How Weight-Bearing & Posture Workouts Support Bone Strength in Osteopenia & Osteoporosis

Osteopenia and osteoporosis are common conditions that affect bone strength and structure, increasing the risk of fractures and loss of independence — particularly as we age. In Australia, more than 900,000 people live with osteoporosis, and over 2 million more have osteopenia, meaning their bone density is below optimal levels but not yet in the osteoporotic range (Osteoporosis Australia, 2023).

While medication and nutrition play an important role, targeted exercise is one of the most powerful tools for improving bone health, posture, and functional strength. At Body Fit Physiotherapy, we focus on safe, progressive, and individualised weight-bearing programs designed to build bone density, improve posture, and enhance overall quality of life.

Understanding Osteopenia and Osteoporosis

Bone is living tissue that constantly remodels — old bone is broken down, and new bone is formed. As we age, this process becomes unbalanced, with bone loss outpacing bone formation.

• Osteopenia represents early bone loss and an increased risk of fracture if bone density continues to decline.

• Osteoporosis occurs when bone becomes porous and fragile, significantly increasing fracture risk — particularly in the spine, hips, and wrists.

Women after menopause and men over 70 are most at risk due to hormonal and age-related changes affecting bone turnover.

Why Exercise Is Critical for Bone Health

The National Osteoporosis Foundation and numerous systematic reviews have confirmed that weight-bearing and resistance training are the most effective non-pharmacological interventions for increasing or maintaining bone mineral density (BMD) (Watson et al., 2018; Beck et al., 2017).

When bone is loaded through impact or muscle contraction, it stimulates bone-forming cells called osteoblasts, triggering the body to strengthen bone structure in response to stress. Essentially, bone becomes stronger when challenged appropriately.

Key Exercise Types for Bone Strength:

1. Weight-Bearing Exercises:

   
   

   Activities performed while upright, such as walking, stair climbing, dancing, or light jogging.

   
   

   • Improve bone density in the hips and spine.

   • Enhance balance and reduce fall risk.

   
   

2. Resistance (Strength) Training:

   
   

   Exercises that use weights, resistance bands, or body weight to challenge muscles.

   
   

   • Builds muscle mass, which indirectly strengthens bone by pulling on it.

   • Targets key areas prone to fracture: hips, spine, and wrists.

   
   

3. High-Impact Training (when safe):

   
   

   Jumping or hopping movements, when appropriate, can provide greater osteogenic stimulus, particularly for pre- and early post-menopausal women (Kelley et al., 2013).

The Often-Neglected Piece: Posture and Back Strength

While weight-bearing and resistance exercise are essential, postural control and spinal strength are equally important — especially in osteoporosis, where vertebral fractures are common.

Over time, gravity pulls us forward, leading to thoracic kyphosis (rounded upper back) and a stooped posture. This position:

• Increases compressive forces on the front of the vertebrae.

• Raises fracture risk in the thoracic spine.

• Affects balance, breathing, and confidence in movement.

Why Back Strength Matters

Research has shown that strengthening the spinal extensors can reduce kyphotic posture and lower the risk of vertebral fractures.

• Sinaki et al. (2002) demonstrated that individuals who performed targeted back extensor strengthening had fewer spinal fractures compared to those who didn’t exercise.

• A Cochrane review (Giangregorio et al., 2015) found that progressive resistance training was safe and effective for improving posture, muscle strength, and functional mobility in people with low bone density.

Key Posture and Back Strength Exercises:

• Wall Angels: Improve shoulder and upper back mobility.

• Prone Back Extensions: Strengthen the spinal extensors that counteract gravity.

• Band Pull-Aparts: Strengthen the upper back and improve scapular stability.

• Bridges: Activate glutes and posterior chain muscles for spinal support.

• Modified Superman (arm/leg lifts): Promote spinal strength safely in a controlled range.

These exercises help maintain an upright posture, reduce spinal loading, and improve confidence in movement.

You should have your local physiotherapist assess if these exercises are appropriate for you before starting them.

How Physiotherapy Helps

At Body Fit Physiotherapy, we take an individualised and evidence-based approach to bone health.

Our physiotherapists assess your:

• Bone health status and risk factors.

• Posture, strength, balance, and functional mobility.

• Exercise tolerance and fall risk.

From there, we design a customised exercise program that safely challenges your bones, strengthens your posture, and supports long-term independence.

Our Programs May Include:

✅ Progressive resistance training with bands, weights, or bodyweight.

✅ Weight-bearing drills for bone loading (e.g., step-ups, mini-hops, heel drops).

✅ Spinal and postural retraining for back and core endurance.

✅ Balance and coordination work to reduce fall risk.

✅ Education on movement safety, daily posture, and lifting techniques.

Manual therapy may also be used to improve joint mobility and relieve stiffness, helping you move more freely and safely.

Beyond Bone Health: The Bigger Picture

Exercise for osteopenia and osteoporosis does more than just strengthen bones — it improves:

• Muscle strength and endurance

• Balance and confidence

• Functional independence

• Mood and mental wellbeing

Regular, guided exercise can even reduce the risk of falls by up to 40% (Sherrington et al., 2019) — a crucial factor, as fractures are most commonly caused by falls rather than bone weakness alone.

Key Takeaways

• Weight-bearing and resistance exercise are the foundation of bone health.

• Strengthening your back and posture helps counteract gravity and prevent spinal fractures.

• Exercise is safe and effective for those with osteopenia and osteoporosis when supervised correctly.

• Physiotherapy provides the guidance, progression, and safety you need to maximise bone and postural strength.

• It’s never too late to start — but the earlier you begin, the greater your long-term benefits.

References

• Beck, B. R., Daly, R. M., Fiatarone Singh, M. A., & Taaffe, D. R. (2017). Exercise and Sports Science Australia position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), 438–445.

• Giangregorio, L. M., et al. (2015). Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database of Systematic Reviews, (1), CD008618.

• Kelley, G. A., Kelley, K. S., & Kohrt, W. M. (2013). Exercise and bone mineral density in premenopausal women: a meta-analysis. BMC Musculoskeletal Disorders, 14, 77.

• Osteoporosis Australia (2023). The Burden of Osteoporosis in Australia.

• Sherrington, C., et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev, (1), CD012424.

• Sinaki, M., et al. (2002). Stronger back muscles reduce the incidence of vertebral fractures: a 10-year follow-up. Bone, 30(6), 836–841.

• Watson, S. L., Weeks, B. K., Weis, L. J., & Beck, B. R. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women with Low Bone Mass. Journal of Bone and Mineral Research, 33(2), 211–220.