L'ostéoporose est un T-score de densité osseuse de -2,5 ou moins, et la fracture est le préjudice : une hanche, une vertèbre ou un poignet qui cède lors d'une chute de sa propre hauteur ou moins. La plupart de ce qui réduit ce risque, vous pouvez le faire vous-même.
L'entraînement intense en résistance et à impact construit l'os, l'entraînement de l'équilibre prévient les chutes qui brisent les hanches, et un apport suffisant en protéines, en calcium et en vitamine D vient surtout de l'assiette. Quand la densité est basse ou qu'un os s'est déjà brisé, le médicament réduit bien les fractures, ajouté par-dessus les bases pour les personnes dont le risque est assez élevé pour le justifier.
Practice Ranking
Every practice we track for Osteoporosis: keeping bone strong, ranked by how well the evidence supports it for this condition. Strength describes the evidence, not our endorsement.
7 practices · 2 to start with
| # | Practice | Evidence | Type | Cost | Effort | Results In | Add to plan |
|---|---|---|---|---|---|---|---|
| 1 | Balance and Fall Prevention: The Strongest Lever, and the Causes That Are Not in Your Legs Most fractures come from a fall, so balance and strength training prevents the break as directly as bone density does. | Strong | Self-Directed | Free | Easy to Moderate | Weeks to Months | |
| 2 | Resistance Training: What It Does, the Low Dose That Works, and How to Start Heavy resistance and impact loading is the lever that actually builds bone; gentle, low-load movement does not. | Moderate | Self-Directed | Free to $$ | Moderate to Hard | Weeks to Months | |
| 3 | Protein and Muscle: the dose, the sources, and building it Eating more protein slightly helps spine density and, contrary to old worries, does not weaken bone. | Moderate | Self-Directed | $ to $$ | Easy to Moderate | Weeks to Months | |
| 4 | Quitting Smoking: What It Does to the Body and the Methods That Actually Work Smoking weakens bone; quitting slows the loss, a reduce-lever alongside alcohol. | Moderate | Pro | Free to $$ | Hard | Days to Longer | |
| 5 | Vitamin D Calcium and vitamin D help most in people who are genuinely deficient or in care; they add little for the already-replete, and very large single doses backfire. | Moderate | Supplement | $ | Easy | Weeks to Months | |
| 6 | Reduce Alcohol and Your Health: What the Evidence Shows Now Heavier drinking raises fracture risk, so cutting back is a protective lever for bone. | Moderate | Self-Directed | Free | Moderate to Hard | Weeks to Months | |
| 7 | Vitamin K2 Vitamin K2 slowed bone loss in one trial of healthy postmenopausal women, on early evidence. | Preliminary | Supplement | $ | Easy | Months to Longer | |
Default order puts the best-supported practices first, with self-directed care ahead of clinical options. Click any row to open the practice.
What It Is
Most fragility fractures happen to people whose scan reads osteopenia, the range between a T-score of -1.0 and -2.5. Far more people fall in that range than in osteoporosis itself, so that is where most fractures come from. A borderline scan is no reason to relax.
Osteoporosis is bone thinned and weakened until it breaks easily, diagnosed on a bone-density scan called a DXA that reports a T-score. The T-score compares your bone density to that of a healthy young adult, measured in standard deviations, how many steps below (or above) that benchmark you are. A reading of -2.5 or below is osteoporosis. The score is only an estimate of risk.
The harm is the fragility fracture: a hip, spine or wrist that gives way from a fall at standing height or less. A tool called FRAX turns your age, sex, weight and a few risk factors into a ten-year estimate of fracture risk. That estimate, not the raw T-score, is what decides whether medication is worth starting.
Bone loss runs higher in several groups:
- In women after menopause, when bone loss speeds up.
- Older men, who fracture too and are treated for it less often.
- Long-term oral steroids, which thin bone fast.
- Early menopause, low body weight, heavy smoking or drinking, celiac disease or an overactive thyroid.
A first fragility fracture is the strongest signal of all, because the risk of the next is highest in the 1–2 years after it.
What Works
The steps are ordered by effort and cost: the free, lasting ones first and medication after. Each carries its own evidence grade. Loading and balance lead because they are free, and they build strength no drug restores. The lifting has to be heavy and progressive to raise density; easy walking on its own helps general health without loading bone hard enough to build it. Balance training earns its place by preventing the falls where most hip and wrist fractures happen. Standing balance work, tai chi or a strength-and-balance class cuts the rate of those falls by about a quarter.
Protein, calcium and vitamin D come mostly from the plate. Calcium comes from milk, yogurt, canned fish with bones, tofu set with calcium and leafy greens. The trials mark where a supplement adds something:
- Calcium and vitamin D together cut fractures in older adults who are short of both.
- Vitamin D alone, in people who already have enough, did not lower fractures.
- Vitamin K2 sits as a supporting supplement, not a treatment.
Medication is added on top of loading, balance work and food when density is low with a high FRAX estimate or a bone has already broken. The drugs cut fractures well, some by half or more.
- Bisphosphonates are the usual first choice, cheap and well proven. A once-a-year zoledronic acid infusion is the alternative for someone who struggles with weekly tablets, and it suits the weeks right after a hip fracture.
- Denosumab is used when risk is higher.
- The bone-building drugs, teriparatide and romosozumab, are for very high risk or several spine fractures, each followed by a bisphosphonate or denosumab to hold the gain. Romosozumab is avoided soon after a heart attack or stroke.
- Raloxifene fits a woman whose risk sits mainly in the spine, since it does not protect the hip, and it lowers breast-cancer risk.
- Menopausal hormone therapy is chosen mainly by women already taking it for menopausal symptoms; the bone protection comes as a bonus.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Balance And Falls
L'exercice d'équilibre et de force a réduit le taux de chutes d'environ un quart
Dans de nombreux essais menés chez des personnes âgées, l'exercice entraînant l'équilibre et la force a réduit le taux de chutes d'environ un quart, et comme la plupart des fractures de la hanche et du poignet surviennent lors d'une chute, cela réduit le risque de fracture par un autre biais.
Une revue Cochrane portant sur 108 essais randomisés et 23,407 personnes âgées vivant à domicile a montré que l'exercice réduisait le taux de chutes de 23 % (rapport de taux 0.77, IC à 95 % 0.71 à 0.83 ; 59 études), preuves de haute certitude. Les programmes fondés sur l'équilibre et l'exercice fonctionnel étaient à l'origine de l'effet (rapport de taux 0.76), tandis que les programmes à composantes multiples et le Tai Chi aidaient également. L'exercice pourrait aussi réduire les fractures liées aux chutes (risque relatif 0.73), bien que cette estimation soit de faible certitude. Measured in: 23,407 community-dwelling adults aged 60+ across 108 randomized trials in 25 countries; on average 76 years old and 77% women. Le résultat solide concerne les chutes elles-mêmes ; l'effet sur les fractures spécifiquement n'est que de faible certitude car beaucoup moins d'essais ont suivi les fractures, et la plupart des essais présentaient un risque de biais incertain ou élevé sur au moins un critère.
The study · 1
Sherrington et al., exercise for preventing falls in older people living in the community · Cochrane Database Syst Rev 2019;1:CD012424
Bone Density
Le calcium associé à la vitamine D n'a pas clairement réduit les fractures de la hanche chez des femmes âgées non sélectionnées
Dans un très vaste essai mené chez des femmes âgées non sélectionnées pour une faible densité osseuse ou de faibles taux vitaminiques, un comprimé standard de calcium et vitamine D n'a pas clairement réduit les fractures de la hanche dans l'ensemble et a légèrement augmenté le risque de calculs rénaux, bien qu'il ait aidé les femmes le prenant de façon fiable.
Dans l'étude Women's Health Initiative, 36,282 femmes ménopausées ont été randomisées vers 1,000 mg de calcium plus 400 UI de vitamine D par jour, ou un placebo. La densité osseuse de la hanche était supérieure de 1.06 % avec la supplémentation, mais la fracture de la hanche n'a pas été significativement réduite dans l'ensemble (rapport de risque 0.88, IC à 95 % 0.72 à 1.08). Chez les femmes ayant effectivement pris leurs comprimés, la fracture de la hanche a diminué significativement (rapport de risque 0.71), et la supplémentation a augmenté le risque de calculs rénaux (rapport de risque 1.17). Measured in: 36,282 generally healthy postmenopausal women aged 50 to 79, not selected for low calcium, low vitamin D or osteoporosis. L'observance était incomplète, la dose de vitamine D (400 UI) est faible selon les normes actuelles, et le bénéfice significatif sur les fractures de la hanche n'est apparu que dans le sous-groupe per-protocole, et non dans la population en intention de traiter ; le risque de calculs rénaux a augmenté.
Who this may not transfer to:Conducted entirely in postmenopausal women. The null overall result reflects an unselected, largely replete population and cannot be read as the effect in men or in people who are genuinely deficient.
The study · 1
Jackson et al., calcium plus vitamin D supplementation and the risk of fractures (Women's Health Initiative) · N Engl J Med 2006;354(7):669-683
La vitamine D seule n'a pas réduit les fractures chez des adultes non carencés
L'administration de vitamine D à des adultes âgés en bonne santé qui n'en manquaient pas n'a pas réduit les fractures osseuses, quel que soit leur type, sur environ cinq ans.
Dans l'essai ancillaire osseux VITAL, 25,871 adultes globalement en bonne santé ont été randomisés vers 2,000 UI/jour de vitamine D3 ou un placebo, et n'étaient pas sélectionnés pour une carence en vitamine D, une faible masse osseuse ou une ostéoporose. Sur une durée médiane de 5.3 ans, la vitamine D n'a pas modifié significativement les fractures totales (rapport de risque 0.98), les fractures non vertébrales (0.97) ni les fractures de la hanche (1.01), sans bénéfice dans aucun sous-groupe de départ, y compris chez les personnes ayant des taux de vitamine D plus bas. Measured in: 25,871 US adults, men 50+ and women 55+, generally healthy and not selected for deficiency or low bone mass; about 51% women. L'essai n'a délibérément pas recruté de personnes carencées en vitamine D ou ostéoporotiques ; il renseigne donc sur la supplémentation systématique chez des personnes déjà suffisamment pourvues, et non sur la correction d'une véritable carence, où la vitamine D reste importante.
The study · 1
LeBoff et al., supplemental vitamin D and incident fractures in midlife and older adults (VITAL) · N Engl J Med 2022;387(4):299-309
Alendronate cut new spine fractures roughly in half in women with a prior fracture
In women who had already broken a bone in the spine, three years of the bisphosphonate alendronate cut new spine fractures roughly in half and about halved hip fractures.
In the Fracture Intervention Trial, 2,027 postmenopausal women with an existing vertebral fracture were randomized to alendronate or placebo for 36 months. New morphometric vertebral fractures occurred in 8.0% on alendronate versus 15.0% on placebo (relative risk 0.53), clinically apparent vertebral fractures in 2.3% versus 5.0% (relative hazard 0.45), and hip fractures were about halved (relative hazard 0.49, 95% CI 0.23 to 0.99). Measured in: 2,027 postmenopausal women aged 55 to 81 with low femoral-neck bone density and at least one existing vertebral fracture. This trial was in women with an existing vertebral fracture, the group at highest risk, so the absolute benefit is largest there; the effect is smaller in people with low density but no prior fracture.
Who this may not transfer to:Tested in postmenopausal women with prior vertebral fracture; bisphosphonates also reduce fractures in men with osteoporosis in separate trials, but the figures here are women's.
The study · 1
Black et al., randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures (Fracture Intervention Trial) · Lancet 1996;348(9041):1535-1541
Denosumab cut new spine fractures by more than two-thirds and hip fractures by 40%
A twice-yearly injection of denosumab cut new spine fractures by more than two-thirds and hip fractures by 40% over three years in women with osteoporosis.
In the FREEDOM trial, 7,868 postmenopausal women with osteoporosis were randomized to denosumab 60 mg or placebo subcutaneously every 6 months for 36 months. Denosumab cut new vertebral fractures to 2.3% versus 7.2% (relative decrease 68%), hip fractures to 0.7% versus 1.2% (40% decrease) and nonvertebral fractures to 6.5% versus 8.0% (20% decrease), with no excess of cancer, infection or osteonecrosis of the jaw over three years. Measured in: 7,868 women aged 60 to 90 with a bone-density T-score between -2.5 and -4.0 at the spine or hip. The clean three-year safety picture does not cover what happens on stopping: bone turnover and fracture risk rebound quickly after denosumab is discontinued, so it is a treatment that has to be continued or handed over to another drug.
Who this may not transfer to:The pivotal fracture trial was in postmenopausal women; denosumab is also used to increase bone density in men, but the fracture figures here are women's.
The study · 1
Cummings et al., denosumab for prevention of fractures in postmenopausal women with osteoporosis (FREEDOM) · N Engl J Med 2009;361(8):756-765
Teriparatide cut new spine fractures by about 65% and built spine density
A daily injection of the bone-building drug teriparatide cut new spine fractures by about 65% and other fragility fractures by about half in women who had already fractured, and built spine density substantially.
In the Fracture Prevention Trial, 1,637 postmenopausal women with prior vertebral fractures received daily self-injected parathyroid hormone (1-34), teriparatide, at 20 or 40 micrograms or placebo for a median 21 months. New vertebral fractures occurred in 5% (20 microgram) versus 14% on placebo (relative risk 0.35), and new nonvertebral fragility fractures in 3% versus 6% (relative risk 0.47). Spine bone density rose 9 to 13 percentage points more than placebo. Side effects were minor. Measured in: 1,637 postmenopausal women with at least one prior vertebral fracture. Teriparatide builds bone but is given for a limited course (typically up to two years) and its gains fade unless followed by an antiresorptive drug; the trial was stopped early, so long-term fracture data from it are limited.
Who this may not transfer to:The pivotal fracture trial enrolled women only; teriparatide is also approved to raise bone density in men, but the fracture figures here are women's.
The study · 1
Neer et al., effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis · N Engl J Med 2001;344(19):1434-1441
Le romosozumab a réduit les nouvelles fractures vertébrales d'environ trois quarts en un an
Le médicament osseux romosozumab a réduit les nouvelles fractures vertébrales d'environ trois quarts lors de sa première année par rapport au placebo, et d'environ moitié par rapport à un bisphosphonate chez les femmes à risque plus élevé, bien qu'il ait été associé à un léger excès d'événements cardiaques sérieux.
Dans l'essai FRAME, 7,180 femmes ménopausées atteintes d'ostéoporose ont reçu du romosozumab ou un placebo par voie mensuelle pendant 12 mois, puis du dénosumab dans les deux groupes. De nouvelles fractures vertébrales sont survenues chez 0.5 % des femmes sous romosozumab contre 1.8 % sous placebo à 12 mois, soit un risque inférieur de 73 %. Dans l'essai séparé ARCH chez des femmes à risque plus élevé, le romosozumab suivi d'alendronate a réduit les nouvelles fractures vertébrales de 48 % par rapport à l'alendronate seul, mais les événements indésirables cardiovasculaires sérieux étaient plus fréquents pendant l'année de romosozumab (2.5 % contre 1.9 %). Measured in: 7,180 postmenopausal women with osteoporosis in FRAME; 4,093 higher-risk women with a fragility fracture in ARCH. Le signal cardiovasculaire observé dans ARCH signifie que le romosozumab est généralement évité chez les personnes ayant récemment subi un infarctus ou un AVC ; il s'agit d'une cure de 12 mois qui doit être suivie d'un médicament antirésorptif pour maintenir les gains.
Who this may not transfer to:Both pivotal trials were in postmenopausal women; romosozumab has since been studied in men, but the fracture and cardiovascular figures here are women's.
The studies · 2
Cosman et al., romosozumab treatment in postmenopausal women with osteoporosis (FRAME) · N Engl J Med 2016;375(16):1532-1543
Saag et al., romosozumab or alendronate for fracture prevention in women with osteoporosis (ARCH) · N Engl J Med 2017;377(15):1417-1427
Le traitement hormonal de la ménopause a réduit les fractures totales d'environ un quart et les fractures de la hanche d'un tiers
Le traitement hormonal de la ménopause a réduit les fractures totales d'environ un quart et les fractures de la hanche d'environ un tiers dans un vaste essai, la preuve la plus claire concernant les fractures dans une population générale de femmes.
Dans l'étude Women's Health Initiative, 16,608 femmes ménopausées ont été randomisées vers des estrogènes équins conjugués plus médroxyprogestérone ou un placebo. Des fractures ostéoporotiques totales sont survenues chez 8.6 % contre 11.1 % (rapport de risque 0.76), les fractures de la hanche ont été réduites d'environ un tiers, et la densité osseuse totale de la hanche a augmenté de 3.7 % sur trois ans contre 0.14 % sous placebo. Le bénéfice sur les fractures s'est maintenu dans tous les sous-groupes de risque. Measured in: 16,608 postmenopausal women aged 50 to 79 with an intact uterus. Le même essai a trouvé un excès de cancers du sein, d'AVC, de caillots sanguins et, dans ce bras, d'événements coronariens, de sorte que l'équilibre global signifie que le traitement hormonal est choisi principalement pour les femmes le prenant pour des symptômes ménopausiques, la protection osseuse étant un bénéfice supplémentaire, et non la raison principale.
The study · 1
Cauley et al., effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial · JAMA 2003;290(13):1729-1738
Une perfusion annuelle d'acide zolédronique après une fracture de la hanche a réduit les nouvelles fractures de 35 % et les décès de 28 %
Chez les personnes qui venaient de se fracturer la hanche, une perfusion annuelle d'acide zolédronique a réduit le risque d'une nouvelle fracture d'environ un tiers au cours des deux années suivantes, et moins d'entre elles sont décédées. Elle est administrée sous forme de perfusion annuelle, ce qui convient aux personnes ayant des difficultés avec les comprimés hebdomadaires de bisphosphonates.
Dans l'essai HORIZON Recurrent Fracture Trial, 2,127 patients (âge moyen 74.5 ans) ayant récemment subi une réparation chirurgicale d'une fracture de la hanche par traumatisme faible ont été randomisés pour recevoir une perfusion intraveineuse annuelle de 5 mg d'acide zolédronique ou un placebo, et suivis pendant une médiane de 1.9 an. Les nouvelles fractures cliniques sont tombées à 8.6 % avec l'acide zolédronique contre 13.9 % avec le placebo, soit une réduction relative de 35 % (P = 0.001), avec moins de fractures vertébrales cliniques (1.7 % contre 3.8 %, P = 0.02) et non vertébrales (7.6 % contre 10.7 %, P = 0.03). La mortalité toutes causes confondues est tombée à 9.6 % contre 13.3 %, soit une réduction relative de 28 % (P = 0.01). Measured in: 2,127 women and men (mean age 74.5) who had undergone surgical repair of a low-trauma hip fracture within the previous 90 days, from 23 countries. L'essai a recruté des personnes juste après une fracture de la hanche, le moment de risque le plus élevé, de sorte que l'ampleur du bénéfice est probablement moindre chez une personne à faible densité osseuse qui n'a pas encore subi de fracture. La première perfusion peut entraîner une brève réaction pseudo-grippale dans les jours suivants, et cette classe comporte les rares précautions concernant la mâchoire et les fractures atypiques du fémur abordées ailleurs sur la page.
Who this may not transfer to:One of the few large fracture-drug trials to enrol both women and men, so its finding carries to older men after a hip fracture, not women only. The lower death rate is specific to the post-hip-fracture setting and should not be read as a general longevity effect of the drug.
The study · 1
Lyles et al., zoledronic acid and clinical fractures and mortality after hip fracture · N Engl J Med 2007;357(18):1799-1809
Le raloxifène a réduit les nouvelles fractures vertébrales d'environ 30 % à 50 % sur trois ans
Le raloxifène, un médicament qui agit comme l'œstrogène sur l'os mais pas sur le sein, a réduit le risque de nouvelle fracture vertébrale d'environ un tiers à la moitié sur trois ans chez des femmes atteintes d'ostéoporose. Il n'a pas diminué les fractures ailleurs, comme à la hanche, il convient donc à une femme dont le risque se situe principalement au niveau vertébral, et il abaisse le risque de cancer du sein dans le cadre de son profil.
Dans l'essai Multiple Outcomes of Raloxifene Evaluation (MORE), 7,705 femmes ménopausées atteintes d'ostéoporose ont été randomisées pour recevoir raloxifène 60 mg/jour, 120 mg/jour, ou placebo pendant trois ans. De nouvelles fractures vertébrales sont survenues chez 10.1 % sous placebo contre 6.6 % sous 60 mg (risque relatif 0.7, IC à 95 % 0.5 à 0.8) et 5.4 % sous 120 mg (risque relatif 0.5, IC à 95 % 0.4 à 0.7). Les fractures non vertébrales n'ont pas été significativement réduites (risque relatif 0.9, IC à 95 % 0.8 à 1.1). Measured in: 7,705 postmenopausal women (mean age 66) with osteoporosis, across 25 countries. Le bénéfice net ne concerne que les fractures vertébrales ; il n'a pas réduit les fractures de la hanche ou d'autres fractures non vertébrales, il n'est donc pas le choix lorsque la protection de la hanche est l'objectif principal. Le raloxifène augmente le risque de caillots veineux et peut aggraver les bouffées de chaleur, ce qui est pris en compte lors du choix.
Who this may not transfer to:Tested only in postmenopausal women; raloxifene is a selective estrogen receptor modulator and is not used for bone in men. The spine-only benefit means it does not stand in for a drug that also protects the hip.
The study · 1
Ettinger et al., reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial (MORE) · JAMA 1999;282(7):637-645
Un entraînement lourd en résistance et en impact a fait gagner environ 2.9 % de densité au rachis, tandis que l'exercice doux en a fait perdre
Des femmes âgées ayant une faible densité osseuse qui ont soulevé des charges lourdes et pratiqué des exercices à impact deux fois par semaine pendant huit mois ont gagné environ 3 % de densité osseuse au niveau du rachis, tandis qu'un groupe pratiquant des exercices doux à domicile en a perdu, et l'entraînement lourd n'a provoqué presque aucune blessure.
Dans l'essai LIFTMOR, 101 femmes ménopausées ayant une faible masse osseuse ont été randomisées vers 8 mois d'entraînement en résistance et en impact de haute intensité, supervisé, deux fois par semaine (5 séries de 5 répétitions au-delà de 85 % de la charge maximale sur une répétition) ou vers un programme de faible intensité à domicile. Le groupe entraînement a gagné 2.9 % de DMO lombaire contre une perte de 1.2 % chez les témoins, et a gagné en DMO du col fémoral (0.3 % contre -1.9 %), en taille et sur toutes les mesures de performance fonctionnelle. L'observance était élevée et un seul événement indésirable mineur (un spasme du bas du dos) a été rapporté. Measured in: 101 postmenopausal women (mean age 65) with osteopenia or osteoporosis (T-score below -1.0), screened to exclude conditions and drugs affecting bone. Un seul essai de 8 mois portant sur 101 femmes, toutes sous surveillance étroite d'un personnel formé ; la sécurité et les gains ne peuvent pas être présumés pour un entraînement lourd non supervisé, et l'essai a mesuré la densité osseuse et la fonction, et non les fractures réelles.
Who this may not transfer to:Tested only in postmenopausal women with low bone mass. The osteogenic response to heavy loading is expected in men too on general physiology, but this trial did not enrol men, so the size of the effect in men is not established here.
The study · 1
Watson et al., high-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial · J Bone Miner Res 2018;33(2):211-220
Un apport alimentaire accru en protéines a légèrement augmenté la densité osseuse au rachis et n'a pas nui à l'os
Une consommation accrue de protéines a été associée à un léger gain de densité osseuse au rachis et à l'absence de dommage osseux, ce qui contredit l'ancienne crainte que les protéines ne fassent perdre du calcium à l'os.
Une revue systématique de la National Osteoporosis Foundation (16 essais randomisés contrôlés, 20 études de cohorte) a trouvé des preuves modérées qu'un apport en protéines plus élevé, par rapport à un apport plus faible, avait un léger effet protecteur sur la DMO lombaire (variation nette +0.52 %, IC à 95 % 0.06 à 0.97), sans effet sur la DMO totale de la hanche, du col fémoral ou du corps entier, et sans effet indésirable sur l'os. Les preuves concernant les protéines associées au calcium et à la vitamine D sur les fractures étaient limitées ou insuffisantes. Measured in: Adults across 16 randomized trials and 20 prospective cohorts of dietary protein and bone outcomes. Le gain de DMO est faible et limité au rachis, les études étaient hétérogènes avec des facteurs de confusion possibles, et les preuves étaient insuffisantes pour montrer qu'un apport plus élevé en protéines réduit les fractures.
The study · 1
Shams-White et al., dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation · Am J Clin Nutr 2017;105(6):1528-1543
Le calcium associé à la vitamine D a réduit les fractures totales d'environ 15 % et les fractures de la hanche d'environ 30 %
La prise combinée de calcium et de vitamine D a réduit d'environ 15 % le risque de fracture osseuse toutes localisations confondues, et d'environ 30 % le risque de fracture de la hanche, chez les personnes âgées.
Une méta-analyse de 8 essais randomisés (30,970 participants) a montré que la supplémentation en calcium et vitamine D réduisait les fractures totales de 15 % (risque relatif sommaire 0.85, IC à 95 % 0.73 à 0.98) et les fractures de la hanche de 30 % (0.70, IC à 95 % 0.56 à 0.87). Le bénéfice était le plus constant chez les adultes âgés vivant à domicile et en institution. Measured in: 30,970 mostly older adults across 8 randomized trials of calcium plus vitamin D versus placebo. L'estimation groupée repose largement sur une analyse de sous-groupe du vaste essai Women's Health Initiative, et le bénéfice est le plus net chez les personnes en déficit de calcium ou de vitamine D, et non chez celles déjà suffisamment pourvues.
The study · 1
Weaver et al., calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation · Osteoporos Int 2016;27(1):367-376
Smoking is behind roughly one hip fracture in eight
Smokers lose bone faster after menopause and end up with a clearly higher chance of breaking a hip; roughly one hip fracture in eight is put down to smoking.
A meta-analysis of bone-density data in 2,156 smokers and 9,705 non-smokers, plus 19 cohort and case-control studies recording 3,889 hip fractures, found that postmenopausal bone loss was greater in smokers, with density falling about 2% more per decade of age and a 6% deficit by age 80. The estimated cumulative hip-fracture risk to age 85 was 19% in smokers versus 12% in non-smokers, and about one hip fracture in eight was attributed to smoking. Measured in: Postmenopausal women across pooled bone-density and hip-fracture studies; limited data in men suggested a similar proportional effect. The association was not explained by smokers being thinner, younger at menopause or less active, but as observational data it cannot fully exclude other lifestyle differences that travel with smoking.
Who this may not transfer to:The pooled estimates are from women; the authors noted limited data in men suggesting a similar proportional effect, but the hip-fracture figures here are women's.
The study · 1
Law and Hackshaw, a meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect · BMJ 1997;315(7112):841-846
Drinking more than two a day was tied to about 40% more hip fractures
Very light drinking was tied to slightly fewer hip fractures, but drinking more than two a day was tied to about 40% more, so the risk rises once intake is regular and heavier.
A systematic review pooling alcohol and bone outcomes found a U-shaped pattern for hip fracture: compared with abstainers, people drinking more than 0.5 to 1.0 drinks a day had a lower hip-fracture risk (relative risk 0.80, 95% CI 0.71 to 0.91), while those drinking more than 2 drinks a day had a higher risk (relative risk 1.39, 95% CI 1.08 to 1.79). Femoral-neck bone density rose roughly linearly with alcohol intake. Measured in: Adults across the pooled observational studies of alcohol, hip fracture and bone density. The data are observational, so unmeasured differences between drinkers and abstainers may explain part of the pattern, and many studies combined moderate and heavy drinkers so the exact beneficial range could not be pinned down.
The study · 1
Berg et al., association between alcohol consumption and both osteoporotic fracture and bone density · Am J Med 2008;121(5):406-418
Une très grande dose annuelle unique de vitamine D a augmenté les chutes de 15 % et les fractures de 26 %
Administrer aux femmes âgées une très grande dose unique de vitamine D une fois par an a entraîné environ 15 % de chutes supplémentaires et 26 % de fractures supplémentaires, et non moins, l'excès de chutes se concentrant dans les mois suivant immédiatement la dose. L'objectif est un apport régulier et modéré de vitamine D pour corriger une carence ; de grandes méga-doses peu fréquentes peuvent jouer contre vous.
Dans un essai en double aveugle, 2,256 femmes vivant en communauté, âgées de 70 ans ou plus, à haut risque de fracture, ont été randomisées pour recevoir une dose orale unique de 500,000 UI de vitamine D une fois par an ou un placebo pendant trois à cinq ans. Le groupe vitamine D a chuté plus souvent (taux de 83.4 contre 72.7 chutes pour 100 personnes-années ; risque relatif 1.15, IC à 95 % 1.02 à 1.30) et a eu plus de fractures (171 contre 135 ; risque relatif 1.26, IC à 95 % 1.00 à 1.59), l'excès de chutes se concentrant dans les trois premiers mois suivant chaque dose. Measured in: 2,256 community-dwelling women aged 70 and older at high risk of fracture. Cette étude a testé un très grand bolus annuel unique ; elle ne remet pas en cause la correction d'une carence avérée avec une quantité quotidienne ou hebdomadaire ordinaire, là où réside le bénéfice de la vitamine D sur les fractures. La raison pour laquelle la méga-dose a augmenté les chutes n'est pas totalement établie.
Who this may not transfer to:Tested in older women given a single huge annual dose; the harm is about that mega-dose pattern and does not transfer to ordinary daily or weekly dosing in either sex.
The study · 1
Sanders et al., annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial · JAMA 2010;303(18):1815-1822
La vitamine K2 (MK-7) a ralenti la perte osseuse du rachis et de la hanche chez des femmes ménopausées en bonne santé
Sur trois ans, un complément quotidien de vitamine K2 a ralenti la perte normale des os du rachis et de la hanche chez des femmes en bonne santé après la ménopause et a amélioré les mesures de résistance osseuse.
Dans un essai randomisé de 3 ans, 244 femmes ménopausées en bonne santé ont pris 180 microgrammes/jour de vitamine K2 (ménaquinone-7, MK-7) ou un placebo. La MK-7 a amélioré le statut en vitamine K et a significativement ralenti le déclin lié à l'âge de la densité osseuse au niveau du rachis lombaire et du col fémoral (mais pas de la hanche totale), amélioré les indices de résistance osseuse calculés et réduit la perte de hauteur vertébrale. Measured in: 244 healthy postmenopausal women (not selected for osteoporosis). Testée chez des femmes en bonne santé avec des os normaux, et non dans l'ostéoporose, dans un seul essai, et elle mesurait la densité et la résistance calculée, et non les fractures réelles, ce qui en fait un complément de soutien, et non un traitement.
Who this may not transfer to:Studied only in healthy postmenopausal women; the effect in men or in people with established osteoporosis has not been established here.
The study · 1
Knapen et al., three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women · Osteoporos Int 2013;24(9):2499-2507
Heart And Vascular
Calcium supplements without vitamin D were tied to about 30% more heart attacks
Le calcium pris en complément sans vitamine D a été associé à un risque de crise cardiaque environ 30 % plus élevé dans l'ensemble des essais regroupés, ce qui explique pourquoi les comprimés de calcium à forte dose ne sont plus recommandés de façon systématique.
Une méta-analyse de 15 essais randomisés contrôlés contre placebo portant sur des suppléments de calcium (au moins 500 mg/jour, sans vitamine D co-administrée) a trouvé un risque accru d'infarctus du myocarde : les données au niveau patient (8,151 personnes) donnaient un rapport de risque de 1.31 (IC à 95 % 1.02 à 1.67), et les données au niveau essai (11,921 personnes) un risque relatif de 1.27 (IC à 95 % 1.01 à 1.59). L'AVC et le décès ont montré des augmentations plus faibles, non significatives. Measured in: About 12,000 mostly older adults across 15 randomized trials of calcium supplements without vitamin D. The absolute increase is modest and the finding is disputed; some cardiovascular events came from self-report and hospital records, later analyzes have disagreed, and the signal was for calcium taken without vitamin D, not for dietary calcium.
The study · 1
Bolland et al., effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis · BMJ 2010;341:c3691
Denosumab is never simply stopped. Spine-fracture risk rebounds to untreated levels, and people can break several vertebrae at once. Any change is arranged with a prescriber and followed by another bone drug.
What To Do This Month
Most of keeping bone strong is steady, everyday work you lead yourself. Find out where you stand, then put the loading, balance and food in place, and treat medication as the earned next step when your risk warrants it.
Ask for a bone-density (DXA) scan and a FRAX ten-year fracture-risk estimate so any decision about medication rests on where you actually stand. If you have already broken a bone from a minor fall, say so, because that changes the picture on its own.
Progressive resistance, the squat, deadlift and overhead press, plus some impact such as jumping, hopping or brisk stepping within what your joints tolerate. Learn the lifts with a coach if they are new. This is the part that builds bone; easy walking on its own will not.
Standing balance work, tai chi or a strength-and-balance class lowers how often you fall, by roughly a quarter. Since most fractures happen in a fall, this is the other half of the job, and it costs nothing.
Aim for 1.0 to 1.2 grams of protein per kilogram of body weight a day and calcium from food. For vitamin D, an ordinary daily or weekly amount is the studied form; one very large annual dose raised falls and fractures. Keep alcohol under two a day and stop smoking.
If your risk is high or you have already fractured, a fracture-reducing drug is the earned next step on top of the basics, chosen with a prescriber for its cautions as much as its benefits. Denosumab especially is never dropped without a bridging drug lined up first.
Go Deeper
Heavy loading raises density, balance work prevents the falls that break bone, and protein feeds the muscle behind both. These are the free levers, and each stands on its own page:
- Heavy resistance training: how to load the skeleton hard enough to raise density, and how to start safely.
- Balance and fall prevention: the training that lowers fall rates, and how fewer falls mean fewer fractures.
- Protein: how much bone and muscle need, and where the old calcium-leaching fear went wrong.
The Chinese Medicine View
Chinese medicine has no bone-density scan and no word for osteoporosis. It reads the picture that comes with thinning bone in later life: aching low back and knees, loss of height and stoop, fatigue. Chinese medicine treats these as patterns rooted mostly in the Kidney. The classical line is that the Kidney governs the bones and generates marrow. The skeleton's strength is tied to Kidney essence, which declines with age.
As a description of how a person presents and ages, this lines up with the Western picture. As a measurement of bone density, it does not line up at all, and neither view proves the other.
The tradition does not always reach for warming Kidney tonics. A person running hot and dry, with night sweats and a red tongue, fits a Kidney Yin picture that calls for nourishing. Where digestion is weak the Spleen is supported first, since in this system the Spleen governs the muscles and the transformation of food into what builds bone. Herbs belong with a qualified practitioner who can match the formula to the pattern, since a tonic that suits one person can be wrong for the next.
The Chinese Medicine View
The patterns most often read behind thinning bone in later life, each with its signature and the direction it points treatment:
Low back and knee weakness and aching, a cold body and cold limbs, tiredness, frequent pale urination, a pale swollen tongue. The direction is to warm and tonify Kidney Yang and strengthen the bones. This is the pattern most often mapped onto age-related bone loss in a person who runs cold.
Aching weak low back and knees with heat signs: night sweats, warm palms and soles, a dry mouth, a red tongue with little coat. The direction is to nourish Kidney Yin and essence; warming is avoided here. It fits the drier, warmer presentation and often the years around and after menopause.
Poor appetite and digestion, loose stools, tiredness after eating, and easy loss of weight or muscle alongside the back and knee weakness. The direction is to strengthen the Spleen so food is transformed and to support the Kidney, since weak digestion is seen as leaving the bones short of what they need.
Cautions
Extra restraintEverything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Bisphosphonates prevent far more hip fractures than the rare thigh fractures they cause
Among 196,129 women aged 50+ taking bisphosphonates in the Kaiser Permanente Southern California system, 277 atypical femur fractures occurred, and the risk rose with longer duration of use and fell rapidly after stopping. In a risk-benefit model, over 3 years of use in White women, 149 hip fractures were prevented against 2 atypical fractures caused; the balance was less favorable in Asian women (91 prevented against 8 caused), who had higher atypical-fracture risk. Atypical femur fractures are rare in absolute terms and the net balance favors the drug for the first several years, but risk climbs with use beyond about 5 years, which is why prescribers reassess and sometimes pause treatment.Black et al., atypical femur fracture risk versus fragility fracture prevention with bisphosphonates
Stopping denosumab without a follow-on drug rebounds spine-fracture risk to untreated levels
A post hoc analysis of the FREEDOM trial and its extension examined 1,001 participants who stopped denosumab. The vertebral-fracture rate rose after discontinuation to the level of untreated participants, and among those who had any off-treatment vertebral fracture, the proportion with multiple (more than one) was higher after stopping denosumab (60.7%) than after stopping placebo (38.7%). Prior vertebral fracture raised the odds of multiple rebound fractures nearly fourfold. This is a post hoc analysis, not a trial designed around discontinuation, but the signal is consistent enough that guidelines now advise transitioning to a bisphosphonate rather than simply stopping.Cummings et al., vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension
Start slow, be smart, read the research, and consult a professional if you have any concerns. This is here to inform your choice, not make it for you.
When to See Someone
A few situations need a professional, and one is an emergency: sudden severe back pain with new leg weakness or loss of bladder or bowel control. These are the signs to get seen about:
- Sudden severe back pain together with new leg weakness or numbness, or any loss of bladder or bowel control, which can mean a spinal fracture pressing on nerves and needs emergency assessment(seek urgent care)
- A bone that breaks from a minor fall or knock, or from standing height, which is a fragility fracture and needs both treatment of the break and a proper bone-health review(seek urgent care)
- A widespread rash, blistering, facial swelling or peeling skin after starting any bone medication, which can be a serious reaction; stop and seek care(seek urgent care)
- New, unexplained back pain in an older adult, a noticeable loss of height, or a new stoop, any of which can be a spine fracture that happened without a dramatic injury
- A new, dull, aching pain in the thigh or groin while on a bisphosphonate or denosumab for several years, which can rarely signal an atypical thigh-bone fracture and is worth flagging promptly
- A tooth or jaw problem, or planned major dental surgery, while on these drugs, since jaw complications are rare but the timing of dental work is worth coordinating
- Being due to stop denosumab, which should never simply lapse; the protection reverses and spine fractures can rebound, so a follow-on drug is arranged first
- Bone loss with a possible driver behind it, such as long-term steroids, early menopause, an overactive thyroid, celiac disease or very low body weight, all of which change the plan and are worth investigating
None of this is meant to alarm you. Osteoporosis is one of the more workable conditions of aging: the loading and balance work that lower fracture risk are mostly yours to do, the medications cut fractures well when they are needed, and the main things to catch early are a fracture that has already happened and a spine fracture pressing on nerves. You can ask for a DXA scan and a FRAX estimate to see where you stand, and take any decision about medication to the person who prescribes it.
Common Questions
I have a low T-score. How worried should I be?
The T-score estimates risk; it does not measure damage already done. What matters more is your ten-year fracture risk. A FRAX estimate reads that from your age, weight and history alongside the scan. Ask for the FRAX number, then set it against how much loading, balance and food work you have in place.
What is the single most effective thing I can do?
Train the skeleton hard and train your balance. Heavy resistance and impact build bone; balance work trims the fall rate by about a quarter. Both are free. Get enough protein and correct any vitamin D shortfall alongside.
Do I need calcium and vitamin D pills?
Taken together, the two lower fractures in older adults deficient in both. Extra vitamin D given to people already replete did nothing for fractures. One very large annual dose of vitamin D raised falls and fractures. Calcium taken as pills without vitamin D has been tied to more heart attacks in some trials. Food is the first source of both.
Are the bone drugs safe, and when are they worth it?
Worth it when fracture risk is high or you have already had a fragility fracture. The rare thigh-bone and jaw complications are far outweighed by the hip fractures prevented over a few years. One rule stands apart: denosumab is not left to lapse, because spine fractures rebound, so a replacement drug is started first.
Is it safe to lift heavy weights if my bones are thin?
Yes, when the loading is progressive and supervised. In the LIFTMOR trial, postmenopausal women with low bone mass gained spine density with only one minor injury across the study. Avoiding all exercise costs you the one thing that builds bone. Learn the lifts with a coach, start where you are, and add load over time.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 21 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
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How confidently the research supports a claim. Strength describes the evidence, not our endorsement.