"I've been told to be careful"
A bone density scan (a DEXA scan) comes back showing osteoporosis, and with it comes a new fear of movement. Many people stop lifting, avoid anything that feels like a jolt and stick to gentle walking, hoping to protect their bones. It is an understandable reaction, but the evidence points in a different direction.
Bone is living tissue. It responds to load, and the right exercise for osteoporosis can help maintain or improve bone strength, reduce the risk of falls and build confidence. The key is knowing which exercise does that, and how to do it safely.
Why bone needs load
Bone is constantly being broken down and rebuilt. When muscles pull on bone and when the body absorbs impact, the bone senses that strain and responds by strengthening the areas under stress. When load disappears, for example during long periods of inactivity, bone is lost.
This is why the type of exercise matters. Swimming and cycling are excellent for the heart and joints, but they put little load through the skeleton. Gentle walking helps general health, but for many people it is not a strong enough signal for the hip and spine.
What the evidence shows about exercise for osteoporosis
For many years, older reviews concluded that exercise had only modest effects on bone density in postmenopausal women (Howe et al., 2011). One reason, researchers later argued, was that most trials used low or moderate intensity.
A 2021 meta-analysis of 53 trials looked at intensity directly. High intensity exercise produced larger gains in lumbar spine bone density than moderate or low intensity, matching what animal research had long shown: the bigger the load, the bigger the bone response (Kistler-Fischbacher et al., 2021).
The best known trial is LIFTMOR, run in Australia with 101 postmenopausal women who had low bone mass. Half of them did supervised, high intensity resistance and impact training twice a week for eight months, including deadlifts, overhead presses, squats and chin-ups with a small jump up and a controlled lowering, built up gradually to heavy loads. Compared with a low intensity home programme, they gained bone density at the spine and held it at the hip, while the low intensity group lost bone. They also lost less height (some even gained a little) and did better on every functional test. Serious problems were not seen (Watson et al., 2018). These results come from closely supervised training and do not mean heavy lifting is safe to start alone. You do not need to train like this; it shows that bone can take more load than most of us think.
What UK experts recommend
In 2022, a UK expert group published the "Strong, steady and straight" consensus statement on exercise for osteoporosis (Brooke-Wavell et al., 2022). Its key recommendations are that people with osteoporosis should do:
- Resistance and impact exercise to maximise bone strength.
- Strength and balance training to reduce falls.
- Spinal extension exercise to improve posture and potentially reduce the risk of vertebral fractures.
The statement also makes an important point about safety: there is little evidence that physical activity causes significant harm, and in general the benefits outweigh the risks. The UK clinical guideline on osteoporosis likewise includes exercise and reducing falls as part of care, alongside medicines when needed (Gregson et al., 2022).
Resistance exercise
Aim for strength training on two to three days a week, working the major muscle groups. Loads should be challenging enough that the last few repetitions of a set are hard, and they should increase over time. Examples include squats, sit to stand, lunges, step-ups, deadlift patterns, rows, presses and heel raises.
Impact exercise
For people without vertebral fractures, building towards around 50 moderate impacts on most days is a commonly used target: heel drops, stamping, skipping, small jumps or jogging steps, which can be spread through the day (Royal Osteoporosis Society). Start low and build gradually.
People who have had a vertebral fracture (a broken bone in the spine) or several low trauma fractures should usually stay at an impact level similar to brisk walking (Brooke-Wavell et al., 2022). This is where individual guidance matters most.
Posture and spine
Back extension exercises, such as lying on your front and gently lifting your head and chest, or seated exercises that draw the shoulders back, help keep the spine strong and upright.
Osteoporosis exercises to avoid, or adapt
The consensus recommends avoiding postures with a high degree of spinal flexion, especially combined with load, during exercise and in daily life (Brooke-Wavell et al., 2022). In practice, that means:
- bending at the hips and knees, not rounding the back, when lifting
- replacing repeated sit-ups or toe-touching stretches with other trunk exercises
- avoiding sudden, forceful twisting with weight
This is not a list of things to fear. It is about adapting movements so you can keep doing them.
See your doctor before carrying on with impact or heavy loads if you get sudden, severe back pain, notice you have lost height, or see a new curve in your upper back. These can be signs of a vertebral fracture.
Where to start
- If you are new to exercise or have had fractures, begin with a supervised assessment and programme.
- Start with body weight or light loads, focusing on technique.
- Increase load gradually over weeks and months; bone adapts slowly, so stay patient.
- Add strength and balance work, because fewer falls also means fewer fractures.
- Keep going. Benefits are lost when exercise stops.
Frequently asked questions
Is it safe to lift weights with osteoporosis? For most people, yes, when exercise is properly prescribed, supervised to begin with and progressed gradually. The LIFTMOR trial showed high intensity training could be done safely in women with low bone mass under supervision (Watson et al., 2018).
Can exercise replace my medication? No. Exercise and medication work in different ways, and many people benefit from both. Speak to your doctor about your medication.
I have had a spinal fracture. Can I still exercise? Yes, with adaptations. Exercise can help reduce pain, improve mobility and quality of life after a vertebral fracture, ideally with specialist advice (Brooke-Wavell et al., 2022).
The bottom line
Gentle exercise feels safe, but bones need more of a challenge to respond. Progressive strength training, appropriate impact and posture work, combined with work to reduce falls, give your skeleton the best chance. Done with guidance, exercise is safe for most people, and the bigger risk is doing too little.
If you would like a bone-focused programme matched to your scan results, fracture history and confidence, create an account at bpr.clinic and book an assessment with our therapists. At the assessment we listen to your history, look at how you move and how steady you are, and give you a plan with starting loads you can follow.
References
- Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research. 2018;33(2):211-220. https://doi.org/10.1002/jbmr.3284
- Kistler-Fischbacher M, Weeks BK, Beck BR. The effect of exercise intensity on bone in postmenopausal women (part 2): a meta-analysis. Bone. 2021;143:115697. https://doi.org/10.1016/j.bone.2020.115697
- Brooke-Wavell K, Skelton DA, Barker KL, et al. Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022;56(15):837-846. https://doi.org/10.1136/bjsports-2021-104634
- Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Archives of Osteoporosis. 2022;17(1):58. https://doi.org/10.1007/s11657-022-01061-5
- Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews. 2011;(7):CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
- Royal Osteoporosis Society. Impact exercise to help make your bones stronger. https://theros.org.uk/information-and-support/exercise/exercise-for-bones/impact-exercise-to-help-make-your-bones-stronger/
