Osteoporosis and exercise

Osteoporosis is the loss of calcium and other minerals from the bones, which makes them weaker and more likely to fracture (break). It becomes more common with age, and women are more likely to develop it because the hormonal changes around menopause speed up bone loss.

Why exercise matters#

A sedentary lifestyle, with little physical activity, encourages the loss of bone mass. People who already have osteoporosis can benefit from exercise just as much as those trying to prevent it.

Exercising regularly can reduce the rate of bone loss, and certain types of exercise can improve bone health and balance. By slowing bone loss and improving strength and coordination, exercise helps reduce the risk of fractures.

Exercise brings other benefits too. It can support better management of other health problems, reduce the need for some medications that may add to the risk of falls, and improve mood and overall vitality. Poor posture, poor balance and weak muscles all increase the risk of fractures, and exercise helps address each of these.

Choosing the right exercise#

A combination of approaches works best:

• weight-bearing impact-loading exercise (such as dancing)
• aerobic exercise
• muscle-building (resistance) exercise, using free weights such as dumbbells and barbells, elastic resistance bands, body-weight exercises or weight-training machines
• specific balance exercises, such as tai chi, to improve posture and stability

Ideally, your weekly physical activity should include something from each of these groups.

Swimming and water exercise#

Swimming and water-based activities such as aqua aerobics or hydrotherapy are not weight-bearing, because the buoyancy of the water counteracts the effects of gravity. They are therefore less effective for building bone.

However, exercising in water can still improve cardiovascular fitness and muscle strength. People with severe osteoporosis or kyphosis (hunching of the upper back), who are at high risk of fractures, may find that swimming or water exercise is their safest and preferred option.

Walking#

Walking is gentle, but on its own it is not enough to build or protect bone. For people who are otherwise inactive, though, walking can be a safe way to introduce some physical activity before progressing to more targeted exercise.

Exercises to approach with care#

Because osteoporosis weakens the bones, some movements carry a higher risk of fracture. Generally, people with osteoporosis should avoid activities that:

• involve loaded forward bending of the spine, such as sit-ups and toe-touches
• increase the risk of falling
• require sudden, forceful or twisting movements (such as a golf swing), unless these are introduced gradually as part of a progressive program and the person is already accustomed to them

How much exercise is needed#

The exact amount of exercise required is not fully established, but general guidance suggests:

• weight-bearing impact-loading exercise on at least three days a week, with each session including a number of impacts
• resistance training two to three times a week, with each session including several sets of a handful of exercises
• balance exercises on at least three sessions a week, building up to a meaningful total of progressive and challenging balance activity
• stretching exercises to promote flexibility

For safety, always make sure you can hold on to something steady if you lose your balance. A physiotherapist or exercise physiologist can give you tailored advice.

Getting started safely#

Regular exercise is an essential part of any osteoporosis treatment program, and you need to continue it over the long term to keep reducing your risk of fracture.

Before starting a new exercise program, talk with your doctor or another health professional. Factors to consider include:

• your age
• the severity of your osteoporosis
• your current medications
• your fitness and ability
• other medical conditions, such as cardiovascular or lung disease, arthritis or neurological problems
• whether improving bone density or preventing falls is the main aim of your program

Always start at a low level and progress slowly. Exercise that is too vigorous too soon can increase your risk of injury, including fractures.

You can also ask your doctor or a dietitian about ways to increase calcium, vitamin D and other important nutrients in your diet, and whether supplements may help. Avoiding smoking and excessive alcohol further supports bone health.

Key Points#

• Women are more likely to develop osteoporosis because the hormonal changes around menopause speed up bone loss.
• A sedentary lifestyle encourages the loss of bone mass.
• Exercise slows the rate of bone loss, which reduces the risk of fractures.
• A combination of weight-bearing, resistance and balance exercise works best, continued over the long term.
• Poor posture, poor balance and weak muscles increase the risk of fractures.
• Always consult your doctor, physiotherapist or exercise physiologist before starting a program.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).