Exercise and Bone Health: How to Build Stronger Bones, Prevent Bone Loss and Exercise Safely With Osteoporosis
Most people who exercise regularly can tell you what they are trying to improve. They want stronger muscles, better cardiovascular fitness, more flexibility, less body fat, better balance, better posture, or maybe they simply want to look and feel better. But there is something underneath all of those muscles that most people barely think about: your bones.
We tend to take our bones for granted. We walk on them, run on them, lift weights with them, play sports with them, and depend on them every single day. Yet many people do almost nothing specifically for their bone health until they hear words like osteopenia, osteoporosis, low bone density, or, worse, fracture.
After more than 23 years of working in fitness, this is something I think we need to talk about much more. Bone health isn't just an issue for somebody in their 70s or 80s. What you do throughout your life matters, and one of the most powerful tools we have for supporting our bones is something I have spent my entire professional life encouraging people to do: exercise.
But there is an important catch. Not all exercise affects bone in the same way. Swimming is fantastic exercise, cycling is fantastic exercise, and walking is excellent for your overall health. However, if our specific goal is to stimulate and maintain bone strength, we need to understand how bones respond to different types of physical stress.
If someone already has osteoporosis or has experienced a fracture, we also need to understand that exercise should not simply stop. It needs to become smarter, safer and more individualized. The Royal Osteoporosis Society makes an important point that I strongly agree with: most people with osteoporosis can exercise safely when the type and intensity are appropriate for them.
This article is not about telling people with osteoporosis to sit down and protect themselves from the world. Quite the opposite. It is about understanding how movement, strength, balance and appropriate loading can help people remain active, independent and confident for as long as possible.
Let's start with the bones themselves.
Your Bones Are Living Tissue
When most people picture a skeleton, they imagine something hard and permanent, almost like the frame of a building. But bone is living tissue. It is constantly responding to what happens to your body.
Throughout life, bone tissue is continually being broken down and rebuilt. When your bones are regularly exposed to appropriate physical forces, that gives them a reason to maintain strength. When they are not challenged enough, they can gradually lose strength. This is one reason physical inactivity can become such a problem as we age.
The Royal Osteoporosis Society explains it very simply:
Bones get stronger when you use them.
Exercise places forces through the skeleton. Impact activities generate forces when your feet contact the ground, while strength training creates force as muscles pull on bones. Both can help maintain or improve bone strength.
That is the basic principle behind exercise for bone health. Your bones need a reason to remain strong.
What Is Osteoporosis?
Osteoporosis is a condition in which bones become weaker and more vulnerable to fracture. The word literally means porous bone. As bone strength decreases, fractures can occur more easily than they would in someone with healthier bones.
Common fracture locations include the:
Hip
Spine
Wrist
And this is why osteoporosis deserves to be taken seriously. A fracture isn't simply an X-ray finding. A hip or spinal fracture can dramatically affect someone's mobility, independence, confidence and quality of life.
But osteoporosis should not automatically mean, "I'm fragile, so I shouldn't exercise."
In fact, becoming less active can create another problem. Less activity can mean weaker muscles. Weaker muscles can contribute to poorer balance. Poorer balance can increase the risk of falling. And falling is one of the major ways fractures occur.
A physiotherapist interviewed by the Royal Osteoporosis Society describes this exact problem: fear of fracture can make people move less, but reduced activity can make them weaker and worsen balance, potentially increasing injury risk if they do fall.
So we have to get away from the idea that protecting bones means avoiding movement. The goal is safe movement not no movement.
What About Osteopenia?
Osteopenia means bone mineral density is lower than expected but has not reached the diagnostic threshold for osteoporosis. Think of it as an important warning sign rather than a reason to panic.
If someone is told that they have osteopenia, I don't want them thinking, "I guess my bones are doomed."
I want them thinking:
"What can I do now?"
This is where lifestyle becomes extremely important. Exercise, nutrition, medical assessment, appropriate treatment when indicated, fall prevention, and consistency all have a place in the bigger picture.
Bone health is a long-term project.
Exercise Is About More Than Bone Density
When we discuss exercise and osteoporosis, everybody immediately focuses on bone density. Understandably, but I think that misses part of the bigger picture.
Imagine two people who have similar bone density. One has strong legs, good balance, good posture, confidence walking up stairs, and enough strength to get out of a chair easily. The other has weak legs, poor balance, difficulty standing, and very little confidence moving. Who would you rather be? Exactly.
Exercise may support bone strength, but it also improves the physical abilities that help protect those bones. That is why I look at bone-health exercise through several different goals:
Build or maintain bone strength
Maintain muscular strength
Improve balance
Reduce fall risk
Maintain good posture and movement mechanics
Preserve independence
Those goals work together. Stronger muscles can help you move better, and better balance can help reduce falls. Better movement mechanics can help you perform everyday activities with more confidence. All of those things matter when we are talking about maintaining independence.
The Three Pillars: Strong, Steady and Straight
I really like the framework used by the Royal Osteoporosis Society because it makes this topic easy to understand. They describe exercise for osteoporosis using three concepts: Strong, Steady and Straight.
"Strong" refers to weight-bearing and impact activity and resistance exercise that supports bone and muscle strength. "Steady" focuses on strength and balance to help reduce falls. "Straight" focuses on spine care, posture and safer ways of bending and lifting, particularly for people at increased risk of vertebral fracture.
That is a very useful way to think about bone-health fitness because simply telling someone, "Go exercise," isn't enough. We need to know what kind of exercise is appropriate, how hard and how often to do it, what we are trying to accomplish, and what needs to change if that person already has osteoporosis.
Let's break it down.
1. Weight-Bearing and Impact Exercise: Give Your Bones a Reason to Adapt
One of the most important categories of exercise for bone health is weight-bearing activity. Weight-bearing exercise means you are supporting your body weight against gravity. Examples include:
Walking
Stair climbing
Dancing
Hiking
Jogging
Running
Tennis
Certain aerobic activities
The Bone Health & Osteoporosis Foundation divides weight-bearing activities into higher- and lower-impact categories. Higher-impact examples include jogging, running, jumping, dancing, stair climbing and tennis. Lower-impact examples include brisk walking, level-surface hiking, elliptical training and stair-step machines.
Why does impact matter? When your foot contacts the ground, force travels through the bones, and the skeleton has to respond to that force. The Royal Osteoporosis Society describes impact exercise as weight-bearing activity where additional force travels through the bones when the feet contact the ground. Appropriate impact exercise can help maintain or improve bone strength.
That does not mean everyone needs to start jumping. This is where individualization becomes critical.
Walking Is Great But Is Walking Enough?
Walking is one of the best forms of exercise we have. I love walking because it improves cardiovascular health, gets people moving, is accessible, and can help maintain mobility. For somebody who has been sedentary, walking may be exactly where I want them to start.
But we need to distinguish between exercise that is healthy and exercise that provides the strongest possible stimulus for bone. Walking is weight-bearing and can contribute to bone health, but for people who can safely tolerate more loading, adding resistance training and appropriate impact activity can provide a broader bone-strengthening program.
The Royal Osteoporosis Society specifically recommends combining impact exercise with strength exercise rather than relying on one type alone. So I would never tell somebody, "Stop walking." I might tell them, "Great. Keep walking. Now let's see what else your body can safely do."
What About Running and Jumping?
For a healthy person without elevated fracture risk, running, jumping and other impact activities can provide useful bone-loading forces. But this is where the internet can become dangerous. Someone gets diagnosed with osteoporosis, reads that jumping strengthens bones, and suddenly starts doing box jumps.
No. That is not how exercise programming works.
If someone has osteoporosis, a history of fractures, poor balance or another condition affecting exercise safety, the appropriate amount of impact must be determined individually. The Royal Osteoporosis Society recommends gradually progressing from lower to moderate impact when appropriate. It does not specifically recommend progressing everyone with osteoporosis to high-impact exercise, because moderate impact can provide bone benefits without requiring maximal impact forces.
The Bone Health & Osteoporosis Foundation similarly cautions that people who have had osteoporotic fractures or who are at elevated fracture risk may need to avoid high-impact activities.
More force is not automatically better. The correct amount of force is better.
2. Strength Training: One of the Best Things You Can Do for Your Bones
Now we get into an area I obviously care a lot about: strength training.
Most people think lifting weights is primarily about building muscle. It certainly can build muscle, but muscles and bones work together. When a muscle contracts against resistance, it pulls on the bones to which it attaches. That mechanical loading provides a stimulus to the musculoskeletal system.
The Royal Osteoporosis Society explains that strength exercise can use body weight, resistance bands, dumbbells or other forms of resistance. As muscles work against that resistance, they pull on the bones, helping maintain or improve bone strength.
This is one of the reasons I believe resistance training becomes more important, not less important, as we age.
Strength Is Independence
Forget bodybuilding for a minute. Forget how much you bench press. Think about normal life. Can you get out of a chair without using your hands? Can you climb stairs, carry groceries, pick something up from the floor or lift a suitcase? Can you catch yourself if you lose your balance? Can you get up if you fall?
Those are strength questions. This is why resistance training for an older adult isn't just about "getting toned." It is about preserving independence.
The Bone Health & Osteoporosis Foundation includes functional movements such as sit-to-stand and rising onto the toes alongside weights, machines, resistance bands, squats and lunges as forms of muscle-strengthening exercise.
You do not need to become a bodybuilder. You need enough strength to live your life.
The Basic Strength Movements
I like the Royal Osteoporosis Society's approach because it organizes strength training around basic movement patterns:
Hinge
Push
Pull
Squat
Brace
Lunge
Step
These are not arbitrary gym exercises. They represent movements we use throughout life. A squat helps you sit and stand, a hinge teaches you to bend through the hips, a row strengthens muscles that contribute to upper-body function and posture, and a step-up resembles climbing stairs.
This is exactly how I like to think about functional training: train movements that make you better at living.
How Much Strength Training?
The Royal Osteoporosis Society recommends gradually building strength exercise and suggests a general range of around 8–12 repetitions per set, with resistance that becomes challenging while still allowing good technique. Strength work can be performed approximately two to three days per week.
But those numbers are not commandments. Someone who has never trained before may start with body weight. A sit-to-stand from a chair may be challenging enough. As strength improves, resistance can gradually increase. Maybe body weight becomes a light resistance band, then dumbbells, then heavier resistance.
That is progressive overload, and it isn't just for bodybuilders. It is simply the principle of gradually asking your body to do more as it adapts.
Technique Matters More When Fracture Risk Is Elevated
I have always cared about exercise technique. But when someone has osteoporosis particularly osteoporosis involving the spine—technique becomes even more important.
The Bone Health & Osteoporosis Foundation recommends extra caution for people who have experienced spinal fractures, particularly with movements involving repeated forward bending, rapid twisting, heavy lifting or activities that increase fall risk.
This does not mean never bend again. You have to bend in everyday life. The Royal Osteoporosis Society makes this distinction very well: forward bending is a normal human movement, but people with osteoporosis may need to modify certain exercises to reduce unnecessary spinal loading.
For example, repeated loaded spinal flexion in exercises such as some sit-ups or toe-touching movements may be replaced with a hip hinge, where movement occurs primarily from the hips while the spine remains more controlled. That is intelligent modification, not fear.
The Hip Hinge: One Movement Everybody Should Learn
If I could teach someone with osteoporosis one basic movement pattern, the hip hinge would be high on my list. Imagine you need to pick something up. Instead of rounding your entire back and reaching toward the floor, you learn to push your hips backward while maintaining a controlled spinal position. That is the foundation of a hinge.
We use that concept in exercises such as the Romanian deadlift, but more importantly, you use it in real life:
Picking up groceries
Reaching into a lower cabinet
Moving objects
Loading a dishwasher
Exercise should teach you how to move better outside the gym.
3. Balance Training: Strong Bones Don't Help if You Keep Falling
This part gets overlooked constantly. People become obsessed with their bone-density score, but fracture prevention is not just about bone density. We also need to reduce the likelihood of falling. Falls can turn reduced bone strength into a fracture, which is why balance training should be a major part of exercise for many older adults and people with osteoporosis.
The Royal Osteoporosis Society recommends balance activities because improving steadiness and muscle strength can reduce the chance of slips, trips and falls. Balance training might include:
Heel-to-toe walking
Supported single-leg balance
Controlled stepping
Sit-to-stand exercises
Tai Chi
Appropriate yoga or Pilates modifications
Direction-change drills
Functional stepping patterns
The exercise needs to match the individual. If somebody has poor balance, I am not going to put them on an unstable surface and hope for the best. I might have them hold a stable support, then gradually reduce the amount of assistance.
Challenge balance without unnecessarily creating a fall. That sounds obvious, but sometimes common sense disappears when people try to make exercises look more advanced.
Fear of Falling Can Become Part of the Problem
This is something I think deserves more attention. After someone receives an osteoporosis diagnosis—or especially after experiencing a fracture—they may become afraid of falling, bending, lifting and sometimes exercise altogether. That fear is understandable.
But complete avoidance of movement can become counterproductive. The Royal Osteoporosis Society's physiotherapy guidance points out that moving less can lead to weaker muscles and poorer balance, potentially increasing the likelihood of injury after a fall.
So part of exercise is rebuilding confidence. Start with what feels safe, master it, and then progress. A successful program doesn't just make the body stronger. It makes the person trust their body again.
4. Posture and Spine Strength Matter
Osteoporosis can particularly affect the vertebrae of the spine. That is why posture, back strength and movement mechanics deserve attention.
The Bone Health & Osteoporosis Foundation recommends posture and functional exercises as part of a comprehensive program, especially for reducing the risk of spine-related injury and helping people move more effectively in everyday life. Exercises that strengthen the muscles supporting the upper back can be useful, and rows are one example. Appropriate back-extension work may also be incorporated depending on the individual.
But exercise selection should reflect medical history. Someone who has experienced vertebral fractures needs different considerations from someone who is exercising preventively with healthy bone density.
This is why I keep coming back to the same principle: the diagnosis may have the same name, but the person does not.
What About Yoga and Pilates?
Yoga and Pilates can offer benefits for:
Mobility
Balance
Body awareness
Strength
Posture
But certain positions may require modification for people with osteoporosis, particularly those at elevated risk of spinal fracture. The Bone Health & Osteoporosis Foundation specifically provides modified yoga and Pilates guidance because some movements involving substantial spinal flexion or twisting may not be appropriate for everyone with osteoporosis.
That does not mean yoga is bad for osteoporosis. It means choose and modify the exercises appropriately. That distinction is important.
Is Swimming Good for Osteoporosis?
Swimming is excellent cardiovascular exercise. It can improve muscular endurance and can be particularly useful for people with painful joints or mobility limitations. However, water supports much of your body weight, which means swimming does not provide the same type of weight-bearing impact stimulus as walking, stair climbing, dancing or jogging.
So if somebody loves swimming, fantastic. Keep swimming. But if the primary goal is improving or maintaining bone strength, I would generally want to add appropriate weight-bearing and resistance exercise if the individual can safely perform them.
The same general idea applies to cycling. Cycling is great exercise, but it should not necessarily be the only exercise you do for your bones.
Are You Too Old to Strengthen Your Body?
No. This is one of the messages I want people to remember. You may not respond exactly the same way at 75 that you did at 25, but that doesn't mean exercise stops mattering.
The Royal Osteoporosis Society specifically emphasizes that exercise remains important as people age because staying active can help reduce losses in bone and muscle strength while improving balance.
Maybe you cannot run. Fine walk. Maybe you cannot jump. Fine—use appropriate lower-impact loading. Maybe you cannot squat with a barbell. Fine—practice getting out of a chair, then make that movement stronger.
Exercise meets you where you are. The important thing is that you keep moving forward.
What If You've Never Exercised Before?
Then start where you are, not where you think you should be. If you haven't exercised in years, I do not care what somebody on social media is doing. Your program might begin with:
Walking
Sit-to-stands
Wall push-ups
Supported balance work
Light resistance bands
Calf raises
That is enough to begin. The Bone Health & Osteoporosis Foundation recommends starting slowly after long periods of inactivity and consulting a healthcare provider when medical conditions or high fracture risk are present.
As your body adapts, we progress. The Royal Osteoporosis Society uses the same philosophy: start slowly and build gradually. That is good advice for almost every fitness program I've ever designed.
Exercise Does Not Replace Osteoporosis Medication
This needs to be very clear. Exercise is extremely important for bone health, but if your doctor has determined that you have a high risk of fracture and prescribed osteoporosis medication, exercise should not automatically be viewed as a substitute.
The Royal Osteoporosis Society explicitly states that healthy habits such as exercise and good nutrition remain important, but exercise does not replace osteoporosis medication when medication is medically indicated.
Exercise and medical treatment can work together. This is not an either/or situation.
A Simple Bone-Health Exercise Strategy
If I were explaining the fundamentals to somebody who wants to protect their bones, I would keep it simple. Think:
LOAD. LIFT. BALANCE. MOVE WELL.
Load the bones with appropriate weight-bearing and impact activity. Lift using resistance training to strengthen muscles and bones. Train balance to reduce fall risk, and learn good movement mechanics so you can remain active confidently.
That does not require living in the gym. A week might include brisk walking, stair climbing or other appropriate weight-bearing activities along with two or three strength sessions and regular balance work.
For someone already fit and healthy, the program might be considerably more challenging. For someone with osteoporosis and a history of fractures, it may be much more conservative. Both can be effective because both are designed for the individual.
How I Would Approach Bone-Health Training at On Your Mark
If someone comes to me and says, "I have osteoporosis. What exercises should I do?" my first response isn't going to be a list of ten exercises. I want more information about the person and their situation.
I would ask questions such as:
How old are you?
What is your exercise history?
Have you had any fractures, particularly spinal fractures?
What has your doctor told you?
How is your balance?
Can you get out of a chair comfortably?
Can you climb stairs?
Do you currently lift weights?
Do you have pain or other orthopedic conditions?
What are you afraid of doing?
And perhaps most importantly: what do you want to be able to do?
Maybe someone wants to keep playing tennis. Maybe she wants to be able to travel. Maybe he wants to continue hiking. Maybe someone simply wants enough confidence to carry groceries and climb the stairs without worrying about falling. Those goals matter.
From there, we can determine what the program needs. It might include:
Progressive resistance training
Weight-bearing activity
Appropriate impact exercise
Balance training
Postural strengthening
Hip-hinge training
Functional movements
Mobility work
Fall-prevention strategies
Then we progress according to how the person responds. The treatment and exercise plan should reflect the individual's abilities, goals, medical history and fracture risk.
Bone Health Is a Lifetime Investment
One of the biggest mistakes we make is waiting until something hurts before thinking about our health. Bones usually don't give you that warning. You can lose bone strength without feeling it. There may be no pain, no stiffness and no obvious limitation. Then a fracture happens.
That is why prevention matters. You don't need to wait for an osteoporosis diagnosis before you start lifting weights. You don't need to wait until your balance deteriorates before you train balance, and you don't need to wait until you become weak before you start getting stronger.
The Royal Osteoporosis Society encourages people to think about bone health throughout life, emphasizing physical activity alongside other healthy lifestyle measures rather than waiting until osteoporosis becomes a problem.
The work you do today matters later.
Final Thoughts: Train Your Bones Like the Rest of Your Body
People spend enormous amounts of time worrying about muscles. How big are my arms? How strong are my legs? How much can I bench press? How much body fat do I have? There is nothing wrong with those goals. I've spent most of my professional life around fitness and strength training.
But underneath every muscle you train is a skeleton that needs to remain strong enough to support you. And unlike a six-pack, you cannot look in the mirror and see your bone density. That makes bone health easy to ignore—until it isn't.
The good news is that you can do something about it. Move, lift, challenge your bones appropriately, train your balance, maintain your strength and learn how to move safely. And start before you think you need to.
If you already have osteoporosis, don't assume the answer is to stop exercising. For most people, it isn't. The answer is to exercise appropriately. You may need to modify the impact, change certain spinal movements, start with balance before progressing to more demanding exercises, or seek professional guidance. But movement remains important.
I have worked with people for more than 23 years, and one lesson I continue to see over and over is that maintaining physical capacity changes what people are able to do with their lives. Strength gives you options, balance gives you confidence, and mobility gives you freedom. Healthy bones help provide the foundation underneath all of it.
You cannot control every factor that affects your bones, but you can give your body a reason to remain strong. And there is no better time to start than now.
Frequently Asked Questions About Exercise and Bone Health
What exercise is best for bone health?
There isn't one single best exercise. A comprehensive bone-health program generally combines appropriate weight-bearing or impact exercise with progressive resistance training. Balance and functional exercises are also important, particularly for older adults and people at risk of falls.
Does walking strengthen bones?
Walking is a weight-bearing activity and is excellent for overall health. For a more complete bone-strengthening program, walking can be combined with resistance training and, when appropriate, additional impact exercise.
Is weightlifting safe with osteoporosis?
Many people with osteoporosis can safely perform resistance exercise, but the program should reflect their fracture history, current strength, balance and medical status. People with spinal fractures or high fracture risk should seek individualized guidance before beginning heavier resistance training.
Can you build stronger bones after 60?
Exercise remains valuable as you age. Staying active can help maintain bone and muscle strength and improve balance. Appropriate strength and impact exercises can remain useful well into later life.
How often should I strength train for bone health?
The Royal Osteoporosis Society recommends incorporating strength training approximately two to three days per week, building resistance gradually according to your ability.
How many repetitions should I perform?
A general starting framework is around 8–12 repetitions per set using a resistance that becomes challenging while still allowing good technique. The exact program should be individualized.
Is running good for bone density?
Running is a weight-bearing impact activity that loads the skeleton. However, it may not be appropriate for everyone, particularly people with high fracture risk, previous fractures or other orthopedic conditions.
Are jumping exercises good for osteoporosis?
Appropriate impact exercise can benefit bone health, but jumping is not suitable for everyone. People with osteoporosis should choose the level of impact appropriate for their fracture risk, balance and medical history rather than assuming that higher impact is automatically better.
Is swimming good for osteoporosis?
Swimming is excellent exercise, but because the water supports body weight, it does not provide the same weight-bearing stimulus as activities performed on land. It can be combined with appropriate resistance and weight-bearing exercise.
Is cycling good for bone health?
Cycling offers excellent cardiovascular benefits but provides relatively little weight-bearing impact. Cyclists who want to prioritize bone health may benefit from adding suitable resistance and weight-bearing exercise.
Should people with osteoporosis avoid bending forward?
Normal bending is part of everyday life. However, people at elevated risk of vertebral fracture may need to modify repeated, forceful or loaded spinal-flexion exercises. Learning a hip-hinge strategy can help reduce unnecessary spinal loading during many activities.
Is balance training really important for osteoporosis?
Yes. Stronger bones are only part of fracture prevention. Improving balance and leg strength can help reduce falls, which can reduce opportunities for fractures to occur.
Can exercise replace osteoporosis medication?
No. Exercise is an important component of bone health, but it should not be considered a replacement for medication when osteoporosis treatment has been medically indicated.
When should I speak with a doctor or physical therapist before exercising?
Professional guidance is especially important if you have experienced spinal fractures, multiple fractures, are currently recovering from a fracture, have significant balance problems, or have another medical condition that may affect exercise safety.
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