How to Improve Bone Health: 6 Habits Women Should Rethink Now

We think a lot about building stronger muscles, improving cardiovascular fitness and protecting our long-term health. Our bones rarely get the same attention.

Perhaps that is because we cannot see them changing. There is no obvious feeling of a bone becoming stronger after a workout or gradually losing density over time. But bone is living tissue. It is constantly breaking down and rebuilding in response to how we move, what we eat, our hormones and the demands we place on our bodies.

And when it comes to how to improve bone health, what we do now matters.

We build most of our bone strength during childhood, adolescence and early adulthood, with peak bone mass generally reached by our late twenties. After this, the focus increasingly becomes maintaining what we have and slowing the rate of bone loss.

For women, this deserves particular attention. Changes in oestrogen through perimenopause and menopause can accelerate bone loss, making the foundations we build earlier in life even more important.

Bone health is not simply about trying to avoid osteoporosis decades from now. Strong bones help us stay active, capable and confident in our bodies throughout life.

Bone health is part of healthy ageing

Our skeleton does far more than hold us upright. Bones support movement, protect our organs and store essential minerals. They also work closely with our muscles to allow us to move, lift, run, balance and respond to the world around us.

A fracture later in life can therefore affect far more than the bone itself. It can reduce mobility and muscle strength and, importantly, affect confidence and independence.

That is why we need to move away from thinking about bone health as something to worry about when we are older.

The habits that support our bones also support our muscles, balance, pelvic floor, physical confidence and general health.

In other words: looking after your bones is simply part of looking after your body.

Why do we overlook bone health when we're younger?

Bone health is largely invisible.

We can notice when we become fitter. We can feel our muscles becoming stronger. We know when our flexibility changes.

We cannot usually feel our bone density.

Osteoporosis is often described as a silent condition because reduced bone density may not become apparent until someone sustains a fracture.

In our twenties and thirties, osteoporosis can also feel like a problem for another stage of life. But genetics are only one part of the picture. Physical activity, nutrition, hormone health, smoking, alcohol and some medications can all influence bone health.

For women, there is another signal that is sometimes overlooked: the menstrual cycle.

Periods can change for many reasons, but repeatedly missed or irregular periods should not automatically be accepted as a consequence of being very active, lean, stressed or busy.

When someone is exercising heavily without adequately fuelling their body, hormonal function can be disrupted. Reduced oestrogen availability can negatively affect bone formation.

From a pelvic-health physiotherapy perspective, menstrual health is an important marker of wider health. A persistent change deserves attention rather than being something we simply train through.

So what can we actually change?

1. Stop relying on low-impact exercise alone

We love Pilates. But Pilates cannot be expected to do everything.

Pilates is excellent for developing strength, control, posture, balance, coordination and movement confidence. Those are all valuable as we age.

But most traditional Pilates does not provide enough impact or external loading on its own to give bones the complete stimulus they need.

Bones respond to challenge.

To improve bone health, think about combining Pilates with meaningful resistance and weight-bearing activity.

That could include progressive strength training alongside brisk walking, running, jumping, skipping, tennis or other multidirectional activities, depending on your body and current level of fitness.

The important word here is appropriate.

High-impact exercise is not right for everybody at every stage. If you are pregnant, recently postnatal, experiencing pelvic-floor symptoms, managing joint problems or already have osteoporosis or an increased fracture risk, your exercise may need adapting.

The answer is not necessarily to avoid loading. It is to find the right load for you and progress it intelligently.

2. Stop spending hours sitting without moving

A workout in the morning does not completely cancel out eight or ten hours of sitting.

Regular movement throughout the day repeatedly exposes our muscles and bones to load while helping maintain the strength, balance and coordination that become increasingly important as we age.

That does not mean another workout.

Stand while taking a call. Walk at lunchtime. Take the stairs. Get up between meetings. Add a few calf raises while you wait for the kettle.

Think of these as movement snacks.

They are not a replacement for structured strength and weight-bearing exercise, but they are an easy way of making movement part of your day rather than something that only happens during a 45-minute class.

3. Stop continually under-fuelling your body

Exercise only works when the body has the resources to adapt to it.

Bones need energy and nutrients to repair and remodel. Consistently eating too little, particularly alongside intensive exercise, can interfere with hormone production and reduce healthy bone formation.

This can occur as part of Relative Energy Deficiency in Sport, or RED-S. Despite the name, it is not something that only affects elite athletes.

Someone who trains regularly, is continually dieting and does not eat enough to meet their body's energy needs can also experience low energy availability.

Protein, calcium, vitamin D and an adequately varied diet all matter. So does simply eating enough.

If you are restricting significant food groups, continually dieting or are unsure whether your diet adequately supports your training, this is an area where individual advice from a registered dietitian can be valuable.

4. Stop dismissing irregular or missing periods

A period stopping is not a badge of fitness.

There are many reasons menstrual cycles change and contraception can make menstrual patterns more complicated to interpret. But unexplained persistent irregularity or missed periods deserves attention.

Low energy availability and changes in reproductive hormones can affect bone health as well as fertility, recovery and wider health.

If your periods become irregular or stop and this is not explained by pregnancy, contraception or a known medical condition, speak to your GP.

And if pelvic-floor symptoms, pain, pregnancy, postnatal recovery or menopause are affecting how confidently you exercise, that is where specialist pelvic-health physiotherapy can be useful.

Exercise should be adapted when necessary, not abandoned.

5. Stop allowing alcohol to become the default way to unwind

This is not about saying you can never have a glass of wine.

It is about recognising patterns.

Regular excessive alcohol consumption can affect nutrition, hormonal health, balance and the normal process of bone remodelling. It can also affect sleep and recovery, which matters if you are asking your body to adapt to exercise.

Notice when an occasional drink has quietly become an automatic one.

Building alcohol-free days into the week and staying within recommended limits is a relatively simple way of supporting not just bone health, but wider health too.

6. Stop expecting supplements to compensate for everything else

Is calcium important for bone health? Absolutely.

Is calcium all you need? No.

Calcium is an essential building block for bones and vitamin D helps the body absorb and use calcium effectively. But simply consuming more calcium cannot compensate for inadequate nutrition, a lack of exercise, prolonged inactivity or hormonal issues.

Strong bones depend on a much bigger picture.

Think regular resistance exercise. Appropriate weight-bearing and impact activity. Enough protein and energy. Healthy hormone function. Calcium and vitamin D. Avoiding smoking and excessive alcohol.

From my perspective as a physiotherapist, specific advice around calcium supplementation falls outside my remit. Supplements are not automatically necessary or appropriate for everyone.

If you are concerned about your calcium intake, vitamin D levels or individual osteoporosis risk, speak to your GP, pharmacist or a registered dietitian rather than simply self-prescribing higher doses.

Calcium matters. It just isn't the whole story.

Where does Pilates fit into bone health?

Pilates has an important role, but we need to be clear about what that role is.

It can develop muscle strength, movement control, balance and confidence. It can also create a brilliant foundation from which people can progress towards more demanding resistance and impact exercise.

What we don't believe in is treating every body in the same way or assuming that simply turning up to any Pilates class is enough.

At CORE LDN, Pilates: Physio is led by physiotherapists rather than Pilates instructors. It starts with understanding how you move, your history, your strength, any injuries or symptoms and what you are actually trying to achieve.

Every movement has a reason.

For someone returning from injury, navigating pregnancy or postnatal recovery, experiencing pelvic-floor symptoms or simply unsure how to begin loading their body more confidently, that clinical understanding matters.

Our physiotherapists can help identify an appropriate starting point and build strength progressively rather than defaulting to either “take it easy” or “push harder”.

Alongside this, our Pilates: Fitness classes are designed for injury-free clients who want progressive Pilates training with control and purpose.

It is an important distinction.

Physiotherapy when your body needs assessment and rehabilitation. Physio-led Pilates when movement needs more clinical thinking. Progressive fitness when you are ready to train.

Not every body needs the same thing.

How to improve bone health: think load, fuel and signals

If there are three things I would encourage women to remember, they are these:

Load your body. Fuel it properly. Listen to its signals.

Build strength with resistance that feels meaningfully challenging. Include suitable weight-bearing and impact activity. Move regularly rather than saving all your activity for one class. Eat enough to support the life and training you are asking your body to do.

And pay attention when your body tells you something has changed.

That might be pain. Pelvic-floor symptoms. Your menstrual cycle. A change in strength. Difficulty recovering.

None of these automatically means you should stop exercising. They may simply mean the way you exercise needs to change.

Bone health is not a separate project to start later in life.

It is built into how we move, eat and look after ourselves now.

Restore. Strengthen. Evolve.