Osteoporosis and Exercise: Why Strength Training Is One of the Most Powerful Medicines for Your Bones

Osteoporosis is often called the “silent disease” because it usually develops without symptoms until a fracture occurs. Unfortunately, for many Australians, the first sign of osteoporosis is a broken wrist after a simple fall, a painful vertebral fracture after lifting something light, or a hip fracture that dramatically changes their independence.

The good news is that a diagnosis of osteoporosis is not the end of an active life. In fact, it can be the beginning of one.

Osteoporosis is often thought of as a condition treated with medication, but that’s only part of the picture. Exercise—particularly progressive strength training combined with appropriate impact loading—is one of the foundations of modern osteoporosis management. Alongside medical treatment where appropriate, it helps build stronger muscles, maintain bone health, reduce falls risk, and preserve independence.

At Body Fit Physiotherapy, we help people with osteopenia and osteoporosis build stronger bodies through evidence-based strength and conditioning programs that improve bone health, muscle strength, balance and confidence.

This article explains:

• What osteoporosis is

• Why bones become weaker with age

• Why strength training is essential

• Why impact exercises are just as important

• How physiotherapists safely guide this process

• How you can take control of your bone health regardless of your age

Understanding Osteoporosis

Bone is living tissue.

Throughout life it is constantly being broken down and rebuilt in a process known as bone remodelling.

When we are younger, we build bone faster than we lose it. Peak bone mass is usually reached in our late twenties to early thirties.

As we age, particularly after menopause in women and later in life for men, bone breakdown gradually exceeds bone formation.

The result is:

• reduced bone mineral density

• weaker bone structure

• increased fracture risk

If this process is mild it is called osteopenia.

When bone density falls below a certain threshold it is classified as osteoporosis.

Importantly, osteoporosis doesn’t mean your bones suddenly become fragile overnight. Rather, the body’s reserve gradually reduces until even relatively small injuries can cause fractures.

Osteoporosis Is More Common Than Most People Realise

According to Osteoporosis Australia and the Healthy Bones Australia guidelines:

• Around two-thirds of Australians over 50 have low bone density (osteopenia or osteoporosis).

• Approximately one in two women and one in three men over 60 will sustain an osteoporotic fracture during their lifetime.

• Hip fractures are associated with substantial loss of independence and increased healthcare utilisation.

These statistics highlight why prevention is just as important as treatment.

Bone Needs Stress to Stay Strong

Many people assume that because osteoporosis weakens bones, they should avoid loading them.

The opposite is actually true.

Bone responds to mechanical loading.

Every time muscles pull on bone during exercise, specialised bone cells receive signals telling them to build stronger bone.

This principle is known as Wolff’s Law.

Without sufficient loading, the body has little reason to maintain bone density.

That’s why inactivity, prolonged sitting and bed rest accelerate bone loss.

Walking Is Excellent… But It Isn’t Enough

Walking is one of the best forms of exercise for:

• cardiovascular health

• mental wellbeing

• maintaining mobility

However, walking generally does not provide enough loading stimulus to significantly increase bone density once osteoporosis is present.

Research consistently demonstrates that maintaining or improving bone density requires:

• progressive resistance training

• impact loading (where appropriate)

• balance training

• functional strengthening

Walking should remain part of your weekly exercise routine—but it shouldn’t be the only exercise you do.

Why Strength Training Is So Important

Progressive resistance training is considered one of the cornerstones of osteoporosis management.

It improves:

Muscle strength

Stronger muscles produce greater forces through bone, stimulating bone formation.

Bone density

High-quality studies demonstrate that appropriately prescribed resistance exercise can help maintain—and in some cases improve—bone mineral density.

Balance

Falls remain the leading cause of osteoporotic fractures.

Improving strength reduces fall risk.

Confidence

Many people with osteoporosis become fearful of movement.

Strength training helps rebuild trust in the body.

Functional independence

Simple activities become easier:

• climbing stairs

• getting off the floor

• carrying shopping

• gardening

• lifting grandchildren

These improvements directly influence quality of life.

Why Progressive Overload Matters

One of the biggest misconceptions is that simply lifting light weights repeatedly is enough.

Bones adapt to progressive overload.

This means the exercises need to become gradually more challenging over time.

Just like muscles stop improving if the same weight is used forever, bones also require progressive stimulus.

This might involve:

• increasing resistance

• increasing complexity

• progressing functional movements

• increasing loading safely

This progression is one reason supervised physiotherapy-led exercise programs are often so valuable.

Why Impact Exercises Are Essential

One of the strongest messages emerging from modern osteoporosis research is that bone responds particularly well to impact loading.

Examples include:

• hopping

• skipping

• jumping

• bounding

• multidirectional landing drills

These exercises create rapid forces through the skeleton that stimulate bone formation.

Large clinical trials, including the LIFTMOR trial, demonstrated that carefully supervised high-intensity resistance and impact training can improve bone density, muscle strength and functional performance in postmenopausal women with low bone density.

Importantly:

Impact exercise is not appropriate for everyone.

Whether impact loading is suitable depends on:

• fracture history

• severity of osteoporosis

• balance

• current strength

• medical history

• confidence

This is where individual assessment becomes critical.

Not Everyone Starts in the Same Place

Someone newly diagnosed with osteopenia may begin impact exercises relatively early.

Someone with severe osteoporosis and previous vertebral fractures may initially focus on:

• posture

• strength

• balance

• movement quality

before progressing further.

There is no “one-size-fits-all” program.

Posture Matters More Than Many People Think

One area often overlooked is spinal strength.

Weakness of the upper back muscles contributes to:

• rounded posture

• increased thoracic kyphosis

• altered spinal loading

• increased vertebral fracture risk

Research supports strengthening the spinal extensor muscles as part of osteoporosis management.

Improving posture also:

• improves breathing

• improves balance

• improves confidence

• reduces fatigue

At Body Fit Physiotherapy we place significant emphasis on building strong postural muscles—not simply because people “look better”, but because they function better.

Why Muscle Is Just as Important as Bone

Bone rarely fails in isolation.

Muscle loss (sarcopenia) often occurs alongside osteoporosis.

After the age of 50:

• muscle mass declines

• muscle power declines even faster

• balance deteriorates

• falls become more common

Muscle is your body’s protective armour.

The stronger you become, the better able you are to absorb unexpected loads, recover from illness, and maintain independence.

The Hidden Risk of Bed Rest

One of the greatest threats to healthy ageing isn’t ageing itself—it’s periods of inactivity.

Research shows that even short periods of bed rest can lead to rapid declines in muscle mass and strength, particularly in older adults.

Within the first week of bed rest:

• muscle protein synthesis falls

• muscle size begins to decrease

• strength declines rapidly

Hospital admissions, illness and surgery are often unavoidable.

What we can influence is the reserve we build beforehand

Think of strength and muscle as your savings account.

If illness forces you to withdraw from that account, having built up a healthy reserve means you’re more likely to recover quickly and return to the activities you enjoy.

Consistency Beats Perfection

One of the biggest predictors of long-term success isn’t finding the perfect exercise.

It’s continuing to exercise.

Research consistently shows that bone responds to regular loading over months and years, not occasional bursts of activity.

Small, sustainable habits almost always outperform short-lived intensive programs.

How Physiotherapy Helps

At Body Fit Physiotherapy, we understand that beginning strength training with osteoporosis can feel intimidating.

Many people tell us:

“I’m worried I’ll break something.”

“I’ve been told not to lift weights.”

“I’m scared of making my bones worse.”

These concerns are understandable.

Our role is to replace uncertainty with confidence.

We begin by listening to your story and understanding:

• your diagnosis

• your fracture history

• your goals

• your confidence levels

• your current strength and fitness

From there we develop an individualised program that progresses safely at a pace appropriate for you.

Our approach may include:

• Comprehensive assessment of strength, balance and mobility

• Individualised progressive resistance training

• Education about safe movement and lifting

• Postural strengthening

• Balance and falls prevention training

• Graduated introduction of impact exercises where appropriate

• Ongoing progression as your strength and confidence improve

We don’t simply give you exercises—we help you understand why you’re doing them and how they support your long-term bone health.

It’s Never Too Late to Get Stronger

One of the most encouraging findings from osteoporosis research is that people continue to respond to strength training well into their 70s, 80s and beyond.

While we can’t completely stop the ageing process, we can significantly influence how well we age.

Strength is one of the few things that improves quality of life across almost every aspect of healthy ageing.

It helps you:

• remain independent

• reduce your risk of falls

• protect your bones

• stay active with family and friends

• continue doing the things you enjoy

Key Takeaways

• Osteoporosis is common, but it is not a reason to stop exercising.

• Progressive strength training is one of the most effective non-pharmacological treatments for maintaining bone health.

• Walking is beneficial but generally isn’t enough on its own to stimulate bone growth.

• Impact exercises can provide an additional bone-building stimulus when prescribed appropriately.

• Strong muscles help protect bones, improve balance and maintain independence.

• A personalised program ensures exercises are both safe and effective.

• Consistency over months and years is the key to long-term success.

How Body Fit Physiotherapy Can Help

At Body Fit Physiotherapy, we believe everyone deserves the opportunity to age with strength, confidence and independence.

Whether you’ve recently been diagnosed with osteopenia or osteoporosis, have experienced a fracture, or simply want to be proactive about your bone health, we’re here to guide you every step of the way.

We’ll work closely with you, your GP and specialist (where appropriate) to develop an evidence-based strength and conditioning program that matches your goals, builds your confidence, and helps you continue doing the things you love.

If you’d like support taking the next step towards stronger bones and a more active future, we’re always happy to help.

To find out more visit: https://www.bodyfit.life/osteoporosis

References

• Healthy Bones Australia. Position Statement on Exercise and Osteoporosis (2023).

• Royal Australian College of General Practitioners. Osteoporosis Clinical Guidelines.

• Watson SL, Weeks BK, Weis LJ, et al. Heavy resistance training is safe and improves bone, function and posture in postmenopausal women with low bone mass: the LIFTMOR Trial. Journal of Bone and Mineral Research. 2018.

• International Osteoporosis Foundation. Exercise recommendations for osteoporosis.

• Giangregorio LM, et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International. 2014.

• Kortebein P, et al. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007.

• Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019.