By Helen Chow, ND, Dip Herb, UK-qualified Naturopath & Herbalist,
Nutrition & Food Design Coach, Designer Realities Mind Coach
Originally published February 10, 2017. Reviewed & Updated October 9, 2026.
Have you ever thought about how much you rely on your bones every single day?
Walking through an airport, carrying your shopping, climbing stairs, gardening, travelling, dancing or simply getting up from a chair — all these everyday activities depend on a strong, well-supported skeleton.
Yet most of us hardly think about our bones until something goes wrong.
Perhaps a friend has been diagnosed with osteoporosis. Perhaps your doctor has mentioned bone density. Or perhaps you’ve noticed that your mother seems to have become shorter as she’s grown older.
Suddenly, bone health becomes a much more interesting subject!
But here’s the encouraging part.
Although we cannot stop ageing, there is a great deal we can do to support our bones, muscles and mobility as we grow older.
And if you’re a woman in your mid-40s, 50s or 60s, this is an excellent time to start.
You may be managing a demanding career, building a business, caring for ageing parents or planning an entirely new chapter of your life.
Whatever your circumstances, the goal is not simply to avoid osteoporosis.
It’s to remain strong, capable and independent enough to enjoy everything you still want to do.
Why bone health changes during midlife and menopause
Our bones are living tissue, constantly being broken down and rebuilt.
During childhood and early adulthood, we build bone relatively efficiently, reaching peak bone mass by early adulthood.
As we grow older, that balance gradually changes. For women, menopause is particularly important because oestrogen plays a major role in maintaining bone density.
As oestrogen levels decline, bone breakdown may begin to outpace bone formation. This can accelerate bone loss, especially during the years surrounding menopause.
However, not every woman going through menopause develops osteoporosis. Genetics, nutrition, physical activity, body composition, medicines and medical conditions all influence bone health.
Midlife is therefore an opportunity to become proactive, rather than waiting until a fracture forces us to pay attention.
Osteopenia and osteoporosis: What’s the difference?
These terms can sound rather frightening when you first hear them. But understanding them helps you make informed decisions.
Osteopenia describes bone mineral density that is lower than the normal young-adult reference range but has not reached the threshold used to define osteoporosis.
Osteoporosis is a condition characterised by reduced bone strength and increased susceptibility to fractures.
A person with osteoporosis may break a bone following a relatively minor fall. The wrist, hip and spine are particularly vulnerable.
Osteoporosis is sometimes called a silent disease because there may be no obvious symptoms until a fracture occurs.
However, osteopenia does not automatically progress to osteoporosis. And bone density is only one part of the picture.
Your age, previous fractures, family history, certain medicines and other health conditions also influence your overall fracture risk.
Your bones, muscles and joints work together
This is something I particularly want to emphasise.
We often discuss bone health, joint health and muscle strength as though they are completely separate subjects. In reality, they’re closely connected.
Your muscles support your joints and control movement. Your bones provide the framework. Your balance and coordination help protect you against falls.
A woman with strong bones but poor balance may still be vulnerable to injury. Likewise, someone with reasonable bone density but very weak leg muscles may struggle to climb stairs or rise comfortably from a chair.
That’s why bone health belongs in our Health Sifu Joint Health series.
If you’ve been experiencing discomfort, begin with Joint Pain After 50: What Actually Helps, which explores ways to manage joint symptoms while maintaining mobility.
And if your knees are giving you trouble, our guide to taking care of your knees explains why strong surrounding muscles, sensible movement and appropriate exercise matter.
The goal is to keep the whole system working together.
Strength training: One of the best investments in your bones
If I could encourage women in midlife to adopt one particularly valuable habit, it would be regular strength training.
Not necessarily heavy gym workouts. Not endless hours exercising. Just sensible, progressive resistance exercise appropriate to your abilities.
When muscles contract against resistance, they place mechanical forces on the bones. Over time, appropriate loading can help maintain or improve bone strength.
Strength training also helps preserve muscle mass, which becomes increasingly important as we age.
You might begin with:
- Sit-to-stand exercises from a sturdy chair
- Light dumbbells
- Resistance bands
- Wall push-ups
- Controlled step-ups
- Progressive resistance training in a gym
Aim to include muscle-strengthening activities on at least two days each week, building gradually according to your present fitness.
The important word is progressive. Your muscles need an appropriate challenge to become stronger. But there’s no need to rush or compete with anyone else.
If you already have osteoporosis, vertebral fractures or significant mobility problems, obtain individual guidance before starting unfamiliar exercises, particularly movements involving heavy loading or repeated spinal bending.
Our article on creating a safe exercise and fitness plan explains how to approach physical activity sensibly.
Walking is wonderful, but is it enough?
Walking is one of the simplest and most enjoyable ways to remain active. It supports cardiovascular health, helps maintain mobility and provides some weight-bearing stimulation.
And it fits naturally into daily life. You can walk while travelling, shopping, exploring a new city or enjoying an afternoon outdoors.
But walking alone may not provide enough resistance to maintain all the muscle and bone strength we need as we age.
This is why combining walking with strength training is so valuable. Depending on your abilities and bone health, other weight-bearing activities might include dancing, hiking, stair climbing or suitable exercise classes.
Swimming and cycling are excellent activities for cardiovascular fitness, but they don’t provide the same weight-bearing stimulus to the skeleton.
If joint discomfort makes walking difficult, don’t assume that all exercise is out of the question.
Our guide to exercises for people with joint pain explains how to adapt movement rather than abandoning it.
The best programme is one that challenges your body appropriately and that you enjoy enough to continue. After all, an exercise programme that you abandon after two weeks isn’t much use!
Balance training: Protecting yourself against falls
Let’s consider something that often gets overlooked. You can have reasonably strong bones, but a fall can still cause serious injury.
Balance depends on several systems working together, including muscle strength, vision, the inner ear and nervous-system coordination. The good news is that balance can often be improved with practice.
Useful exercises may include:
- Standing on one leg while holding a stable support
- Heel-to-toe walking
- Tai Chi
- Controlled step-ups
- Exercises that challenge coordination and stability
Start with support if necessary, particularly if you’re new to balance training. There is no prize for attempting a difficult balance exercise and falling over!
If you experience dizziness, repeated falls or significant unsteadiness, seek professional assessment.
Balance training isn’t only for people in their 70s or 80s. Developing good balance and coordination during your 40s, 50s and 60s can help preserve physical confidence for years to come.
Calcium: Important, but not the whole story
Calcium is essential for maintaining bone structure.
However, I sometimes think we’ve become so focused on calcium that we forget everything else involved in bone health.
Calcium matters, certainly. But so do vitamin D, protein, exercise, hormones and overall nutritional adequacy.
Good dietary calcium sources include:
- Milk, yoghurt and cheese
- Sardines or canned salmon with edible bones
- Calcium-set tofu
- Calcium-fortified foods
- Certain green vegetables, including kale and broccoli
Calcium recommendations vary between countries.
For example, the UK reference intake for adults is 700 mg daily, while the US recommended intake for women aged 51 and over is 1,200 mg daily.
These differences reflect national nutritional guidelines rather than a single universally agreed requirement.
Your personal needs may also depend on medical conditions, dietary restrictions and other factors.
More calcium is not automatically better. Unnecessary high-dose supplementation may cause problems, including kidney stones in some people. A food-first approach is generally preferable when practical.
For a broader look at the nutrients that matter during midlife, read Vitamins and Minerals After 50: What Women Need.
Vitamin D: Helping your body absorb calcium
Vitamin D plays an important role in calcium absorption and normal bone metabolism.
Without sufficient vitamin D, your body may struggle to absorb calcium effectively. Vitamin D can come from sunlight exposure, certain foods and supplements. Food sources include oily fish, egg yolks and fortified products.
However, the amount your body produces from sunlight depends on several factors, including season, latitude, skin pigmentation, clothing and time spent outdoors.
Women with limited sunlight exposure or risk factors for deficiency may need supplementation. But taking very large doses without medical guidance isn’t a sensible shortcut to stronger bones. The appropriate amount depends on individual circumstances.
Don’t overlook protein
Protein is another essential part of maintaining a strong, functional body.
Although we usually associate protein with muscle, it also contributes to the structural matrix of bone. And preserving muscle is particularly important when we’re trying to prevent falls and maintain mobility.
This becomes even more relevant for women who want to lose excess body fat during or after menopause.
Losing weight should not mean sacrificing valuable muscle.
Very restrictive diets, particularly those that provide inadequate protein or calories, can undermine muscle preservation and potentially harm bone health.
If you’re working towards a healthier body composition, focus on adequate nutrition, resistance exercise and sustainable changes rather than simply chasing a lower number on the scales.
Our article on protein after 50 explains how much women may need and why protein matters for muscle preservation and healthy ageing.
Can losing weight affect your bones?
This is especially relevant for women in midlife.
If you’re carrying excess body fat, gradual weight loss may improve metabolic health and reduce the load on painful weight-bearing joints.
But there is an important distinction between losing excess fat and simply losing weight. When weight loss is too rapid, calorie intake is excessively restricted or protein is inadequate, some of the weight lost may come from muscle.
Bone density can also decline during weight loss, particularly when the energy deficit is substantial.
That doesn’t mean women should avoid weight loss when it would benefit their health. It means the approach matters.
The goal is to improve body composition while protecting muscle, strength and bone health.
This is one reason resistance training and adequate protein belong in any sensible midlife weight-management programme.
And it’s a principle we’ll return to throughout our Health Sifu metabolic-health and nutrition articles.
Other factors that can affect bone strength
Nutrition and exercise are important, but they’re not the whole picture. Certain conditions and lifestyle factors can increase the risk of osteoporosis and fractures.
These include:
- Early menopause
- Previous fractures after minor trauma
- A parental history of hip fracture
- Very low body weight
- Smoking
- Excessive alcohol consumption
- Long-term use of oral corticosteroids
- Rheumatoid arthritis
- Some thyroid, digestive and other medical conditions
Women receiving certain cancer treatments may also experience accelerated bone loss.
If any of these factors apply to you, it’s worth discussing your bone health with an appropriate healthcare professional.
In particular, women with rheumatoid arthritis or those requiring long-term steroid medication may need additional attention to fracture prevention.
Should you have a bone density scan?
A DXA scan measures bone mineral density, usually at the hip and spine. It can help diagnose osteoporosis and assess fracture risk.
However, not every woman needs a scan simply because she’s turned 50. Your doctor may first consider your age, medical history, previous fractures and other risk factors.
A fracture-risk assessment tool such as FRAX may help determine whether a scan or treatment is appropriate.
You should particularly discuss assessment if you’ve experienced a fracture following a minor fall, have lost noticeable height, have a strong family history of hip fractures or have other important risk factors.
If osteoporosis is diagnosed, lifestyle measures remain valuable.
However, women at high fracture risk may also benefit from prescribed medication to reduce the likelihood of fractures.
Exercise and supplements are not substitutes for effective osteoporosis treatment when medication is indicated.
Your bone health checklist for midlife
You don’t need to overhaul your entire life overnight.
Start with a few consistent habits.
- Include resistance training at least twice a week, where appropriate.
- Walk and enjoy other suitable weight-bearing activities.
- Practise balance exercises safely.
- Eat sufficient protein.
- Include calcium-rich foods regularly.
- Ensure adequate vitamin D.
- Avoid smoking and limit alcohol.
- Maintain a healthy body composition without excessive dieting.
- Discuss personal fracture-risk factors with your healthcare professional.
- Keep building strength as the years pass.
Consistency matters far more than occasional bursts of enthusiasm. And small improvements accumulated over months and years can make a meaningful difference.
Health Sifu Note: Build your next 20 years
When I think about healthy ageing, I don’t imagine spending the next 20 years worrying about everything that might go wrong.
I think about everything we still want to do.
Travelling to interesting places.
Exploring new interests.
Building businesses or pursuing meaningful work.
Enjoying our friendships and families.
Walking confidently
Carrying our own bags
Maintaining the freedom to choose how we live.
Many women in their 40s, 50s and 60s are nowhere near finished with their ambitions. In fact, some of us are only just getting started!
That’s why I want you to think about bone health as an investment in your future.
Not simply preventing osteoporosis, but preserving the strength, mobility and independence that make life enjoyable.
You don’t have to become an athlete. You don’t have to transform everything overnight.
But you can make conscious, deliberate choices today that support the woman you want to be 10, 20 or even 30 years from now.
And that is what building your next 20 years is all about.
Make Smarter Choices
Consciously. Deliberately.
Scientific references and further reading
- National Osteoporosis Guideline Group — Clinical guideline for the prevention and treatment of osteoporosis (2024). Comprehensive guidance on osteoporosis diagnosis, risk assessment and treatment.
- NOGG — Non-pharmacological management of osteoporosis. Guidance on calcium, vitamin D, exercise, diet, smoking and falls prevention.
- NOGG — Summary of main recommendations. Guidance on FRAX assessment, bone-density scans and treatment thresholds.
- NHS — Osteoporosis. Patient information on symptoms, diagnosis, treatment and prevention.
- NHS — Food for strong bones. Practical dietary guidance on calcium and vitamin D.
Health Sifu Disclaimer: This article provides general health education and is not a substitute for individual medical assessment or treatment. If you have osteoporosis, previous fractures, significant medical conditions or concerns about bone density, seek personalised advice from an appropriately qualified healthcare professional.
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