How to slow bone loss and reduce fracture risk

Osteoporosis makes bones weaker and more likely to break, but you can slow that process and lower your fracture risk through a combination of medication, diet, exercise, and lifestyle changes. The goal is not to reverse bone loss that has already happened—that is not yet possible—but to stop it from getting worse and to prevent falls that could cause a break.

What works best depends on how weak your bones are, your age, your overall health, and whether you have already broken a bone. Your doctor can recommend a specific plan based on your bone density scan results and your personal risk factors.

Key Takeaways

  • Calcium and vitamin D are the foundation: most adults need 1,000 to 1,200 mg of calcium daily and 600 to 800 IU of vitamin D, though your doctor may recommend more.
  • Weight-bearing exercise like walking, jogging, or dancing, plus strength training, slows bone loss and improves balance to prevent falls.
  • Medications called bisphosphonates are the most common treatment and work by slowing the rate at which your body breaks down bone.
  • Avoiding smoking and limiting alcohol reduces bone loss and lowers fracture risk.
  • Your doctor should monitor your progress with repeat bone density scans every one to two years to see whether your treatment is working.

Getting enough calcium and vitamin D

Calcium is the mineral your bones are made of, and vitamin D helps your body absorb it. Without enough of both, your bones cannot stay strong. Most adults over 50 need 1,000 to 1,200 mg of calcium per day and 600 to 800 IU of vitamin D per day, though your doctor may recommend higher amounts depending on your bone density and other factors.

Calcium comes from dairy products like milk, yogurt, and cheese, as well as leafy greens, almonds, and fortified foods like orange juice and cereals. If you cannot get enough from food alone, your doctor may recommend a calcium supplement. Vitamin D comes from fatty fish like salmon and mackerel, egg yolks, and fortified milk, or from sun exposure—though the amount varies by season and where you live. Many people with osteoporosis need a vitamin D supplement to reach the recommended amount.

Take calcium and vitamin D supplements at different times if possible, because taking them together can reduce how much calcium your body absorbs. If you take a bisphosphonate medication (described below), take it on an empty stomach with a full glass of water, and wait at least 30 minutes before eating or taking other medications, including calcium supplements.

Medications that slow bone loss

Bisphosphonates are the most commonly prescribed medications for osteoporosis. They work by slowing the rate at which your body breaks down bone tissue. Common bisphosphonates include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). These are usually taken as a pill once a week or once a month, though some forms are given as an injection or infusion once a year.

Other medication classes work differently. Denosumab (Prolia) is an injection given twice a year that blocks a protein involved in bone breakdown. Hormone-related therapy like raloxifene (Evista) mimics estrogen and can slow bone loss in women past menopause. Teriparatide (Forteo) is an injectable medication that actually stimulates bone formation, though it is typically used only when other medications have not worked or when bone loss is severe.

Your doctor will choose a medication based on how weak your bones are, whether you have already broken a bone, your age, your kidney function, and any other health conditions you have. It can take months to see results on a bone density scan, so your doctor will usually repeat the scan after one to two years of treatment to check whether the medication is working.

Exercise to strengthen bones and prevent falls

Weight-bearing exercise—activities where your feet or legs carry your body weight—stimulates bone formation and slows bone loss. Walking, jogging, dancing, and stair climbing are all weight-bearing activities. Aim for at least 150 minutes of moderate-intensity weight-bearing exercise per week, which can be broken into 30-minute sessions on most days.

Strength training two or more days per week also helps protect bones and improves the muscle strength that keeps you stable and prevents falls. You do not need heavy weights; resistance bands, body weight exercises, or light dumbbells are effective. Focus on exercises that work your legs, hips, and core, since falls on these areas cause the most serious fractures in people with osteoporosis.

Balance exercises reduce your risk of falling in the first place. Tai chi, yoga, and simple exercises like standing on one leg or walking heel-to-toe can improve balance. If you have already broken a bone or have very weak bones, talk to your doctor or a physical therapist before starting a new exercise program, because some movements can increase fracture risk.

Lifestyle changes that protect your bones

Smoking speeds up bone loss and increases fracture risk. If you smoke, quitting is one of the most important things you can do for your bones. Alcohol also weakens bones, especially when consumed in large amounts. Limit alcohol to no more than one drink per day for women and two drinks per day for men.

Caffeine can interfere with calcium absorption, but only in large amounts—more than 400 mg per day, roughly four cups of coffee. If you drink a lot of caffeine, try to balance it by getting enough calcium and vitamin D.

Some medications can weaken bones as a side effect. Corticosteroids like prednisone, used to treat conditions like rheumatoid arthritis and asthma, increase bone loss. If you take corticosteroids long-term, talk to your doctor about whether you need additional bone protection, such as a bisphosphonate medication.

Preventing falls at home

A fall that would cause only a bruise in someone with healthy bones can cause a serious fracture in someone with osteoporosis. Preventing falls is just as important as strengthening bones. Remove tripping hazards like loose rugs and clutter from hallways and stairs. Install grab bars in the bathroom, especially near the toilet and shower. Make sure stairs and hallways are well-lit, and consider using a cane or walker if you feel unsteady.

Wear shoes with good grip and support, and have your vision and hearing checked regularly—poor eyesight and hearing loss both increase fall risk. If you take medications that make you dizzy or drowsy, talk to your doctor about whether the dose can be adjusted or the medication changed.

Monitoring your progress

Your doctor will track how your bones are responding to treatment by repeating your bone density scan (DEXA scan) every one to two years. This scan measures bone mineral density and shows whether your treatment is slowing bone loss, stopping it, or even increasing bone density slightly.

Between scans, your doctor may also order blood tests to check your calcium and vitamin D levels and to monitor how well your kidneys are working, especially if you are taking a bisphosphonate. Tell your doctor right away if you break a bone, because that may mean your current treatment needs to be adjusted or changed.

Frequently Asked Questions

Can osteoporosis be reversed?

No medication can reverse osteoporosis and restore bone density to what it was before. However, treatment can stop bone loss and sometimes increase bone density slightly. The goal is to prevent further weakening and reduce fracture risk.

How long do I need to take osteoporosis medication?

That depends on your bone density, your age, and how well the medication is working. Some people take medication for five to ten years, while others take it longer. Your doctor will discuss with you when to continue, adjust, or stop treatment based on your repeat bone density scans.

What should I do if I cannot tolerate my osteoporosis medication?

Tell your doctor about the side effects you are experiencing. Different medications work in different ways, so switching to another class of medication may solve the problem. Your doctor can also adjust the dose or the schedule of administration.

Is it too late to start treatment if I already have broken a bone?

No. A fracture is actually a sign that treatment is needed. Starting medication and making lifestyle changes after a fracture can prevent future breaks and help you recover safely.

Can I get enough calcium and vitamin D from food alone?

Some people can, but many cannot, especially if they avoid dairy, have difficulty absorbing nutrients, or live in a place with limited sun exposure. Your doctor can test your vitamin D level and recommend whether you need supplements.