Geriatric

Osteoporosis and Bone Health

Expert-reviewed guidance on osteoporosis — what loads bone, which movements need modifying, and why the program should be prescribed.

  • Expert Reviewed
  • Evidence Based
  • Patient Focused

Reviewed by Dr. Eva Lassey, PT, DPT · View full bio → · Last updated August 27, 2026

Ages covered on this page: Older adults

Osteoporosis means bone has become less dense and more fragile, raising the risk of fracture — most commonly at the spine, hip, and wrist.⁠1 Bone responds to load, which is why weight-bearing and resistance exercise are central to management rather than optional additions to medication and calcium.⁠2,3 But the type of loading matters more here than almost anywhere else in exercise prescription: bending forward from the waist and twisting the spine are movements people with osteoporosis are advised to avoid, flexion exercises have been linked to more vertebral fractures than extension exercises, and generic exercise advice can cause harm.⁠4,5 Preventing falls matters as much as bone density, because most hip fractures in older people result from falls.⁠6

What is osteoporosis, and how is it diagnosed?

Bone is living tissue that continuously remodels — old bone removed, new bone laid down. Osteoporosis is what happens when removal outpaces replacement, leaving bone less dense and structurally weaker.⁠4

It typically has no symptoms until a fracture occurs, which is why it's often diagnosed only after one.⁠1

Osteopenia describes lower-than-normal bone density that hasn't reached the threshold for osteoporosis.⁠4 It can progress to osteoporosis without treatment, which is why it's where prevention has the most to work with.⁠9

Diagnosis is usually by DEXA scan, alongside fracture risk assessment that takes account of age, history, and other factors.⁠2

Does exercise help osteoporosis? Bone loading and falls

Bone adapts to the loads placed on it. Loading stimulates bone formation; the absence of loading accelerates loss. That's why prolonged inactivity and bed rest speed up bone loss.⁠1,10

  • Loading the skeleton helps maintain bone density at the sites that matter — hip and spine. In trials in women after menopause the effect was small but possibly important.⁠10
  • Preventing falls matters at least as much, because most hip fractures in older people result from falls.⁠6 Exercise that improves balance and strength reduces falls, and may reduce fall-related fractures.⁠11 → Falls and balance

Exercises and movements to avoid with osteoporosis

This is where generic exercise advice becomes a safety issue. In established osteoporosis, particularly with previous vertebral fracture, certain movements carry increased fracture risk:⁠12

  • Repeated or loaded forward bending of the spine — such as sit-ups and toe touches⁠4,5
  • Forceful twisting of the trunk, particularly combined with bending⁠4
  • High-impact activity once you have osteoporosis⁠2
  • Movements that combine bending and twisting — reaching down and across to lift something is the everyday version⁠1,4

The concern goes back to a small study of 59 women with postmenopausal spinal osteoporosis: over one to six years, new vertebral fractures occurred in 89% of those given flexion exercises and 16% of those given extension exercises.⁠5

What this doesn't mean: it doesn't mean avoiding exercise, and it doesn't mean avoiding all bending forever. It means the program should be prescribed rather than generic, and that someone with established osteoporosis or a previous fracture needs individual assessment.⁠12 Ask directly: "I have osteoporosis — is this program appropriate, and are there movements I should modify?" A physical therapist should have a specific answer.

Which exercises help osteoporosis and bone health?

  • Weight-bearing exercise — activity where you support your own body weight against gravity, such as brisk walking, climbing stairs, or dancing.⁠13 Walking counts, though in trials the larger effects on bone density came from resistance training and combined programs,⁠10 and high-impact exercise is advised against once you have osteoporosis.⁠2
  • Progressive resistance training — in trials, resistance training for the legs had the largest effect on bone density at the hip,⁠10 and it is one of the best activities for bone health.⁠2 It loads bone as well as muscle.⁠13
  • Balance and functional training — for the falls half of the equation: in older adults living at home, balance and functional exercises reduce the rate of falls by about a quarter.⁠11
  • Postural and back extensor strengthening — supports spinal posture and is generally recommended in preference to flexion-based work.⁠5,12
  • Consistency over years. Exercise for bone is a long-term habit rather than a short course.

Alongside exercise: medical management, calcium and vitamin D as advised by your doctor, stopping smoking, and moderating alcohol.⁠1 Exercise complements these rather than replacing them. → Find a physical therapist

Recovering from a vertebral fracture caused by osteoporosis

Common, frequently missed, and different to manage.⁠8 Many vertebral fractures happen without a fall — a cough, a bend, lifting something light.⁠1 Some cause sudden severe back pain; others are found only on an x-ray taken for another reason.⁠7

Recovery involves pain management, gradual return to movement, posture and back extensor work, and adjusting daily tasks to reduce spinal loading — how you get out of bed, how you lift, how you reach.⁠7,12

Some people move less after a fracture, out of pain or fear of another one. That's worth addressing, because prolonged inactivity speeds bone loss.⁠1

Osteoporosis therapy goals, with examples

Carry a grocery bag in each hand · Get up from a low chair unaided · Walk 30 minutes on uneven ground · Lift a grandchild safely · Return to my exercise class

Improve bone density · Increase spinal extensor strength

Frequently Asked Questions

Is walking enough?

Walking is weight-bearing and worth doing, but in trials the larger effects on bone density came from resistance training and combined programs,⁠10 and walking programs on their own have not been shown to prevent falls.⁠11 Resistance and balance training add what walking doesn't.

Can exercise reverse osteoporosis?

Not on its own. In trials, exercise had a small effect on bone density,⁠10 and in older adults its main benefit is strength and balance, which lowers the chance of falling.⁠2,11 It's part of management alongside medical treatment.

What exercise is best for osteoporosis?

Weight-bearing activity plus progressive resistance training, alongside balance work.⁠3,13 In trials, resistance training for the legs had the largest effect on bone density at the hip.⁠10

Is osteopenia the same as osteoporosis?

No. Osteopenia describes lower-than-normal bone density that hasn't reached the osteoporosis threshold.⁠4 It can progress to osteoporosis without treatment, which is why it's where prevention has most to work with.⁠9

Is lifting weights safe with osteoporosis?

Progressive resistance training is one of the best activities for bone health,⁠2 and in trials it had the largest effect on bone density at the hip.⁠10 With established osteoporosis or a previous fracture the program should be prescribed rather than generic.⁠12 Ask directly whether the program is appropriate for you and which movements to modify.

How do I know if I've had a vertebral fracture?

Sudden back pain after a minor movement, loss of height, or a developing forward curve of the upper back all warrant assessment.⁠1 Vertebral fractures can happen without a fall, may cause no symptoms at first,⁠7 and often go undiagnosed.⁠8

What exercises should I avoid with osteoporosis?

Movements that twist the spine or bend forward from the waist, such as sit-ups and toe touches, can cause fractures in people with osteoporosis.⁠4 How much to modify depends on your fracture risk and history, so this needs individual assessment rather than a generic list — ask a physical therapist about your situation.⁠12

Why does falls prevention matter for osteoporosis?

Because most hip fractures in older people result from falls.⁠6 Exercise that challenges balance and strength reduces falls, and may reduce fall-related fractures.⁠11

Conditions and pages that commonly come up alongside osteoporosis.

Geriatric therapy

The hub for balance, falls, and staying independent in later life.

Learn more →

Falls and balance

The other half of the equation — what a fall costs depends on bone strength.

Learn more →

Low back pain

What actually helps, and the symptoms that need urgent care.

Learn more →

Recovery after hip replacement

Where a fracture leads to surgery, what recovery involves.

Learn more →

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Sources

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis Causes, Risk Factors, & Symptoms. Checked October 6, 2026.
    Show the passageHide the passage
    Fractures “happen most often in bones of the hip, vertebrae in the spine, and wrist”; there are “typically no symptoms until a bone is broken”; vertebral fracture can cause severe back pain, loss of height or a stooped posture, and fragile bones can break from minor falls or “normal stresses such as bending, lifting, or even coughing”; prolonged inactivity speeds bone loss; prevention includes exercise, calcium and vitamin D, medication, not smoking and moderate drinking.
  2. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: Diagnosis, Treatment, and Steps to Take. Checked October 6, 2026.
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    DXA is the most common bone density test and helps predict fracture risk; “the best physical activities for bone health include strength training or resistance training”; for older adults exercise no longer increases bone mass but builds strength and balance, which “can help lower your chance of falling”; people with osteoporosis “should avoid high-impact exercise.”
  3. Giangregorio LM, Papaioannou A, Macintyre NJ, et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International. 2014;25(3):821–835. doi:10.1007/s00198-013-2523-2 (PMID 24281053). An international panel “strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture.”
  4. National Institute on Aging. Osteoporosis. “Osteoporosis develops when more bone is broken down than replaced”; osteopenia is “low bone density that’s not as severe as osteoporosis”; activities that may cause a fracture include “twisting your spine, like swinging a golf club, or bending forward from the waist, like sit ups and toe touches.” Checked October 6, 2026.
  5. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Archives of Physical Medicine and Rehabilitation. 1984;65(10):593–596. (PMID 6487063).
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    Of 59 women with postmenopausal spinal osteoporosis followed for one to six years, additional vertebral fractures occurred in 16% of the extension exercise group and 89% of the flexion exercise group; “Extension or isometric exercises seem to be more appropriate.”
  6. American Academy of Orthopaedic Surgeons, OrthoInfo. Hip Fractures. “Most hip fractures sustained by older people result from falls”; the pain is “usually limited to the groin and the upper part of the thigh,” and with most hip fractures “you will not be able to stand, bear weight.” Checked October 6, 2026.
  7. MedlinePlus Medical Encyclopedia. Compression fractures of the back. Checked October 6, 2026.
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    Osteoporotic compression fractures “may cause no symptoms at first. Often, they are discovered when x-rays of the spine are done for other reasons”; later symptoms include back pain that “gets worse with walking, but is not felt when resting”; treatment includes pain medicine and physical therapy “to improve movement and strength around the spine.”
  8. Delmas PD, van de Langerijt L, Watts NB, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. Journal of Bone and Mineral Research. 2005;20(4):557–563. doi:10.1359/jbmr.041214 (PMID 15765173).
    Show the passageHide the passage
    Vertebral fractures are “the most common complication of osteoporosis” and “frequently do not come to clinical attention”; in 2,451 women with osteoporosis, local x-ray reports missed 34% of fractures.
  9. American Physical Therapy Association, ChoosePT. Physical Therapy Guide to Osteoporosis. “Osteopenia means your bones are weaker but not as weak as in osteoporosis. Osteopenia can turn into osteoporosis without treatment.” Checked October 6, 2026.
  10. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews. 2011;(7):CD000333. doi:10.1002/14651858.CD000333.pub2 (PMID 21735380).
    Show the passageHide the passage
    43 trials, 4,320 women: inactivity and unloading reduce bone mass; progressive resistance training for the legs had the largest effect on bone density at the hip and combined programs at the spine; overall “a relatively small statistically significant, but possibly important, effect of exercise on bone density,” with no effect on fracture numbers.
  11. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;(1):CD012424. doi:10.1002/14651858.CD012424.pub2 (PMID 30703272).
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    108 trials, 23,407 people aged 60 and over: balance and functional exercises reduce the rate of falls by 24%; exercise may reduce fall-related fractures (low-certainty evidence); the effect of walking programs on falls is uncertain.
  12. Giangregorio LM, McGill S, Wark JD, et al. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporosis International. 2015;26(3):891–910. doi:10.1007/s00198-014-2881-4 (PMID 25510579).
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    Daily balance training and endurance training for the spinal extensor muscles are recommended for all; guidance on spine-sparing movement should consider fracture risk, impairments and activity history “rather than providing generic restrictions,” and after vertebral fracture physical therapist consultation is recommended.
  13. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Exercise for Your Bone Health. Weight-bearing exercises include brisk walking, climbing stairs and dancing; resistance exercises “put stress on bones, so they can make bones stronger as well”; “A combination of these types of exercise is best.” Checked October 6, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Exercise programs for established osteoporosis should be individually assessed. Contact your doctor for sudden back pain, loss of height, or a fracture after a minor injury.