Bone is living tissue that rebuilds itself all the time. It peaks around 25 to 30 and then slowly thins, faster in women after menopause. Heavy lifting and impact can still strengthen bone later in life, preventing falls matters as much as density, and the medicines that work are badly underused.
Good evidenceUpdated Oct 2026 · 3 new studiesBone is constantly broken down and rebuilt. Bone mineral density is measured with a low-dose X-ray called a DEXA scan and reported as a T-score, compared with a healthy young adult. A score between −1 and −2.5 is osteopenia; −2.5 or lower is osteoporosis.
Bone mass peaks in the mid-20s to early 30s and then slowly falls, with a faster drop in women in the years after menopause as oestrogen falls. Steroid tablets, smoking, heavy drinking and low body weight speed the loss. Men lose bone too, and although osteoporosis is more common in women, men are more likely to die after a fracture.
Most fractures follow a fall, and most happen in people whose scan isn't in the osteoporosis range. That's why doctors estimate overall risk with tools like FRAX, which adds age, past fractures, family history and other factors, and why muscle strength and balance matter as much as bone density.
Bone mass peaks around age 25 to 30, then slowly falls, with a faster drop in women in the 5 to 10 years after menopause. Impact and strength training raise the peak and slow the fall. Illustration based on typical population curves.
Heavy lifting and jumping bend bone very slightly.
Cells inside bone detect the strain and signal for reinforcement.
Bone-building cells add mineral where the load is greatest.
Denser bone plus stronger muscles and better balance mean fewer fractures.
The T-score compares your bone density with a healthy young adult. Fracture risk also depends on age, falls and past fractures.
101 women after menopause with low bone mass
Twice-weekly supervised heavy lifting and jumping for 8 months raised spine bone density by 2.9% while the light-exercise group lost 1.2%. Only one minor injury was reported.
Read the source ↗108 trials, 23,407 older people
Balance and strength exercise cut the rate of falls by 23% (high certainty) and may reduce fall-related fractures by about a quarter (low certainty).
Read the source ↗159 trials, 79,193 people
Tai chi cut the number of older people who fell by about 29%, and group or home exercise programmes also reduced falls.
Read the source ↗53 trials, 91,791 older people
Vitamin D alone did not prevent fractures. With calcium it slightly cut hip fractures, mainly in care homes: about 9 fewer per 1,000 a year there versus 1 fewer in the community. Kidney problems were slightly more common.
Read the source ↗Evidence review
Recommends bone density screening for all women 65+ and younger women after menopause with raised risk. Evidence for men was judged insufficient, which is not advice against it.
Read the source ↗Almost 10,000 women aged 65+, 10 years
Tea drinkers had slightly higher hip bone density, and more than 5 cups of coffee a day was linked to lower density. Moderate coffee showed no harm. Observational and small differences.
Read the source ↗A large 2026 review found calcium and vitamin D supplements do little to prevent fractures or falls in most people. An updated Cochrane review confirms that alendronate prevents fractures, especially in people at high risk, and US guidance now advises scans for younger women after menopause if their risk is raised.
Every study added to this page since January 2025. Green rings are the strongest evidence: large trials or meta-analyses.
Wells et al., 2025 (Cochrane). Fractures per 100 women over up to 3 years, placebo versus alendronate. Mostly low-certainty evidence.
69 trials, 153,902 adults
Calcium, vitamin D or both gave little to no reduction in fractures or falls (moderate to high certainty), with similar results by age, sex and past fractures. It may not apply to people with bone disorders or on bone medicines.
119 studies of postmenopausal women
In women at higher risk, alendronate cut spine fractures from about 5 to 2 per 100 over up to 3 years, and wrist and other fractures too. In lower-risk women the benefit was smaller. Most evidence was low certainty.
Over 59,000 adults with type 2 diabetes
People taking semaglutide had about 15% fewer fractures than those on other weight or diabetes drugs, despite losing more weight. Based on health records, not peer reviewed, and raw fracture rates differed only slightly.
Don't rely on calcium or vitamin D pills to prevent fractures unless you're deficient, frail or your doctor gives them with a bone medicine. Put the effort into strength, impact and balance training instead, and if you've broken a bone after 50 or your risk is high, ask about medicines such as alendronate.
Load your bones, keep your balance, and use medicines when your risk is high.
Progressive strength training 2–3 times a week. With low bone density, start supervised.
Skipping, jumping, stair running or brisk hill walking, if your joints allow.
Tai chi and balance exercises cut falls, the trigger for most fractures.
Dairy or fortified alternatives, beans, fish with bones and enough protein at each meal.
Supplements help people who are deficient or housebound, not those with normal levels.
A broken bone from a simple fall after 50 is a cue to check bones and consider treatment.
✕ MythOsteoporosis is a women's disease.
✓ FactIt's less common in men, but men are more likely to die after a fracture, and many are never tested.
✕ MythCalcium and vitamin D pills prevent fractures.
✓ FactA 2026 review of 69 trials found little to no benefit for fractures or falls in most people.
✕ MythWith weak bones you should avoid lifting.
✓ FactIn LIFTMOR, supervised heavy lifting raised bone density in women with low bone mass, with only one minor injury.
✕ MythBone medicines do more harm than good.
✓ FactRare side effects like jaw or unusual thigh-bone problems exist, but for people at high risk the fractures prevented far outnumber them.
Aim to get calcium from food. Vitamin D makes sense if you're deficient, housebound or in a care home, or if your doctor prescribes it with a bone medicine.
Yes. It's a quick, painless scan lying on a table, with a very low dose of X-rays.
Routine screening isn't firmly recommended, but men with a fracture after a simple fall, long-term steroid use, low testosterone or heavy drinking should ask.
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Lifting heavy weights can raise bone density after menopause.
Lifting heavy weights can raise bone density after menopause.
In LIFTMOR, 8 months of supervised heavy lifting raised spine density by 2.9% while the control group lost 1.2%.
Calcium and vitamin D supplements prevent fractures in most people.
Calcium and vitamin D supplements prevent fractures in most people.
A 2026 BMJ review of 69 trials and over 150,000 adults found little to no benefit for fractures or falls.
Vitamin D with calcium helps prevent hip fractures.
Vitamin D with calcium helps prevent hip fractures.
A small effect showed up mainly in care-home residents, about 9 fewer per 1,000 a year; in the community it was about 1.
Osteoporosis only affects women.
Osteoporosis only affects women.
About 1 in 18 US men over 65 has it, and men are more likely to die after a fracture.
Exercise reduces falls in older people.
Exercise reduces falls in older people.
A Cochrane review of 108 trials found balance and strength training cut falls by 23%, with high certainty.
Most fractures happen in people who don't have osteoporosis on a scan.
Most fractures happen in people who don't have osteoporosis on a scan.
That's why fracture risk tools like FRAX also count age, falls and past fractures.
Alendronate prevents fractures in women at high risk.
Alendronate prevents fractures in women at high risk.
A 2025 Cochrane review found spine fractures fell from about 5 to 2 per 100 women over up to 3 years.
Drinking coffee weakens your bones.
Drinking coffee weakens your bones.
In older women, only more than 5 cups a day was linked to lower bone density; moderate coffee showed no harm.
Bone mass peaks around your late 20s.
Bone mass peaks around your late 20s.
Building bone with exercise when young gives a bigger reserve to lose later.
With low bone density you should avoid exercise to prevent breaks.
With low bone density you should avoid exercise to prevent breaks.
Supervised strength, impact and balance training is safe for most people and lowers falls, the main cause of fractures.
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