Nutrition & lifestyle

Calcium & vitamin D

Calcium is the raw material of bone; vitamin D lets your gut absorb it. Together they are the base layer of every osteoporosis plan — and ensuring adequacy is recommended for all adults, regardless of fracture risk. But they are a foundation, not a cure: in high-risk patients, calcium and vitamin D support medication rather than replace it.

• Calcium: most adults over 50 need roughly 1,000–1,200 mg/day from all sources. Food is the best source — dairy, fortified plant milks, leafy greens, tofu, canned fish with bones. Supplement only the shortfall; more is not better, and very high supplemental doses offer no added bone benefit.
• Vitamin D: commonly 800–1,000 IU/day for older adults, adjusted to blood levels. We check 25-OH vitamin D and repletion where it's low, because deficiency undermines everything else.

Protein & diet

Bone is roughly half protein by volume, and adequate dietary protein supports both bone and the muscle that protects against falls — a point that matters especially for older adults, who often under-eat protein. A balanced diet with enough calories, fruits and vegetables, and protein spread across the day supports bone health; extreme or very-low-weight diets undermine it (low body weight is itself a fracture risk factor). There is no single "bone diet" that substitutes for the fundamentals.

Exercise & fall prevention

Movement helps bone and, just as importantly, helps you avoid the fall that breaks it. Two kinds of activity matter most:

• Weight-bearing and resistance exercise — walking, stair-climbing, and progressive strength training load the skeleton and help maintain bone and muscle.
• Balance and mobility training — practices such as tai chi improve balance and reduce falls.

Fall prevention is a therapy in its own right: review medications that cause dizziness, correct vision, address home hazards (rugs, lighting, grab bars), and treat conditions that impair balance. For patients who are significantly under-treated or exhausted, we pace activity sensibly while optimizing treatment — then get them moving. None of this replaces medication for high-risk disease, but it treats the whole person and measurably lowers the risk of a fracture.

Supplements & myths

This is the area where claims most outrun evidence. Patients ask about these constantly, so here is an honest accounting — graded by what the published evidence supports, not by what is marketed.

How we grade evidence. From established, guideline-supported care (A) through moderate (B) and conflicting (C) to experimental (D) and insufficient (E). A supplement having a plausible mechanism, or nudging a lab value, is not the same as preventing fractures.