Osteoporosis: Can the Right Exercise Actually Build Stronger Bones?

If you have been diagnosed with osteoporosis or osteopenia, you may have heard the same advice many times: “Stay active and do some exercise.”

Staying active is important—but when it comes to improving bone strength, not all exercise is equal.

What doesn't work as well for building bone?

Walking is excellent for general health, fitness and maintaining independence, but walking alone has not shown significant effects on BMD at the spine, radius or whole body in peri- and postmenopausal women.

Swimming and cycling are also excellent cardiovascular activities, but because they provide relatively little weight-bearing skeletal loading, they should not be relied upon as the main bone-building exercise. Low-load resistance training and stretching alone are also unlikely to provide the stimulus needed to maximise bone adaptation.

That doesn't make these activities “bad”—it simply means your bones may need a different stimulus.

Osteoporosis means that bone strength is compromised, increasing the risk of fracture. The encouraging news is that research shows appropriately prescribed exercise can do much more than simply keep you moving.

Can we stop bone loss—or even build bone?

Bone responds to mechanical loading. Importantly, the research shows that only the bones being loaded respond, and greater loading can produce a greater bone response.

One important study was the LIFTMOR trial, which investigated high-intensity resistance and impact training in postmenopausal women with low bone mass.

Participants completed supervised exercise for around 30 minutes, twice per week for eight months, progressively training at approximately 85% of their one-repetition maximum (1RM).

Compared with low-intensity exercise, High-intensity exercise improved lumbar spine bone mineral density by about 2.9%, while the control group lost about 1.2%. Femoral-neck BMD was also better maintained/improved relative to control.

What was the exercise intensity?

This is where osteoporosis exercise becomes interesting.

The LIFTMOR program wasn't light resistance exercise. It used 5 sets of 5 repetitions, progressing above 85% 1RM, at an RPE of approximately 16+ (“very hard”).

Later research has similarly used exercises such as the deadlift, back squat and overhead press, together with impact and balance exercises. However, this does not mean someone with osteoporosis should walk into a gym tomorrow and start lifting heavy weights. The research programs were progressive, individualised and closely supervised.

Exercise vs medication—is one better?

It shouldn't necessarily be exercise OR medication.

Osteoporosis medications can substantially reduce fracture risk and are recommended for people at high risk of minimal-trauma fracture. Exercise addresses something medication cannot do alone: it can improve muscle strength, balance and physical function, while appropriately loaded exercise can also stimulate bone.

Strong bones are only half the story: preventing falls

Why do we care so much about strength and balance? Because a fracture often happens when osteoporosis meets a fall.

Falls are therefore a major part of fracture prevention. Important risk factors can include reduced lower-limb strength, poor balance and mobility, alongside medical, medication, vision and environmental factors.

This is particularly important for hip fractures: around 90% occur following a fall. That means osteoporosis management shouldn't focus only on a DXA scan—it should also address the person's ability to move safely and confidently.

Current Australian osteoporosis guidelines recommend progressive moderate-to-vigorous resistance training at least twice weekly, weight-bearing impact exercise and challenging balance training.

The message is simple:

Don't just exercise more—exercise for the right purpose.

For someone with osteoporosis, a well-designed program should aim to load the bones, strengthen the muscles, challenge balance and reduce falls risk, while considering fracture history and individual health conditions.

If you're unsure where to begin, an Accredited Exercise Physiologist (AEP) can assess your strength, balance, function and fracture risk and develop a safe, progressive exercise program specifically for you.