:
- Cocoa extract supplementation
- A multivitamin/mineral supplement
- Both supplements
- Or placebo versions of both
The cocoa extract supplement delivered 500 mg of cocoa flavanols daily, a dose comparable to or higher than what is typically consumed through diet alone. Flavanols are a sub-class of phytonutrients which are produced by specific plants, in this case, from cocoa, the same ingredient used for making chocolate.
Researchers tracked self-reported fractures over time, including hip fractures, wrist fractures, spine fractures, and other clinically significant breaks.
What the Study Found
In a large, well-designed clinical trial, the findings offered clear insight into how cocoa extract supplementation performs in real-world aging populations:
- Cocoa extract supplementation did not reduce fracture risk
- Multivitamin supplementation did not reduce fracture risk
- This held true across fracture types, age groups, sex, and baseline risk factors
In other words, even sustained cocoa extract supplementation at a meaningful dose did not translate into fewer broken bones in generally healthy older adults.
For those interested in longevity science, this finding is not disappointing: it’s illuminating. Sometimes, studies result in not finding a difference when comparing something to placebo, and we can still learn from that.
Why Fracture Prevention Is So Hard Biologically
To understand why cocoa extract supplementation didn’t reduce fractures, it helps to understand how fractures actually occur.
Bone Density Is Only One Piece of the Puzzle
Bone mineral density (BMD) matters—but it is not destiny. Many fractures occur in people without osteoporosis, and many people with low BMD never fracture.
Fracture risk reflects:
- Bone quality, not just density
- Microarchitecture of bone tissue
- Rate of bone turnover
- Muscle strength and coordination
- Balance and fall risk
- Vision, reaction time, and neurological health
A supplement may influence one pathway (such as antioxidant activity or bone metabolism) without affecting the broader system enough to prevent real-world fractures.
Why Bone Density and Quality are So Important to Longevity
Studies have clearly defined the connection between the quality and density of our bone, and our longevity. This is apparently due to the strength (fracture resistance) of bone, and the bone marrow. Bone marrow is our main bank of hematopoietic stem cells, which produce our blood cells as well as the main source of stem cells. As we age, unless we take steps to preserve our bones, the marrow converts from red (full of cells) to yellow (full of fat). Do we have your attention now?
Aging Is a Systems Problem, Not a Single-Nutrient Problem
Cocoa flavanols have demonstrated effects on cellular signaling and oxidative stress in controlled environments. But fracture prevention requires coordinated improvements across multiple biological systems simultaneously.
This is why interventions that look promising “on paper” or in preclinical models often fail to move hard clinical endpoints like fractures.
Longevity biology is complex by design.
What About Cocoa Flavanols and General Health?
It’s important to be precise here.
This study does not suggest that cocoa flavanols are harmful or useless. In fact, other COSMOS publications have demonstrated benefits of cocoa flavanols for cardiovascular outcomes and cognitive performance.
However, when evaluating whether cocoa extract supplementation is “good for you,” the answer depends on what outcome you’re measuring.
For fracture prevention specifically, this large clinical trial suggests cocoa extract supplementation is not sufficient on its own.
Chocolate, Cacao Powder, and Nutritional Context
It’s also worth clarifying a common point of confusion.
- Chocolate varies widely in flavanol content depending on processing
- Cacao powder nutritional information can differ dramatically between products
- Many commercial chocolates contain sugar and fat that offset potential benefits
Importantly, obtaining 500 mg of cocoa flavanols from chocolate alone would require unrealistic caloric intake. This is why standardized cocoa extract supplementation is used in clinical research rather than dietary chocolate consumption. And of course, we at ReCELLebrate are looking at phytonutrient exosomes derived from cocoa.
Multivitamins, Bone Health, and Expectations
The COSMOS trial also evaluated multivitamin supplementation, often viewed as a foundational element of many anti-aging routines.
Here again, the findings were sobering:
- Multivitamins did not reduce fracture risk
- Even with included vitamin D and calcium, no protective effect was seen
This aligns with growing evidence that while multivitamins may help address nutritional gaps, they do not reliably prevent complex age-related outcomes like fractures.
What This Means for Longevity-Focused Supplement Strategies
At ReCELLebrate, we view studies like this as essential course correction, not discouragement.
They reinforce a core principle of regenerative and longevity medicine:
Meaningful health outcomes rarely come from isolated ingredients.
Modern longevity approaches increasingly focus on:
- Cellular resilience
- Metabolic flexibility
- Inflammation regulation
- Tissue repair signaling
- Muscle-bone crosstalk
- Fall prevention and neuromuscular health
This is why thoughtful supplement strategies, such as those explored within platforms like LONGEVEX, emphasize systems biology rather than single-nutrient solutions. Importantly, these approaches are not framed as fracture prevention tools, but as part of a broader effort to support healthy aging at the cellular level.
The Role of Regenerative Medicine in Bone Health
Regenerative medicine shifts the conversation from “what nutrient is missing?” to “how do tissues maintain function over time?”
Emerging strategies focus on:
- Supporting stem cell signaling environments
- Modulating chronic inflammation
- Enhancing musculoskeletal resilience
- Improving recovery after injury
- Preserving functional independence
Fracture prevention ultimately lives at the intersection of biology, biomechanics, and behavior—a space where regenerative medicine continues to evolve.
A Thoughtful Path Forward
The COSMOS study offers a valuable reminder: biological plausibility is not the same as clinical effectiveness. Cocoa extract supplementation may be biologically interesting—but fracture prevention remains a far more complex challenge.
At ReCELLebrate, we believe the future of healthy aging lies in integrating rigorous science with regenerative insight—always grounded in evidence, transparency, and care.
If you’re curious about how longevity-focused strategies, regenerative medicine, or evidence-informed supplementation may fit into your personal health journey, we invite you to reach out to ReCELLebrate. A conversation with our team can help clarify what the science supports as you plan for a healthier, more resilient future.
Frequently Asked Questions (FAQ)
Is cocoa extract supplementation good for you?
Cocoa extract supplementation may support certain aspects of cardiovascular or cognitive health, but this large clinical trial found no benefit for fracture prevention in older adults.
Do cocoa flavanols strengthen bones?
While cocoa flavanols influence bone cells in laboratory studies, this did not translate into fewer fractures in real-world clinical outcomes.
Can supplements prevent age-related fractures?
Most supplements, including cocoa extract supplementation and multivitamins, have not been shown to reliably prevent fractures on their own. That doesn’t mean one should not supplement properly, especially with vitamin D, a crucial element in bone building biology.
Is cacao powder good for bone health?
Cacao powder contains flavanols, but its nutritional content varies widely. Dietary cacao alone is unlikely to deliver consistent or sufficient flavanol doses for clinical effects.
Why do fractures still happen even with good nutrition?
Fractures reflect whole-body aging processes, including balance, muscle strength, reaction time, inflammation, and bone quality—not just nutrient intake.
What is the best way to support my bones, support my bone marrow, and foster bone-health for longevity?
The three ingredients to making bone are: weight bearing exercise (not cycling or swimming, although those are heart healthy), vitamin D3 levels of 100-150, (the sun alone won’t do it), and optimal bioidentical hormones (you cannot make bone without these).
References:
- Crandall CJ, Chou SH, Kim E, et al. Effects of cocoa extract supplementation and multivitamin/multimineral supplements on self-reported fractures in the Cocoa Supplement and Multivitamin Outcomes Study randomized clinical trial. Journal of Bone and Mineral Research. 2025;40(5):591–602. doi:10.1093/jbmr/zjaf030
- Dayer SR, Mears SC, Pangle AK, et al. Does superior bone health promote a longer lifespan? Geriatric Orthopaedic Surgery & Rehabilitation. 2021;12:21514593211036231. doi:10.1177/21514593211036231
- Johansson C, Black D, Johnell O, Odén A, Mellström D. Bone mineral density is a predictor of survival. Calcified Tissue International. 1998;63(3):190–196. doi:10.1007/s002239900513
- Johansson H, Odén A, Kanis J, et al. Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden. Osteoporosis International. 2011;22(5):1411–1418. doi:10.1007/s00198-010-1331-1
- LeBoff MS, Chou SH, Ratliff KA, et al. Supplemental vitamin D and incident fractures in midlife and older adults. New England Journal of Medicine. 2022;387(4):299–309. doi:10.1056/NEJMoa2202106
- Sesso HD, Manson JE, Aragaki AK, et al. Effect of cocoa flavanol supplementation for prevention of cardiovascular disease events: The COSMOS randomized clinical trial. American Journal of Clinical Nutrition. 2022;115(6):1490–1500. doi:10.1093/ajcn/nqac055
- Shi L, Yu X, Pang Q, Chen X, Wang C. The associations between bone mineral density and long-term risks of cardiovascular disease, cancer, and all-cause mortality. Frontiers in Endocrinology (Lausanne). 2022;13:938399. doi:10.3389/fendo.2022.938399
- Tapia-Aguayo A, Krüger S, Wessjohann LA, et al. Cocoa pulp as a novel source of plant-derived exosome-like nanovesicles: Method comparison and physicochemical characterization. Frontiers in Bioengineering and Biotechnology. 2026;13:1729503. doi:10.3389/fbioe.2025.1729503
- Trivedi DP, Khaw KT. Bone mineral density at the hip predicts mortality in elderly men. Osteoporosis International. 2001;12(4):259–265. doi:10.1007/s001980170114
- Yang T, He M, Huang J, et al. From garden to clinic: Plant-derived exosome-like nanovesicles for precision oxidative stress therapy. International Journal of Nanomedicine. 2025;20:15569–15598. doi:10.2147/IJN.S569204