Contributing Writer: Carolyn Torkelson, M.D. (Ep. 007#) After 30 years in clinical practice, Dr. Torkelson now writes and consults on women’s health issues, focusing on mature women. https://womenagingwell.org
Bone health refers to the strength, density, structure, and overall condition of your bones. With so much conflicting information in the media about bone health, it’s no surprise that many women wonder what they should actually do to protect their bones. There are questions about diet, nutrients, hormones, exercise, medications, testing, and diagnosis.
But one question that seems to be on the minds of many women is: What exercise is best for my bones?
Recently, I spoke at a yoga retreat about bone health and aging women. One woman asked me that very question. My answer was simple: “The best exercise is the exercise you will do regularly–and that helps you avoid the sitting cycle.” We often make exercise more complicated than it needs to be. We worry about what is “best,” how much we should do, and whether we are doing it correctly. But when it comes to our bones, one of the most important things we can do is keep moving.
Our bones respond to the forces placed on them. Walking, climbing stairs, dancing, strength training, yoga, Tai Chi and other weight-bearing activities can help maintain bone strength as we age. Regular movement also helps maintain muscle strength, balance, coordination, and confidence—all important for reducing the risk of falls.
As an aging physician with osteopenia myself, I ask many of the same questions. I have learned that bone health is not about doing one thing perfectly. It is about understanding what happens to our bones as we age and putting a few important, evidence-based practices in place early.
Why Bone Health Matters
Our bones are living tissue. Throughout our lives, old bone is broken down (Osteoclast cells) and new bone is built (Osteoblast cells). After menopause, the decline in estrogen can accelerate bone loss.
Why does this matter? Because a fracture—particularly a hip fracture—is much more than a broken bone. These statistics are sobering: About 30% of older adults die within one year of a hip fracture, with many of these deaths occurring in the first few months; and fewer than half of survivors fully regain their pre-fracture level of function or independent mobility. That’s why I think bone health is more than preventing osteoporosis. It’s about preserving strength, mobility, and independence that allows us to live our lives fully.
Know Your Bones
A DXA, or dual-energy X-ray absorptiometry scan, is the standard test used to measure bone mineral density. The results include a T-score, which compares your bone density with that of a healthy young adult reference population. Osteopenia generally means a T-score between minus 1.0 and minus 2.5. A T-score of minus 2.5 or lower is one of the criteria used to diagnose Osteoporosis – bone disease in which bone mass and strength decrease, making bones more fragile and increasing the risk of fracture.
Although routine insurance coverage for DXA screening often begins at age 65, younger women with risk factors may benefit from earlier evaluation. For some women, having a baseline DXA around the menopausal transition can provide valuable information about where they are starting and allow changes to be followed over time. DXA scans should ideally be performed on the exact same machine and at the same location to ensure accurate tracking over time, but don’t avoid screening if that is not possible.
What Can We Do?
Estrogen Therapy: The years surrounding menopause are a particularly important time for bone health. As estrogen levels decline during the menopausal transition, bone remodeling increases, which can accelerate bone loss. This is why for many women, menopausal hormone therapy (MHT) may help prevent bone loss and reduce the risk of osteoporotic fractures. This is one reason I don’t think women should wait until they are 65 to have their first DXA. We need to know what your bones are doing earlier.
Nutrition and Digestion: Fruits, vegetables, whole grains, legumes, nuts, and seeds provide fiber and other compounds that reduce inflammation and support digestive health and overall bone health. Adequate protein becomes increasingly important as we age because maintaining muscle is closely connected to maintaining strength, balance, and protection from falls. (I discuss protein needs in greater detail in Chapter 9 of my book, Beyond Menopause: New Pathways to Holistic Health*.)
Supplements: Vitamin D is essential for calcium metabolism and bone health. Rather than automatically taking a large dose, I prefer that women know their vitamin D level and discuss an appropriate dose with their healthcare provider. Typically, that means 1000-2000 IU daily ( 25-50 mg). Calcium is also important, but more is not necessarily better. Ideally, we should obtain much of our calcium from food and use supplements when dietary intake is inadequate. Magnesium and other nutrients also play roles in bone metabolism. Vitamin K, including K2, is an area of ongoing research, although the evidence is not yet strong enough to suggest that everyone needs a K2 supplement specifically to prevent fractures.
Areas of research: Ongoing research looks at how aging affects cellular energy and bone formation. NMN (nicotinamide mononucleotide), is an emerging area because it can increase NAD+ levels, which are involved in cellular energy metabolism. Under investigation is whether this pathway might eventually help support osteoblast function and slow down age-related bone loss.
Stress: Chronic stress with persistently elevated cortisol can have negative effects on bone remodeling, muscle, and overall health. Finding ways to manage stress—through sleep, exercise, time outdoors, breathing exercises, meditation, social connection—are important to taking care of the whole body and bone support.
And sometimes lifestyle changes aren’t enough: Some woman are reluctant to take medication for osteoporosis; I understand that hesitation. Most of us would prefer to manage our health through food, exercise, and lifestyle whenever possible. These things are important—but significant bone loss is a medical condition, not simply a consequence of aging.
When fracture risk becomes high enough, lifestyle measures alone may not provide enough protection. FDA-approved medications, including bisphosphonates and other osteoporosis treatments, have been shown to substantially reduce the risk of fractures in appropriate patients.
Start Early and Pay Attention
So, don’t dismiss medication simply because you had hoped to manage your bone health “naturally”. If your risk of a serious fracture becomes high, medication may be an important part of protecting your bones, maintaining your mobility, and preserving your independence for years to come.
These are message I hope you take away: Don’t wait for a fracture to start caring for your bones. Don’t wait until you are 65. Don’t wait until a DXA tells you that you have osteoporosis. Know your bone health. Understand what happens to your bones during menopause. Eat well. Get enough protein and the nutrients your bones need. Move your body. Strengthen your muscles. Work on your balance. Manage stress. And have an informed conversation with your healthcare provider about whether hormone therapy, a DXA scan, supplements, or medication makes sense for you.
Healthy aging is not just about living longer. It is about remaining strong enough to live independently and fully for as long as possible.
*Torkelson, C., & Marienau, C. (2023). Beyond Menopause: New Pathways to Holistic Health. CRC Press. Also see Books by Women – Women Over 70
