Background:
Postmenopausal women and people with rheumatoid arthritis face accelerated bone loss and higher fracture risk through overlapping mechanisms including estrogen deficiency and chronic inflammation. Given limitations and adverse effects of long‑term pharmacotherapy, effective non‑pharmacological strategies are needed. This review summarizes recent evidence on lifestyle, exercise, nutritional, educational, behavioral, and multicomponent interventions to preserve bone health.Materials and Methods: We conducted a structured search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English‑language studies through ۳۱ December ۲۰۲۵. Eligible studies evaluated non‑pharmacological interventions in postmenopausal women or adults with rheumatoid arthritis (RA). Screening, data extraction, and quality appraisal used validated, design‑specific tools. Because of clinical and methodological heterogeneity, findings were synthesized narratively.Results: Fourteen studies met inclusion criteria. In postmenopausal women, structured exercise—especially high‑intensity resistance and impact‑loading programs—most consistently preserved or increased bone mineral density (BMD) at the lumbar spine and femoral neck. In RA, exercise yielded clearer improvements in muscle strength, lean mass, and physical function than in BMD, indicating mainly functional benefits. Calcium and vitamin D had modest effects, chiefly attenuating loss among those with low baseline intake or deficiency. Educational and behavioral interventions improved osteoporosis knowledge, self‑efficacy, and adherence to preventive behaviors but showed limited direct BMD impact. Limited data suggest combining exercise with nutritional optimization may provide additive bone benefits in postmenopausal women.Conclusion: Non-pharmacological approaches provide population-specific benefits. Exercise most effectively improves BMD in postmenopausal women, while in RA it more consistently enhances physical function than skeletal outcomes. Individualized, multimodal programs combining exercise, nutrition, and behavioral support may best preserve bone health and reduce future fracture risk.
