Integrating Muscle, Nutrition, and Function into Bone Care, with Gina Woods, MD

Bone health has long been framed through the lens of bone mineral density and T scores, but as the field evolves, so too does the definition of success. Gina Woods, MD, Clinical Professor of Medicine and Director of the Osteoporosis and Preventive Bone Health Programs at University of California San Diego, gave a talk at Rheumatology Winter Clinical Symposium 2026, held February 11-14 in Maui, Hawaii, that challenged clinicians to think beyond numbers on a DEXA report and reconsider what optimal skeletal care truly means. In rheumatology especially, where chronic inflammation, glucocorticoid exposure, and multimorbidity intersect, fracture prevention is only one part of a larger goal: preserving independence, mobility, and quality of life over time.

In an interview with RheumatologyLive, Woods emphasized a broader, more functional model of bone care. While tools such as trabecular bone score (TBS) are now well integrated into routine screening and provide additional insight into bone quality, emerging imaging modalities remain largely investigational. At the same time, she underscored the importance of recognizing chronic inflammatory disease itself as a major skeletal risk factor, reinforcing the need for earlier screening and proactive management in rheumatology populations.

A central theme of her talk was integration, particularly the integration of muscle health, nutrition science, and structured exercise into routine bone management. Sarcopenia and muscle weakness are critical drivers of falls and fracture risk, yet often receive less attention than bone density alone. Nutritional strategies are also evolving, with growing interest in food-first approaches to calcium and protein intake, the role of the food matrix, and the potential influence of the gut microbiome on skeletal outcomes. Exercise prescriptions, she emphasized, should be specific: moderate- to high-intensity resistance training at least twice weekly, use of major muscle groups, incorporation of impact activities when appropriate, and structured balance training to reduce fall risk.

“We need to incorporate nutrition and lifestyle factors into our treatment plans. [It’s] something patients want. We hear this loud and clear, and even though the effects of exercise and nutrition interventions may be modest compared to what medications can do, these are really important to patients, and really the foundation for good bone health,” Woods said.

Reference

Woods G. Outside the box: Bone Health; new approaches and considerations. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.