Balancing Medications and Movement: A Holistic Approach to Osteoporosis in the Elderly

As the global population continues to age, managing osteoporosis effectively among older adults becomes a crucial health challenge. Increasing efforts are focusing on integrating pharmacological treatments with lifestyle changes to enhance bone health, underscoring a holistic approach to care.

In clinical practice, the same pharmacological approaches that bolster bone density also mitigate fracture risks, linking drug efficacy to patient safety. Antiresorptive and anabolic drugs form the backbone of osteoporosis management by effectively reducing fracture risk (as outlined in major clinical guidelines), and they are most effective when paired with lifestyle measures and fall-prevention strategies to support overall safety. Read more on current pharmacological approaches.

Recent trial results support more individualized sequencing and combination approaches, with benefits demonstrated on endpoints such as vertebral fracture reduction and gains in lumbar spine BMD. Sequential and combination treatment strategies have been enhanced through insights from established trials, such as romosozumab followed by alendronate in ARCH, which reduced vertebral fractures, supporting structured sequencing to improve outcomes.

By contrast, not all progress depends on medications alone. Exercise interventions are key, as mechanical stress and resistance training can improve bone mineral density, muscle strength, and balance, which together are associated with a lower risk of falls.

In parallel, nutritional and activity-based enhancements, such as a balanced diet with calcium and vitamin D and regular physical activity, work synergistically with drug treatments to provide comprehensive care; typical targets include about 1,000–1,200 mg/day of calcium from diet and vitamin D sufficient to maintain adequate 25(OH)D levels, with supplementation focused on those with low intake or deficiency.

Nevertheless, adherence challenges are common, underscoring the need for practical support. Disruption of sedentary lifestyle habits not only supports BMD maintenance and reduces fall risk but also complements pharmacological effectiveness.

For active older adults who aim to maintain their activity levels, emerging trends in sports medicine settings now emphasize tailored interventions for this subgroup.

Looking ahead, advances in monitoring technology now allow more timely adjustments that could support better outcomes, such as adherence tracking with connected injectors or detection of falls via wearables to prompt follow-up. These technologies help track elements such as medication adherence and fall events, supporting more responsive, data-informed care.

The next logical step is to unify these insights to inform future updates, recognizing that major guidelines already address pharmacologic choices but continue to debate optimal sequencing and duration, including when to consider drug holidays.

Key Takeaways:

• Integrating pharmacotherapy with targeted exercise, nutrition, and fall prevention provides complementary pathways to reduce fracture risk and maintain function.
• Sequencing matters: evidence-backed transitions (e.g., anabolic to antiresorptive) can consolidate gains in BMD and reduce vertebral fractures while supporting adherence.
• Timelier monitoring and adherence support tools can bridge gaps between guideline recommendations and day-to-day practice for older adults.