Lifestyle modifications


  • A healthy nutrient rich diet (3)
  • Adequate vitamin D (women: 800 IU/day) and calcium intake (women: 1200mg/day from diet or supplements) for maintaining good bone health (1, 6). However there is mixed evidence for vitamin D and calcium supplementation reducing fracture risk (1)
  • Avoid heavy alcohol intake (5). Alcohol intake is a risk factor for osteoporosis (3)
  • Compared to abstainers, persons consuming 0.5-1 drinks a day have 1.38 times the risk of developing osteoporosis (4)
  • Protein intake: There is mixed evidence on a high protein intake and bone density. Some studies show that increased protein intake reduces the risk of hip fractures, while other studies suggest that a high protein intake may increase bone resorption and calcium excretion (5)


  • Regular exercise, preferably weight bearing, which help maintain good bone health (1, 5)
  • Balance training reduces the risk of falling (1)
  • Exercises that increase muscular strength and improve balance may be the most beneficial (5)
  • Exercise improve bone mineral density of the lumbar spine. There is however uncertainty about the recommended dose, frequency and type of activity (1)
  • Exercise reduces the risk of (osteoporotic) fractures (5)
  • Prevention: Regular exercise plays a role in prevention of osteoporosis in people over 65 years of age, improving BMD of the lumbar spine and hip (2) 
  • Excessive exercise in premenopausal women may cause amenorrhea and weight loss leading to osteoporosis (5)


  • Smoking cessation reduces the risk of fractures (3)
  • Smoking one pack of cigarettes per day throughout life is associated with 5-10% reduction in bone density (5)
  • Smoking may also reduce the effectiveness of estrogen therapy (5)


  • Maintaining optimal body weight (3)


  • Recommended intake of calcium: 1000mg/day (men) and 1200mg (women). Vitamin D: 800-1000 IU/day (2, 5). Higher vitamin D doses in some people may be necessary (2)
  • A diet high in high in fruit and vegetables, fish, poultry and whole grains reduces the risk of low BMD and hip fractures (3)
  • A typical western dietary pattern high in processed and red meat, animal fat, refined sugar and soft drinks may increase the risk of low BMD and hip fractures (3)
  • A vegan diet is associated with increased risk of fractures (3)


1) https://bestpractice.bmj.com/topics/en-gb/85/management-approach

2) https://bestpractice.bmj.com/topics/en-gb/85/prevention

3) https://www.nogg.org.uk/full-guideline/section-5-non-pharmacological-management-osteoporosis

4) https://www.sciencedirect.com/science/article/abs/pii/S0376871619300584

5) https://www.uptodate.com/contents/overview-of-the-management-of-osteoporosis-in-postmenopausal-women

6) https://www.uptodate.com/contents/calcium-and-vitamin-d-supplementation-in-osteoporosis


Calcium intake calculator


Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font