Background: Dietary intervention is a valuable co-therapy in the primary and secondary prevention of fractures, and food and cooking skills protect against nutrition risk in older adults. Culinary Medicine (CM) interventions have potential to improve dietary quality and health outcomes, but there is a lack of randomized trials in this area. Objective: This pilot trial assessed the feasibility and acceptability of implementing and evaluating dietitian-led virtual CM intervention for bone health as an adjunct to usual care at our specialty osteoporosis center. Methods: Forty adults aged 45 years and older referred for fracture risk assessment were randomized to receive either usual care (group nutrition education) or usual care plus a CM program. The CM program included a 1.5-hour virtual group session with two dietitians, a recipe package, and an optional follow-up session. The usual care group could attend the CM program after study completion (wait-list control). At baseline and 3 months, participants completed surveys on home cooking and confidence in eating well for bone health and were asked to complete 2 dietary recalls. The CM group completed an acceptability survey post-session. Primary feasibility outcomes were recruitment (target: 100% in 6 months), adherence (target: ≥85%), and retention (target: ≥85%). Acceptability was measured using a questionnaire adapted from the Theoretical Framework of Acceptability. Findings: We recruited 40 participants in 6 months, meeting the recruitment target. The adherence target was also met. Most participants (80%, CI 64%-91%) were retained through the 3-month follow-up, indicating feasibility but suggesting this aspect of study design could be improved. Only 5 participants (25%, CI 9%-49%) completed all 4 dietary recalls. The intervention was generally acceptable, with the lowest scores in the ‘burden’ and ‘opportunity cost’ constructs. Conclusion: This pilot RCT suggests CM intervention is a feasible and acceptable adjunct to usual care at our osteoporosis center. However, dietary assessment measures were infeasible as delivered, and further refinement of the intervention may improve acceptability sub-constructs. In future studies, opportunities exist to increasingly tailor CM interventions for older adults, and test the optimal duration and intensity needed to achieve meaningful improvements in behavior change, nutrition status, and bone preservation.