I think loss of estrogen is the most important factor and for me, no amount of dietary or supplement or exercise approaches made up for that. We are living a lot longer. Osteoporosis was not as common when people died much earlier.

If someone has osteopenia or very early osteoporosis, I do believe the more holistic approaches can do a lot of good, as can learning how to move safely, doing tai chi for balance, and so on.