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Osteoporosis & Low Bone Mass

Osteoporosis makes bones thin and fragile, and it usually causes no symptoms until a bone breaks — most often in the spine, hip or wrist. Screening, medicines, exercise, good nutrition and fall prevention lower the risk of a break. Sudden new back pain, or a fall followed by not being able to stand, needs prompt care.

Get medical help right away if:

  • After a fall, someone has severe hip or groin pain, can’t stand or put weight on the leg, or the leg looks shorter or turned. These are signs of a broken hip. Don’t drive to the hospital — call for an ambulance (NHS, AAOS OrthoInfo). In the U.S., call 911.
  • New back pain comes on suddenly, especially if you have, or might have, osteoporosis. A spine (vertebral compression) fracture causes back pain where the bone broke, often worse when you move and eased by lying down. In weak bones it can follow a fall, or simply reaching, twisting, coughing or sneezing (AAOS OrthoInfo). The NHS advises an urgent appointment for severe back pain that starts suddenly or is getting worse quickly (NHS).
  • Call 911 if back pain comes with pain, tingling, weakness or numbness in both legs; loss of feeling around the genitals or bottom; new trouble controlling your bladder or bowels; chest pain; or if it started after a serious accident (NHS). A serious spine fracture can press on nerves and cause symptoms in the legs (AAOS OrthoInfo).
  • If you take romosozumab (Evenity) and have symptoms of a heart attack or stroke, call 911: its label warns it may increase the risk of heart attack, stroke and cardiovascular death and tells patients to seek prompt medical attention (FDA label, DailyMed).

Call your prescriber promptly (not an emergency) if you take a bisphosphonate, denosumab or romosozumab and get new or unusual thigh, hip or groin pain — a dull ache can come weeks or months before a rare “atypical” thighbone fracture (Fosamax label, Prolia label, USPSTF, 2025). Don’t wait for a chiropractic, acupuncture or massage appointment for any of the problems above.

What is osteoporosis?

Your body keeps breaking down old bone and replacing it with new bone. Osteoporosis develops when more bone is broken down than replaced, so the honeycomb-like inside of the bone and its outer shell grow thinner and weaker (NIA). Breaks are most common in the hip, spine and wrist (MedlinePlus), and broken hips and spines can cost older adults their mobility and independence (NIA): only 40% to 60% of people who break a hip regain their earlier mobility (USPSTF, 2025).

A “silent” disease

Osteoporosis is called silent because people may notice nothing until a bone breaks (NIA). It isn’t usually painful until then, and it is often diagnosed only when a fall or sudden impact causes a fracture. Sometimes a cough or sneeze breaks a rib or partly collapses a spine bone, and some older people develop a stooped posture from broken spinal bones (NHS).

Osteopenia (low bone mass)

Osteopenia is the stage before osteoporosis: bone density is lower than average, but not low enough to count as osteoporosis. It doesn’t always lead to osteoporosis, though depending on your fracture risk your doctor may still suggest a bone-strengthening medicine (NHS). It is now often called low bone mass; fracture risk is higher than normal but not as high as with osteoporosis (AAOS OrthoInfo).

How common is it?

In 2017–2018, 12.6% of U.S. adults aged 50 and over had osteoporosis (19.6% of women and 4.4% of men), and another 43.1% had low bone mass (CDC/NCHS). Among people 65 and older, 27.1% of women and 5.7% of men have osteoporosis (USPSTF, 2025).

Who is at risk?

Risk rises with age, and women lose bone quickly for several years around menopause (NIA). Slim, thin-boned people and White and Asian women are at highest risk (MedlinePlus). Other risk factors include (NIA, NHS, AAOS OrthoInfo):

  • a family history of osteoporosis, especially a parent who broke a hip, and a broken bone of your own after age 50;
  • early menopause (before 45), removal of the ovaries, or periods stopped by over-exercising or dieting — see our female problems guide;
  • long-term steroid tablets, acid-reflux medicines called proton pump inhibitors, some epilepsy medicines, and hormone treatments for breast or prostate cancer;
  • conditions such as an overactive thyroid or parathyroid, rheumatoid arthritis (see our arthritis guide), malabsorption from coeliac or Crohn’s disease (see our celiac disease guide), chronic kidney disease (see our kidney guide), and eating disorders;
  • low body weight, too little calcium, vitamin D or protein, physical inactivity or long bed rest, smoking and heavy drinking.

Screening: bone density tests and FRAX

The U.S. Preventive Services Task Force (USPSTF) recommends osteoporosis screening for all women 65 and older, and for postmenopausal women under 65 who have at least one risk factor and are found to be at increased risk using a clinical risk tool. For men, it found the evidence insufficient to recommend for or against screening (USPSTF, 2025).

  • DXA (DEXA) scan: the standard screening test measures bone density at the hip or lower spine using low doses of radiation (USPSTF, 2025). It is short and painless, taking 10 to 20 minutes (NHS).
  • T-score: your result is compared with a healthy young adult. Above −1 is normal, between −1 and −2.5 is osteopenia, and below −2.5 is osteoporosis (NHS).
  • FRAX: the most studied fracture-risk calculator, FRAX estimates the 10-year chance of a hip fracture or other major osteoporotic fracture for people aged 40 to 90, with or without a bone density result; it is more accurate with one. The USPSTF cautions that its race-specific versions may underestimate risk in Asian, Black and Hispanic people (USPSTF, 2025).
  • Does screening help? In three large trials in older European women, screening led to about 5 fewer hip fractures per 1,000 women over 3.7 to 5 years (USPSTF, 2025).

When to talk with a provider (not an emergency): ask about a bone density test if you’re a woman 65 or older, or past menopause with risk factors (USPSTF, 2025). Older men who break a bone easily or have risk factors should also ask about testing (NIA). If you’re over 50 and have broken a bone, ask about a fracture liaison service, which helps prevent further breaks (NHS). See a doctor about back pain if your back has changed shape, the pain is worse at night, or it comes from between your shoulders (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Bone density screening, then medicines that slow bone loss (bisphosphonates, denosumab, raloxifene, HRT) or rebuild bone (teriparatide, abaloparatide, romosozumab), plus calcium, vitamin D, exercise and fall prevention. Medicare covers a bone density test every 24 months for eligible people, at no cost if the provider accepts assignment. Medicine costs being researched. Bisphosphonates roughly halve spine fractures in trials. All medicines have risks; denosumab shouldn’t be stopped without switching to another medicine.
Chiropractic No evidence it treats bone loss. A chiropractor may spot signs of osteoporosis on X-rays and refer; gentle care for back pain only after fractures are ruled out. About $90–$200 for a first visit and $55–$100 for follow-ups without insurance; Medicare covers only spinal adjustments. We found little research. Rare rib fractures after spinal manipulation have occurred in older women with osteoporosis — tell your chiropractor.
Acupuncture Needling, sometimes with moxibustion, alongside — never instead of — osteoporosis medicines. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Chinese trials report small bone density gains and less pain, but the review we read didn’t measure fractures, and the studies have important limits.
Herbal medicine Soy isoflavones, strontium supplements and Chinese herbal formulas are promoted for bones. Cost estimate being researched. Soy may modestly slow bone loss after menopause. Strontium supplements and herbal formulas are unproven for preventing fractures.
Massage therapy Gentle massage for comfort and pain relief — no deep pressure on the spine or ribs, and never over a new fracture. One national chain: about $70–$90 a month for a 60-minute membership session. Other costs being researched. May ease pain but isn’t shown to strengthen bone. Rare fractures have been reported after massage, including in people with osteoporosis.
MBHA Wellness Coach Weight-bearing and strength exercise, balance work such as tai chi, home fall-proofing, calcium-rich food, and help quitting smoking and cutting alcohol. Cost estimate being researched. Supports — never replaces — medical care. Exercise cuts falls by about a quarter and modestly helps bone density.

Approach 1 of 6

Conventional medicine (AMA)

Treatment aims to slow or stop bone loss and prevent fractures, using diet, exercise, fall prevention and medicines that either slow bone loss or help rebuild bone (MedlinePlus). Whether you need medicine depends on your risk of breaking a bone; if you’ve already broken one because of osteoporosis, you should still be offered treatment (NHS). We don’t list doses; ask your doctor or pharmacist.

1. Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid)

These slow the rate at which bone is broken down. They come as tablets, a liquid or an injection, usually take 6 to 12 months to work, and may be taken for five years or longer (NHS). In trials reviewed by the USPSTF, bisphosphonates cut spine fractures by about half — 18 fewer per 1,000 people treated — and may have lowered hip fractures by about 3 per 1,000, a borderline result (USPSTF, 2025). The alendronate (Fosamax) label says it increases bone mass and reduces fractures, including of the hip and spine, in postmenopausal women (Fosamax label).

  • Taking tablets safely: take them on an empty stomach with a full glass of plain water, stay sitting or standing upright afterward, and wait before eating, drinking or taking other medicines (NHS, Fosamax label). Tablets can irritate the food pipe; stop and get medical advice for trouble or pain swallowing, pain behind the breastbone, or new or worse heartburn. They should not be used by people who can’t sit or stand upright for 30 minutes, or who have certain food-pipe problems or low blood calcium (Fosamax label).
  • How long? The best length of treatment hasn’t been determined. The label advises re-checking the need for treatment regularly and says people at low fracture risk may consider stopping after 3 to 5 years (Fosamax label).
  • Yearly infusion: zoledronic acid (Reclast) is given into a vein once a year. It must not be used with severely reduced kidney function, and flu-like symptoms such as fever and aching muscles are common in the first few days (Reclast label).
  • Jaw osteonecrosis (rare): jaw bone that fails to heal, usually after a tooth extraction or infection; the risk may rise with longer use (Fosamax label). It is most often linked with high-dose intravenous treatment for cancer, and you may need a dental check-up before starting (NHS). One review put the rate at 0.01% to 0.06% of bisphosphonate users (USPSTF, 2025).
  • Atypical thighbone fractures (rare): breaks of the thighbone shaft with little or no injury, sometimes in both legs, often preceded by a dull, aching thigh pain for weeks or months. Report new thigh or groin pain. These fractures also happen in people with osteoporosis who haven’t taken bisphosphonates (Fosamax label).

2. Denosumab (Prolia)

Denosumab is a biological medicine given by injection (NHS). In postmenopausal women with osteoporosis it reduces spine, non-spine and hip fractures (Prolia label).

  • Boxed warning: people with advanced chronic kidney disease, including those on dialysis, are at greater risk of severely low blood calcium after an injection, which has led to hospitalization, life-threatening events and deaths. Their treatment should be supervised by a specialist in kidney-related bone disease (Prolia label).
  • Don’t stop without a plan: after denosumab is stopped, fracture risk rises, including the risk of several spine fractures. New spine fractures have occurred as early as 7 months (on average 19 months) after the last injection, and people who stop should be moved to another bone-loss medicine (Prolia label).
  • Other warnings: jaw osteonecrosis, atypical thighbone fractures, serious infections (get prompt care for signs such as cellulitis), skin rashes, and severe bone, joint or muscle pain (Prolia label).

3. Bone-building (anabolic) medicines: teriparatide and abaloparatide

Teriparatide (Forteo) and abaloparatide (Tymlos) are daily injections related to parathyroid hormone. They are approved for people at high fracture risk or for whom other medicines failed or weren’t tolerated, and reduce spine and non-spine fractures in postmenopausal women (Forteo label, Tymlos label). Unlike medicines that only slow bone thinning, parathyroid hormone treatment can increase bone density (NHS).

4. Romosozumab (Evenity)

Romosozumab blocks a protein called sclerostin. It is approved for postmenopausal women at high fracture risk, and use is limited to 12 monthly treatments because its bone-building effect wanes; after that, a medicine that slows bone loss should be considered (Evenity label).

  • Boxed warning: it may increase the risk of heart attack, stroke and cardiovascular death. It should not be started within a year of a heart attack or stroke and should be stopped if one occurs. In a trial, major heart events were more common with romosozumab than with alendronate (Evenity label).
  • It also carries warnings about low blood calcium, jaw osteonecrosis and atypical thighbone fractures (Evenity label).

5. Raloxifene and hormone therapy

  • Raloxifene (Evista) acts like estrogen on bone and is only for women after menopause; side effects include hot flushes and leg cramps (NHS). Its boxed warning covers a higher risk of blood clots in the legs and lungs — women with a current or past clot should not take it — and a higher risk of death from stroke seen in women with heart disease or at high risk of it (Evista label).
  • Hormone replacement therapy (HRT) helps keep bones strong and can lower fracture risk; some types slightly raise breast cancer risk, and HRT tablets slightly raise the risk of blood clots (NHS). See our female problems guide.

What it costs

  • Bone density test: Medicare Part B covers bone mass measurement once every 24 months (more often if medically necessary) for people who qualify, such as women at risk because of low estrogen or people taking steroid medicines; you pay nothing if the provider accepts assignment (Medicare.gov). Cash prices: cost estimate being researched.
  • Physical therapy: Medicare Part B helps pay for medically necessary outpatient PT; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Osteoporosis medicines: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

MBHA found no evidence that chiropractic care treats bone loss; we found little research on chiropractic care for osteoporosis itself, and the studies we found concern safety. Where a chiropractor can help is in noticing warning signs: a 2024 article in a chiropractic journal recommends that chiropractors check every X-ray of patients over 50 for signs of weak bone and spine or hip fractures, and refer promptly — though X-rays aren’t a test for osteoporosis; a bone density scan is (Uhrenholt et al., 2024).

Safety

  • In nearly a million spinal manipulation sessions at Hong Kong chiropractic clinics, the only two severe side effects were rib fractures in women over 60 with osteoporosis (Chu et al., 2023).
  • Among older Medicare patients, injury risk after a chiropractic visit was lower overall than after a primary care visit, but injury was more likely in chiropractic patients who had osteoporosis (Whedon et al., 2015).
  • Serious problems after spinal manipulation are very rare, but may be more likely in people with health problems that raise their risk of injury (NCCIH).

MBHA caution: if you have osteoporosis or low bone mass, tell your chiropractor before any treatment and ask about gentle techniques instead of forceful thrusts to the spine and ribs. Don’t have your spine manipulated for sudden new back pain until a doctor has ruled out a spine fracture (see the warning signs at the top of this page).

What it costs

  • Without insurance: about $90–$200 for a first visit and $55–$100 for follow-ups; an exam plus several weeks of care can total $500–$1,000 (The Pricer).
  • Medicare covers only spinal adjustments to correct a subluxation — not X-rays, massage or acupuncture a chiropractor orders; you pay 20% after the deductible (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has a long history of use for osteoporosis in China (Ma et al., 2025), and a growing number of trials report results, but the evidence has important gaps.

What the research says

  • A 2025 review of 40 randomized trials with 2,654 people found that acupuncture, alone or added to usual medicine, increased bone density and lowered pain scores compared with control groups. All the patients were in China, and the authors called for high-quality trials in other countries (Ma et al., 2025).
  • The outcomes in that review were bone density, pain and lab measures, not fractures — and fewer fractures is what matters most. We found little research on whether acupuncture prevents broken bones.

If you try acupuncture, use it as an add-on to your medical plan, not a replacement for proven osteoporosis medicines.

Safety

Relatively few complications have been reported. Problems have come from non-sterile needles and poor technique; the FDA requires acupuncture needles to be sterile and single-use (NCCIH). MBHA caution: tell your acupuncturist about any spine fractures, and ask for help getting on and off the treatment table.

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). Medicare covers acupuncture only for chronic low back pain, not for osteoporosis (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

MBHA found no herb or supplement proven to replace osteoporosis medicines. Here is what the evidence says about the most popular choices. Calcium and vitamin D have their own section.

Soy isoflavones

Soy isoflavones probably have a beneficial effect on bone density in postmenopausal women (NCCIH). A 2022 review of 18 trials found that isoflavones taken for 6 to 24 months modestly slowed bone loss at the spine and hip after menopause (Barańska et al., 2022); those trials measured bone density, not fractures. In a study that followed more than 24,000 women in Shanghai, those who ate the most soy food had fewer fractures, especially in the early years after menopause (Zhang et al., 2005) — but a study like this can’t prove soy caused the difference.

Safety: some people are allergic to soy; concentrated isoflavone extracts have been used safely in studies for up to six months; side effects can include bloating, constipation, diarrhea and nausea; high-tyramine soy foods such as tofu and soy sauce can dangerously raise blood pressure with MAOI antidepressants; and amounts above normal food levels may be unsafe in pregnancy (NCCIH).

Strontium

A medicine form, strontium ranelate, cut spine fractures by 37% and other fractures by 14% over three years in postmenopausal women with osteoporosis, in trials summarized by a 2006 Cochrane review. But it slightly raised the risk of blood clots in the veins and lungs and of some nervous-system problems, and the review’s spine bone density gain was only about half as large once adjusted for the strontium itself in the bone (O’Donnell et al., Cochrane, 2006). Strontium ranelate is not among the FDA-approved osteoporosis medicines the USPSTF lists (USPSTF, 2025).

Strontium is also taken as a dietary supplement, such as strontium citrate. We found little research on it: one small study of 10 women taking it on their own measured strontium building up in their bones over several years, not whether it prevented fractures (Moise et al., 2014). MBHA caution: because of the clot risk seen with strontium ranelate, talk with your doctor before trying any strontium product.

Chinese herbal medicines

A Cochrane review of 108 trials testing 99 different Chinese herbal medicines found that their benefit for bone density is still uncertain. Only seven small trials reported fractures, with inconsistent results; no serious side effects were reported, though some people had nausea or diarrhea (Liu et al., Cochrane, 2014).

Supplements and your medicines: some herbs interact with medicines — for example, ginkgo taken with warfarin raises the risk of major bleeding (NCCIH). Bisphosphonate tablets must be taken before any other food, drink or medicine of the day (Fosamax label), so take calcium and other supplements at a different time (NHS). Tell your doctor and pharmacist about every supplement you use. We don’t list doses.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

MBHA found no evidence that massage strengthens bone, but it may help with pain. The NHS lists massage, along with painkillers, heat, cold and relaxation, among ways to manage pain when living with osteoporosis (NHS).

What the research says

We found little research on massage for osteoporosis. In one small pilot trial of 20 people with painful spine fractures, a 10-week physiotherapy program of exercise plus hands-on (manual) therapy reduced pain and improved function compared with no treatment; the authors said a larger trial is needed (Bennell et al., 2010).

Safety

  • Serious side effects are rare, but a broken bone has been reported, some cases with vigorous massage such as deep tissue work or in elderly people (NCCIH). One report describes a 66-year-old man with osteoporosis whose spine bone broke after a back massage (Guo et al., 2013).
  • An older woman broke a spine bone while using an electric massage chair; the report’s authors advise people with or at risk of osteoporosis to be cautious with deep massage from these chairs (Jeon et al., 2019).

MBHA caution: tell your massage therapist you have osteoporosis or low bone mass. Ask for light to moderate pressure, no deep pressure over the spine and ribs, and help changing position. Never have massage over a new or suspected fracture.

What it costs

At one national chain, Massage Envy, a membership runs about $70–$90 a month for one 60-minute session, with a 12-month initial term; prices vary by location (The Pricer). Other costs being researched.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the daily habits that protect your bones, alongside — never instead of — your medical care.

Move every day, safely

  • Weight-bearing exercise (where your feet and legs carry your weight, such as brisk walking or dancing) and resistance exercise (such as weights) are particularly important for bone density. Swimming and cycling aren’t weight-bearing. If you have osteoporosis, check with your doctor before starting a new program (NHS).
  • Avoid movements that twist the spine, like swinging a golf club, or bend forward from the waist, like sit-ups and toe touches (NIA).
  • See Exercise and fall prevention for the evidence.

Prevent falls

  • Ask your provider to check your fall risk and review your medicines, have your eyes checked every year, do strength and balance exercises such as tai chi, remove trip hazards and add brighter lighting (CDC).
  • Install night lights and grab bars in the bathroom, stand up slowly, and use a cane or walker if it helps you feel steadier (NIA). Secure rugs, use non-slip mats, and have regular sight and hearing tests; some older people wear hip protectors to cushion a fall (NHS).
  • See our balance and fall prevention guide.

Eat for your bones

Get enough calcium, vitamin D and protein (NIA) — see Calcium and vitamin D — and go easy on salt: too much sodium can make your body lose calcium (AAOS OrthoInfo).

Smoking and alcohol

Smoking raises the risk of weak bones and too much alcohol harms them (NIA); quitting smoking and cutting down on alcohol help prevent osteoporosis (NHS). A coach can help you make a plan and stick to it.

What it costs

Cost estimate being researched.

Another approach

Spine and hip fractures: what to expect

Spine (vertebral compression) fractures

Spine fractures are the most common osteoporosis fractures — about 1.5 million a year in the U.S., almost twice as common as hip or wrist fractures — and often the first sign of weak bones. The front of the weakened bone cracks and loses height (AAOS OrthoInfo).

  • Treatment: most people feel better within about three months without surgery, using rest, a small amount of pain medicine and sometimes a back brace. For severe pain from a recent fracture that doesn’t improve, kyphoplasty or vertebroplasty (injecting bone cement) may be options; two large studies found vertebroplasty helped only in the short term (AAOS OrthoInfo). Reviews also support getting moving early and, once acute pain is controlled, exercise to improve function (Ameis et al., 2018), though a Cochrane review couldn’t tell whether exercise after a spine fracture prevents further fractures or falls (Gibbs et al., Cochrane, 2019).
  • Preventing the next one: more than 30% of people with a spine fracture have another fracture within a year, so treatment for osteoporosis is important (AAOS OrthoInfo).

For other causes of back pain, see our back problems guide.

Hip fractures

Most hip fractures happen in older people whose bones have been weakened by osteoporosis; sometimes the bone is so weak it breaks while the person is just standing or walking (AAOS OrthoInfo). Each year nearly 319,000 older people are hospitalized for hip fractures, and falls cause 88% of hip-fracture emergency visits and hospital stays (CDC). A broken hip needs surgery, usually on the day of arrival at hospital or the next day; anyone over 50 who breaks a hip should ask about a fracture liaison service to prevent further breaks (NHS). See the hip fracture section of our hip guide.

Another approach

Calcium and vitamin D: food first, supplements with care

Calcium is the main mineral in bone (NHS), and vitamin D helps your body absorb it (MedlinePlus).

  • Calcium-rich foods: milk, cheese and yogurt; leafy greens such as kale, broccoli and bok choy; canned sardines and salmon with their soft bones; and calcium-fortified cereals, juices, soy and rice drinks and tofu (MedlinePlus).
  • Vitamin D: your skin makes it in sunlight, but too much sun raises skin cancer risk. Few foods contain it naturally — egg yolks, saltwater fish and liver — so most comes from fortified milk, cereal and yogurt (MedlinePlus).
  • Who may fall short: postmenopausal women absorb and keep less calcium (MedlinePlus), and older adults and people with celiac or Crohn’s disease may need extra vitamin D (MedlinePlus).

Do supplements prevent fractures?

For people who don’t have osteoporosis, the answer so far is mostly no:

  • In 2018 the USPSTF recommended against daily low-dose vitamin D and calcium supplements to prevent fractures in postmenopausal women living at home, and found too little evidence to judge higher doses, or supplements for men and premenopausal women (USPSTF, 2018). An update is in progress: its draft recommends against vitamin D, with or without calcium, to prevent fractures in postmenopausal women and men 60 and older living at home (USPSTF, 2025).
  • A Cochrane review found that vitamin D alone is unlikely to prevent fractures in older people. Vitamin D plus calcium slightly lowered hip fractures — about 1 fewer per 1,000 people a year living at home, and 9 fewer per 1,000 in care homes and other institutions (Avenell et al., Cochrane, 2014).

Possible harms

If you have osteoporosis or take an osteoporosis medicine, the advice is different. You may need more calcium, usually as supplements (NHS), and the labels for denosumab and romosozumab say patients should be adequately supplemented with calcium and vitamin D during treatment (Prolia label, Evenity label). Ask your provider whether you need supplements and how much; they may check your blood levels first (MedlinePlus, MedlinePlus). We don’t list doses.

Another approach

Exercise and fall prevention

Exercise can slow bone loss and lowers the chance of falls.

  • Bone density: a Cochrane review of 43 trials in postmenopausal women found a small but possibly important effect of exercise on bone density; strength training for the legs helped most at the hip and combined programs helped most at the spine. No effect on the number of fractures was shown (Howe et al., Cochrane, 2011).
  • Is heavy lifting safe? In the LIFTMOR trial, 101 postmenopausal women with low bone mass did eight months of closely supervised, high-intensity strength and impact training. Their bone density and physical function improved more than with gentle home exercise, with only one minor back spasm reported (Watson et al., 2018), and follow-up spine scans found no new spine fractures in the training group (Watson et al., 2019). These women were otherwise healthy and expertly supervised — don’t try this on your own.
  • Tai chi: a 2022 review found that tai chi may modestly improve bone density in postmenopausal women compared with no exercise, with few side effects, though the evidence is of low certainty (Liu et al., 2022). Tai chi may also reduce falls in older adults (NCCIH).
  • Falls: in a Cochrane review of 108 trials, exercise cut the rate of falls in older people living at home by 23% and may also reduce fall-related fractures (Sherrington et al., Cochrane, 2019). More than one in four people 65 and older falls each year, and falling once doubles the chance of falling again (CDC).

For more on staying steady, see our balance and fall prevention guide.

Another approach

Men and osteoporosis

Osteoporosis is less common in men — about 1 in 20 men over 50, compared with 1 in 5 women (NIA) — but it is not rare, and although fractures are more common in women, the excess risk of death linked to osteoporosis and fragility fractures is greater in men (USPSTF, 2025).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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