The most effective approach to osteoporosis combines three things: getting enough calcium and vitamin D, doing regular weight-bearing exercise, and working with your doctor on medication if your bone loss is significant. A bone density scan score of -2.5 or lower indicates osteoporosis, while scores between -1 and -2.5 signal osteopenia, a milder form of bone loss that still warrants attention.
Calcium and Vitamin D Needs
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 bones lose density faster than they can rebuild. The daily targets depend on your age and sex:
- Women over 50: 1,200 mg of calcium and 600 IU of vitamin D
- Men 51 to 70: 1,000 mg of calcium and 600 IU of vitamin D
- Men and women over 70: 1,200 mg of calcium and 600 IU of vitamin D
Food sources are the best starting point. Dairy products, fortified plant milks, canned sardines and salmon (with bones), broccoli, and kale all contribute calcium. Vitamin D is harder to get from food alone, though fatty fish and fortified foods help. Your skin produces vitamin D from sunlight, but many older adults don’t get enough sun exposure to meet their needs, making supplements a practical choice. If you’re considering calcium supplements, splitting the dose across meals improves absorption, since your body can only use about 500 mg at a time.
Protein and Other Nutrients
Protein plays a larger role in bone health than many people realize. About half of your bone volume is protein, and getting enough supports both the structure and the repair process. The International Osteoporosis Foundation recommends older adults with osteoporosis aim for at least 0.8 grams of protein per kilogram of body weight daily. For someone weighing 150 pounds (68 kg), that works out to roughly 55 grams a day, the equivalent of a chicken breast, a cup of Greek yogurt, and a serving of lentils.
Magnesium and vitamin K2 also appear to be involved in bone metabolism. Magnesium deficiency can negatively affect bone and muscle health, and vitamin K2 may improve bone quality and reduce fracture risk by helping direct calcium into bones rather than soft tissues. That said, the evidence for supplementing these nutrients specifically for osteoporosis is still inconclusive. Eating a varied diet with leafy greens, nuts, seeds, and fermented foods covers most people’s needs for both.
Exercise That Builds Bone
Bone responds to mechanical stress by getting stronger, which is why weight-bearing and resistance exercises are central to managing osteoporosis. The key types break down into four categories.
Weight-bearing aerobic exercise means activities done on your feet where your bones support your body weight. Walking, dancing, low-impact aerobics, stair climbing, elliptical training, and even gardening all qualify. These put gentle, repetitive force through your hips, spine, and legs.
Strength training uses free weights, resistance bands, or your own body weight to strengthen muscles, tendons, and bones. Exercises targeting the upper back are especially valuable because they counteract the rounded posture that often develops with spinal bone loss. For most people, one set of 12 to 15 repetitions per exercise is sufficient.
Balance and stability exercises don’t build bone directly, but they reduce your risk of falling, which is how most osteoporosis-related fractures happen. Simple options include standing on one leg, heel-to-toe walking, and tai chi, which has strong evidence for fall prevention in older adults.
Flexibility exercises help maintain range of motion in joints and reduce stiffness. Gentle stretching after a warm-up, yoga (with modifications to avoid excessive spinal flexion), and range-of-motion routines all help. Avoid high-impact activities, sudden twisting motions, and forward bending exercises like sit-ups if you have significant bone loss, as these increase fracture risk.
Medications for Osteoporosis
When bone loss is severe or fracture risk is high, lifestyle changes alone aren’t enough. Several classes of prescription medication can either slow bone breakdown or stimulate new bone growth.
The most commonly prescribed are bisphosphonates, which work by slowing the cells that break down old bone. This allows your body to maintain more of its existing bone mass. Oral bisphosphonates come with specific instructions: you take them first thing in the morning on an empty stomach with water, then stay upright (sitting or standing) for 30 to 60 minutes without eating or drinking anything else. This prevents the medication from irritating your esophagus. Some bisphosphonates are taken weekly or monthly rather than daily, and injectable versions are given less frequently.
For people with very high fracture risk, bone-building medications take a different approach. Instead of just slowing bone loss, they stimulate the formation of new bone. These are typically limited to two years of use during a patient’s lifetime due to safety considerations, after which treatment transitions to a bone-preserving medication to maintain the gains. Other options include medications that block specific signals involved in bone breakdown and treatments that mimic estrogen’s bone-protective effects without being estrogen itself.
The choice of medication depends on how severe your bone loss is, your fracture history, and other health conditions. Most people stay on some form of treatment for years, and the sequencing of medications matters. Starting with a bone-building drug and then switching to a bone-preserving one, for example, tends to produce better long-term results than the reverse.
Fall Prevention at Home
Preventing fractures isn’t just about stronger bones. It’s about not falling in the first place. Most osteoporosis-related fractures happen from falls at home, and simple modifications significantly reduce that risk.
In bathrooms, mount grab bars near the toilet and on both the inside and outside of your tub and shower. Place nonskid mats or strips on any surface that gets wet. In the bedroom, keep night lights and light switches within reach of your bed, and keep a flashlight and phone nearby. Throughout the house, remove throw rugs or secure all carpets firmly to the floor, and put non-slip strips on tile and wooden surfaces. Keep electrical cords near walls and away from walking paths, and arrange furniture so nothing blocks your usual routes.
For stairs, make sure there are secure handrails on both sides. Install good lighting with switches at the top and bottom, and consider motion-activated plug-in lights for hallways and stairwells. In the kitchen, keep frequently used items at waist level so you don’t need to reach overhead or bend low. Clean up spills immediately, and consider preparing food while seated if you’re prone to fatigue or unsteadiness. Outside, keep steps in good repair with non-slip material, clear debris from walkways, and consider adding a grab bar near your front door for balance while unlocking it. Never stand on chairs or tables to reach high items. Use a reach stick or a sturdy step stool with a handrail.
Habits That Hurt Bone Health
Smoking accelerates bone loss. It interferes with the cells that build new bone and reduces the body’s ability to absorb calcium. If you smoke, quitting is one of the most impactful things you can do for your skeleton.
Alcohol has a threshold effect: up to two units per day does not appear to increase osteoporotic fracture risk, but drinking above that level is clearly linked to more fractures and faster bone loss. Heavy drinking also impairs balance, compounding the fall risk. A sedentary lifestyle is another major contributor. Bones that aren’t regularly loaded with weight-bearing activity lose density more quickly, creating a cycle where weakness leads to inactivity that leads to more weakness.