Can you rebuild bone density after 50 (and after menopause)?

The short answer is “Yes”. Many women do see measurable improvements in bone density (especially at the spine). And even when the DEXA number barely moves, you can still make big gains in bone strength and fracture protection by getting stronger, steadier, and fueling your body well.

What’s realistic?

• Exercise can move the needle. Programmes that mix progressive strength training with some carefully dosed impact tend to show small but meaningful bone gains, especially at the spine and femoral neck (head of the femur).
  
• Walking isn’t usually enough on its own. Keep walking (it’s brilliant for heart, mood and balance), but add strength and a touch of impact to target bone. However, if recovering from injury or unused to exercise, walking is a great place to start.
  
• Medication can create bigger, quicker changes if your fracture risk is high. Trial results show around 10% gains at the spine and mid-single-digit gains at the hip over a year or two with some treatments.  However, as with any medications, there is always a risk of side-effects. Your GP/specialist will advise what’s right for you.
  
• Strength, balance and confidence reduce falls which is often more important in real life than a small change on a scan. 

What actually works (and why)

1) Strength + a touch of impact

Bones respond to load. Here are some great ways to introduce strength and impact into your routine:

• Twice a week full-body strength: squats or sit-to-stands, hip hinges (e.g., deadlift pattern), rows, presses, calf raises. 2–3 sets, build the load slowly. (Seek professional advice to ensure you do these correctly).
  
  
• Impact at your level (if safe for you): small hops, brisk step-ups, or weighted heel drops. Start tiny, progress gradually, and keep it well coached.
  
  

2) “Bone nutrients” 

• Calcium: roughly 700 mg/day from food (yoghurt, tofu, cheese, greens, fortified milks). Supplement only if you fall short.
  
• Vitamin D: if you’re low or at risk, daily supplementation is often advised (your clinician will set the dose).
  
• Protein: many women 50+ feel and perform better around 1.0–1.2 g per kg bodyweight per day, spread across meals. Protein supports bone and muscle.
  

3) When to consider medication

If you’ve had a fragility fracture, have very low T-scores, or carry several risk factors, medication may be wise. In the UK, bisphosphonates are usually first-line; denosumab is another option; anabolic medicines (like teriparatide or romosozumab) are used for very high risk and are usually followed by an anti-resorptive to “lock in” gains. Your clinician will tailor this.

4) Balance, posture, steadiness

Most fractures follow a fall. Build balance and spinal extensor strength. A simple posture cue: place one hand on your breastbone, the other on your lower ribs. Soften the ribs down, then gently lift the breastbone a couple of millimetres - feel your spine lengthen, head stack, and back muscles switch on.

Tip: avoid repetitive forced spinal flexion if you have osteoporosis.

Rebuild, Maintain, Protect

• Bone density (BMD) is one aspect but bone quality, shape, muscle strength and fall risk matter too.
  
• Small DEXA changes can be within the margin of error. Ask your clinic for its “least significant change” so you know what counts as a true shift. If possible, have each DEXA scan performed on the same machine.

A simple, safe starting plan

1. Strength x2/week: hinge, squat, push, pull, calf raises. Slow tempo. Add a little load each week. Gradually increase to 5-7 days a week.
   
2. Create impact at a level that is right for you: start with low-amplitude options; progress carefully.
   
3. Daily balance + posture: single-leg stands; breastbone-lift cue above.
   
4. Fuel it: hit your protein, calcium and vitamin D; don’t chronically under-eat.
5. Reduce or avoid ultra processed foods.
6. If your risk is high, speak to your GP about options and timing regarding medication.

Where HRT fits

For some women (especially nearer the menopause window and under 60), HRT can protect bone and reduce fractures. It’s individual (benefits and risks vary) so discuss with your clinician.

What not to rely on

• Walking alone to build density (keep it, but add loading).
  
• Crunch-heavy routines or repeated deep spinal flexion if you have osteoporosis - choose spine-friendly core work and seek out advice on appropriate exercises).
• Occasional mega-doses of vitamin D (“bolus” dosing) unless specifically advised. Steady daily dosing is usually preferred. 

How to track progress

• Function: you lift a bit heavier, get up from the floor easier, feel steadier.
  
• Posture & comfort: taller through the spine, fewer twinges.
  
• DEXA: aim to hold or gain; re-scan on your clinician’s timeline (often 1–3 years) and compare against your clinic’s “least significant change.”
  
  

Places to learn more:

• Royal Osteoporosis Society (UK) - exercise, nutrition, and scan guidance.
  
  
• NOGG (UK guidance) - who needs medication and how it’s chosen.
  
  
• FRAX  - fracture risk calculator (used with or without a DEXA).
  
  
• ESPEN / other protein guidelines for older adults - practical ranges and meal ideas.
  
  

Reminder: This is general education, not personal medical advice. If you’ve had a recent fracture, very low T-scores, or new pain, please check in with your GP or specialist.