Osteoporosis is a progressive condition characterised by reduced bone density and structural deterioration, leading to an increased risk of fractures. With millions affected worldwide, osteoporosis is a major public health concern, particularly among postmenopausal women and older adults. While medications play a crucial role in treatment, exercise is a fundamental component of osteoporosis prevention and management. Research has shown that targeted physical activity can improve bone density, enhance muscle strength, and reduce the risk of falls, making it an essential strategy for maintaining skeletal health.
The Science Behind Exercise and Bone Health
Bone is a dynamic tissue that undergoes continuous remodelling in response to mechanical stress. Weight-bearing and resistance exercises stimulate osteoblast activity, the process by which new bone is formed. This is particularly important for individuals with osteoporosis, as progressive loading helps counteract bone loss while also improving muscle strength, coordination, and balance—key factors in fall prevention.
Evidence-Based Exercise Recommendations
1. Resistance Training: Strengthening Bones Through Load
Strength training applies mechanical stress to bones, triggering adaptive responses that enhance bone mineral density (BMD). Exercises such as weightlifting, resistance band training, and body-weight movements (e.g., squats, lunges, and push-ups) are particularly effective. Studies suggest that targeting major muscle groups at least twice a week promotes both muscular and skeletal adaptation. However, progression should be gradual, with increasing resistance guided by an exercise or medical professional to avoid undue strain.
2. Weight-Bearing and Impact Exercises: Stimulating Bone Adaptation
Ground-reaction forces are a key stimulus for bone formation, and weight-bearing activities such as brisk walking, stair climbing, and dancing exert beneficial stress on the skeleton. Higher-impact activities like running create forces of up to 2.5 times body weight, which can significantly enhance bone strength. However, high-impact movements such as jumping should be approached with caution, particularly in individuals with advanced osteoporosis or a history of fractures.
For those at lower fracture risk, moderate-impact exercises such as heel drops and gentle hopping can be introduced under professional supervision. The principle of progressive overload is important—gradually increasing intensity ensures optimal adaptation without excessive risk.
3. Balance and Flexibility Training: Reducing Fall Risk
Falls account for the majority of osteoporosis-related fractures, making balance and stability exercises a critical component of prevention strategies. Practices such as Tai Chi, yoga, and targeted balance drills improve proprioception, postural control, and muscle coordination. However, certain movements, particularly deep spinal twists and forward bends, should be modified to prevent undue stress on vulnerable areas such as the spine.
Running and Osteoporosis
Running has long been associated with bone-loading benefits, but excessive or poorly managed running can increase the risk of stress fractures, particularly in the lower limbs. Each running stride generates a force equivalent to approximately 2.5 times body weight, making it a potent stimulus for bone adaptation. However, the cumulative effect of repeated impact can lead to microdamage if adequate recovery is not observed.
Key considerations for safe running with osteoporosis:
- Gradual progression: Increase distance and intensity conservatively to allow for skeletal adaptation.
- Optimised nutrition: Ensure an adequate intake of calcium, vitamin D, and protein to support bone remodelling.
- Recovery periods: Allow sufficient time between high-impact sessions to facilitate bone repair.
Optimising Safety: Exercise Modifications for Osteoporosis
While exercise is highly beneficial for osteoporosis, certain precautions must be observed:
- Avoid high-risk movements: Deep spinal twists, heavy overhead lifting, and high-impact landings may increase fracture risk.
- Emphasise core stability: Strengthening abdominal and lower back muscles supports spinal alignment and reduces fall risk.
- Personalised exercise prescription: Collaborate with an exercise or medical professional to develop an appropriate, individualised regimen.
The Role of Nutrition and Lifestyle in Bone Health
Exercise alone is not sufficient—optimal nutrition is critical for bone maintenance and recovery.
- Calcium and vitamin D: Essential for bone mineralisation and strength, obtained from dietary sources or supplementation when necessary.
- Adequate protein intake: Supports muscle mass, which exerts mechanical forces that contribute to bone strength.
Guidelines and Expert Recommendations
Leading organisations such as the International Osteoporosis Foundation advocate for a multimodal exercise approach, combining aerobic, resistance, and balance training. Given the variability in individual bone health, exercise regimens should be tailored, particularly for those with prior fractures or mobility challenges. Consulting with an exercise or medical professional is essential before implementing a new exercise programme.
Conclusion
Exercise is a powerful, evidence-based intervention for managing osteoporosis, providing benefits that extend beyond bone health to overall functional well-being. By prioritising progressive resistance training, weight-bearing activities, and balance exercises, individuals can enhance skeletal strength, reduce fall risk, and improve quality of life. When combined with appropriate nutrition and professional guidance, an active lifestyle remains not only possible but essential for long-term bone health.
Catherine Ashley