Mayo Clinic: Why Women Lose Muscle and Bone – And How to Stay Strong

You’ve probably heard the old saying "use it or lose it." When it comes to your bones and muscles, this simple phrase carries a powerful truth, especially as you grow older.

Maybe you’ve noticed it already: mornings that start a little slower, movements that require a bit more effort, or stiffness that just wasn’t there before. Behind some of those changes, something else might be quietly happening inside your body. As the years go by, you naturally begin to lose bone density and muscle mass, and this process can have a major impact on your strength and stability.

Here’s how, and why, it happens and what you can do to improve bone health. 

Building – and losing – bone and muscle

Bones and muscles are living, dynamic tissues. They're constantly breaking down and rebuilding. When you're young, your body makes new bone faster than it breaks down old bone, resulting in an increase in bone mass. After the early 20s, this process slows down. Most people reach their peak bone mass by age 30.¹

After that, old bone begins to break down more quickly than new bone forms, leading to a slow but steady loss in bone mass.² This is what causes osteopenia, which can lead to osteoporosis – bones that are weaker, thinner, and more likely to break.

Likewise, muscle mass also peaks around age 30. After that, it can decrease 3-8% each decade – and even faster after the age of 60.^3,4 Age-related muscle loss is called sarcopenia.

Osteoporosis is often called a "silent disease" because many people aren’t aware they have it until they break a bone, often from something as minor as a stumble. The signs of sarcopenia tend to be more noticeable and include a decline in strength, coordination, and stability. 

Together, these two conditions significantly increase the risk of falls and fractures, reduce mobility, and make everyday tasks difficult to manage.

Why women are more at risk 

Women, especially after menopause, face a unique set of challenges. Estrogen, a hormone that helps protect bones and maintain muscle mass, drops sharply during this time. And when estrogen declines, bone and muscle loss can accelerate.¹ 

But estrogen isn’t the only culprit. Women generally have a lower peak bone mass and less muscle than men in early adulthood. So, when bone and muscle loss begin later in life, women already have less to lose.

Men also lose bone and muscle mass as they age, but the decline in testosterone, which helps maintain both, is much more gradual.⁵

Good news: Science shows it’s never too late to build muscle and bone strength

Here’s the part that surprises many people: Bone and muscle loss are a normal part of aging, but osteoporosis isn't inevitable. The keys to preventing the disease are building strong bones when you’re young and slowing the rate of bone loss as you age.^1,6

Even if you’ve never really been active, science shows that the right kind of exercise can build strength, maintain bone density, and reduce your risk of falls.⁷

But not all exercise is equal when it comes to bone and muscle health. Movements that offer the most benefit include: 

1. Weight-bearing exercises. When you’re on your feet and moving against gravity, you stimulate the production of osteoblasts, the cells that help build new bones.⁸ Think walking, hiking, dancing, or playing pickleball.

Some studies show that weight-bearing exercise in premenopausal women can boost estrogen levels naturally, mimicking the effects of hormone replacement therapy.⁹ 

A note about safety: Higher impact activities that involve running or jumping are beneficial as well, but if you have osteoporosis or problems with stability, talk to your health-care professional before starting.

2. Resistance training. Resistance training (also called strength training) is essential – not just for building muscle, but for maintaining the health of the bones that are most vulnerable to osteoporosis, like those in the hips, spine, and neck.¹⁰

And it doesn’t take heavy lifting to make a meaningful impact. Research shows that light weights combined with higher repetitions can slow bone loss and build strength. That means even gentle, consistent movement can make a real difference.¹⁰

Another bonus to resistance training? It strengthens your muscles and improves balance. This is crucial because stronger muscles support and protect your bones, and improved balance reduces the risk of falls – a leading cause of fractures in older adults.¹¹

There’s a starting place for everyone

Movement is good medicine, but there isn’t a one-size-fits-all prescription. The best part of exercise is that it’s adaptable. Pick the exercises you can do and for how long you can do them. As you become more experienced, bump up the intensity or work out for a longer period. The key is to be consistent.

Exercise and good nutrition are partners in prevention

Fueling your bones and muscles is also important. Choose foods that are high in calcium and vitamin D, like:¹

• Low-fat dairy products
• Dark green leafy vegetables
• Canned salmon or sardines with bones
• Trout and salmon
• Soy products, like tofu
• Fortified cereals and orange juice

Adults between the ages of 18 and 50 need 1,000 milligrams (mg) of calcium each day. This increases to 1,200 mg at age 51 for women and 71 for men. And don’t overlook vitamin D, which improves the body’s ability to absorb calcium. Most people need at least 600 international units (IU) a day, and it bumps up to 800 IU after age 70.⁶  And you may need considerably more if you’re starting with a low blood level of vitamin D.

In the end, it’s about living well

The loss of bone and muscle is a natural part of aging, but you have more control than you think. By staying active, eating well, and being proactive, you can stay strong, steady, and independent well into the future.

A word from Thorne

While diet is a good place to start when including bone-supportive nutrients, it is not always easy to get all you need from diet alone – particularly vitamin D, which has few dietary sources unless it’s added to foods like cereal, bread, and juices. Wild caught salmon is a rare exception – containing 800-1,000 IU per 3.5-ounce serving. Consider supplementing your diet with bone supportive nutrients, including vitamins D and K and minerals calcium and magnesium.

Protein is necessary for muscle support. You can supplement the protein in your diet with protein powders or amino acid supplements containing all the essential amino acids.

References

1. Osteoporosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968. [Accessed April 1, 2025.]
2. Osteoporosis. National Institute on Aging. https://www.nia.nih.gov/health/osteoporosis/osteoporosis. [Accessed April 1, 2025.]
3. Holloszy JO. The biology of aging. Mayo Clin Proc. 2000 Jan;75 Suppl:S3-8; discussion S8-9.
4. Melton LJ 3rd, Khosla S, Crowson CS, et al. Epidemiology of sarcopenia. J Am Geriatr Soc. 2000;48(6):625-630.
5. Barone B, Napolitano L, Abate M, et al. The role of testosterone in the elderly: What do we know?. Int J Mol Sci. 2022;23(7):3535. 
6. LeBrasseur NK, Chen C, eds. Your bones, muscles and joints In: Mayo Clinic on Healthy Aging. 1st ed. Mayo Clinic Press; 2024.
7. Shanb AA, Youssef EF. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. J Family Community Med. 2014;21(3):176-181.
8. Chang X, Xu S, Zhang H. Regulation of bone health through physical exercise: Mechanisms and types. Front Endocrinol (Lausanne). 2022;13:1029475.
9. Tong X, Chen X, Zhang S, et al. The effect of exercise on the prevention of osteoporosis and bone angiogenesis. Biomed Res Int. 2019;2019:8171897.
10. Nicholson VP, McKean MR, Slater GJ, et al. Low-load very high-repetition resistance training attenuates bone loss at the lumbar spine in active post-menopausal women. Calcif Tissue Int. 2015;96:490-499. 
11. Fall prevention in older adults. Centers for Disease Control and Prevention. https://www.cdc.gov/falls/about/index.html. [Accessed April 8, 2025.]