Exercise for Strong Bones - How to prevent and manage Osteoporosis

Increasingly, osteoporosis is recognised as a global health challenge, affecting women and men, and increasing the risk of life changing bone fractures. Thankfully, there’s a wealth of evidence-based guidance on how to maintain and even strengthen your bones at any stage of life. In this article, we’ll discuss what osteoporosis is, who is at risk, and what the best exercise is to prevent or manage osteoporosis.

What is Osteoporosis?

Osteoporosis is a condition where bones gradually lose their density and strength, making them more susceptible to fractures. Fractures, especially of the hip, can be devastating - leading to mobility loss and even increased risk of mortality, particularly in older adults.

It is caused by an imbalance of the bone remodelling cycle, whereby breakdown exceeds formation. The wrist, spine, hip, and pelvis are the most common fracture sites, and for this reason, exercise programs would ideally target these areas. More on this shortly.

The World Health Organisation defines osteoporosis with a ‘T-score’, measure by a DEXA scan. -2.5 leads to a diagnosis of Osteoporosis, and a score between -1.0 and -2.5, “osteopenia,” or low bone mass. Importantly, while osteopenia is a precursor to - and technically a lower risk than - Osteoporosis, low trauma fragility fractures occur in 50% of women and 70% of men diagnosed with osteopenia. A very good reason to act fast to prevent further progression of the condition.

Who is at Risk?

Several factors influence your risk of osteoporosis and related fractures

• Age - Risk increases with time, both physiologically, and by nature of increased exposure to other risk factors.
  

• Menopause - Oestrogen is bone protective. With the sharp decline in oestrogen occurring during this life-stage, women can lose up to 20% of their bone density in the 5–7 years after menopause.
  

• Sedentary lifestyle - stress to the bones and the muscles that attach is a powerful stimulus for bone formation.
  

• Low dietary calcium and vitamin D - Either presently and/or low intake during earlier decades (<30 years of age).
  

• Use of medications - such a corticosteroids for inflammatory conditions (Rheumatoid Arthritis).
  

• Family history of osteoporosis.
  

• Low testosterone (in men).
  

• Smoking and excessive alcohol use.

  
  

The Power of Prevention: Building and Protecting Bone early on

Bone mass peaks at around age 30. If you’re reading this, and you’re under the age of 30, what you do now significantly impacts the bone health of your future self. For long term bone health, the goal is to store away as much bone mass as possible through exercise and dietary behaviours.

As bone mass steadily declines after age 30 - at approximately 0.5% per year - starting at a higher baseline, and setting up the habits to slow decline down as we age, is essential. By gaining an additional 10% peak bone mass, osteoporosis development could be delayed by around 13 years, and reduce lifetime fracture risk by 50%.

If you’re reading this, and you’re over the age of 30, following the exact same principles will help you decrease the rate of bone loss, and even improve bone density slightly. It is never too late to start implementing bone healthy behaviours, and reduce bone fracture risk significantly. In fact, no matter what age you are, bone healthy behaviours should start right NOW.

Exercise: More Than Just “Staying Active”

It’s now clear that not all movement is equal when it comes to bone health. Staying active is essential for good health, but exercise specificity is important for bone cell formation to be stimulated. What works for bone?

• Weight-bearing, high-impact activities - Exercises such as hopping, jumping, skipping, and running can stimulate bones to build more density and strength.
  

• High Load Progressive resistance training (PRT) - Lifting moderate-to-heavy weights (appropriately) stresses the muscles and bones, initiating the bone formation machinery. Exercises like squats, deadlifts, lunges, have shown to be particularly effective for hip and lumbar (lower) spine bone health, and higher loads (whereby < 6 reps is hard) proves to be more effective than lighter loads.
  

• Balance training - Strong muscles and good balance reduces the risk of falls, which is crucial, since most fractures occur after a fall. Single leg balance, single leg strength training (step ups), Tai chi & some forms of yoga are all good options for balance training.
  

What about walking? 

While walking offers great cardiovascular and metabolic benefits (particularly when brisk), on its own, it is just not sufficient to keep bones strong. Bones need high forces, either from muscular tension acting on specific bones, or high ground reaction forces like:

• Single leg hopping (3.4 x body weight)

• Vertical jumps (4.7 x body weight), or

• Jump squats (7.1 x body weight).

  
  

How much is enough?

• Weight Training: Should be done at least twice per week for 30 to 60 minutes. A program should include 6-8 exercises of all major muscle groups, with a particular emphasis on lower body (hip) musculature.

  
  

  This could be 4-5 lower body exercises (squats, lunges, hip thrusts, hip abductors, calf raises) and 3-4 upper body exercises, which incorporate gripping, pushing and pulling (push ups, rows & pulldowns).

  
  

  Start by doing 2 sets of 12-15 repetitions, focusing on good form. As you progress over weeks to months, loads can increase, whereby 3 sets of 6-8 repetitions is challenging.

• Impact activity: 4–7 occasions per week. This could be moments integrated into daily activity, or exercises incorporated into your strength routine, where short bouts of hops, jumps or stomps are done.
  

  Aim for 50-100 repetitions (scaled for intensity individual appropriateness) per occasion. This could be: -

  • 5 x 10-20 hops on the spot

  • 3-5 x 10-15 squat jumps

  • 2-3 x high knees jogging on the spot

  • Accumulate 5-10mins of jump rope skipping

• Balance Training This should be done regularly where possible, especially in older adults, or those with history of falls. Balance training, like all exercise should be progressive, where it continues to push the outer realms of your stability.
  

  A starting point may be single leg balance while the kettle boils, progressing to a mini single leg squat, progressing to tapping the other foot to the floor around you, requiring reactivity. Tools like wobble boards, balance beams can be introduced for increased challenge and interest. With all balance exercises, you can stay close to a wall, post or bench if nervous about falling.
  

  For those more confident with balance, incorporate single leg, staggered stance or inline positions into strength training. It can also be incorporated into impact activity, such as side to side bounding or depth jumps onto one foot.

Some very important considerations

Progressive loading

Like with all exercise, no matter the goals - bone health or not - it should be done progressively. Start with lower loads, modest overall volume, lower impact forces, and build up gradually. Yes, we want to give our bones the love they need, but don’t forget about all your other tissues that need time to adapt. Ligaments, tendons, cartilage, and bones themselves don’t do well with too much too soon, and therefore may be susceptible to overuse injuries.

Tailored for you only

Always consider where you are right now before starting your bone health exercise program. Do you have any co-morbidities that might influence your exercise program? For example, someone with a history of low back pain should consider exercises that minimise potential aggravation, and incorporate those that build low back strength and load tolerance. Or someone with a foot condition may find impact exercise inappropriate for now. Always seek guidance from an Exercise Physiologist or Physiotherapist.

Strength precedes impact

If you’ve never done impact activity before, in the name of progressive loading, start with 6 to 8 weeks of strength training to condition your joints to general load. Build strength and co-ordination before adding impact exercises. Also, ensure that landing mechanics are appropriate. This means that knees should not collapse inward or outward excessively, but rather track over the toes.

Some risky movements for some

For those with known vertebral (spinal) osteoporosis, it’s important to avoid excessive or high repetition spine bending and twisting, and lifting loads with a rounded back. Considerations should be made for exercises such as rowing, crunches, some yoga or pilates positions, or some associated house or yard work movements. High speed twisting like racquet sports or golf may also be contraindicated if there is a high risk of low-trauma fracture.

When it comes to osteoporosis, knowledge is power—but action is what drives real change. Research consistently shows that targeted, progressive exercise is one of the key strategies to build and maintain bone strength, reduce fracture risk, and support long-term health. Whether you're aiming to build peak bone mass in your younger years, or slow the rate of decline later in life, it’s never too early—or too late—to start.

As an Accredited Exercise Physiologist, I offer tailored programs that align the information in this blog post with your goals, health status, and lifestyle - I’d love to support you on that journey. Learn more about working with me