Bone density matters,
but fracture risk is a wider system

Dual-energy X-ray absorptiometry, usually called a DXA or DEXA scan, estimates bone mineral density. It is clinically useful, but it does not directly measure every aspect of bone quality, muscle strength, balance, eyesight, medication effects or the likelihood of falling.

Fracture resilience therefore depends on both the strength of the skeleton and the forces it is exposed to. Stronger legs, better balance and appropriate movement can reduce fall risk, while progressive loading can help maintain or improve bone density at specific sites.

Bone needs enough mechanical strain
to stimulate remodelling

Bone adapts most strongly to loads that are greater or different from usual daily activity. Resistance training creates muscular forces that pull on bone. Weight-bearing impact, such as brisk stair climbing, hopping, running or jumping where appropriate, adds ground-reaction forces.

The response is site-specific. Training the legs does not automatically improve bone density at every skeletal location, and programme effects depend on intensity, frequency, duration, technique and adherence.

Impact can strengthen bone,
but it must match fracture risk and ability

Impact exercise is useful because bone responds to rapid changes in force. However, the same exercise may be appropriate for one adult and unsafe for another.

A systematic review and meta-analysis of randomised trials in adults aged 50 and over with low bone density or previous fragility fracture found that impact exercise, alone or combined with resistance training, improved lumbar-spine and femoral-neck bone density and improved Timed Up and Go performance. The certainty of evidence was low, so programmes still need individualisation.

Read current NHS guidance on weight-bearing and resistance exercise for osteoporosis prevention.

Stronger bone helps,
but avoiding the fall can matter even more

Many fragility fractures occur after a fall. That means muscle strength, reaction speed, balance, vision, footwear and the home environment can be as important as small changes in bone density.

Resistance training builds force. Balance work helps the nervous system control the body when the base of support changes. Walking and aerobic fitness support general capacity, while task-specific practice can improve confidence with stairs, uneven ground and getting up from the floor.

Read NHS guidance on activity, falls and keeping bones strong in later life.

Protein supports the bone matrix and muscle,
but more is not always better

Bone contains a collagen-rich protein matrix that becomes mineralised. Protein also supports the muscle that loads and protects the skeleton.

An umbrella review of systematic reviews concluded that protein intakes above standard recommendations did not show a clear harmful effect on adult bone health. Evidence for additional benefits was limited and inconsistent. Another National Osteoporosis Foundation review found a small favourable effect on lumbar-spine BMD but no consistent improvement at the hip or femoral neck.

Correct deficiency and meet requirements,
rather than assuming more creates stronger bone

Calcium is a major mineral component of bone. Vitamin D supports normal calcium absorption and normal bones. UK NHS guidance states that adults generally need 700 mg of calcium daily and should consume 10 micrograms of vitamin D daily.

Many adults can obtain calcium through a balanced diet. Vitamin D is more difficult to obtain from food alone, and UK guidance commonly recommends supplementation during autumn and winter, with year-round supplementation for some higher-risk groups.

Read current NHS guidance on calcium, vitamin D and food for healthy bones.

Essential roles do not automatically mean
high-dose supplementation improves fracture outcomes

Vitamin K contributes to the maintenance of normal bones, and magnesium contributes to normal muscle function and the maintenance of normal bones. Those authorised nutritional roles are clear.

Clinical supplementation outcomes are more complex. A meta-analysis of vitamin K trials reported mixed results across vitamin K forms, populations and outcomes. Food supplements should therefore support nutritional adequacy rather than be presented as stand-alone osteoporosis treatment.

The evidence is promising in selected groups,
but not proof of universal bone rebuilding

Type I collagen forms much of the organic framework of bone. This has created interest in collagen peptides as part of bone-support nutrition.

A 12-month randomised study in postmenopausal women with low bone mineral density reported improved spinal and femoral-neck BMD with a specific 5 g collagen-peptide product compared with placebo. A later trial in women with osteopenia examined collagen alongside calcium and vitamin D and reported favourable changes in some bone outcomes.

Exercise and nutrition support bone,
but they do not replace osteoporosis care

Osteoporosis treatment decisions are based on more than a DXA result. Age, sex, fracture history, medicines, medical conditions and overall fracture risk all matter.

People with a previous low-trauma fracture, significant height loss, long-term oral steroid use, early menopause, very low body weight, strong family history or other major risk factors should discuss assessment with a clinician.

Read current NHS information about osteoporosis treatment and fracture prevention.

Train bone, muscle and balance
as one connected system

Read the current UK Chief Medical Officers’ physical activity guidelines.

Complete the three-part
structural foundation

• Structural foundations: What Structural Health Really Means for Adults.
• Tendons and ligaments: How Connective Tissue Adapts to Load and Recovery.
• Joint support: Collagen Supplements for Joint Health.
• Strength support: Creatine for Strength and Muscle Recovery.