Everything your doctor doesn’t know and won’t tell you about osteoporosis

CAVEAT: Before starting any supplement, drug, or exercise program, talk to your doctor. Understand that the risks of inactivity are probably higher than the risks of exercise. I’m not your doctor. You assume any risks from taking or not taking the advice here.

If you're over 40, your peak bone density and mass are in the rear-view mirror. As we age, we all lose bone mass, unless we can manage to build it back up. Osteoporosis, which affects over 10 million Americans over 50, can lead to fractures that steal independence. According to Dr Doug Lucas:

• 50 percent of adults over 50 are at risk of a fracture.

• 50 percent of women and 25 percent of men will suffer a fracture from poor bone quality in their lifetime (I’ve had 10).

• Women have a higher chance of a fragility fracture than they do of heart attack, stroke, and breast cancer combined!

• 24 percent of people over 60 with a hip fracture die within 12 months.

• Independence is permanently lost for 50 percent of patients who fracture a hip.

I broke both hips in my early 50s. My bones are now far stronger than they were 20 years ago. I have learned how to build bone, and you can too.

In this article, I lay out what I think is the useful information about osteoporosis for most people. I make the case against drugs and for specific bone-building exercise, and I go through all the useful supplements. Then, I show a video on what does work — resistance and impact exercise, plus balance and stability exercises, supported by the right diet and supplements. You can do it, it’s not difficult, and it doesn’t take much time. If you don’t want to read about the drug issues, just skip to the exercise section at the end, it’s the most important.

This article should take you about 40 minutes to read and watch, and it should save many people at least one fracture later in life.

If you're interested in supplements, you'll find specific recommendations on my stack page. If you’re interested in a consultation, see my pricing page.

I have a special note about the AlgaeCal company at the very end.

What are bones?

If you're over 50, you should have an interest in maintaining bone density and mass, which means you should be planning to grow bone, because you are almost certainly light on bone in your hips and spine right now. That's why I recommend this book, The Osteoporosis Breakthrough, by Dr Doug Lucas, who explains everything more precisely but with more words than I can dedicate here. It’s actually a short, very readable book.

Bones are living tissues that constantly remodel, balancing the activity of cells that build bone (osteoblasts) and those that break it down (osteoclasts). Calcium provides rigidity, collagen provides flexibility. Together, they create a composite material stronger than either alone, like reinforced concrete (collagen as rebar, calcium as cement).

The human skeleton contains two primary bone types: cortical (compact) bone and trabecular (spongy) bone, each with distinct roles and traits.

Cortical bone, forming 80% of skeletal mass, is dense and strong, creating the hard outer layer of bones like the femur. It provides structural support and resists bending.

Trabecular bone, found inside bone ends (e.g., in vertebrae), is porous and lattice-like, making up 20% of bone mass. It supports marrow, aids shock absorption, and remodels faster (10–20% annually vs. cortical’s 2–5%).

Plus, your bones function as red-blood-cell factories to boot!

Approximately 10–20% of your skeleton is remodeled annually in adults, and your entire skeleton turns over in 7-10 years. Isn’t that amazing?

The process of building bone relies on nutrients like calcium, vitamin D, vitamin K, and collagen, which form the bone’s mineral and flexible matrix. However, the key driver of bone growth is mechanical stress—carrying weight and absorbing impacts. Soccer players have thicker, stronger bone in their lower kicking leg by about 20 percent. Tennis players have stronger bone in their hitting arm by 30-40 percent. Ancient tribal skeletons of our past relatives who paddled boats had huge shoulder capsules and arm bones from paddling, while people living in mountainous regions have stronger, thicker knees and ankles. The majority of people in wheelchairs for over five years have moderate to severe demineralization in their hips and spines, and more than 80 percent of people in wheelchairs after ten years have osteoporosis, regardless of age. Without stress, bones weaken, no matter how many supplements you take.

And bone mass disappears for women as soon as they start to lose estrogen from menopause:

Look at people in their 80s: look at their wrists. They are tiny. Why? No stress! If you want to keep it, you have to use it.

The bad news: running, tennis, cycling, swimming, even hiking and most other sports don't build your hips and spine. Yoga, pilates, and walking are about the same. Almost everyone over 40 is demineralized, and the hips, spines, and wrists are often the weakest links. No, you are not the exception, and no, mountain biking does not do it. If you row competitively, you probably are one of the few people with a strong spine and hips.

The key concept is that your body builds enough bone to meet the needs of your anticipated activities and no more. This is called Wolff’s law. Spend a year building up your legs with exercise and your body will happily build the bone needed to support that activity. Stop and your body will begin dismantling that bone within days. That's why demineralization is such a risk for astronauts, who train with big rubber bands daily in space, and why it's so dangerous for them to walk when they get back after a few months in a zero-gravity environment.

Now I’m going to cover supplements, drugs, diagnostics, estrogen, diet, and then exercise, fall prevention, vibration plates, and maintenance at the end.

Supplements

Calcium
Calcium is the main mineral in bone and the main supplement doctors prescribe. Studies, like a 2007 analysis in The Lancet, show that 500–1200 mg of calcium daily can slow bone loss in postmenopausal women by about 1% per year. Vitamin D, often paired with calcium, helps your body absorb it, reducing fracture risk in those with low levels. But here’s the catch: while calcium and vitamin D prevent further loss, they don’t significantly build new bone without exercise. If your DEXA scan shows a slight uptick after starting calcium, it’s likely because you’re losing less bone, not growing more.

The best kind of calcium to get is the calcium found in leafy green vegetables. That's why I recommend AlgaeCal Plus, which is made from algae, so it's essentially the same as getting your calcium directly from vegetables. AlgaeCal Plus gives you 360 IU of calcium in the morning and 360 IU at night, for a total of 720 IU of bioavailable calcium.

Do you need more than 720 IU of calcium? The answer is … we don’t know. Recommendations for vitamin D range from 800 to 40,000 IU per day! But it’s not how many units you take, it’s how much vitamin D is in your blood. So you need to test and adjust, and it’s probably different in summer vs winter. Peter Attia recommends 60-80 ng/mL. Others recommend around 30-40 ng/mL. The amount you need to take to achieve this depends very much on you and your lifestyle and where you live. On the other hand, Dr Brad Stanfield says we should be careful and that most recent studies show that there are dangers to getting too much vitamin D (but it takes years to do the damage, so don’t worry).

The Endocrine Society recently lowered their recommendations to 600 IU daily for people 50-70 and 800 IU daily for those over 70. Clearly, we need more and better research.

The way I think of it now is that it makes sense to get the basic 800 IU that comes with AlgaeCal Plus and then supplement to hit a blood-level target. Some people are naturally low and need more. Some people get a lot of vitamin D from their diet, while others don’t. If you’re outside all summer, you may want a supplement during winter, or you may have enough from the 800 IU in AlgaeCal Plus. To do it right, you need a blood test in about January. Generally, if you’re not deficient in vitamin D, you probably don’t need to supplement very much. But the jury is still out.

Magnesium
Magnesium has so many benefits, and the negative effects of not enough magnesium are so bad that most athletes and bodybuilders now take magnesium. But it also plays a critical role in bone building. It stimulates the activity of osteoblasts and enzymes from the phosphatase group, which are involved in the bone formation process. Most good calcium supplements, like AlgaeCal Plus, come with magnesium.

There are actually eight kinds of magnesium. Optimal to support muscle growth are magnesium citrate and glycenate or bisglycenate. The recommended daily allowances (RDA) for magnesium are:

• 400-420 mg. per day for men 19-51 years of age

• 310-320 mg. per day for women 19-51 years of age

• 350-360 mg. per day for pregnant women

• Adults over 51 should aim for the upper limit of the recommended range for their gender

Split doses (e.g., morning and evening) to improve absorption. You could take a citrate in the morning and then a glycinate at night, which aids sleep, enhancing recovery.

Calcium and heart disease?
Calcium supplements may contribute to arterial plaque buildup, potentially increasing heart disease risk, but the evidence is conflicting. A 2010 study in BMJ found that taking calcium supplements without vitamin D raised the risk of heart attack, possibly because high doses cause calcium to deposit in arteries. However, a 2016 study in the Journal of the American Heart Association showed no clear link between calcium supplements and artery calcification in women over several years. Dietary calcium from food seems safer than supplements, and risks may vary based on dose and vitamin D use.

More research is needed, but for now I believe the researchers who say taking the amount of calcium you get in your daily dose of AlgaeCal Plus is not a cardiovascular risk, as long as you’re also getting enough K2 (see below).

Kidney stones
Calcium supplements can help keep your bones strong, but they might also raise your risk of kidney stones, those razor-sharp little crystals that form in your kidneys. A study from the 1990s showed that eating calcium-rich foods cut kidney stone risk in half for men, because the calcium binds with oxalates and prevents them from reaching the kidneys. But a 2006 study found that taking 1000 mg of calcium supplements daily increased stone risk by about one-fifth in older women, especially if taken on an empty stomach.

The key is how you take supplements. Taking high doses of calcium without food or water can spike calcium levels in your urine, making stones more likely. To stay safe, stick to 400 mg or less per dose, take it with meals, and drink plenty of water—8 to 10 cups a day. Food sources are your best bet for calcium, but if you need supplements, talk to your doctor, especially if you’ve had kidney stones before.

Know your list of foods high in oxalates. When you eat these foods, be sure to take a calcium supplement at the same time, so they bind together in your stomach and don't go into your bloodstream. Otherwise, the oxalates can make their way to your kidneys and wait there for the calcium ions needed to build a stone.

Collagen
Collagen supplements are popular for skin, nails, hair, and joint health. Collagen is a peptide (a kind of protein complex) harvested from cow, chicken, and fish bones, and chicken eggs. Does collagen also help build bone? Collagen forms the flexible framework of bones, but evidence for bone benefits from supplements is thin. Collagen supplements probably help joints rebuild, and it can’t hurt for building bone. But if you skip the collagen and just take AlgaeCal Plus, you probably won’t be at a disadvantage. I tell my clients that if you have joint pain, or if it helps your hair and nails, take collagen.

It’s possible that taking collagen is helping you build some small amount of bone or making your bones more resilient. You’d never be able to see the difference on a DEXA scan, or even a REMS scan. If you’re a big strong person who’s lifting heavy, you can take it or leave it. But if you’re on the skinny side or getting more frail, it can’t hurt to get your daily collagen. I take mine every day, because I do notice a difference in my joints.

Vitamin D
Vitamin D is like a key that unlocks your body’s ability to build strong bones. It helps your gut absorb calcium and ensures calcium gets deposited into your skeleton to form hard, healthy bone tissue. Without enough vitamin D, even a calcium-rich diet won’t fully protect your bones, leading to weak bones or conditions like osteoporosis.

But more isn’t always better. Recent research, like a 2023 study in JAMA Network Open, warns that taking too much vitamin D (over 4000 IU daily) can cause problems, such as high blood calcium levels, which may harm your heart, kidneys, or even weaken bones. To stay safe, aim for 800–2000 IU daily from food (like salmon or fortified milk), sunlight, or supplements, and check with your doctor before taking higher doses. If your blood test shows you are deficient, take enough to get into the higher range of normal, but make sure you aren't getting too much. Get a reasonable amount of vitamin D and get outside more. Keep in mind that people in their 80s and 90s need extra vitamin D, simply because their skin is less efficient at making it.

Vitamin K2
Vitamin K2 is like a traffic cop for calcium, guiding it to your bones to keep them strong and away from places it shouldn’t go, like your arteries. It activates proteins, such as osteocalcin, that help calcium stick to the bone matrix, making bones denser and less prone to fractures. A 2013 study found that K2 supplements (180 mcg/day of MK-7) slightly improved bone density in postmenopausal women after three years, especially when combined with calcium and vitamin D.

You can get K2 from foods like natto (fermented soybeans), egg yolks, and cheese, but many people don’t eat enough of these. Supplements can help, but they’re not a magic fix—K2 works best with exercise, which signals bones to grow, and nutrients like calcium and vitamin D. Taking too much K2 (over 200 mcg/day) is rarely harmful but may not add extra benefits. K2 is in most calcium supplements these days, you don't need extra.

Strontium: a red herring
Strontium, another supplement closely related to calcium in the periodic table but denser, raises the most questions. Found in products like strontium citrate, it mimics calcium and can lodge in bones. Clinical trials, such as a 2004 study in the New England Journal of Medicine, showed strontium ranelate increased DEXA scores by 1–3% over three years and cut fracture risk by 20–30%. Sounds promising, right? But strontium’s heavier atomic structure absorbs more X-rays, making bones appear denser on DEXA scans than they truly are. Up to 75% of the density gain may be a DEXA artifact, not stronger bones. Plus, strontium can cause blood clots you don't want.

Doug Lucas says that he sometimes recommends strontium for some of his patients, it’s probably not necessary, it can potentially support bone growth, but we still don’t have good studies that isolate the effect of strontium vs other micronutrients. I’m not sure when he recommends it, but he says less than half of his patients want to take it, and he’s “open to that.” It’s not his default recommendation. I wonder whether patients taking strontium are just crowding out their calcium and if calcium would do as good a job or better. Since I’m not your doctor, this is something to discuss with your endocrinologist.

Boron: a non-key ingredient
Boron plays a supportive role in bone formation by enhancing calcium, magnesium, and vitamin D metabolism, modulating hormones like estrogen, and potentially stabilizing the collagen matrix. Its effects are modest, with 1–3 mg/day from diet or supplements improving nutrient retention and BMD slightly, especially in postmenopausal women or vitamin D-deficient individuals. However, boron cannot replace calcium’s mineral role, collagen’s structural role, or exercise’s critical stimulus for bone growth. It’s a helpful but non-essential player in bone health. You probably get enough boron in your normal diet anyway.

Osteoporosis drugs

Now we come to the elephant in the room: the big-money osteoporosis drugs that don't work.

Bisphosphonates: a trap for getting your money and making your bones worse
Bisphosphonates like Fosamax (alendronate), Boniva (ibandronate), and Actonel (risedronate) are billion-dollar drugs marketed for osteoporosis, promising to reduce fracture risk "by 50 percent." But the benefits are actually an accounting trick.

Drugmakers boast a 40-50% relative risk reduction in fractures. Impressive? Not when you ask about the absolute risk. For women with osteoporosis, the annual hip fracture risk is 1-2%. A 50% relative drop means the risk of fracture went from 2.2 percent to 1.1 percent. That’s an absolute risk of 1.1%. Over five years, treating 100-200 women prevents one fracture. Meanwhile, there are serious side effect risks: 1 in 1,000 face osteonecrosis of the jaw, a painful, disfiguring condition, and 1-5 per 10,000 suffer atypical femur fractures—see the image below. Esophageal irritation, heartburn, and rare heart rhythm issues add to the toll.

But the drug companies make sure the story is told to search engines the "right" way. All large language models produce the same result when asked about the risks of bisphosphenates:

This is exactly the story drug companies want told. They manipulate the journal summaries and abstracts to achieve what I call online narrative supremacy. Most doctors believe these drugs actually help, because most doctors don’t know the difference between relative and absolute risk.

Bisphosphonates don’t build bone; they trap old, brittle bone, reducing bone quality. “Drug holidays” are recommended after 3-5 years to reduce risks, yet long-term safety remains unclear. Worse – these drugs realign the structure of your bones to make them brittle and fragile, resulting in “atypical fractures” where your bone breaks like a stick of chalk …

An atypical fracture caused by drugs: this is not how bones naturally break.

Not to mention the life-threatening jaw problems. Osteonecrosis of the jaw is a condition where areas of the jawbone become exposed and do not heal properly, leading to bone death. Symptoms may include jaw pain, swelling, gum infections, loose teeth, or exposed bone. Patients are advised to not have any extensive dental work done while on these drugs.

If your doctor recommends bisphosphenates, don't ask questions and don’t argue. Walk out. Find a better doctor.

New horizons in osteoporosis treatment: the post-bisphosphonate era
Are there other options? Yes, there are. Bisphosphonates have long had the lion’s share of the marketing budget (and profits), pretending to reduce fracture risk by slowing bone breakdown. However, for patients who can’t tolerate them, experience fractures despite treatment, or face long-term risks like osteonecrosis of the jaw (ONJ), or have to take their required drug holidays, newer post-bisphosphonate therapies offer hope.

At least, they offer hope to drug companies seeking more profits. Because — tada! — the new drugs solve the problems created by the old drugs!

Or … do they?

Prolia (Denosumab), a twice-yearly injectable monoclonal antibody, reduces relative vertebral fracture risk by 68%, with an absolute risk of ~4.8% (from 7.2% to 2.4% over 36 months). Ideal for bisphosphonate-intolerant patients, but stopping it triggers rapid bone loss and a 3–5% absolute risk of rebound fractures within 6–14 months. ONJ and atypical fractures occur in less than1% of patients, with infections in the range of 4% (absolute risk). Okay, so only 4 out of 100 people get infections.

Forteo (Teriparatide), a synthetic parathyroid hormone, increases bone density by 6–9% and reduces relative vertebral fracture risk by 65%, with an absolute risk of about 10% (from 14.3% to 4.6% over 21 months). That’s a significant reduction in fractures. Forteo only costs $41,100 yearly, and the daily injections only cause nausea or hypercalcemia in about 10% of patients. ONJ risk is ~0.02%, and osteosarcoma, seen in animal studies, has not yet been seen in humans.

Evenity (Romosozumab), a monthly sclerostin inhibitor, boosts bone density by 15% and cuts relative vertebral fracture risk by 73%, with an absolute risk of about 3.7% over 12 months. That is statistically significant. However, a 30% relative increase in heart attack risk (absolute risk: ~1–2% higher vs. placebo) limits its use in those with cardiovascular history, and its $21,900 annual cost would give you a completely setup home gym in just 12 months.

With billions in annual sales, these drugs enrich Big Pharma while offering marginal benefits compared to exercise and nutrition, which strengthen bones safely, give you more ability to prevent falls, and make you feel great. It is possible that some people with severe risk of fracture could benefit from these drugs, but if you’re reading this, you’re almost certainly not one of them.

All about DEXA scans

A DEXA scan is the most common — but not the best — way to measure bone density. In my view, too many people get DEXA scans. They are mostly a marketing tool to get people moving on the conveyor belt to taking drugs they shouldn’t be taking in the first place.

After you get a DEXA scan, you get a T-score, which is your bone density compared to that of an average 35-year-old. If you’re 50 or 60, of course your score is going to be negative! Why would they compare you to people 20 years younger? Because then they can give you the diagnosis of “osteopenia,” which labels you “at risk of a fracture,” and just a few years later, they can say you finally have osteoporosis, it’s time to start your lifelong drug regime (minus the holidays).

Think about bone-density tests for a minute. The only time you need to test anything in medicine is if you’re planning to do something different depending on the outcome of the test. You’re looking at two paths of action, and the test tells you which one.

• Scenario A: You just got a DEXA scan and learned that your bones are not as strong as they could be. What do you do? You keep taking your supplements and you get into the gym and build bone! You wake up every morning and say “It’s another day to build bone, and I’m going to do it.”

• Scenario B: You just got a DEXA scan and learned that your bones are as strong as they could be. You’re above average. What do you do? You keep taking your supplements and you get into the gym and build bone! You wake up every morning and say “It’s another day to build bone, and I’m going to do it, because if I’m not building bone I’m losing bone.” You don’t ease up. You don’t worry about building too much bone (that doesn’t happen).

• In both scenarios, you’re going to do exactly the same thing after the test. So, why test?

Unless you have a very rare condition, you don’t ever need a bone-density test. If your doctor recommends a bone-density test, make sure he/she tells you the two different paths you will take based on the results, because it’s most likely to be taking a drug. Otherwise, forget the test and get your bones into the gym.

If NASA could prevent bone demineralization with a drug, they would, but they can’t. That’s why they have a resistance gym in the space station.

Estrogen: a key signaling factor

Estrogen, often thought of as a female hormone, plays a vital role in building and maintaining strong bones in both women and men. In women, estrogen helps bones grow by slowing down the activity of cells that break down bone, allowing bone-building cells to add more bone tissue. This is especially important during youth and pregnancy, but after menopause, when estrogen levels drop, bone loss speeds up, raising osteoporosis risk. A 2002 study in The Lancet showed that estrogen therapy in postmenopausal women can preserve bone density and reduce fracture risk.

In men, estrogen is less abundant but still critical. Men produce estrogen by converting testosterone, and it works similarly to protect bone by limiting bone breakdown. A 1998 New England Journal of Medicine study found that low estrogen levels in older men were linked to weaker bones and higher fracture rates.

Not all women can or should have hormone replacement therapy, but most can. If you can take it, you will build more bone, build more muscle, and feel better with more estrogen. I recommend every woman talk with her doctor and, if she can, try HRT for at least six months. If you don't like it at that point, think twice about getting off, because you can't build as much bone without it as you can with it. As with any treatment, you need to understand the costs, benefits, side-effects, and tradeoffs.

If you’re looking for a good HRT doctor, I recommend Pema Bioidentical.

Diet

You hear a lot of people recommending all kinds of diets to improve bone density. The research on which diet is optimal for preventing bone loss is generally poor and mixed. It seems clear that various diets have an impact, but there are many other confounding lifestyle factors that make it difficult to tease out. Most studies show that young people should consume dairy products to grow bone in their teens and 20s, some studies show that consuming dairy products, especially fermented-milk products like yoghurt, help prevent bone loss. Some research says that a plant-based diet is bad for bones, while others point out that plant-based milks are probably just as good.

Almost all researchers agree on two things: 1) get as much calcium you can from leafy green plants, and 2) you need enough protein to support healthy bones.

Protein
We don’t know that much about protein and bone building, but here’s how to think of it: you should get the optimal amount of protein for health and longevity. This will support you in building muscle and bone. While the protein doesn’t directly contribute to building bone, a low-protein diet will deprive you of bone density.

I have been vegan most of my life. At age 51, I fell and broke my right hip. At age 53, I fell and broke my left hip. This is my actual x-ray:

That’s a definitive diagnosis of osteoporosis. We now know that vegans break far more bones than non-vegans, vegans do not grow as tall as meat eaters, and that a low-protein diet is almost guaranteed to demineralize your skeleton.

In addition, insulin resistance probably contributes to osteoporosis. If you’re insulin resistant, reduce carbohydrates, and if you’re pre-diabetic or worse, eliminate them from your diet.

The general recommendation today is to consume one gram of protein per pound of ideal bodyweight per day, and meat protein is better protein. While I still don’t eat meat, I do consume a lot of whey protein and high-protein yoghurt, in addition to as much tofu, pea protein, protein bars, shakes, and nuts as I can get. I’m always trying to get as much protein as possible, which means on some days I probably meet my one-gram-per-pound goal.

People who consume a lot of meat don’t have that problem, but they should probably limit red meat to about 20 percent of protein calories to help prevent heart disease.

People in their 80s and 90s need even more protein. There’s even evidence that it helps people with Alzheimer’s function better. Keeping up your protein intake will support your bone-building program, while not getting enough protein will work against it.

Genetics and Osteoporosis
Osteoporosis is heavily influenced by genetics, similar to how genetics determines lung cancer risk — some people can smoke all their lives and be healthy and not die of cancer, but the choice to smoke increases the chances of getting cancer dramatically. Similarly, your genes account for 50–85% of bone mineral density (BMD) variation, setting your bone strength baseline by age 30. Genes like COL1A1 (collagen) or VDR (vitamin D) determine peak bone mass and loss rates. You do inherit much of your two parents’ genetic fracture risk. A parent’s hip fracture raises your risk of fracture at age 70 to 5–10 percent vs. around 1–2 per year for a person of the same age.

But even genetic “superstars” aren’t immune — poor diet, inactivity, or menopause can erode BMD by 10–20 percent. A sedentary lifestyle will still decrease bone mass in these people, while weight-bearing exercise and calcium/vitamin D intake can boost BMD by 2–5 percent, countering genetic risks. Protection is relative, not absolute. For example, research on LRP5 mutations shows carriers have stronger bones lifelong but can still face age-related decline if calcium intake or physical activity is inadequate. Genetic testing for key variants can pinpoint vulnerability, but understand that the older you get, the more bone you’ll lose, even if it’s at a lower rate than for other people. Regardless of your genes, the remedy is still the same … exercise.

The key to building bone: exercise

To build bone, you need the raw ingredients, but you need to give your bones the signal to build. And only exercise does that (see the section on the LIFTMOR trial, below). There are three general kinds of exercise that contribute to bone building and stability.

Resistance exercise must be very heavy. You need a lot of weight or heavy resistance bands to compress your bones enough to give them the signal to build. It’s not impossible, it’s just not what most people do. Research shows that bench pressing or squatting half your weight isn’t enough. You have to go more into powerlifter territory, lifting your own body weight and more. Or you need to do a lot of reps. That’s beyond most recreational gym goers. If you’re going to do it, it’s going to be with a barbell rather than with dumbbells or kettlebells. Certainly, more lifting is better, but it takes years of conditioning and skill building to compress the bones enough to get them to grow. If you can do it, you’ll be building muscle for longevity as well.

But most people can’t do that, and for us, there is impact exercise. I’d rather have you watch a video than describe it, so I made one. This is, as far as I can tell, the best, most thorough impact video on YouTube. Please set aside time to watch it:

Plyometrics are fast moves that develop explosive and reactive power. They help build bone, and they give you more ability to jump, hop, and get out of a tricky situation. A good example is hopping on one leg and trying for distance and accuracy, maintaining your balance once you stop. Hopping up to a step or platform in ever-increasing increments on one leg is fantastic. The more you practice, the more you’ll energize and retain small muscles that will help you avoid an accident.

Fall prevention

The other kind of exercise that contributes to bone health is exercise to help with stability, so you’re not a fall risk. You won’t break a bone if you don’t fall in the first place. There are a range of exercises that reduce your fall risk.

Balance training starts with balancing on one leg and going up from there. You should constantly be training for balance, which is why I never touch the handrails of any stairs. The other one is the toe squat, where you are resting your butt on your heels and your heels are off the ground. This is an easy thing for 20-year-olds to do and a difficult thing for 50-year-olds to do. I practice it about ten minutes every day. Finally, there’s the test of putting on your sock and then shoe and tying your shoe while balancing on the other foot. If you can keep doing that as you age, you’ll be less of a fall risk.

Stability training helps prevent falls. I work with all my clients on balance, hopping, squatting, and other movements to keep from losing stability. For example, walking backward up an inclined treadmill is one exercise that will improve the muscles at the back of the leg and prevent falls.

Step-ups and step-downs are important exercises to help you navigate terrain as you get older. I spend a lot of time on many types of step-ups and step-downs, so I’m always prepared to go down stairs, jump down, squat, get up off the floor with no hands, etc.

Carrying loads helps build and maintain bone. You can carry weights in the gym, you can carry a backpack. You can also get a weight vest and do walking and hiking under load. I would rather see you walk 3 miles carrying weight than 6 miles unweighted. See my list of weight vests and packs in the store on this site. See my video below on carrying your groceries home on your back.

Motor unit training involves quick, precise moves, like you would do in tennis, basketball, or ultimate frizbee. These are cutting, turning moves that involve acceleration and torque. Parcours, tire training, pylons, trail running are all good examples. Fast motor units are some of the first to go, which is why 40-year-olds aren’t as agile as 30-year-olds. You can train this, but it takes a good trainer or set of videos to show you what to do.

Preventing falls is as important as building bone to resist a break. All these exercises combine to give you stronger joints, stronger hips and spine, and stronger wrists and arms, so when you’re 80 you have the abilities you had in your mid-60s. Keep it up every day and you’ll be in far better shape than your peers as they decline.

Maintenance

As I mentioned, if you’re not building bone, you’re losing bone. Both happen slowly, but a year can make a significant difference. Once you’re on a bone-building program, you’re on it for life. You don’t get to take time off.

What does that mean, exactly?

When you travel, you should plan to exercise and get in your impact work. It’s not that difficult, you can do it in your hotel room. You should be squatting and lifting as much as you can, even if it’s just your own body weight (push-ups, squats, wall-sits, etc.)

Suppose you get sick and are unable to exercise. If it’s a week, focus on getting better and go back to your regular routine as soon as you can. But if it’s longer, you should try to find a way to do your impact work. If I were going to be laid up for more than a few weeks, the first thing I’d do is order a vibration plate and learn to use it properly. Take this seriously. At the very least, put some effort into not losing bone.

The LIFTMOR trial

The LIFTMOR trial (2015–2017), conducted in Australia, assessed high-intensity resistance and impact training (HiRIT) in 100 postmenopausal women with low bone mass (osteopenia or osteoporosis). Over 8 months, participants performed twice-weekly supervised HiRIT, including deadlifts, squats, overhead presses, and drop landings from a hang on a bar for impact. HiRIT significantly improved bone mineral density (lumbar spine: ~2.9%, femoral neck: ~2.2%), muscle strength, balance, and functional mobility compared to a low-intensity control group. Bone turnover markers showed reduced resorption. the Functional Reach Test showed enhanced stability. Only one minor musculoskeletal adverse event was reported, confirming HiRIT’s safety and efficacy for bone health.

This trial and others show that resistance and impact training have a huge effect on bone density, make you feel great, contribute to other health factors, and make you even more stable and less of a fall risk in the first place.

Vibration plates
You may have seen or tried a vibration plate. They look like this:

Studies of vibration plates show that they don’t tend to build bone, but they do help reduce the rate of loss of bone. The key is hips and spine. It’s not a silver bullet, it’s not the only thing you should rely on to build bone, but it probably helps add to a good bone-building exercise program. There’s a bit of a learning curve to make sure you get the right one and use it correctly, which I’m not going to go into here. If you can afford one, I recommend trying it. I think vibration plates will probably play a larger and larger role in reversing osteoporosis as we learn more and keep improving them.

Very important to understand that cheap vibration plates are worthless. Do not buy an “oscillation” plate, only a vibration plate. You need to spend at least $350 on a good one. Anything lower is worthless. Visit the store section of my site to learn about these products.

Magical thinking about growing bone
So now we know that exercise plus supplements are the key to growing bone, and drugs are not. Then why do seniors in Facebook groups report better DEXA results after taking supplements or pills? Some may have corrected their nutrient deficiencies, slowing bone loss. Others might be moving more—perhaps walking or gardening—without realizing the activity, not the supplement, is driving gains. Strontium users, in particular, may see inflated DEXA scores that don’t mean tougher bones. There’s also a 4-percent margin of error on any DEXA scan, which can lead to misleading numbers.

Positive thoughts and a good attitude do not build bone unless they help get you into the gym. I keep commenting over and over: you can’t build bone without exercise, no matter how many special herbs and pills you take. It’s not about fruits, mushrooms, red sage, horsetail, medicinal herbs, or prunes. Scientific studies have failed to show any effect from these things.

Summary

The real path to stronger bones combines nutrition, supplements, and estrogen with exercise. The side effects are beneficial. Weight-bearing activities like hiking/walking with a backpack or stair-climbing, impact training like heel drops, resistance exercises like lifting light weights, can boost bone density by 1–3 percent each year, and that adds up. Supplements aren’t magic pills, but they provide the raw materials exercise requires to build bone.

For added inspiration, I’m including my video on how and why you should carry all your groceries home in your backpack, even if it means climbing 27 flights of stairs with 60 pounds on your back.

Before starting any supplement, talk to your doctor. I’m not your doctor. You assume any risks from taking or not taking the advice here. Move your body daily—even a 30-minute walk is better than no walk. Strong bones come from action, not just a bottle. By blending exercise with smart nutrition, you can protect your bones and keep living life to the fullest.

Final word on AlgaeCal: I recommend AlgaeCal Plus to all my clients. It’s a great product. However, the AlgaeCal people decided to censor and remove me from their Facebook group, I think because I said strontium was unnecessary, citing Dr Doug Lucas’s opinion. I also said that no supplement can make you build bone, you need supplements and exercise to do that. I also said that their collagen was good but there are many equivalent collagens on the market. So it seems clear that the reason for the AlgaeCal Facebook group is to sell as much product as possible and limit a truth-seeking scientific discussion that helps people as they age. I recommend AlgaeCal Plus, but not their Facebook group.

Learn more about longevity by exploring this website. Learn the facts you should know about extending your life. Book your time to talk with me about your situation — the first hour is at a discounted rate.