How to improve bone health: a physiotherapist’s guide for women

We tend to notice when our muscles become stronger. The shopping feels lighter, the stairs feel easier, or a movement that once seemed difficult begins to feel familiar. Our bones offer rather less feedback.

That makes them easy to overlook, particularly in our twenties, thirties and forties, when osteoporosis can feel like a concern for a much older version of ourselves.

As a physiotherapist and the founder of CORE LDN, I think about bone health as part of helping people stay capable throughout life. Walking around Richmond Park, lifting a child, returning to running or carrying your own suitcase all ask something of your skeleton. The habits that support it deserve attention well before there is a problem.

Understanding how to improve bone health begins with a few connected things: the way we load our bodies, how adequately we fuel them, and whether we pay attention when something changes.

Strong bones are built throughout life

Bone is living tissue. It is constantly being broken down and rebuilt, responding to physical demands, nutrition and hormones.

We build most of our bone mass during childhood, adolescence and early adulthood, generally reaching a peak by our late twenties. Through adulthood, maintaining bone strength becomes increasingly important. That does not mean you have missed your opportunity if you are reading this at 35 or 45. Your bones still respond to how you look after them.

For women, hormonal health is an important part of the picture. Falling oestrogen levels around menopause can accelerate bone loss, which makes the foundations established earlier particularly valuable.

Osteoporosis can develop without obvious symptoms until a bone breaks. A fracture later in life can affect much more than the injured area, interrupting activity and reducing strength, confidence and independence.

Looking after your bones now is one way of supporting the life you want to keep living.

Give your bones a reason to stay strong

Bones respond to load. When muscles work against resistance, they pull on bones. Weight-bearing activity also places demands through the skeleton, with different activities providing different levels of impact.

Progressive strength training and appropriate impact exercise therefore have an important place in supporting bone strength.

That might mean lifting weights, working against resistance or gradually making bodyweight movements more challenging. Alongside this, brisk walking, dancing, running, skipping or tennis can provide weight-bearing activity, depending on your health and starting point.

These activities are not interchangeable. Walking is a useful place to begin, but someone already comfortable walking long distances may need a greater challenge to provide a stronger bone-loading stimulus.

The aim is to build gradually. Choose resistance that feels meaningfully challenging while allowing you to move with control, and increase the demand as your capacity develops. Your bones do not need a dramatic announcement that you have taken up weightlifting. They need a challenge you can return to consistently.

Where Pilates fits into how to improve bone health

I love Pilates for the strength, control and confidence it can help people develop. Improving balance and coordination also matters as we age, because staying steady helps reduce the likelihood of falls.

But the benefits of Pilates do not mean every class provides all the loading your bones need.

Traditional mat or reformer Pilates may need to be complemented by progressive resistance training and suitable impact activity. How much challenge a session provides depends on the exercises, resistance, positions and the person doing them.

At CORE LDN, our physiotherapy-led Pilates helps us connect movement with individual needs. Someone rebuilding strength after an injury may need a different starting point from someone who feels comfortable in class but needs to progress towards heavier resistance.

The useful question is whether your overall routine gives your body the range of challenges it needs. Pilates can be a valuable part of that routine, and a foundation for progressing further.

Movement belongs outside your workout too

A class or strength session is valuable, but it is also worth noticing how much of the rest of your day is spent sitting.

Break up long stretches at your desk when you can. Walk at lunchtime, take the stairs or stand up between calls. A few calf raises while waiting for the kettle can make movement part of an ordinary day.

These small opportunities help keep you active and support the muscles, balance and coordination that make everyday movement easier. They complement structured exercise; they do not provide the same stimulus as progressively challenging strength and impact work.

You do not need to turn every spare minute into training. Make regular movement easier to fit into the life you already have.

Feed the body you are asking to adapt

Exercise places a demand on the body. Food provides the resources to respond.

Bones need adequate energy and nutrients to repair and remodel. Consistently eating too little, especially alongside demanding exercise, can disrupt hormonal function and compromise bone health.

This can occur as part of relative energy deficiency in sport, known as RED-S. Despite the name, it can affect recreational exercisers as well as elite athletes.

Someone can be committed to training and still be under-fuelling without realising it. Continual dieting, skipping meals or removing whole food groups without suitable replacements can make it difficult to meet the body’s needs.

Adequate protein, calcium-rich foods and vitamin D all matter, alongside eating enough overall. If you are unsure whether your diet supports your activity, a registered dietitian can help you make sense of it.

Pay attention to changes in your periods

From a pelvic health perspective, I would encourage women to see menstrual health as useful information about their wider health.

Periods can change for many reasons. Pregnancy, contraception, perimenopause and medical conditions can all affect bleeding patterns, so an irregular cycle does not automatically mean there is a problem with your bones.

However, repeatedly missed periods should not simply be accepted as a consequence of being very active, lean, stressed or busy. Low energy availability can disrupt reproductive hormones, and reduced oestrogen can affect bone health.

If your periods stop or change persistently without a clear explanation, speak to your GP. Eating adequately and seeking advice are more useful responses than pushing through and hoping the body will adjust.

Calcium matters, but it cannot do everything

Calcium is an essential building block for bones. Vitamin D helps the body absorb and use it. Neither removes the need for appropriate exercise, adequate food or attention to hormonal health.

It is worth looking at the whole routine before assuming a supplement is the missing piece.

In the UK, the NHS advises adults to consider a daily supplement containing 10 micrograms of vitamin D during autumn and winter. Some people need supplementation throughout the year. You can read the NHS vitamin D guidance or ask a pharmacist about your circumstances.

Specific advice about calcium supplements sits outside my remit as a physiotherapist. If you are concerned about your intake or your risk of osteoporosis, speak to your GP, pharmacist or a registered dietitian. Higher doses are not automatically more helpful.

Smoking and excessive alcohol consumption also deserve attention. If a drink has become an automatic way to unwind each evening, consider the pattern across your week and make room for alcohol-free days.

Find the right challenge for your body

Advice about bone-loading exercise needs to leave room for different bodies and different stages of life.

During pregnancy, after childbirth, or when someone is experiencing leaking, pelvic heaviness or pain, exercise may need to be adapted. This does not automatically mean abandoning strength work. It means choosing a suitable starting point and progressing with support.

A pelvic health physiotherapist can assess symptoms and help guide a return to greater resistance and, where appropriate, impact.

If you have osteoporosis, a previous fragility fracture or an increased fracture risk, get individual advice before introducing new impact activities or heavier loading. Exercise can remain an important part of looking after your bones, alongside any medical treatment you need.

Looking after your future starts with what you do now

When women ask me how to improve bone health, I come back to three things: load your body, fuel it properly and listen to its signals.

Build strength progressively. Include weight-bearing activity and an appropriate level of impact. Eat enough to support what you ask your body to do, and seek advice when your symptoms or menstrual cycle change.

At CORE LDN, our physiotherapy in East Sheen begins with understanding your health, how you move and what you want to feel capable of doing. That might involve rehabilitation, physiotherapy-led Pilates or support to progress towards more demanding exercise.

Strong bones help support the park walks, the running, the lifting and the ordinary movements that make up a full life. Giving them some attention now is an investment in continuing to enjoy those things.

Thank you for reading, Claire. Founder of CORE LDN.

Restore. Strengthen. Evolve.