Osteoporosis, or decreased bone density and bone strength, becomes more common with age, inactivity, nutrient insufficiency, and hormonal changes after menopause, especially declining estrogen. In the U.S., current CDC data estimate that 18.8% of women age 50 and older have osteoporosis at the femoral neck or lumbar spine, and 51.4% have low bone mass. Among women age 65 and older, the FDA estimates osteoporosis affects about 1 in 4 women.
Osteoporosis remains significantly underdiagnosed. A 2025 NHANES trend analysis found that approximately 69% of U.S. adults with osteoporosis were undiagnosed, highlighting the importance of screening.
Dexa Scan
Osteoporosis can be diagnosed with a DEXA scan (dual-energy X-ray absorptiometry), a simple, painless test that measures bone mineral density. While current U.S. screening guidelines recommend routine DEXA screening beginning at age 65 for most women, I believe many women benefit from assessing their bone health much earlier. If you are postmenopausal, have a small frame, a family history of osteoporosis or fractures, experienced early menopause, have used corticosteroids, have low body weight, or have other risk factors for bone loss, I encourage you to advocate for earlier screening. Identifying declining bone density before osteoporosis develops provides a valuable opportunity to intervene with nutrition, exercise, hormone optimization when appropriate, and other lifestyle strategies that can help preserve bone strength and reduce future fracture risk.
Comprehensive Approach
Bone health is best supported through a comprehensive approach: weight-bearing and resistance exercise, fall prevention, adequate protein, minerals, vitamin D, vitamin K, and—when appropriate—medical or hormonal support. Calcium remains important, but it is only one part of bone metabolism. Current recommendations suggest women age 51 and older aim for about 1,200 mg of total calcium daily from food and supplements combined, rather than automatically taking high-dose calcium.
Supplements
Key nutrients involved in bone formation and remodeling include magnesium, boron, zinc, copper, manganese, vitamin D, vitamin K, vitamin C, folate, B6, and B12. Calcium supplements should be separated from thyroid hormone medication by at least four hours, because calcium can reduce thyroid hormone absorption.
Vitamin D plays a vital role in calcium absorption, bone remodeling, muscle function, and immune health. Because individual needs vary, I recommend measuring a 25-hydroxyvitamin D blood level rather than supplementing blindly. While conventional laboratory reference ranges often consider levels above 30 ng/mL adequate, I suggest an optimal range of approximately 45–60 ng/mL for overall health and bone support. Supplementation should always be individualized based on laboratory testing, lifestyle, sun exposure, age, and personal health history.
Hormones
Hormonal health also matters. Menopausal hormone therapy has been shown to help prevent bone loss and reduce fracture risk, though it is generally considered prevention rather than treatment for established osteoporosis. Testosterone and DHEA may play supportive roles in some women, but the evidence is more individualized and should be guided by symptoms, labs, risk factors, and medical supervision.
Omega-3 fatty acids from fatty fish or fish oil may also support healthy inflammation balance and overall musculoskeletal health, though they should be considered supportive rather than a primary osteoporosis treatment.
For women with confirmed osteoporosis or high fracture risk, current medical care includes more options than Fosamax alone, including other bisphosphonates, denosumab, anabolic therapies, and newer bone-building medications. The best approach depends on DEXA results, fracture history, age, kidney function, cardiovascular history, and overall risk profile.
