Guide | September 29, 2026

Preventing Osteoporosis: Strengthen Your Bones

Osteoporosis often develops over many years without initially causing any obvious symptoms. That is precisely what makes the disease so insidious: a decline in bone strength itself does not usually cause pain. For some people, osteoporosis is therefore not diagnosed until after a bone fracture has already occurred.

Typical questions include:

• How can I prevent osteoporosis?
• At what age should I start having my bone density measured?
• What symptoms indicate osteoporosis?
• How important are calcium and vitamin D?
• Which sport strengthens bones?
• Who is at increased risk for osteoporosis?
• What can I do on my own to maintain my bone health?

That is precisely why effective osteoporosis prevention should begin as early as possible.

At the ROC Regenerative Center in Aschheim near Munich, we do not assess bone health based solely on a single measurement. Bone strength, muscle strength, balance, risk of falls, nutrition, hormones, comorbidities, and certain medications can all collectively influence an individual’s risk of fracture.

This guide explains how you can prevent osteoporosis, which risk factors are important, when an osteoporosis test or bone density measurement may be advisable, and what role exercise, diet, vitamin D, calcium, and strength training play. The DVO Guideline 2023 on the Prevention, Diagnosis, and Treatment of Osteoporosis serves as an important foundation for this. The guideline explicitly states that fracture risk should not be assessed based solely on bone density but should also take other clinical risk factors into account.

Osteoporosis isn't just about low bone density

Low bone density is a major risk factor for osteoporotic fractures. However, it does not fully explain an individual’s risk of fracture. Two people with similar bone density test results may have different levels of fracture risk.

Other relevant factors include, for example:

• Age,
• previous bone fractures,
• Tendency to fall,
• Muscle strength,
• certain medications,
• Concomitant conditions,
• Body weight,
• Family risk factors.

Systemic glucocorticoids, for example, are among the risk factors for osteoporotic fractures considered in the current DVO guidelines. Therefore, the question “What is my bone density?” is not sufficient for a comprehensive diagnosis of osteoporosis. The more important question is: “What is my actual risk of suffering an osteoporotic fracture in the coming years?”

Can osteoporosis be prevented?

Not every risk factor for osteoporosis can be influenced. For example, we cannot change age, genetic predisposition, or certain pre-existing conditions. However, other factors can be specifically addressed.

Osteoporosis prevention includes, in particular:

• regular physical activity,
• Strength training,
• adequate calcium intake,
• adequate vitamin D intake,
• adequate protein intake,
• Preventing underweight,
• Maintaining muscle strength,
• Balance and coordination training,
• Reducing the risk of falls,
• Review of medications and conditions related to osteoporosis.

The DVO guideline explicitly recommends physical activity with the goal of improving muscle strength, balance, coordination, and reaction time.

Preventing Osteoporosis Through Exercise

People who are afraid of osteoporosis or bone fractures understandably tend to be less active at times. In the long term, however, prolonged inactivity can have exactly the opposite effect of what is beneficial for bones and muscles. Bones respond to mechanical stress. Muscle contractions, as well as compressive and tensile forces, are stimuli to which bone tissue can adapt. At the same time, exercise improves muscle strength, which is an important protective factor against falls.

Therefore, the general rule is: Bones need appropriate stress—not constant rest.

However, this does not mean that every person with osteoporosis should jump, lift heavy weights, or start an intense exercise program. Exercise must be tailored to a person’s age, fracture risk, fitness level, pre-existing medical conditions, and, if applicable, any existing vertebral fractures.

What kind of exercise is good for osteoporosis?

When it comes to preventing osteoporosis, different types of exercise serve different purposes. A combination of these is often particularly beneficial.

Strength Training for Bones and Muscles

Strength training is an important part of osteoporosis prevention. Resistance training challenges the muscles. The forces generated during this process also act on the skeleton. Depending on the individual’s situation, the following exercises should be prioritized:

• Leg muscles,
• Hip muscles,
• Back muscles,
• Core muscles,
• Shoulder girdle.

Strong muscles don't just support bone health. They also help you stand up more confidently, navigate stairs, and react more quickly if you stumble.

Weight-bearing exercise for osteoporosis

Activities that involve supporting your own body weight can also be beneficial for bone health. These include, for example:

• Walk,
• brisk walking,
• Hiking,
• Climbing stairs,
• Dancing.

Depending on your fitness level and individual risk of fracture, higher-intensity exercises can also be part of a training program. Cycling and swimming are excellent endurance sports and can be particularly beneficial for people with joint problems. However, because they place less weight on the skeleton, they provide different mechanical stimuli than, for example, walking or strength training. This does not mean that swimming or cycling are “bad” for people with osteoporosis. For bone health, they simply shouldn’t be the only forms of exercise you engage in.

Balance Training to Prevent Falls

Osteoporosis isn't just about keeping bones as strong as possible. Preventing falls is just as important. A strong bone that doesn't fall is less likely to break than a bone of comparable strength that is subjected to repeated falls. Balance and coordination are therefore key to preventing osteoporosis. Possible exercises include, for example:

• Standing on one leg,
• Tandem stand,
• controlled standing up and sitting down,
• Balance exercises on different surfaces,
• Coordination exercises,
• Targeted gait training.

The DVO recommends an annual fall assessment starting at age 70. Following a fall, an appropriate evaluation is important regardless of age.

Exercises for Osteoporosis: What Should Be Tailored to the Individual?

A general exercise program found online may not be suitable for every patient. Special caution may be required, for example, in the following cases:

• pre-existing vertebral fractures,
• severe osteoporosis,
• repeated falls,
• a significant imbalance,
• severe back pain,
• Hip or knee osteoarthritis,
• neurological disorders,
• prolonged physical inactivity.

The first step is to determine which movements are safe and appropriate. At ROC Ortho in Aschheim, we can perform an orthopedic assessment of your musculoskeletal system and, if necessary, work with the physical therapy team to develop a suitable exercise plan to gradually increase your activity level. For more information, visit ROC Ortho and ROC Physio.

Calcium and Osteoporosis: How Much Is Recommended?

Calcium is an essential mineral for bones. The DVO guideline recommends a total daily intake of 1,000 mg of calcium. This refers to the total intake from diet and—if necessary—supplements. Examples of calcium-rich foods include:

• Milk and dairy products,
• calcium-rich mineral water,
• certain green vegetables,
• Legumes,
• Nuts and seeds,
• calcium-fortified foods.

Whether additional calcium supplements are necessary depends on how much calcium is already being obtained through the diet. More is not automatically better.

Calcium Tablets for Osteoporosis: Don't Take Supplements Blindly

If you want to prevent osteoporosis, you don’t necessarily have to take calcium tablets. If you’re already getting the required amount through your diet, additional supplementation may not be necessary. Special caution is required for certain medical conditions. The DVO lists, among other things, kidney stones and certain disorders of calcium metabolism as situations in which general recommendations must be adjusted on an individual basis. For this reason, we do not recommend taking high-dose calcium supplements solely out of concern for osteoporosis.

How much vitamin D should you take if you have osteoporosis?

If supplementation is necessary, the DVO specifies a standard daily dose of 800 IU of cholecalciferol. The guideline also recommends not exceeding doses of 2,000 to 4,000 IU per day unless there is a specific medical reason to do so.

However, the specific dose may vary from person to person. This applies, for example, in cases of a confirmed deficiency or certain medical conditions. Therefore, high-dose vitamin D supplements should not be taken long-term without a medical indication.

Protein for Strong Bones and Muscles

Protein is often underestimated in the context of osteoporosis. However, it’s not just the muscles that need protein. Bones also contain an organic matrix whose structure is closely linked to overall nutrient intake. An adequate protein intake is particularly important in older age, because muscle loss can simultaneously increase the risk of falls. The DVO recommends that people aged 65 and older who are at increased risk of fractures follow a high-protein diet with at least 1.0 g of protein per kilogram of body weight per day. Good sources of protein include, for example:

• Dairy products,
• Eggs,
• Fish,
• Meat,
• Legumes,
• Tofu and other soy products,
• Combinations of various plant-based protein sources.

In cases of relevant kidney disease, the appropriate protein intake should be determined on an individual basis in consultation with a doctor.

Do I need dietary supplements to prevent osteoporosis?

Not automatically. Supplements are particularly useful when intake through diet or sun exposure is insufficient, or when there is a medically significant deficiency or increased need. A sensible approach is therefore: assess your diet → consider individual risk factors → determine lab values if necessary → supplement in a targeted manner. Not: take as many supplements as possible as a precaution. This distinction is particularly important in the case of osteoporosis, because bone health is not determined by a single vitamin or mineral level.

Preventing Osteoporosis: Exercise, Nutrition, and Fall Prevention Go Hand in Hand

The most effective prevention does not come from a single measure. Strength training without adequate nutrition is just as incomplete as calcium without exercise, or good bone density combined with a high risk of falls.

Several factors are interrelated when it comes to bone health:

• Bone strength,
• Muscle strength,
• Balance,
• Nutrition,
• Vitamin D and calcium intake,
• Body weight,
• Concomitant conditions,
• Medications,
• individual risk of falling.

This is precisely why the current DVO guideline does not consider osteoporosis to be merely a “bone density disorder.” In addition to osteodensitometry, basic diagnostic procedures include, among other things, medical history, clinical findings, fracture risk assessment, and, when indicated, further tests.

Causes of Osteoporosis: Who Is at Increased Risk?

Osteoporosis is usually not caused by a single factor. Often, several factors interact and influence bone metabolism, muscle strength, and fracture risk over the course of many years. The most important risk factors include age, a history of bone fractures, family history, certain medical conditions, and medications. Hormonal changes, being underweight, smoking, heavy alcohol consumption, and limited physical activity can also play a role. Women are more likely to develop osteoporosis, particularly after menopause. Declining estrogen levels alter bone metabolism and can accelerate bone loss.

However, osteoporosis is by no means limited to women. Men, too, can experience a significant decrease in bone strength—for example, as they age, due to hormone deficiency, certain medical conditions, or long-term use of medications.

What risk factors indicate the need for an osteoporosis evaluation?

The DVO guideline recommends baseline osteoporosis screening for postmenopausal women and men aged 50 and older if they have a medically significant combination of risk factors. The decision is not based on a single threshold value, but rather on the individual’s risk of fracture. Factors that may be particularly relevant include, among others:

• previous fractures of the vertebrae, hip, pelvis, upper arm, or forearm,
• Bone fractures resulting from relatively minor trauma,
• Hip fracture in a mother or father,
• long-term use of systemic glucocorticoids,
• significantly underweight,
• Smoking,
• heavy alcohol consumption,
• repeated falls,
• reduced muscle strength or unsteadiness while walking,
• Diabetes mellitus,
• chronic kidney disease,
• certain gastrointestinal disorders and the post-bariatric surgery period,
• certain hormonal disorders,
• certain cancer treatments,
• long-term use of certain medications.

For example, the DVO explicitly identifies systemic glucocorticoids as a relevant risk factor for fractures. The dose and duration of treatment also play a role.

Familial Osteoporosis: What Role Do Genes Play?

Family history can also provide clues about an individual’s risk of osteoporosis. A hip fracture in the mother or father is particularly relevant. The DVO explicitly takes this factor into account when assessing fracture risk. If close relatives have already suffered osteoporotic fractures, this does not automatically mean that you will also develop osteoporosis. However, this information should be included in a structured risk assessment.

Smoking and Alcohol as Risk Factors for Osteoporosis

Smoking is one of the modifiable factors associated with an increased risk of fractures. Heavy alcohol consumption can also increase the risk—through, among other things, its effects on bone metabolism, muscle strength, balance, and the likelihood of falling. The DVO lists both current smoking and heavy alcohol consumption among the relevant risk factors and risk indicators, respectively. Preventing osteoporosis, therefore, involves more than just calcium and vitamin D; lifestyle and fall prevention are also key components.

Conditions That May Contribute to Osteoporosis

In cases of osteoporosis, it is particularly important to investigate other possible causes if the condition occurs unusually early or cannot be adequately explained by age and typical risk factors. Possible comorbidities include, for example:

• Hyperparathyroidism,
• certain thyroid disorders,
• Hypogonadism,
• Diabetes mellitus,
• chronic kidney disease,
• chronic inflammatory diseases,
• rheumatoid arthritis,
• chronic intestinal diseases,
• Celiac disease,
• certain types of cancer.

Not all of these conditions necessarily lead to osteoporosis. However, they can influence an individual’s risk and, given a relevant medical history, may warrant further diagnostic testing.

Osteoporosis Symptoms: Why the Disease Is Often Diagnosed Late

Osteoporosis itself often does not cause any clear symptoms for a long time. For this reason, the condition is sometimes not diagnosed until a fracture typical of osteoporosis has already occurred. A bone does not automatically become painful simply because its density or strength decreases. Symptoms often result from fractures or their consequences.

What symptoms may indicate osteoporosis?

Possible warning signs include:

• A broken bone following a relatively minor fall,
• new-onset severe back pain,
• known vertebral fractures,
• increasing loss of size,
• new onset of a hunched back,
• changes in posture,
• repeated falls.

Vertebral fractures, in particular, can sometimes go unnoticed. In such cases, a loss of height or an increasing curvature of the spine may be the first signs.

Osteoporosis Test: How Is Osteoporosis Diagnosed?

If osteoporosis is suspected, a single test is not always sufficient. The DVO outlines a basic diagnostic approach for osteoporosis consisting of several components:

1. Medical history, including assessment of fracture risk factors,
2. clinical examination,
3. DXA bone density measurement,
4. Core Laboratory,
5. If indicated, additional imaging to check for vertebral fractures. 

Bone density measurement is therefore a key component—but not the entirety of osteoporosis diagnosis.

Bone Density Measurement: The Most Important Test for Osteoporosis?

When patients ask about an “osteoporosis test,” they are often referring to a DXA bone density scan. This test typically measures bone mineral density in the hip and lumbar spine. The DVO lists DXA measurements of the lumbar spine and hip as part of the basic diagnostic workup. The results help to better assess bone strength and fracture risk. However, they should not be interpreted in isolation.

Osteoporosis Diagnosis: Why Lab Results Can Be Important

A bone density test measures bone mineral density. However, it does not automatically explain why it is reduced. For this reason, when indicated, baseline laboratory tests are also part of osteoporosis diagnosis. The DVO explicitly lists this as part of the recommended baseline diagnostic workup. Laboratory tests can, among other things, provide clues to conditions that affect bone metabolism. Which values are actually relevant depends on the patient’s medical history and test results.

Osteoporosis in Men: Why Identifying the Cause Can Be Especially Important

Especially when osteoporosis occurs in a younger man or the severity is inconsistent with his age, it is important to investigate possible secondary causes. These may include, for example:

• Hormone deficiency,
• Medications,
• chronic kidney disease,
• inflammatory diseases,
• Diseases of the digestive system,
• certain cancer treatments.

This does not mean that a comprehensive battery of hormone and laboratory tests is automatically necessary for every man. The diagnostic approach should be tailored specifically to the patient’s medical history and test results.

Risk of Falls in Osteoporosis: Factors to Consider

A good first step is to take an honest look at your daily life. For example, pay attention to the following points:

• Are there any loose rugs or tripping hazards in the apartment?
• Is the path to the bathroom adequately lit at night?
• Are the stairs clearly visible and equipped with a secure handrail?
• Do you wear shoes that make you feel stable?
• Are your eyeglass prescriptions still up to date?
• Do you experience dizziness or unsteadiness when standing up?
• Have you had one or more falls within the past year?
• Do you feel unsteady when climbing stairs?
• Are you finding it increasingly difficult to get up from a chair?
• Are you taking any medications that may cause fatigue, a drop in blood pressure, or dizziness?

A single factor does not automatically indicate a high risk of falling. However, if several factors are present, it is worth conducting a targeted assessment.

Balance Training for Osteoporosis

Balance can be trained. Depending on your individual fitness level, suitable exercises might include, for example:

• Standing on one leg,
• Tandem stand,
• controlled standing up and sitting down,
• Change of direction,
• Walking on different surfaces,
• coordination exercises,
• Guided balance training.

If you have already experienced falls, have noticeable unsteadiness when walking, or have a history of osteoporotic fractures, your exercise routine should be tailored to your individual situation. Especially if you are at higher risk of falling, professionally guided physical therapy may be beneficial.

What medications are available to treat osteoporosis?

In general, we can distinguish between various mechanisms of action.

Factors taken into account include, among others:

• previous fractures,
• Level of fracture risk,
• Dude,
• Bone density,
• Kidney function,
• Concomitant conditions,
• Prior treatments,
• possible side effects,
• Individual therapy requirements.

Osteoporosis Treatment at the ROC: Looking Beyond Bone Density

The treatment of osteoporosis is not solely about improving a T-score. The most important question is how to reduce the future risk of fractures. Depending on the initial situation, this may include:

• Bone density measurement,
• Assessment of previous fractures,
• clinical examination,
• Identification of risk factors,
• Laboratory tests when indicated,
• adequate intake of calcium and vitamin D,
• Strength and balance training,
• Fall prevention,
• specific drug therapy, if necessary.

At ROC Ortho, we can review these factors together and determine which next steps make sense. You can find information about our bone density testing and orthopedic services at ROC Ortho directly on our website.

What role does regenerative medicine play in osteoporosis?

Many patients with osteoporosis also have:

• Osteoarthritis,
• Back pain,
• Muscle weakness,
• Restrictions on movement,
• previous fractures,
• Balance problems.

These symptoms, in turn, can affect how much exercise and strength training are actually possible. At ROC Ortho, therefore, osteoporosis diagnosis and orthopedic treatment can work together effectively. If, for example, osteoarthritis or back pain makes necessary strength training difficult, this issue should also be taken into account.

Osteoarthritis and Osteoporosis at the Same Time: What Should You Do?

Osteoarthritis and osteoporosis are not mutually exclusive. A patient can have both hip osteoarthritis and reduced bone density at the same time. This can make exercise planning more complicated: The bones need to be loaded, while a painful joint may not tolerate high loads well. In such situations, exercise must be tailored so that muscle strength and bone density are sufficiently stimulated without permanently overloading the affected joint. If you have additional joint issues, you can find information about our osteoarthritis therapy and ROC Physio.

When should you have your bone health checked?

An orthopedic or osteopathic evaluation may be particularly helpful if:

• a bone fracture has already occurred after minimal stress,
• if a vertebral fracture is known or suspected,
• they have lost a significant amount of height,
• If you are taking systemic glucocorticoids long-term,
• when several risk factors for osteoporosis are present,
• if repeated falls occur,
• there is a relevant family history,
• if certain hormonal or chronic conditions are present,
• You are receiving treatment that may affect your risk of fracture.

For information on diagnostics, see " Bone Density Testing and Osteoporosis Treatment at the ROC."

The Medical Team

Dr. med. Daniel Filesch

Specialist in orthopaedics and trauma surgery

Martina Berger

Doctor for regenerative orthopaedic procedures

Dr. med. Edan Manos

Doctor for regenerative orthopaedic procedures

Patrick Heine

Specialist in orthopaedics and trauma surgery

Modern office space

Frequently Asked Questions About Osteoporosis Prevention

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