Concerned about osteoporosis? What helps prevent fractures beyond medication

By Hadia Zainab, CNN

(CNN) — Val Stones, the “Great British Baking Show” star, was walking across a field to a nearby school meeting when she misjudged a step, fell onto her wrist and broke it.

“I heard it break,” said Stones, author of “The Cake Whisperer,” who was 56 when that break led to the discovery that she had osteoporosis.

Osteoporosis is often called the “silent disease” because it rarely causes symptoms in its early stages — bones can weaken quietly for years before a fracture reveals the problem.

The most common metabolic bone disease worldwide, osteoporosis affects about 10 million people in the United States and over 3 million people in the United Kingdom. Women make up the majority of cases, and while the risk increases with age, younger women can develop osteoporosis, too.

The condition often develops from osteopenia — a state of lower-than-normal bone density that, if left unchecked, can lead to a significant drop in bone density and strength.

“Increasing bone density means improving both strength of the bone and the amount of mineral packed within it,” said Dr. Connie Oh, a sports medicine physician at Hoag Orthopedic Institute in Irvine, California. “This happens only when the body builds new bone faster than it breaks old bone down.”

Stones exercised regularly and maintained a healthy weight. But she said her diet was low in healthy fats and calcium — both essential for building bone. Bone health, experts say, is a team sport: It isn’t driven by a single nutrient or workout but by the combined effects of diet, movement, hormones and everyday habits over time.

“I now know that exercise with a well-balanced diet would have been better,” Stones said.

Twenty years after her diagnosis, Stones manages the condition through regular exercise and good nutrition and advocates for bone health, developing bone-friendly recipes inspired by her love of baking and shared with the Royal Osteoporosis Society in the United Kingdom.

Building bone without medication

Bones constantly remodel throughout a lifetime. Old bone breaks down, and new bone forms in its place. With age and during transitions like menopause, the balance often tips toward bone loss. That means supporting bone health earlier on builds a stronger foundation for later in life.

Existing research supports the idea that diet and exercise can meaningfully improve bone health. In a 2021 study, researchers followed over 7,000 older adults in care homes over two years and found that those who increased their intake of calcium- and protein-rich foods had 33% fewer fractures overall, nearly half as many hip fractures and an 11% lower risk of falls.

Smaller studies point in a similar direction. In a 2023 study of postmenopausal women with osteoporosis, those who followed a structured lifestyle program alongside usual care saw greater improvements in bone density after six months than those receiving standard care alone.

Nutrition that supports stronger bones

Calcium and vitamin D are widely considered the foundation of bone health and remain central to treatment plans that don’t involve medication. Calcium helps build and maintain strong bones, while vitamin D allows the body to absorb that calcium effectively. Without enough of either, bones can gradually weaken over time.

“If I could, I would tell my younger self to eat not only the greens and oranges but the whites and creams too,” Stones said via email.

A person’s overall diet matters more than any single nutrient, said Lindsay Malone, an instructor and functional medicine dietitian in Case Western Reserve University School of Medicine’s department of nutrition, via email.

“Protein is essential — it helps build muscle. If you’re building muscle strength, you’re also building bone strength, Malone said.

Higher protein intake is linked to greater bone density, but it only helps up to a certain point. In a a 2025 study, women saw gains when eating up to about 60 grams of protein a day. Beyond that, eating more didn’t seem to provide extra bone strength.

Magnesium, vitamin K, potassium, phosphorus and trace minerals also help maintain healthy bones.

After her diagnosis, Stones said she increased her intake of calcium-rich foods and developed recipes, including a cake made with soy milk, dried fruits and plenty of calcium-rich seeds. She also created a “menopause cake,” which she included in “The Cake Whisperer.” The recipe is called “Ladies’ Cake.”

Many people can meet their nutrient needs through food, particularly by following a varied, whole-food diet, Malone said. She recommends anchoring meals with protein, eating about 2 cups of vegetables each day, including leafy greens several times a week, and regularly choosing fortified or calcium-rich foods.

For vitamin D, Malone recommends egg yolks, fortified foods, fatty fish like salmon and sardines, certain cheeses, such as Parmesan-Reggiano, low-fat ricotta and part-skim mozzarella, as well as liver. “If a person isn’t eating these foods regularly, a vitamin D supplement is appropriate,” she added.

For calcium, especially for those who don’t consume dairy, she suggests fortified plant milks, calcium-fortified tofu, canned fish with bones, beans, nuts and seeds, along with whole grains and legumes for extra mineral support.

While getting enough nutrients is important, so is making sure your body can absorb them. Vitamin D, for example, is fat-soluble, which means it’s best absorbed when eaten with healthy fats, Malone explained.

Exercise that builds bone

It’s important to get moving to protect and build bone. During exercise, muscles release the hormone irisin. This molecule directly stimulates bone-building cells, helping increase bone density and strength.

“The best ways to build bone density are resistance exercises, like lifting weights and exercises that make your bones take impact, such as jumping or running,” said Ashley Katzenback, a doctor of physical therapy at Cape Concierge Physical Therapy in Massachusetts.

“You need to lift a weight that’s heavy enough for your strength so your muscles have to pull on your bones,” Katzenback explained. “Muscle attaches to bone and when it pulls, it creates stress that stimulates bone growth.”

Studies also show that when done carefully and under supervision, resistance training and high-impact exercises can help improve or maintain bone density in postmenopausal women, especially in the spine and hip, which are common sites for fractures.

Before beginning any new exercise program, consult your doctor and stop immediately if you experience pain.

Stones says she does balance exercises every day to help prevent falls, along with a set of movements that includes stretching, light weights and push-ups.

“Also, when you’re waiting for a kettle to boil, the microwave to ping, a cake to mix, or tea or coffee to brew, get some steps in,” Stones said. “I’m almost 76 now, and I’m quite happy if I get 7,000 steps per day.”

Katzenback recommends four sets of five repetitions with heavy weights to stimulate bone growth. She adds that it’s best to combine resistance and impact exercises, though resistance training is the most effective. By “heavy weights,” she explains, it doesn’t mean lifting something dangerously heavy — it means using a weight that feels challenging.

For beginners, especially if you’ve been mostly sedentary, it’s best to start gradually, building a daily walking habit first. You might begin with 3,000 to 5,000 steps a day, then slowly work up to four days of strength training and two days of balance exercises each week. Once that feels manageable, move on to heavier strength training and add jumping or other impact exercises.

“Posture is extremely important. We have to load the bones in a way they can handle,” Katzenback said.

For people with osteoporosis, Katzenback says certain movements should be avoided. “One of the most common ways a compression fracture can happen is by bending over to pick something up off the ground,” she said. Instead, use safe body mechanics, which can mean squatting to pick up a weight rather than bending over.

“If your form is correct, everything is stacked safely, keeping your bones protected,” she said.

Bone health over a lifetime

To protect bone strength, people need to support rebuilding and reduce the factors that speed up bone breakdown in the first place.

Malone explained that high sodium intake can increase calcium loss in urine, while excessive alcohol is linked to lower bone density and a higher fracture risk. Moderate caffeine, however, appears safe for most people if calcium intake is adequate.

The state of our gut health matters, too. Ongoing inflammation in the digestive tract can interfere with how well nutrients are absorbed. Certain weight-loss medications and steroids can also affect vitamin D levels in the body.

Oh recommends a DEXA scan, a test using a large noninvasive X-ray machine that measures bone density, for women 65 and older, for younger postmenopausal women with risk factors, for men 70 and older and for younger men at risk.

With the right lifestyle changes, it’s possible to improve bone density from osteoporosis to osteopenia, Katzenback said. However, medication is recommended for those already diagnosed with osteoporosis or at high risk of fracture.

Stones was prescribed a chewable tablet providing 1,000 milligrams of calcium daily, along with a weekly dose of prescription alendronic acid — also known as alendronate.

“It isn’t a disease that can be treated and cured; it’s one that I can only fight with the tools at my disposal,” she said. “I can only hope that my sheer will to live and enjoy my family — especially watching my grandchildren grow up — will keep me going.”

It takes about a year to see a measurable change in bone density on a scan after making lifestyle changes, Katzenback said. “You can gain strength and bone mass at any age, and you have the choice to keep moving forward.”

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