Preventing fractures comes down to three things: building stronger bones, maintaining the muscle and balance that protect those bones, and reducing the chances of falling. Most fractures in adults over 50 result from bones that have quietly thinned over years combined with a fall that wouldn’t have caused injury a decade earlier. The good news is that every major risk factor for fractures is at least partially within your control.
Calcium and Vitamin D: The Non-Negotiables
Calcium is the primary mineral your bones are made of, and vitamin D is what allows your body to absorb it. Without enough of either, your skeleton slowly loses density regardless of what else you do.
Adults ages 19 to 50 need 1,000 mg of calcium per day. Women over 50 and men over 70 need 1,200 mg. Teenagers and young adults up to age 18 need even more, at 1,300 mg, because that’s when bones are still actively growing. Dairy products, fortified plant milks, leafy greens, canned sardines, and tofu made with calcium sulfate are all reliable sources. If your diet falls short, a supplement can fill the gap, but splitting the dose (taking 500 to 600 mg at a time rather than the full amount at once) improves absorption.
For vitamin D, adults up to age 70 need 600 IU daily, and adults over 70 need 800 IU. Your skin produces vitamin D from sunlight, but many people don’t get enough this way, especially in northern latitudes or during winter. Fatty fish, egg yolks, and fortified foods contribute some, though supplements are often the most practical route.
Protein Matters More Than You Think
Protein affects bone mineral density, the internal microstructure of bone, and overall bone strength. When calcium intake is sufficient, higher protein intake is associated with lower fracture risk. In one clinical trial, people recovering from a hip fracture who received an extra 20 grams of protein daily for six months lost 50% less bone density in the upper femur over the following year compared to those who didn’t.
The standard recommendation is 0.8 grams of protein per kilogram of body weight per day, but experts increasingly suggest older adults aim for 1.2 grams per kilogram or higher to offset the body’s declining ability to use protein efficiently with age. For a 150-pound person, that’s roughly 82 grams per day. The source matters less than hitting the target: meat, fish, eggs, dairy, beans, lentils, and soy all count. One important caveat: higher protein intake only appears to protect bones when calcium intake is also adequate. In studies where people ate plenty of protein but less than 800 mg of calcium per day, the benefit disappeared or even reversed.
The Best Exercises for Bone Strength
Bone responds to mechanical stress by getting denser and stronger. Two types of exercise deliver this stimulus most effectively: weight-bearing impact activities and progressive resistance training.
Weight-bearing impact exercise means anything where your feet hit the ground with force. Jogging, running, dancing, jumping rope, and even hopping drills all qualify. Walking counts as low-impact weight-bearing exercise and is better than nothing, but it produces a weaker stimulus than activities with more ground reaction force.
Resistance training, meaning lifting weights or working against bands, targets the major muscle groups that attach to the hip and spine, which are the two sites most vulnerable to osteoporotic fractures. The exercises that matter most are squats, deadlifts, lunges, hip abduction and adduction, back extensions, and leg presses. Research shows the greatest bone benefits come from progressively increasing the weight over time, working at a high intensity (around 80% to 85% of the maximum you can lift once), and training at least twice a week.
Combining both types is ideal. Resistance training provides direct muscular loading on bone, while weight-bearing aerobic exercise adds impact loading that bone can’t get from lifting alone. One study using advanced 3D imaging found that high-intensity resistance training combined with impact exercises significantly improved the cortical thickness and mineral content of the femur neck, one of the most common hip fracture sites.
Preventing Falls: Where Most Fractures Actually Start
For adults over 65, the fracture problem is really a falling problem. Strengthening bones helps them survive a fall, but avoiding the fall in the first place is equally important.
Balance training is one of the most effective interventions. Tai Chi, in particular, has strong evidence behind it. A meta-analysis of 24 randomized controlled trials found that Tai Chi reduced the risk of falls in older adults by 24%. It improved both static balance (like standing on one leg) and dynamic balance (like turning and walking at the same time). Practicing two or more times per week produced significantly better results than once a week.
Muscle loss, known as sarcopenia, is a major driver of falls. A large meta-analysis covering over 52,000 older adults found that people with sarcopenia had roughly 71% to 84% higher odds of fracture compared to those without it. Progressive resistance training directly addresses this by maintaining the muscle mass and strength that keep you stable on your feet.
Making Your Home Safer
Many preventable falls happen at home. A room-by-room check can eliminate common hazards:
- Floors and stairs: Remove throw rugs and small area rugs entirely. Apply no-slip strips to tile and wooden floors. Install handrails on both sides of all stairways, and make sure light switches are at both the top and bottom of every staircase.
- Bathrooms: Mount grab bars near the toilet and on both the inside and outside of the tub or shower. Use nonskid mats or strips on any surface that gets wet. Leave a night light on after dark.
- Bedrooms: Keep a night light and a light switch within reach of your bed. Place a phone nearby so you don’t have to rush to answer it.
- Kitchen: Store frequently used items at waist height so you’re not reaching overhead or bending low. Clean up spills immediately. Consider preparing food while seated if you tire easily or feel unsteady.
- Outdoors: Repair uneven steps. Add non-slip material to outdoor stairs. In winter, treat walkways with ice melt or sand. Keep your porch light on after dark.
A few general habits also help: keep electrical cords against walls and out of walking paths, arrange furniture so you have clear pathways through every room, and be aware of where pets are when you’re moving around. If reaching high shelves requires a step stool, make sure it has a handrail and that someone is nearby. Better yet, use a reaching tool or move frequently used items to a lower shelf.
Alcohol and Smoking
Chronic alcohol consumption disrupts the normal cycle of bone breakdown and rebuilding. It impairs the cells responsible for forming new bone, reduces cortical thickness, and degrades the internal lattice structure that gives bone its resilience. A dose-response meta-analysis found that fracture risk climbs steadily with alcohol intake above about one standard drink per day. Interestingly, moderate consumption (roughly one drink per day) showed no negative effect on bone mineral density and was even associated with a slightly lower hip fracture risk in some middle-aged and older populations. The risk is in going beyond that.
Smoking is similarly harmful to bone. Quitting is considered part of the gold-standard lifestyle approach to reducing osteoporosis burden, alongside good nutrition and regular exercise.
Know Your Bone Density
A bone density scan, called a DEXA scan, measures how much mineral is packed into your bones. The result is reported as a T-score. A score of negative 1 or higher is healthy. Between negative 1 and negative 2.5 indicates osteopenia, a milder form of bone thinning. A score of negative 2.5 or lower indicates osteoporosis.
Screening is generally recommended for women at 65 and men at 70, or earlier if you have risk factors. A tool called FRAX can estimate your 10-year probability of a major osteoporotic fracture using clinical risk factors like age, sex, body mass index, smoking status, alcohol use, personal or parental fracture history, and whether you have conditions or take medications that weaken bone. It can be used with or without a bone density measurement, making it a useful first-pass screening tool.
When Lifestyle Isn’t Enough
If you already have osteoporosis or have had a fragility fracture, prescription medications can substantially reduce the risk of another one. The most widely studied class of bone-protecting drugs reduced the risk of new spine fractures by 68%, hip fractures by 40%, and fractures at other sites by 20% over three years in a large clinical trial of postmenopausal women with osteoporosis. These medications work by slowing down the cells that break down old bone, allowing new bone formation to gradually catch up.
Medication is typically considered when your T-score falls at or below negative 2.5, when your FRAX score crosses a certain treatment threshold, or when you’ve already broken a bone from a minor fall or impact. The decision depends on your individual risk profile, and the specific medication chosen varies based on your age, health history, and fracture location.