I was just thinking that, too! I know people in their late 60s who look younger and prettier than Madonna is in this pic! But, I have to say, most vegetarians I know tend to age more quickly, and seldom ever look healthy.
Sounds like she's exercising and running too much so she looks gaunt like she's wasting away: "The mum-of-two exercises at least three hours a day, sometimes runs 10-miles, and eats mainly whole grains and vegetables."