How to Prevent Osteoporosis Before It’s Too Late

You can take steps to prevent osteoporosis or slow its progression by eating a healthy and nutritious diet, being active, taking supplements that improve bone health, and taking medications to reduce its effects. There is no cure for osteoporosis, and its effects cannot be reversed once they occur.

Osteoporosis is a disease characterized by a decrease in bone mass and density (BMD). Left untreated, it can lead to weak bones and fractures (broken bones). It is known as a “silent disease” because its symptoms are not always easy to detect. Most people don’t know they have it until they experience their first fracture, usually the result of a slip and fall.

Role of Diet in Osteoporosis Prevention 

Eating a healthy and nutritious diet rich in protein, calcium, and vitamin D can reduce the risk and effects of osteoporosis. In fact, diet is the number one strategy for preventing the condition.

Examples of protein-rich foods include:

• Cottage cheese

• Eggs

• Fish

• Greek yogurt

• Lentils

• Meat

• Quinoa

• Tofu

Calcium-rich foods include:

• Yogurt

• Milk, including nondairy milks like almond and oat milk (may be fortified, meaning calcium added, check the nutrition facts on the package)

• Tofu

• Salmon

• Cheese 

• Chia seeds

• Figs

Vitamin D-rich foods include: 

• Trout

• Salmon

• Milk and nondairy milk (fortified, meaning vitamin D has been added in processing, check nutrition facts on the package)

• Breakfast cereal (fortified)

• Sardines

• Eggs 

• Beef liver

• Tuna 

Certain foods and beverages have been linked to an increased risk of osteoporosis. They should be consumed in moderation, especially if you have other risk factors, such as a family history of osteoporosis. These foods and beverages have been found to negatively impact bone mineral density, a measure of the calcium and other minerals in bones.

Foods and drinks to limit include:

• Sugar-sweetened beverages, particularly carbonated ones like sodas

• High sodium foods

• Red meat

• Caffeine

• Alcohol 

• Wheat bran because it contains phytates (or phytic acid), which are naturally occurring compounds in plants that can keep your body from absorbing calcium

Exercise

Research shows people who are not physically active are more likely to experience a hip fracture (broken hip) compared to those who are physically active. According to the International Osteoporosis Foundation (IOF), the more sitting you do, the higher your risk of a fracture is.

The IOF recommends 30 to 40 minutes of exercise three to four times a week. They recommend a combination of weight-bearing, muscle-strengthening resistance, and balance exercises:

• Weight-bearing exercises: Examples of weight-bearing exercises are walking, jogging, dancing, aerobics, and playing sports that involve running, jumping, or walking.

• Muscle-strengthening/resistance exercises: Examples include lifting weights, using weight machines, or exercises using resistance bands.

• Balance exercises: These exercises are beneficial for improving strength, balance, and flexibility. Tai chi, yoga, and Pilates are examples of exercises that promote balance.

Lifestyle Changes

Certain lifestyle behaviors can affect your bone health throughout your life. These include:

• Avoiding smoking and exposure to secondhand smoke: Smoking cigarettes and exposure to secondhand smoke can increase the risk of bone fractures. If you are struggling to quit smoking, a healthcare provider can help.

• Drinking alcohol in moderation or not at all: Alcohol can affect the ability to regenerate and strengthen bones. If you drink alcohol, do so in moderation, which is considered one alcoholic drink per day for women and two drinks per day for men.

• Limiting caffeine: Excess caffeine can interfere with bone metabolism and calcium absorption. Try to limit your caffeine consumption to one caffeinated beverage per day.

• Weight management: Excess body weight may increase risk for fractures at certain body sites and increase the risk of osteoarthritis (wear-and-tear arthritis, a different condition from osteoporosis). Low body weight may also increase the risk of osteoporosis due to a low mechanical load (needed to stimulate bone formation), which can lead to decreased bone density and increased fracture risk.

• Sleep: Poor-quality sleep may be associated with an increased risk of osteoporosis. Both long-term and short-term sleep problems can lead to decreased bone mineral density. Working on your sleep hygiene can help you sleep better.

• Stress management: Stress hormones are believed to affect bone mineral density.

  ^{Johns Hopkins Medicine. Osteoporosis.}

  Getting good quality sleep, exercising, meditation, and other lifestyle changes can help reduce stress in your life. If you have difficulty coping with stress, consider counseling. 

• Bone conditions: If you have a condition that affects your bone health, such as rheumatoid arthritis (an autoimmune disease causing inflammation and damage within joints), ask your healthcare provider for ways to protect your bones and reduce fracture risk.

Supplements 

Your healthcare provider can recommend certain types of supplements to help you manage your bone health and reduce your risk for osteoporosis and bone fractures.

Do not take supplements without consulting a healthcare provider. Some may interact with medications, and some may have specific instructions regarding when to take them. Ensure any suspected deficiency is confirmed, which may require a blood test.

Dietary supplements that may improve bone health include:

• Calcium

• Copper

• Vitamin D

• Iron

• Magnesium

• Manganese

• Selenium

• Soy isoflavones

• Zinc

Supplement Safety

The Food and Drug Administration (FDA) regulates dietary supplements differently than it does medications, meaning they are not subject to the same testing and approval processes as prescription drugs. Therefore, it is important to consult with a healthcare professional before using dietary supplements to manage any health condition.

Medications

Various medications are available to prevent bone loss and lower your risk of fractures.

Osteoporosis medications include:

• Bisphosphonates: These are antiresorptive medications that prevent bone loss by reducing bone resorption (the breakdown of old bone). They are considered first-line treatments for osteoporosis and osteopenia (lower than normal bone density).

• Calcitonin: This is an older osteoporosis medication given to people who cannot take other treatments. It increases levels of calcitonin, a natural hormone that prevents bone breakdown. 

• Evenity (romosozumab): Evenity is both an antiresorptive and anabolic (promotes bone growth) medication that blocks chemicals in the body that stop bone growth and lead to bone breakdown.

• Parathyroid hormone (PTH) analogs: PTH analogs are anabolic medications given as subcutaneous injections (injections given under the skin), like Forteo (teriparatide) and Tymlos (abaloparatide).

• Prolia (denosumab): Prolia is an antiresorptive injection that may be a first-line option for postmenopausal people at high risk for fractures. It can also be used in men.

• Selective estrogen receptor modulators (SERMs): SERMs are typically given to postmenopausal people who cannot take bisphosphonates or Prolia. These drugs work by activating estrogen receptors in bone tissue to prevent bone breakdown.

Bone Density Testing

BMD testing measures calcium and other minerals in bone tissue. BMD testing can lead to osteoporosis diagnosis, measure fracture risk, and monitor osteoporosis treatment. 

The U.S. Preventive Services Task Force (USPSTF) recommends that women age 65 and older have their bone mineral density tested. They also recommend testing for women under age 65 who have undergone menopause (when menstruation stops for good) and are at high risk for osteoporotic fractures. The 2025 guidelines do not recommend screening for men.

When to Ask a Provider 

Osteoporosis is linked to specific risk factors. These include:

• Having a history of bone fractures

• Having a diagnosis of osteopenia

• Smoking 

• Entering menopause, since estrogen deficiency can lead to bone loss

• Family history of osteopenia and osteoporosis 

• Being female since there is a 4 times more likely risk

• Advancing age, as risk increases after 60

• Body weight that is too low or too high 

• Consuming too much alcohol, sodium, or caffeine

• Race: While osteoporosis can affect anyone, white and Asian women have a higher risk

• Taking medications that may increase your risk for osteoporosis, including corticosteroids, some diabetes medications, selective serotonin reuptake inhibitors (SSRIs), and proton pump inhibitors (PPIs)

If you are taking medications that may affect your bone density or have other risk factors, talk to a healthcare provider about options for managing your bone health.

If you are diagnosed with osteopenia, you may be able to reduce your risk for osteoporosis with various preventive measures and medications to improve bone density and strength. If a medication you are taking adds to your risk, your healthcare provider can reduce your dose or prescribe a less risky treatment. 

Osteopenia

Osteopenia refers to bone density loss that, if it worsens, can lead to osteoporosis.

Osteopenia has the same risk factors as osteoporosis and may also occur naturally with age.

The same preventive measures for osteoporosis help prevent osteopenia.

A healthcare provider may recommend supplements or medications to improve bone health, slow down bone loss, and improve osteopenia. They may also recommend regular bone density measurements, especially if you have a family history of osteoporosis. 

Summary

Osteoporosis causes bones to become weak and prone to fractures. It occurs due to age or if you have a family history of the condition, but diet and lifestyle also play a part. To protect your bones, eat a diet rich in protein, calcium, and vitamin D. Be active, do not smoke, and only consume alcohol and caffeine in moderation, if at all.

Your healthcare provider may recommend supplements to improve your bone health, including calcium and vitamin D supplements. They can also prescribe treatments to strengthen your bones and reduce bone loss. 

Women age 65 and over should have their bone mineral density tested regularly. Women under 65 who have gone through menopause and are at high risk for osteoporosis fractures should also be tested.