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calcium supplementation only if dietary intake is inadequate) [4] Nutritional assessment to ensure adequate protein intake during weight loss (minimum 1.0-1.2g/kg body weight) Encouragement of weight-bearing exercise and resistance training to maintain bone strength, in line with UK Chief Medical Officers' Physical Activity Guidelines Medication review to identify and address other factors affecting bone health Repeat fracture risk assessment in high-risk patients, with DXA scanning as clinically indicated based on NICE/NOGG guidance Patients experiencing weight loss faster than planned (particularly if exceeding 0.5-1kg per week sustained over several weeks) should be reviewed to ensure nutritional adequacy and consider whether treatment adjustment is appropriate

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