DEAR DR. ROACH: I am an 80-year-old Asian woman. Each day, I walk 4 miles and do 30 minutes of stretching, as well as 1 hour of cardio, strength or balance exercises by following videos provided by my health insurance. Also, my brother and sister who are in their 60s and 70s have weak bones and muscles. It seems to run in my family.

In 2000, with a T-score of -1.9, I was diagnosed with osteopenia and commenced three episodes of treatment: For the first treatment, I took Fosamax in 2001, then started Actonel in 2002 for a total of six years. My T-score was now -1.7. Three years later, my T-score was back to -1.9, so in 2009, for the second treatment, I restarted Actonel but switched to Boniva in February 2010 for a total of four years. My T-score was now -1.4.

Then, after four more years, my T-score was -2.2. For my third treatment, I restarted Boniva and took it from 2018-2025. My T-score is now -1.4. My primary care doctor has me on a “pill vacation” for one year, and I’m awaiting further treatment until a bone density test at the end of 2025. But I fear that without treatment, my aging bones are only getting worse.

I try to eat right, stay active, and have started doing yoga pose videos that claim to strengthen my bones. Will they? Which shots or other treatments might help me avoid further deterioration of my bones? — R.M.H.

ANSWER: Osteoporosis is a condition of bones that predisposes someone to getting a fracture. Anyone can get osteoporosis, but white and Asian women are at the highest risk.

Treatment of osteoporosis includes lifestyle adjustments, including quitting smoking and reducing alcohol intake, if appropriate, and regular exercise. Both muscle-building and weight-bearing exercise are important. Yoga and stretching probably do have some additional benefit on top of your stamina-building (“cardio”) and strength exercises. Even though the evidence is not very strong, most people with osteoporosis are treated with calcium and vitamin D.

I use the FRAX score to decide whether medication therapy is indicated for a patient. In men and women who are at a high risk of fracture, medicines in the bisphosphonate class — such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) — are the most commonly used first-line treatments.

Bisphosphonates last for a long time in the body’s tissues. We don’t want to use them for too long since they suppress the normal amount of bone breakdown that is key to maintaining healthy bone. Treatment for too long can lead to atypical femur fractures. A “drug holiday” is a common strategy, and given how long you have taken various bisphosphonates, I wouldn’t worry too much about the year off.

You have had less of a response than most of my patients have had to bisphosphonates, and many experts would change the class of drugs if you remain at a high risk via your FRAX score. Should you need further treatment, a different type of medicine like teriparatide (Forteo) or romosozumab (Evenity) might be considered.

At this point, you should be seeing an expert such as an endocrinologist who specializes in osteoporosis treatment. Finally, although celiac disease has been thought to be less common in Asians, it often leads to poor absorption and osteoporosis, so it’s worth considering a test. Symptoms of celiac disease can be very subtle.