Taking Action on Osteoporosis — Exercise, Nutrition, and Medical Support

Osteoporosis and osteopenia can feel overwhelming, but the reality is far more empowering. Women have several proven strategies to protect bone health, reduce fracture risk, and maintain strength and independence. This guide explains what works, why it works, and how to take meaningful action at any age.

Why Action Matters in Midlife

During late perimenopause and the first several years after menopause, bone remodeling accelerates and bone breakdown can begin to exceed bone formation. Many women lose a noteworthy percentage of bone density during this transition [1,2]. Although this shift can be discouraging, bones remain responsive to strength training and mechanical loading across the lifespan. Women in their 50s, 60s, and 70s can still improve bone strength, balance, muscle power, and confidence in daily movement.

Exercise: The Most Effective Non-Drug Strategy

Exercise improves bone strength, muscle mass, balance, and fall resilience. Programs that combine strength, incremental impact, and balance training consistently show the strongest benefits for reducing fracture risk [3,4,5].

Strength Training: The Foundation of Bone Resilience

Strength training applies force to bone in a way that stimulates maintenance or growth. It also supports posture, joint health, and everyday function.

Key elements include:

• Multi-joint exercises such as squats, hinges, lunges, step-ups, rows, and presses

• Gradual increases in resistance over time

• Two to three strength sessions per week

• Focus on hips, quadriceps, back extensors, and scapular muscles to support balance and gait

Stronger muscles reduce fall risk and improve stability, which is essential for long-term bone health.

Impact Training: Safe, Controlled, and Effective

Impact training stimulates bone through ground reaction forces. It does not require high-impact jumping. Instead, it involves small, controlled forces introduced only after strength and form are solid.

Examples include:

• Step-downs and step-ups

• Controlled heel drops

• Light pogo hops

• Small front, back, or lateral line hops

Volume should increase gradually, and next-day soreness should remain mild. When implemented safely, these exercises support bone strength and lower-extremity resilience [6].

Balance Training: Reducing Fall Risk

Most fractures occur because of falls, not because bone density alone is low. Balance training significantly reduces fall risk and is a key part of fracture prevention.

Balance work may include:

• Single-leg balance

• Narrow-base stance progressions

• Direction changes

• Dual-task exercises

• Gentle reactive challenges

Short, daily practice is ideal and requires minimal space or equipment.

Nutrition: Fueling Bone From the Inside Out

Nutrition plays a central role in bone remodeling and muscle repair.

Key principles include:

• Adequate protein to support bone matrix and muscle recovery

• Calcium to support bone mineralization

• Vitamin D to assist calcium absorption

• Regular meals for stable energy availability

• Whole-food patterns rich in fruits, vegetables, and lean proteins for micronutrients

Specific supplementation should be discussed with a primary care provider or registered dietitian.

Medical Therapies: An Overview of Options Your Clinician May Discuss

If you know you have bone loss or think you may, please speak with your primary care provider. The following is a general overview of medication options your clinician may offer. These therapies can slow bone loss, stabilize existing bone, or build new bone when needed.

Medical therapy and exercise often work best together.

Antiresorptive Medications (Slow Bone Breakdown)

These medications slow the rate of bone resorption and help prevent further loss.

Common families include:

• Bisphosphonates such as alendronate or risedronate

• Denosumab

• Selective estrogen receptor modulators (SERMs)

Long-term research supports their ability to reduce vertebral and non-vertebral fracture risk [7].

Anabolic Medications (Build New Bone)

Anabolic medications stimulate osteoblast activity to increase bone formation. They are typically used when fracture risk is high.

Examples include:

• Teriparatide

• Abaloparatide

• Romosozumab

These treatments are commonly followed by an antiresorptive medication to maintain gains [8].

Hormone Therapy in Early Menopause

Hormone therapy may help preserve bone during early menopause while also easing menopausal symptoms. Decisions about hormone therapy should be made with a clinician familiar with a woman’s health history and risk factors.

Lifestyle Factors That Support Bone Strength

Everyday habits influence bone remodeling and fracture resilience:

• Regular physical activity

• Adequate energy intake

• Not smoking

• Moderating alcohol

• Aerobic activities such as walking, hiking, Nordic walking, cycling, dancing, or swimming

These behaviors support cardiovascular health, balance, muscle mass, and overall vitality.

Why a Combined Approach Works

No single strategy is enough on its own. Strength training, impact, balance work, supportive nutrition, lifestyle habits, and medication when appropriate create a comprehensive plan for lifelong bone strength.

Consistency matters more than perfection. Your bones respond to what you do regularly, and starting at any age offers benefits.

Our final resource explains what to expect in physical therapy, including functional testing, safe strength and impact progressions, and how to combine your PT home program with EWF’s structured training to maintain momentum long after discharge.

References

1. Greendale GA et al. Bone mineral density loss in the menopause transition: The SWAN study. J Bone Miner Res. 2012.

2. Cauley JA. Estrogen and bone health in men and women. J Bone Miner Res. 2014.

3. Sherrington C et al. Exercise for preventing falls in older people. BMJ. 2019.

4. Liu C-J, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2021.

5. Karinkanta S et al. Effects of exercise on bone, fall prevention, and balance in postmenopausal women. Osteoporos Int. 2009.

6. Benedetti MG et al. Impact exercise for bone health. Clin Cases Miner Bone Metab. 2015.

7. Adler RA et al. Managing osteoporosis in patients on long-term bisphosphonate treatment. J Clin Endocrinol Metab. 2016.

8. Cosman F et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014.