Osteoporosis and Osteopenia: How Exercise Can Improve Bone Health

If you've been diagnosed with osteopenia or osteoporosis, you may have been told that you need to be careful with exercise and avoid putting too much stress on your bones.

The reality is more encouraging.

The right type of exercise can be an important part of maintaining bone health, improving physical capacity and reducing the risk associated with falls and fractures.

The challenge is finding the right amount and type of loading for the individual.

What are osteopenia and osteoporosis?

Osteoporosis is a condition characterised by reduced bone strength, which increases the risk of fractures. These commonly occur at the hip, spine and wrist, although fractures can occur elsewhere.

Osteopenia describes bone density that is lower than the healthy reference range but not low enough to meet the diagnostic threshold for osteoporosis.

Having osteopenia doesn't mean that a fracture is inevitable. It does, however, provide an opportunity to address the factors that can influence bone health.

And exercise is one of those factors.

How does exercise help bone health?

Bone is living tissue and responds to the mechanical forces placed upon it.

Resistance training creates forces through both the muscles and bones, providing a stimulus that can help maintain or improve bone strength.

This is particularly important as we age, when maintaining muscle strength and physical capacity becomes increasingly important.

But there's another piece of the puzzle.

Fracture risk isn't just about bone density

Someone's risk of sustaining a fracture isn't determined by their bone density alone.

Falls are an important contributor to fractures, particularly as we age.

This means that a good bone-health program shouldn't focus exclusively on trying to improve bone density. It should also aim to develop:

• Strength • Balance • Coordination • Physical capacity • Confidence with movement

Becoming stronger and more physically capable can help people remain active and better able to cope with the demands of everyday life.

Do you need to lift heavy weights?

This is where things get interesting.

Some of the research demonstrating benefits for bone health has used heavy strength training.

The LIFTMOR trial demonstrated that a high-intensity resistance and impact training program could improve bone mineral density and physical function in post-menopausal women with osteopenia or osteoporosis. [1]

More recently, the STOP-EM trial investigated heavy strength and impact training in peri-menopausal and early post-menopausal women. The results were encouraging, with the study demonstrating the potential of this type of training to help prevent muscle and bone loss. However, it was a feasibility trial, so further research is needed before we can draw firm conclusions about its effectiveness. [2]

So should everyone with osteopenia or osteoporosis be lifting heavy?

Not necessarily.

A 2020 systematic review and meta-analysis compared high- and low-load resistance training and found that both approaches produced similar effects on bone mineral density in middle-aged and older adults. [3]

This is important because it suggests that improving bone health doesn't necessarily require everyone to undertake very heavy resistance training.

Heavy training can be beneficial.

But heavy training isn't necessarily the only way to exercise for bone health.

The appropriate level of loading should be based on the individual, taking into account their current strength, experience, medical history, fracture risk, preferences and goals.

Your exercise program should be individualised

The idea of lifting heavy weights can be intimidating, particularly if you haven't spent much time in a gym before.

It doesn't have to be.

An effective program can be tailored around your:

• Current strength and fitness 

• Exercise experience 

• Medical history 

• Fracture risk 

• Lifestyle 

• Preferences 

• Goals

For some people, a structured gym-based strength program may be appropriate.

For others, starting with lower loads and gradually building strength may be a better option.

The important thing is that the program provides an appropriate stimulus while remaining safe, manageable and sustainable.

You don't need to be an experienced gym-goer to start working on your bone health.

What can you realistically expect from exercise?

It's important to have realistic expectations.

Exercise can support bone health, but it shouldn't be viewed as a guaranteed way to dramatically reverse osteoporosis or return bone density to a "normal" level.

For many people, maintaining bone density and preventing further decline is already a worthwhile outcome.

And we shouldn't forget the benefits that happen outside the bone.

Improving strength, balance and physical capacity can help people stay active and potentially reduce their risk of falls.

In other words, we're not simply trying to build stronger bones.

We're trying to build a stronger, more capable person.

What if you're worried about exercising with osteoporosis?

A diagnosis of osteoporosis can understandably make people nervous about exercise.

The answer isn't necessarily to avoid loading your body.

Instead, it's about finding the appropriate level of loading for you and gradually building your capacity.

A physiotherapist can assess your current physical capacity and help you develop an exercise program that takes your individual circumstances into account.

You don't need to be an experienced gym-goer, and you don't necessarily need to lift very heavy weights from day one.

The starting point is simply finding an appropriate place to begin.

Osteoporosis Physiotherapy in Tokyo

If you're living in Tokyo and have been diagnosed with osteoporosis or osteopenia, or you're concerned about your bone health, Club 360 can help you develop an appropriate exercise strategy.

Our physiotherapy team can assess your strength, movement and physical capacity and help you build a program around your individual needs, experience and goals.

The aim isn't simply to lift heavier weights or chase a better number on a bone-density scan.

It's to help you build the strength and physical capacity to remain active, confident and independent for as long as possible.

If you'd like to discuss osteoporosis, osteopenia or your bone health with a physiotherapist in Tokyo, contact Club 360 to arrange an assessment.

References

1. Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research. 2018;33(2):211–220.

2. Whitman PW, Alexander CJ, Kaluta L, McDonough MH, Jordan MJ, Billington EO, Burt LA, Gabel L. Preventing muscle and bone loss in peri-menopausal and early post-menopausal females with heavy strength and impact training: Results from the STOP-EM randomised waitlisted controlled feasibility trial. Bone Reports. 2026;30:101931.

3. Souza D, Barbalho M, Ramirez-Campillo R, Martins W, Gentil P. High and low-load resistance training produce similar effects on bone mineral density of middle-aged and older people: A systematic review with meta-analysis of randomized clinical trials. Experimental Gerontology. 2020;138:110973. doi:10.1016/j.exger.2020.110973. PMID: 32454079.