Preventing bone fractures comes down to two things: keeping your bones strong and avoiding the falls and impacts that break them. Both are largely within your control, and the earlier you start, the better your protection. Here’s what actually works, based on the strongest available evidence.
Build Bone Density With the Right Exercise
Not all exercise strengthens bones equally. Your skeleton responds to mechanical stress by adding mineral density, but it needs the right kind of stress. Weight-bearing activities like walking, jogging, and stair climbing force your bones to work against gravity. Resistance training, where you lift or push against an external load, goes further.
A specific form called high velocity resistance training, which involves lifting weights with a fast push and slow return, has been shown to increase bone mineral density by 0.9% to 5.4% at the spine, total hip, and femoral neck in older adults. That may sound modest, but even small gains in density translate to meaningfully lower fracture risk, especially when compounded over years. The key threshold: at least two sessions per week. Below that, the bone-building effect drops off.
If you’re new to resistance training, start with bodyweight exercises or light weights and progress gradually. Squats, lunges, deadlifts, and overhead presses all load the bones most vulnerable to fractures. Swimming and cycling, while great for cardiovascular health, don’t provide enough skeletal loading to build bone.
Reduce Your Risk of Falling
After age 65, falls cause the vast majority of fractures. Preventing them is just as important as strengthening bone itself.
Balance training is one of the most effective tools available. Tai chi, in particular, has strong evidence behind it. Older adults who practiced one to three hour-long sessions per week for up to 26 weeks lowered their fall risk by 43% and cut their likelihood of a fall-related injury in half. That’s a remarkable return on a low-impact, accessible activity. Yoga and single-leg stance exercises offer similar balance benefits, though the data for tai chi is especially robust.
A simple screening tool can tell you where you stand. The Timed Up and Go test, used by clinicians, asks you to stand from a chair, walk about 10 feet, turn around, walk back, and sit down. According to the CDC, taking 12 seconds or longer to complete this signals an elevated fall risk. You can try this at home to get a rough sense of your balance and mobility.
Make Your Home Safer
Most falls happen at home, and many are preventable with straightforward changes. The American Academy of Orthopaedic Surgeons recommends these modifications:
- Lighting: Install light switches at both the top and bottom of stairs. Use motion-activated lights in hallways and stairways. Place easy-access switches at room entrances so you never walk into a dark room.
- Grab bars: Mount them on bathroom walls near the toilet and along the bathtub or shower.
- Rugs: Secure loose area rugs with double-sided tape or slip-resistant backing. Remove throw rugs from the kitchen entirely, and never place loose rugs at the top or bottom of stairs. Use a slip-resistant mat next to the bathtub.
Cluttered walkways, trailing cords, and poor footwear are other common culprits. A single walk-through of your home with fresh eyes can reveal hazards you’ve stopped noticing.
Get Enough Calcium and Vitamin D
Calcium is the primary mineral in bone, and vitamin D is what allows your body to absorb it. Without adequate levels of both, no amount of exercise will fully protect your skeleton.
Most adults need about 1,000 mg of calcium per day, rising to 1,200 mg for women over 50 and men over 70. Dairy products, fortified plant milks, canned sardines and salmon (with bones), broccoli, and kale are reliable sources. If your diet falls short, a supplement can fill the gap, though food sources are generally better absorbed.
For vitamin D, the recommended daily intake is 600 IU (15 mcg) for adults up to age 70 and 800 IU (20 mcg) for those over 70. Your skin produces vitamin D from sunlight, but many people, especially those in northern latitudes, with darker skin, or who spend most of their time indoors, don’t make enough. A simple blood test can check your levels.
Protein Matters More Than You Think
Bone isn’t just mineral. About a third of its structure is a protein framework (collagen) that gives it flexibility and resilience. Adequate protein intake also preserves the muscle mass that protects bones during a fall.
The baseline recommendation for healthy adults is 0.8 grams of protein per kilogram of body weight per day. For a 150-pound person, that’s roughly 55 grams. Many bone health experts argue that older adults benefit from more, closer to 1.0 to 1.2 grams per kilogram, because aging bodies use protein less efficiently. Spreading your intake across meals rather than loading it all at dinner improves absorption.
Limit Alcohol and Quit Smoking
Heavy alcohol consumption weakens bones through multiple pathways: it interferes with calcium absorption, disrupts hormones that regulate bone turnover, and increases fall risk. Women who consume 15 or more grams of alcohol per day (roughly one standard drink) have a 24% higher fracture risk compared to light drinkers and abstainers. That risk climbs steeply for women who are also underweight, reaching 73% above baseline in one large study of middle-aged women.
Smoking impairs blood flow to bone, reduces calcium absorption, and accelerates estrogen breakdown in women, all of which contribute to bone loss over time. While the relationship between smoking and fracture risk is complex and varies by population, the overall pattern is clear: smokers lose bone faster and heal fractures more slowly.
Know When to Get Screened
Bone density scanning, done with a painless imaging test called DXA, can detect bone loss years before a fracture occurs. The U.S. Preventive Services Task Force recommends screening for all women aged 65 and older. Postmenopausal women younger than 65 should be screened if they have risk factors like low body weight, a parent who fractured a hip, smoking, or heavy alcohol use.
For men, there are no universal screening guidelines yet. The evidence hasn’t been strong enough for the task force to make a blanket recommendation, but men with known risk factors (long-term steroid use, low testosterone, heavy drinking, or a family history of osteoporosis) should discuss screening with their doctor.
A tool called FRAX estimates your 10-year probability of a major fracture based on age, sex, weight, and clinical risk factors. Treatment thresholds vary by age. For example, a 10-year major fracture probability above 7.3% at age 50, or above 20.3% at age 70, generally triggers a conversation about medication.
Medications That Lower Fracture Risk
When bone density is low enough to qualify as osteoporosis, or when fracture risk is high, medications can make a significant difference. The most commonly prescribed class, bisphosphonates, slows bone breakdown and reduces the risk of hip, spine, and other major fractures compared to no treatment. They’re taken as a weekly or monthly pill, or in some cases as a yearly infusion.
Newer options work differently. Some stimulate new bone formation rather than simply slowing loss, and a large network analysis in The BMJ found these bone-building treatments more effective than bisphosphonates at preventing both spinal and clinical fractures. One injectable treatment that blocks a protein involved in bone breakdown also reduces hip fracture risk, though it was less effective than bone-building agents for overall clinical fractures.
Which medication makes sense depends on your fracture risk level, your age, and whether you’ve already had a fracture. Someone with very high risk or a recent spinal fracture may benefit from starting with a bone-building agent, while someone with moderate risk might do well with a bisphosphonate alone. These are decisions shaped by your individual FRAX score and DXA results.
Start With What You Can Control Today
The most impactful steps require no prescription: lift weights at least twice a week, practice balance exercises, get adequate calcium, vitamin D, and protein, limit alcohol, and make your home fall-proof. These habits compound over time. Bone responds slowly to change, both positive and negative, so consistency matters far more than intensity. If you’re over 50, adding a bone density screening to your preventive care gives you a clear picture of where you stand and whether you need to do more.