On this page 6 sections
Your guide
What you'll learn
If you have osteoporosis, you may have heard exercise will lead to fracture. This discourages many of the older population from starting to exercise. However, exercise can help protect your bones and reduce the likelihood of life altering injuries from osteoporosis. This article will help identify some of the best exercises for osteoporosis with an emphasis on strength training to strengthen muscles and bones. It's never too late to start exercising!
Benefits of Exercise for Osteoporosis
Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients (1). Certain types of exercise strengthen muscles and bones, which helps to reduce your risk of bone fracture. Given that fractures result from falls, improving muscle tone and balance through exercise can reduce the risk of falls (4).
Posture may be able to be maintained or improved, which often helps to decrease or relieve pain in troublesome areas like the shoulders and back. Exercising if you have osteoporosis means finding the safest and most enjoyable exercises that you can be consistent with! Whether that's using resistance bands, going to the gym, using machines, or using free weights, it's important to find what feels right to you! Check with your doctor if you're at risk for osteoporosis-related symptoms or if you are beginning an exercise routine for the first time.
Why Strength Training?
Research has shown that bone responds preferentially to mechanical loads that induce high-magnitude strains at high rates or frequencies and that weight-bearing loading is vital (3). This means that bones respond well to heavier loads and frequent stimulation, especially in weight-bearing positions.
READ: RETURN TO RUNNING AFTER A BONE STRESS FRACTURE
A properly designed strength training routine can check all of these boxes for bone health, which is what makes it useful in the fight against osteoporosis. Strength training is often performed at 2-4 sessions throughout a week with an emphasis on progressive overload, which is using more weight or performing more reps over time.
Balance is often incorporated into strength training routines, which is another added benefit and helps to decrease the likelihood of falls. There's no one size fits all recommendation for strength training and everyone begins their journey at a different place or at a different time.
LISTEN: HOW TO IMPROVE BALANCE AND POSTURAL STABILITY WITH [P]REHAB
Proper form and technique are important for maximizing your results and minimizing injury. A trained exercise professional like a personal trainer or physical therapist can teach you the correct technique and develop a strength training routine based on the equipment that is accessible to you.
Osteoporosis Exercises for the Lower Body
Large multi-joint compound exercises such as the squat and deadlift that are conducted in weight-bearing positions and involve extensive muscle recruitment have the potential to apply large loads at clinically relevant bone sites such as the spine and hip (2). The squat and the deadlift are two of the most popular strength training exercises for the lower body and include multiple variations of the same exercise with slight changes which change muscle recruitment. Single-leg exercises, often referred to as unilateral exercises, can help train the balance component.
Many individuals learn to squat correctly first by learning the bodyweight squat and then progressing to a loaded variation like a goblet squat. A goblet squat, as seen below, is an exercise that can be loaded safely and fairly heavily with a kettlebell or a dumbbell for the majority of osteoporotic patients and may not require a progression beyond this. However, as a personal trainer who works with osteoporotic clients, I have had clients progress to heavier versions of the squat like the front squat, Zercher squat, and back squat. This came after years of mastering the goblet squat and working through a full range of motion under heavier loads.
Exercise 01 of 04
Exercise demonstration
Goblet Squat - Kettlebell
View exercise instructions
- HOW: Hold a kettlebell by the bell or the handles and keep it close to your chest as best as you can. Keep your shoulders lined up over your knees and ankles. Perform a squat while maintaining good form throughout your upper and lower body.
- FEEL: This should primarily be a leg workout as well as an upper-body workout as the KB gets heavier.
- COMPENSATION: Do not bend or arch your back excessively, do not lose form.
The deadlift is often touted as the king of exercises for lower back strengthening. While it may seem like an intimidating exercise, many find it quite fun and it's an exercise that trains a lot of muscle at the same time. Many individuals first learn this exercise by learning how to hip hinge correctly. Following the hip hinge, learning how to RDL is usually the next step in the progression before learning how to deadlift from the floor.
I have some clients who don't reach the progression of deadlifting from the floor due to structural or mobility limitations and that's ok. Deadlifting from a raised position like blocks, or heavy RDLs can be extremely effective in strengthening and building the bone of the low back.
I have one 64-year-old client who was diagnosed with osteoporosis nearly 10 years ago. Since that time, she's completely reversed osteoporosis and added bone to her lumbar spine as indicated by her latest DEXA scan. It's no surprise that the deadlift has become her favorite exercise!
Exercise 02 of 04
Exercise demonstration
Deadlift - Band
View exercise instructions
- HOW: Start in a standing position with a band anchored under your feet and around the top of your upper back. Hold onto the band in each hand - try to position the band similarly to how you would position a barbell in a back squat. To begin the exercise, perform a hip hinge and push your butt back as far as you can that your anatomy will allow you to with good form. Lower down to what you feel comfortable with, then drive your feet through the ground to return to starting position and repeat.
- FEEL: This should feel like a lower body workout, specifically your glutes, hamstrings, and entire posterior chain.
- COMPENSATION: Do not excessively bend or arch your back, perform a good hip hinge with proper form. Perform the conventional deadlift movement with a hip hinge, not a squat
Single leg strengthening exercises require more balance and performing them bodyweight is often a challenge in itself. I recommend learning these exercises using a support system like a suspension strap or wooden dowel to help with the coordination. Exercises that fall into this category include all variations of the split squats and lunges. I'll often teach these exercises first in a static position, like a split squat, where the client is working on balance and stability moving straight up and down. Once proficient under load and a full range of motion, we'll move on to the more dynamic versions of these exercises like lunges.
Osteoporosis Exercises for the Upper Body
Much like the lower body, large multi-joint compound exercises that are conducted in weight-bearing positions are going to be best here. For the upper body pushing muscles like the pecs and deltoids, I like variations of the bench press, push-ups, and shoulder press. For the upper body pulling muscles like the lats and rhomboids, I like variations of rows and pulldowns.
Exercise 03 of 04
Exercise demonstration
Bird Dog - Row, Kettlebell
View exercise instructions
- HOW: Begin with one knee bent on a bench. The other leg should be up and straight out from your hip. The arm on the side of the leg on the bench should be holding a kettlebell. The other arm on the side where the leg is kicked out behind you is placed on the bench with a slight bend in the elbow stabilizing your body. Engage your shoulder blade muscles and pull the kettlebell up acting like you are pinching a pencil in between your shoulder blade and your spine. Lower the kettlebell down and repeat as many times as prescribed.
- FEEL: With the leg kicking out you will feel the muscles on the back of the hip working, with the arm that is punching out you will feel the muscles on top of the shoulder and back of the shoulder blade working. You should feel the mid back muscles working as you row up.
- COMPENSATION: Avoid rotating the trunk, arching the back as you raise your leg and row up. Don’t shrug the shoulder as you raise the arm.
The Bird Dog - Row, as seen above, is a great compound exercise that challenges balance, and core and shoulder strength! It's definitely a row variation that should be worked up to but can be a very functional multi-joint exercise to perform! Bent-over Single Arm Rows, both supported and unsupported, are a great exercise to progress to the Bird Dog - Row because they require isometric contraction of the erector spinae muscles of the lower back. This is a great way to train multiple muscle groups at the same time, especially while in a weight-bearing position.
With individuals new to strength training, I often recommend learning the bench press exercise with dumbbells. While the bench press with the barbell is a great exercise, it may require you to have someone spotting you from behind in case the barbell gets stuck on your chest. With dumbbells, you can drop them onto the floor.
Exercise 04 of 04
Dumbbells also provide more degrees of freedom for your shoulders, which many find to be more comfortable than training with a barbell. While push-ups are often touted as a beginner or basic exercise, the reality is that these exercises require a significant amount of upper body strength. I believe it is an amazing exercise that can be used with osteoporotic patients once you have improved upper body strength with exercises like the dumbbell bench press or dumbbell shoulder press. To learn some of our favorite push-up exercises, check out this blog HERE!
Exercise demonstration
Bench Press - Dumbbell
View exercise instructions
- HOW: Lie back on a bench with your feet ideally on the ground. Brace your stomach and drive your heels into the ground, then push the dumbbells up into the air. Lower your arms back to the starting position, and then repeat. Your arms can be angled 45 degrees from your torso, or however you prefer.
- FEEL: This should feel like an upper body workout, your arms and chest will feel like they are working.
- COMPENSATION: Do not lose pressure in your abdomen when you are pushing the dumbbells overhead. At the top of the press the weights/objects should be positioned over your shoulders. Do not excessively flare your elbows. Stay strong through your wrists keeping your knuckles facing the ceiling.
With upper body pulling exercises, I'll often teach clients how to use the correct muscles on strength training machines like a lat pulldown or seated row. These machines offer more stability and help teach you how to effectively pull using your back musculature with the correct posture.
LEARN MORE ABOUT OUR SHOULDER PREHAB PROGRAM
Curious as to where you can find some of the above exercises plus more? Check out our Shoulder Prehab Program to get started!
Best Exercises for Osteoporosis - Closing Thoughts
- Bones respond well to heavier loads and frequent stimulation, especially in weight-bearing positions, which makes strength training an excellent choice for preventing osteoporosis.
- For the lower body, choose multi-joint weight-bearing exercises like the squat, deadlift, and single-leg variations including split squats and lunges.
- For the upper body, choose multi-joint weight-bearing exercises like bench press, shoulder press, lat pulldown, and rows.
- Remember, there's no one size fits all recommendation for strength training and everyone begins their journey at a different place or at a different time. It's never too late to begin exercising!
References
- Benedetti, M. G., Furlini, G., Zati, A., & Letizia Mauro, G. (2018). The effectiveness of physical exercise on bone density in osteoporotic patients. BioMed Research International, 2018, 1–10. https://doi.org/10.1155/2018/4840531
- Granhead, H. A. N. S., Jonson, R. A. G. N. A. R., & Hansson, T. O. M. M. Y. (1987). The loads on the lumbar spine during extreme weight lifting. Spine, 12(2), 146–149. https://doi.org/10.1097/00007632-198703000-00010
- Kohrt, W. M., Snead, D. B., Slatopolsky, E., & Birge, S. J. (2009). Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women. Journal of Bone and Mineral Research, 10(9), 1303–1311. https://doi.org/10.1002/jbmr.5650100906
- Yong, E. L., & Logan, S. (2021). Menopausal osteoporosis: Screening, prevention and treatment. Singapore Medical Journal, 62(4), 159–166. https://doi.org/10.11622/smedj.2021036
About The Author
Ryan Nosak, MS, CSCS, SCCC
[P]rehab Writer & Content Creator
Ryan was born and raised in Throop, Pennsylvania and he has worked in the world of fitness since he was 15 years old. Ryan realized he had a deep affinity for strength training and how it can alter the human mind, body, and spirit. He began his coaching career in high school by coaching his friends through strength training sessions, which inspired him to pursue a career in strength and conditioning.
Ryan spent 10 years as a Division 1 strength and conditioning coach with stops along the way at Penn State, Tennessee State, Vanderbilt, Robert Morris, Charlotte, and DePaul. He is a Certified Strength and Conditioning Specialist and operates his own training practice, RyNo Strength, out of Studio DelCorpo in Chicago, IL. He specializes in fat loss, body composition, strength, and sports performance training programs.
Ryan received his Bachelor’s Degree in Kinesiology from Penn State and a Master’s in Sport Management from Western Carolina University. In his free time, Ryan enjoys training for bodybuilding, eating at amazing restaurants in Chicago, and spending time with his wife and dog.