Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat, and Beat Osteoporosis


Miriam Nelson with Sarah Wernick
From The Publisher: An Interview With Miriam Nelson:

I often speak to professional and community groups - it's part of my mission to spread the word about strength training and women's health. Last year I noticed that more than half of these questions concern osteoporosis. Increasingly, women know that it's so important to maintain their bones as they get older, but they're ...
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New York, NY 2000 Hard cover First edition. 1st/1st by Print Line New in new dust jacket. Excellent condition with no rips, tears or markings. Glued binding. Paper over boards. ... With dust jacket. 318 p. Contains: Illustrations. Audience: General/trade. Comes in New Brodart Cover. USPS Tracking. M16-62114 Read more Show Less

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Miriam Nelson with Sarah Wernick
From The Publisher: An Interview With Miriam Nelson:

I often speak to professional and community groups - it's part of my mission to spread the word about strength training and women's health. Last year I noticed that more than half of these questions concern osteoporosis. Increasingly, women know that it's so important to maintain their bones as they get older, but they're uncertain about the best strategy to follow. I decided to write this book so I could pull together all the information women - and men - need to beat this terrible disease.

My research and the research of others have taught me a great deal about osteoporosis. But I've learned just as much from the women with whom I've worked. I know that the pain of osteoporosis is not just physical. It causes emotional pain and fear - changes that sap the vitality from too many women who still have meaningful lives to lead.

I will turn 40 a month after this book is released. I'm more aware than ever that I'm at risk for this disease: I'm a woman; I'm white; I'm slender; and I have a family history of osteoporosis. And I'm also aware that I can take steps now to keep my bones strong for a lifetime. That's why no matter how busy I get, I work hard to maintain my active lifestyle and healthy diet.

Whatever your age, I urge you to heed this terrific slogan from the Massachusetts Osteoporosis Awareness Program: "Support your bones. They support you."

" authoritative resource on how to prevent, treat, and beat osteoporosis...features a questionnaire that reveals risk factors; tips on supplements; recommended exercises; facts on the latest medications; and a chapter for men."

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Editorial Reviews

From Barnes & Noble
For All Ages

Do you -- or does someone you know -- have a protruding tummy? Back pain? A recent wrist fracture? These may be signs of a fitness problem or poor body mechanics, or they may be signs of something far more serious and insidious: osteoporosis.

Mention osteoporosis and many people think "old lady's disease" and envision a hunched-over, gray-haired woman tottering along with a cane. Yet osteoporosis is hardly limited to the elderly -- that tottering woman with the cane may be much younger than you think. In fact, 28 million Americans, ranging in age from 20 on up, suffer from some degree of osteoporosis. It can and does strike at any age, and most, but not all, of its victims are women. And it carries more than the threat of debilitation; it can also be a matter of life and death. Yet it is preventable and treatable if you know what to do, which is the primary objective of Strong Women, Strong Bones.

Written by Miriam Nelson, Ph.D., whose research in the area of osteoporosis has been published in a number of reputable and distinguished journals, including the Journal of the American Medical Association and the New England Journal of Medicine, and Sarah Wernick, Ph.D., an award-winning freelance health writer, Strong Women, Strong Bones is one of the most comprehensive looks at osteoporosis to be found anywhere. It's not only informative, it's also practical, providing a step-by-step process for adopting a lifestyle that can prevent or treat the disease.

Nelson begins by covering the basics of osteoporosis: how it begins, what causes it, how it manifests itself as it progresses, and what level of disability it can cause. She dispels several common myths, such as the belief that increasing one's intake of calcium is enough, by itself, to prevent osteoporosis, the belief that once bone is lost it's gone forever, and the belief that men can't get the disease.

The emphasis is on prevention, which makes Strong Women, Strong Bones as appropriate for a woman of 20 or a man of 50 as it is for a woman nearing, in, or beyond her menopausal years. But there is plenty of helpful information for those who already have the disease and are looking to reverse or ameliorate its effects. Nelson delves into the science in a language laypeople can understand, discussing the basics of bone formation, growth, and function.

The book also includes a comprehensive personal risk assessment, which evaluates everything from diet and family history to how much time is spent in the sun absorbing vitamin D. Once risk is determined, a reader can then learn the appropriate life plan to adopt in order to decrease her risk or alleviate damage already done. The book explores the three areas crucial to preventing and treating osteoporosis -- nutrition, physical activity, and, when appropriate, medications -- looking at each in great detail and incorporating them all into hands-on programs for daily living.

Nelson explores a number of forms of exercise, then combines them in balanced and comprehensive workouts that provide aerobic activity, weight-bearing exercise, and strength training. She clearly defends the need for each type of exercise and discusses its benefits in the prevention and treatment of osteoporosis. Each program of exercise is organized into weekly plans that provide for a gradual (12-week) increase in pace and intensity and that take into account one's previous degree of fitness and athleticism. Regardless of whether you are a novice or a trained athlete, Nelson's exercise programs can be adapted and adopted to fit your needs.

Strong Women, Strong Bones also includes dietary tips to ensure an adequate intake of calcium and the necessary vitamins. There are charts showing age-specific calcium requirements, the calcium content of foods, and foods that might interfere with calcium absorption. Nelson has even developed five-day sample menu plans to meet age-specific minimum daily calcium requirements, with different plans for those on low-calorie diets, low-fat diets, lactose-intolerant diets, and vegetarian diets.

Nelson also looks at the current raft of medical treatments and medications used to treat osteoporosis and its complications. She explains current-day diagnostic studies, their pros and cons, and the interpretation of their results. She explores the new therapies being used in the treatment of fractures, such as synthetic bone cement, gene implants, and the use of ultrasound waves and electrical stimulation to promote bone growth and repair.

Throughout the text, Nelson supports and supplements her information with anecdotal evidence that covers the gamut of osteoporosis problems, complications, and sufferers. There are also a number of statistics, some of which are alarming. Yet, as the anecdotal evidence suggests, it's a much-needed alarm for Americans, many of whom are at high risk for death and disability from osteoporosis but don't realize it. Armed with Strong Women, Strong Bones, that risk can be greatly reduced.

—Beth Amos

Sandra C. Raymond
Comprehensive information on good nutrition, proper exercise, and, when necessary, medication management... an excellent resource.
A clear, friendly, accessible style...Miriam Nelson and Sarah Wernick are a superb team.
Library Journal
Osteoporosis is a preventable and treatable disease characterized by decreasing bone mass. Nelson and Wernick, coauthors of Strong Women Stay Young and Strong Women Stay Slim, explain in a clear and friendly manner how bones grow; osteoporosis risk factors; how to adjust the diet to include calcium, vitamin D, and other bone-essential nutrients; the types of weight-bearing exercises that should be performed to promote maximum bone health; and the latest osteoporosis treatment options. The authors urge readers to think about how this disease pertains to them by using the book's handy "One-Hour Self Assessment Checklist" once a year. Nancy E. Lane's The Osteoporosis Book (LJ 10/1/98) contains similar prevention and treatment information, but Strong Women, Strong Bones focuses more heavily on diet and exercise and contains sample menus, a grocery shopping list, a detailed exercise program, and sample logs for keeping track of diet and workouts. Men also get osteoporosis, and the authors briefly explain how they can adapt the nutrition and exercise advice to meet their needs. Highly recommended for consumer health collections. (Illustrations not seen.)--Samantha J. Gust, Niagara Univ. Lib., NY Copyright 2000 Cahners Business Information.\
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Product Details

  • ISBN-13: 9780399145971
  • Publisher: Penguin Group (USA)
  • Publication date: 4/3/2000
  • Edition number: 1
  • Pages: 318
  • Product dimensions: 6.26 (w) x 9.29 (h) x 1.14 (d)

Read an Excerpt

Chapter 1: The Silent Crippler

JILL: "I do a lot of lectures at schools. I ask kids what someone with osteoporosis looks like, and they say, 'An old lady all hunched over.' Then I tell them that I have osteoporosis, and their jaws drop. I'm 34 and very athletic; I look like the picture of health.

I was diagnosed at age 27. I was a competitive runner. I started having stress fractures in my feet and even in my femur. I broke my wrist three times - once I broke both of my wrists at the same time. I knew something wasn't right."

* * * * *

Perhaps you have osteoporosis or bone loss already. Maybe you're wondering about your bones because your grandmother fractured her hip, or your mom is developing a "dowager's hump." You're wise to be concerned. Twenty-eight million Americans, mostly women, suffer from osteoporosis - dangerous thinning of the bones. When you have osteoporosis, your bones become so fragile they could break from a minor fall, from lifting a baby out of a crib, or even from an exuberant hug.

Though the obvious problems usually occur later in life, we now know that the invisible damage begins earlier - much earlier than most of us realize. For Jill, it probably started when she was in college. "I was a Division 1 track and cross-country runner on scholarship," she says. "My diet was well rounded but I was obsessive about exercise." A woman's estrogen levels can drop when she over-exercises or under-eats. One sign of low estrogen is missed periods. Jill didn't have regular menstrual periods for years.

Fortunately, most young women have normal cycles and enjoy the natural protection of estrogen, which plays a vital role in bone health. But as our estrogen production slows, bone loss begins. Starting around age 35 we lose up to one percent of our bone mass each year. These losses accelerate rapidly after menopause.

Osteoporosis is insidious because you can't see or feel what's happening. Most people who have the disease don't know it. And then a bone breaks. Each year 430,000 Americans wind up in the hospital because of fractures related to osteoporosis. Hip fractures - which represent about 300,000 of that total - are devastating. One victim in five dies within a year, and half are never able to live independently again. Most of us know someone who has suffered a hip fracture. But you may be surprised to learn that complications of this injury kill even more women every year than breast cancer. Preventing osteoporosis is really a life-and-death matter, like preventing cancer and heart disease.

Hip fractures are just the most obvious part of the problem. Millions of women suffer distressing symptoms that they don't connect to fragile bones. A woman may not realize that her chronic back pain comes from crush fractures in her spine. Fragile vertebras have crumbled under the ordinary stresses of everyday life. Osteoporosis can make a woman look old before her time - but she may have no idea that her slumped posture and protruding tummy are caused by fractures in her spine.

And then there's the emotional fallout. Katie, diagnosed with severe bone loss at age 54, fell into a deep depression:

"I felt I didn't have a future. My mother had recently moved into a nursing home, and I thought, 'I'll just take the next bed.'

I became a hermit. I was terrified of walking outdoors in the winter. If the street was slick with ice and I had to cross, I'd go up to a stranger and say, 'Can I hold onto you - I'm afraid I'll fall.' I quit walking at night. I quit carrying heavy groceries. I stopped walking the dog, because I was afraid she'd jerk the leash and I'd fall."

With support from her husband, Katie began an exercise program and improved her diet; her doctor prescribed medication to help her bones. "It's still a challenge," says Katie, "but it feels really good to make my body stronger."

As a woman, you have one-in-three odds of suffering from osteoporosis in your lifetime. But you can beat those odds. Medical experts now consider osteoporosis a preventable disease. And it's treatable. Thanks to new findings about nutrition and exercise, as well as new medications, you can protect yourself - provided you know how.


Some women don't give a thought to osteoporosis - even though they really should. Others are terrified, but uncertain about what to do. Or they may think they're doing everything possible to prevent osteoporosis. They diligently exercise and carefully watch their diet - but the measures they've adopted are not the most effective ones.

Do you still believe these common myths about osteoporosis?

Myth #1: Osteoporosis is an old lady's disease.

Women in their twenties and thirties can get osteoporosis. Fortunately this doesn't happen often; most early victims of the disease have significant risk factors such as prolonged use of steroid medications or lengthy periods of eating disorders. Ironically, many of these women are dancers or athletes, who look healthy and fit.

The bones we have later in life reflect what we did as kids, teens, and young adults. So in a very real sense, osteoporosis is a disease that starts in childhood.

* * * * *

LAURA: "I'm 44 and I was diagnosed with osteoporosis last year. But in retrospect, I'm sure I've had it since my thirties, because I had an eating disorder for many years. I feel different. Only my two best friends know I have osteoporosis. Most people would wonder why it's so bad in a woman my age, and it's embarrassing to admit what I did to myself."

* * * * *

Myth #2: After menopause, women can prevent osteoporosis by consuming calcium-fortified foods and beverages and taking calcium supplements.

Many women religiously drink milk, buy calcium-fortified cereal, and take a calcium supplement just to be sure. If they're premenopausal, extra calcium can help build strong bones. But simply upping calcium consumption has never been shown to increase bone density or prevent fractures in older women. Add vitamin D to that calcium, and the effects are dramatic: bone density increases significantly and fractures are reduced by 50 percent. That's because vitamin D is needed to absorb calcium and turn it into bone, and many postmenopausal women don't get enough. New research suggests that other nutrients are important too.

Myth #3: Walking is the best exercise for preventing and treating osteoporosis.

Walking is a wonderful exercise - for the heart. But no study has ever shown that a middle-aged or older woman can increase her bone density by taking up walking. The light impact of walking provides only mild stimulation to bone. If you've been walking for decades, that can add up. Women with a lifelong habit of regular walking have higher bone density - and a 30 percent lower fracture rate - than their sedentary age-mates. However, the short-term effects of walking on bone are minor. Even a yearlong walking program has very little effect.

Please don't think I'm criticizing walking! On the contrary, it's one of my favorite physical activities. I strongly encourage you to develop a walking habit - it will help retard further bone loss and has many other health benefits. Similarly, swimming and bike riding are terrific exercises for the heart. But because they're low impact and don't involve weight bearing, they do very little for your bones. Again, I'm not suggesting that you give up these enjoyable activities. But if you want to prevent osteoporosis and fractures, your exercise program should include more.

As you probably know by now, weight lifting isn't just for people who want to look like Ms. Olympia or Arnold Schwarzenegger. My research and numerous other investigations have shown that with just two or three strength-training sessions per week, women can halt bone loss and even regain bone density. And they do not develop bulky muscles! On the contrary, they usually become trimmer and shapelier.

We're also learning that higher-impact activities, such as jumping and stair climbing, can be very helpful for bone - provided they're done carefully. Very important is balance training to prevent falls. Think about it: If your bones are fragile, the last thing you want is to fall. Our balancing ability usually declines with age, so falling becomes a significant risk. The combination of exercises that improve both bone density and balance can dramatically reduce your risk of fractures from osteoporosis.

Myth #4: Once you've lost bone, you can never get it back.

The latest treatments can actually restore bone. Even small gains in bone density can make a meaningful difference in your chance of a fracture. Hormone replacement therapy and newer medications can reduce the odds by an astonishing 50 to 75 percent. And there's evidence that a combination of medication, exercise, and nutritional measures is even more effective.

Myth #5: Men can't get osteoporosis.

Alas, they can. An estimated two million men have this disease, which is tragically undertreated in men. A man is far more likely to suffer an osteoporosis-related fracture during his lifetime than he is to get prostate cancer. Yet men - and even their doctors - are largely unaware of the problem. A Gallup survey of men found that fewer than 2 percent had been told by their doctor that they may be at risk for osteoporosis. This book is written mainly for women, but men can follow the program and help their bones too.

* * * * *

JAMES: "I'm a radiologist. Last year we were checking out a new bone density testing machine. I hopped up on the machine myself to see what being tested was like. My results were grossly abnormal, indicating osteoporosis. That seemed impossible. I was a 37-year-old man in excellent health. I assumed the machine was defective. But I tested myself on different equipment and the same numbers came up.

Though I was shocked by the diagnosis, it explained several puzzling fractures. Six months earlier, on a trip to the lake with my family, I'd broken three ribs falling into the water. I thought it was just bad luck. The year before I'd slipped on an icy patch in the parking lot and fractured my shoulder blade.

I had no obvious risk factors. I was physically fit and very active - I'm the captain of a bicycling team; my diet was good. My primary care doctor gave me a full physical, and I learned I had an endocrine problem: low testosterone. As I read more, I realized I'd been showing symptoms of a deficiency for some time. My energy had been low and I hadn't felt right. I'd been wondering if it was just middle age.

I take testosterone, Fosamax, and calcium supplements with vitamin D. I use a treadmill; I started weight training. I love it. Being stronger is very satisfying. I've been on this therapy for sixteen months, and I feel terrific. In less than two years my bone density has increased to a point where I no longer have a diagnosis of osteoporosis."

* * * * *


No matter what your age, no matter what your starting point, this program will help you improve your bones. Even if you've already had significant bone loss or fractures, it's not too late.

The Strong Women, Strong Bones program combines the three essential measures for preventing and treating osteoporosis: nutrition, physical activity, and (when appropriate) medication. I want to emphasize that these elements work most powerfully when used together. For instance, if you're already taking hormone replacement therapy, you can further reduce your risk of fractures by doing strength training as well.

* Nutrition

You probably watch your diet, but it might need minor adjustments for optimal bone benefits. Most women find that when they make changes for the sake of their bones, they end up eating better for overall health.

Calcium gets all the attention, but it's just one of the key nutrients for healthy bones. Vitamin D is essential - perhaps even more important than calcium. The best diet for bones also includes plenty of fruits and vegetables. We now know that the nutrients responsible for this benefit include vitamin K, vitamin C, magnesium, potassium, and possibly other vitamins and minerals. And we're beginning to suspect that soy has special promise for bone too.

* Physical activity

I hope you're already physically active. If so, you can continue the exercise you enjoy. But you may not be doing everything possible for strong bones. This book will help you fill in the gaps. And if you're currently sedentary, the program will ease you into a more active, healthier lifestyle.

Exciting new research shows that just two minutes a day of vertical jumping - yes, leaping up and down - can produce significant improvements in bone. I know you've heard warnings about the dangers of high-impact activities for joints, and of course, jumping isn't appropriate for everyone. But healthy, fit women under age 50 can benefit from jumping if they follow appropriate cautions. And different higher-impact activities, such as stair climbing, are safe for most women. The Strong Women, Strong Bones program includes vertical jumping where appropriate, plus a combination of other exercises that have proven value for bone.

* Medication

If you're like me, you'd probably rather not take medication. But this is a very beneficial part of treatment for women with bone loss. Until just a short time ago, options were quite limited. But several powerful new medications have changed that. One new drug not only builds bone - it also decreases the risk of breast cancer.


It's easy to take our bones for granted, especially when we're young and menopause seems far away. But our skeleton has to last a lifetime. Strong Women, Strong Bones will give you all the information you need to take charge of your bone health.

Here's what the book contains:

* The latest scientific information

Women tell me that they're more motivated to make lifestyle changes when they understand the reasons behind them. This is especially important for a disease like osteoporosis, which advances invisibly. Symptoms rarely appear until bone loss has become significant. So you need to know what's happening under the skin before it's too late.

- Chapter 2 describes the process by which bone is formed - and the many factors that influence that process.

- Chapter 3 explains how osteoporosis develops, and tells you the earliest signs to watch for.

* The essential tests

We're much more fortunate than our mothers and grandmothers. Osteoporosis struck earlier generations of women without warning. But we have resources that can alert us to the danger long before we fracture a bone.

- Chapter 4 will help you figure out if you're at special risk for bone loss.

- Chapter 5 explains how bone density testing works and why this exam is every bit as important as regular mammograms. The best bone density tests predict fractures more successfully than cholesterol levels predict heart attacks or blood pressure predicts stroke. Yet these tests are underutilized, and insurance doesn't always cover them. As a result, less than 10 percent of people with significant bone loss are aware of their problem. You'll find out if you need to be tested, and you'll learn how to make your case with your HMO or insurance company.

- Chapter 6 looks at a forgotten factor in osteoporosis: falls. You may be surprised when you take the balance tests in this chapter! Poor balance isn't just a problem of the elderly. Most of us begin to lose our balancing ability well before age 50. Fortunately, there's a lot you can do to protect yourself, from simple balance exercises to fall-proofing your home.

* A plan for action

The next three chapters get down to work.

- Chapter 7 helps you evaluate your diet and make changes. The chapter includes five complete daily menus, showing how anyone can follow a bone-boosting diet - even women who are watching their weight or who don't eat dairy foods.

- Chapter 8 provides complete instructions for a comprehensive exercise program designed to strengthen your bones. The program features weight bearing aerobic exercise; strength training; vertical jumping (if appropriate); balance exercises; and stretching. That might sound like a lot, but once you master the moves, it takes less than three hours a week. You'll learn how to devise customized workouts that are safe, effective, and convenient.

- Chapter 9 describes all currently approved medications for preventing and treating osteoporosis, including hormone replacement therapy, Fosamax, Evista, and calcitonin. No single option is right for everyone. I'll also discuss many unproven treatments that women have questions about.

- Chapter 10 is a mini-workbook that will help you pull everything together. I'll walk you through a one-hour-per-year plan for setting goals and staying on track.

* Also included

The book has these additional features:

- Chapter 11 discusses osteoporosis in men, and explains how men can adapt the program in this book.

- Chapter 12 provides answers to frequently asked questions.

- Appendices include a glossary and a bibliography.

Osteoporosis is not an inevitable part of getting older. The Strong Women, Strong Bones program is designed to prevent bone loss and fractures. But it does so much more than that. The same measures that help your bones also improve your health - and your emotional well being - in many other ways.

* * * * *

ANNE: "Three years ago, I fell on stairs at an appliance store. I crashed down and broke my left wrist so badly I was hospitalized. They tested my bones, and I was diagnosed with osteoporosis. I began exercising. Three times a week I go to a fitness center. I lift heavy weights, walk and run on a treadmill, and use a stair climber. I also started taking medication. The following year I fell and broke my wrist again, but that time the break was milder. And last year I had two falls and didn't break anything.

I used to love climbing in the White Mountains, but I'd stopped. Now I can do it again. It's like I've gotten a little younger. This summer I backpacked in Yosemite with my oldest son and my granddaughter. We camped out in back country for seven days and six nights. I carried a 30-pound pack with no problems. I had a lot of joy on this trip. We climbed the Half Dome at Yosemite. It's quite a place. The trail is just a narrow ledge carved into the rock. A man climbing ahead of us heard my son call me Mom. He turned around and asked me, 'How old are you?' I told him, 'I'm 74.' He almost fell off the mountain.

From Strong Women, Strong Bones, by Miriam Nelson, Ph.D, with Sarah Wernick. (c) April 2000 . Miriam Nelson, Sarah Wernick used by permission.
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Table of Contents


Chapter 1: The silent crippler
Why every woman needs to be concerned.

Chapter 2: The secret life of bone
The process by which bone is formed - and the many factors that affect it.

Chapter 3: The anatomy of osteoporosis
How the disease develops, and the earliest signs to watch for.


Chapter 4: Are you at risk?
A quiz that tells you if you're at special risk for bone loss.

Chapter 5: Put your bones to the test
How bone density testing works, why this exam is every bit as important as regular mammograms - and tips on getting your insurance to cover it.

Chapter 6: Falling - the forgotten factor
Surprising balance tests, and how to prevent the falls that endanger fragile bones.


Chapter 7: Calcium and beyond
The essential bone nutrients, and how to make sure you're getting them, with five complete daily menus, including plans for women who are watching their weight or who don't eat dairy foods.

Chapter 8: Bone-boosting workouts
Complete illustrated instructions for a comprehensive exercise program designed to strengthen your bones.

Chapter 9: Good news about medication
Information about all currently approved medications for preventing and treating osteoporosis, including hormone replacement therapy; plus discussion of soy and other alternative treatments.


Chapter 10: The Strong Bones workbook
A one-hour-per-year plan for setting goals, plus worksheets and tips for staying on track.

Chapter 11: Men get osteoporosis too!
Information about the neglected problem of osteoporosis, with instructions that allow how men to adapt the program in this book.

Chapter 12: Questions and answers
More information about osteoporosis testing, nutrition, exercise, and medication.
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