Synergistic management of metabolic syndrome with postmenopausal osteoporosis: A retrospective case report

Metabolic syndrome (MetS) and postmenopausal osteoporosis (POP) commonly coexist, amplifying cardiovascular and fracture risk through shared mechanisms of insulin resistance, inflammation, and impaired energy metabolism. Conventional management often emphasises pharmacotherapy and calcium supplementation, while overlooking the optimisation of metabolic health. Emerging evidence supports nutritional and exercise-based strategies that target both metabolic and skeletal integrity. This study aimed to evaluate the synergistic effects of a low-carbohydrate and ketogenic diet (LCK), resistance training (RT), and bioavailable calcium supplementation on bone mineral density (BMD) and metabolic health in a patient with concurrent POP and MetS. A 65-year-old postmenopausal woman with baseline osteoporosis and MetS provided documentation for a 36-month, three-phase retrospective data analysis. Phase 1 intervention included an LCK (12 months); Phase 2 combined LCK with RT three times per week (12 months); and Phase 3 added daily bioavailable calcium supplementation (12 months). Bone mineral density was assessed via dual-energy X-ray absorptiometry at baseline, 12, 24, and 36 months. Secondary outcomes included metabolic markers, body composition, and inflammatory indices. Progressive increases in BMD T-scores were observed across major skeletal sites. Metabolic outcomes included improved biomarker levels and favourable changes in weight and waist circumference. No adverse effects occurred. Sometimes KD nutrition may not be enough to preserve BMD. The integration of ketogenic nutrition, RT, and calcium supplementation may synergistically enhance BMD while improving metabolic health in individuals with POP and MetS. This multimodal approach represents a promising adjunct to standard management of MetS and osteoporosis and warrants validation through controlled clinical studies.