Quick answer: Walking alone does little for bone density. The right exercise for bone health comes in three types, and each one does a different job.
- Strength: progressive resistance training that loads the hip and spine.
- Impact: short, sharp loads on your feet, scaled to what is safe for you.
- Balance: the training that stops the fall in the first place.
- Start point: an assessment that checks your bone density results, fracture history and falls risk before you load anything.
Reviewed by Krystal Lam, BHealthSc, MPhysio, Physiotherapist (AHPRA PHY0004063450), Tensegrity St Leonards and Macquarie Park.
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If you have osteoporosis or low bone density, your doctor has probably told you to exercise. That advice is right. However, it is not specific enough, because bones respond to some types of exercise and ignore others. Walking is good for your heart, your mood and your general health. On its own, it does little for your bone density.
Healthy Bones Australia recommends three types of exercise for bone health: weight-bearing impact exercise, progressive resistance training and balance training. Each one does a different job. So here is what each type does, what the research says, and how to start without hurting yourself.
1. Strength training: loading the bone through the muscle
Bone adapts to load. When a muscle pulls hard on the bone it attaches to, the bone responds by laying down more mineral where the stress is. That is why strength training comes first on the list.
The catch is the word “progressive”. The load has to go up over time. Lifting the same light weights for a year keeps you ticking over, but it does not give the bone a reason to change. In contrast, a supervised program starts you at a safe level. Then it builds the load up step by step as your technique and confidence improve.
The exercises that matter most load the hip and spine, because those are the sites where fractures do the most damage. That means squats, hip hinges and deadlifts, step-ups, rows and overhead presses. All of them scale, so a beginner version with a light dumbbell and a chair is still the same exercise.
2. Impact: short, sharp loads
Impact exercise means activity on your feet where you land with some force. For example, jogging, skipping, stair climbing, dancing and jumping all count. The quick jolt tells the bone it is in use.
This is the type most people with osteoporosis worry about, and with good reason. Impact is not safe for everyone. If you have a recent fracture, a history of vertebral fractures or a high risk of falling, you need a lower-impact version. In some cases, you leave impact out altogether for now. Also, the right starting point is small. A heel drop or a low step-down is impact. Nobody starts with box jumps.
3. Balance: the one that stops the fall
Most osteoporotic fractures happen because of a fall. In fact, roughly one in three people over 65 falls each year. So the third type of exercise is not about the bone at all. It is about keeping you on your feet.
Balance training works best when it gets harder over time. First, you stand on one leg beside a bench. Then you take the hand away, add a head turn, step over something, and finally catch a ball while you do it. Each step up in difficulty trains the reactions that catch you when you trip.
What the research says about exercise for bone health
The strongest evidence for this approach comes from a series of Australian trials. Professor Belinda Beck’s team at Griffith University ran them.
The original LIFTMOR trial involved postmenopausal women with low bone mass. It tested eight months of supervised high-intensity resistance and impact training, twice a week. As a result, the exercise group improved their lumbar spine bone density compared with a low-intensity control group. They also improved their strength and function.
LIFTMOR-M then repeated the approach in men over 45 with low bone mass. The exercise group improved cortical thickness at the femoral neck. They also preserved bone at the wrist and shin, where the control group lost it. Over eight months, the exercise group had two minor musculoskeletal events.
MEDEX-OP compared the high-intensity program with a low-intensity, Pilates-based program in 115 postmenopausal women. Lumbar spine bone density rose 1.9 per cent in the high-intensity group and 0.1 per cent in the low-intensity group. Both programs improved function, but the high-intensity group gained more leg and back strength. Both were also safe. There were seven adverse events across the whole trial, split between the two programs.
Two things stand out from these trials. First, the load matters. The programs that changed bone used heavy weights, well beyond what most people with osteoporosis would pick up on their own. Second, a trained person supervised every session in every trial. They taught, checked and progressed each exercise, which is a large part of why the injury rate stayed low.
Healthy Bones Australia makes the same point. It encourages adults diagnosed with osteoporosis, including those who have recovered from a fracture, to work with a physiotherapist or exercise physiologist who can tailor the exercise safely.
Home equipment for exercise for bone health
You do not need a gym to start. These are the items our physiotherapist most often suggests for home sessions between appointments. They support your program. They do not replace assessment, and what suits you depends on your bone density, your balance and your history.
- Resistance bands, pack of 5. For rows, presses and hip work at home. The graded set lets you start light and step the load up as your technique improves.
- Latex loop bands, pack of 5. For the glute and hip strengthening that supports the hip, which is one of the two sites where fractures do the most damage.
- Foam balance pad. A softer, unstable surface for the balance progressions. Use it beside a bench or wall, and only once your physiotherapist has cleared you for it.
Heavy weights, impact work and anything on an unstable surface are the parts of the program that need supervision first. So start those in the clinic, not from a video.
What we do at Tensegrity
The Stronger Bones Program at our St Leonards and Macquarie Park clinics follows this approach. It runs for 12 weeks, tailored to you and led by physiotherapist Krystal Lam.
You start with a 60-minute assessment. Krystal goes through your bone density results, your fracture and falls history and your medications. She also measures your strength and balance. That assessment decides what is safe for you, including whether impact work is right for you yet. After that, each weekly session covers strength, impact and balance exercises set to your level. You also get a short home program to do between sessions.
We can’t promise a change in your bone density. Instead, the program aims to support your strength, your balance and your confidence with movement, alongside the care you get from your GP.
If you have put off exercise because you are not sure what is safe, the assessment is the place to start. Book online at tensegrity.com.au/stronger-bones-program or call us on 1300 903 929.
This post is general information only. It does not replace individual assessment or advice from a registered health practitioner.
Book an assessment
Book a Stronger Bones assessment
The Stronger Bones Program runs at two clinics. Book directly at your nearest one:
Prefer to talk it through first? Call us on 1300 903 929. Also, if you have physiotherapy extras cover, ask about no-gap sessions when you book.
See a GP promptly instead if you have sudden, severe back pain, pain after a fall that stops you putting weight through a leg, or new numbness, tingling or weakness. Those need a medical check before any exercise program.
Frequently asked questions
Is walking enough exercise for bone health?
Walking is good for your heart and general health, but on its own it does little for bone density. Bones need progressive resistance, some impact and balance training. Walking is a good base, not the whole plan.
Is it safe to lift weights with osteoporosis?
For most people, yes, if the load starts at a level that suits you and builds up gradually under supervision. Technique matters most for the spine, so hinges and lifts are taught before they are loaded.
Do I need a referral or a bone density scan first?
You do not need a GP referral to book. However, bring your bone density (DXA) results if you have them, because they help your physiotherapist decide what is safe to start with.
What should I avoid?
Loaded forward bending and twisting of the spine, and high impact before you are ready. Your assessment sets the limits for you, and they change as you get stronger.
Sources
- Healthy Bones Australia. Exercise and bone health. https://healthybonesaustralia.org.au/your-bone-health/exercise-bone-health/
- 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
- Harding AT, Weeks BK, Lambert C, Watson SL, Weis LJ, Beck BR. A comparison of bone-targeted exercise strategies to reduce fracture risk in middle-aged and older men with osteopenia and osteoporosis: LIFTMOR-M semi-randomized controlled trial. Journal of Bone and Mineral Research. 2020;35(8):1404-1414. https://doi.org/10.1002/jbmr.4008
- Kistler-Fischbacher M, Yong JS, Weeks BK, Beck BR. A comparison of bone-targeted exercise with and without antiresorptive bone medication to reduce indices of fracture risk in postmenopausal women with low bone mass: the MEDEX-OP randomized controlled trial. Journal of Bone and Mineral Research. 2021;36(9):1680-1693. https://doi.org/10.1002/jbmr.4334