Exercise for Women With Osteoporosis: A Practical Guide

What osteoporosis actually means

Osteoporosis is a reduction in bone density and bone quality that raises fracture risk. It is diagnosed from a DEXA scan, using a T-score: a score of -2.5 or lower at the hip or lumbar spine meets the definition of osteoporosis, while -1.0 to -2.5 is classed as osteopenia (low bone mass). A fracture from a minor fall, such as a wrist or vertebral fracture from a trip at standing height, can also lead to the diagnosis regardless of the scan number.

Women are affected more often because bone loss speeds up when oestrogen drops at menopause, and the loss is steepest in the first several years afterwards. Long-term corticosteroid use, low body weight, early menopause, some cancer treatments, coeliac disease and a family history of hip fracture all add to the picture. None of that means movement becomes off limits. It means the type, dose and progression of loading needs thought.

Why loading is part of osteoporosis management

Bone is living tissue that remodels in response to mechanical strain. Cells called osteocytes detect strain and signal bone-building osteoblasts, so bone adapts to the forces it repeatedly meets. Walking on flat ground produces relatively low strain. Heavier resistance work and impact produce more, which is why intensity matters in programs designed for bone.

The second half of the equation is falls. Most fragility fractures happen because someone with fragile bone hits the ground. Leg strength, hip stability, reaction time, ankle mobility and single-leg control all influence whether a stumble becomes a fall. Working on those is as much a part of osteoporosis management as loading the skeleton itself.

What the exercise research points to

The Australian position statement on exercise and osteoporosis (Beck, Daly, Fiatarone Singh and Taaffe, Journal of Science and Medicine in Sport, 2017) recommends three ingredients: progressive resistance training at moderate to high intensity, weight-bearing impact activity, and challenging balance and mobility work. Low-intensity walking alone is not enough to change bone, though it has plenty of other value.

The LIFTMOR trial from Griffith University (Watson et al., Journal of Bone and Mineral Research, 2018) tested this directly in postmenopausal women with low bone mass. Participants trained twice a week for eight months, 30 minutes per session, supervised, using heavy deadlifts, overhead press and squats plus jumping chin-up drops. The high-intensity group showed greater gains in lumbar spine and femoral neck bone mineral density than the control group, and the trial reported a low rate of adverse events under supervision.

Those findings inform how we program, without meaning every woman should be deadlifting in week one. Someone with three prior vertebral fractures, significant thoracic kyphosis and back pain needs a different starting point from someone diagnosed with osteopenia at 54 who still plays tennis.

What the assessment covers

At our Five Dock and Gladesville clinics, a first appointment for osteoporosis is mostly information gathering and testing.

We go through your DEXA results and T-scores if you have them, any fracture history and how those fractures happened, medications including bisphosphonates or denosumab, vitamin D and calcium status, falls in the past year, menopause timing, and what exercise you have done previously and enjoyed.

Then we measure. Common tests include five-times sit-to-stand and timed up-and-go for functional leg strength and mobility, grip strength as a general strength marker, single-leg stance time with eyes open and closed, hip abductor and quadriceps strength testing, thoracic spine posture and mobility, ankle dorsiflexion range, and a look at how you walk and turn. Height is worth recording, because a loss of more than 3cm from your recorded adult height can indicate vertebral fracture.

Those numbers give us a baseline to retest against, and they tell us which exercises are appropriate now rather than in three months.

What a session involves

A typical program has four parts, and a session usually runs 45 to 60 minutes.

Resistance work targets the hips and spine, since those are the sites that matter most for fracture. Think squat or leg press patterns, hip hinge patterns, rows and overhead pressing, loaded carries. Load progresses gradually, often across sets of 5 to 8 repetitions once technique is consistent, because heavier loads generate the strain bone responds to.

Impact work is introduced only where it suits your fracture risk and joint tolerance. It might start as heel drops or step-downs and progress to hopping or small jumps.

Balance and mobility work sits in every session: narrowed stance, single-leg tasks, head turns, reaching outside your base, stepping over obstacles, and reactive stepping drills.

We also spend time on technique for daily tasks. How you lift a suitcase, get out of a low chair, carry shopping and pick up a grandchild matters more over a year than any single exercise.

Movements that need more care

Repeated or loaded end-range spinal flexion and twisting are the main things we modify. That includes sit-ups, toe touches, weighted side bends, and some Pilates and yoga positions such as deep forward folds and seated spinal twists. For a woman with vertebral fractures, these carry more risk than benefit, and there are alternatives that train the same muscles with the spine in a neutral position.

We also look at fall exposure outside the gym: slippery bathroom floors, uneven footpaths, low light on stairs, bifocals, and footwear.

What progress realistically looks like

Strength and balance test scores often shift first, and we usually retest at around 8 to 12 weeks. Bone responds far more slowly. A full remodelling cycle takes roughly three to four months, and DEXA scans are generally repeated no more often than every one to two years, so bone density changes are not something you monitor week to week.

Consistency does most of the work. Two to three resistance sessions a week, most weeks, over years, is the pattern the research is built on. Programs are progressed as your strength changes, and reviewed after any fracture, fall, medication change or new scan.

When to get symptoms checked

Sudden mid-back pain, especially after lifting, coughing or a minor jolt, warrants prompt assessment, as does a noticeable loss of height, a new rounding of the upper back, or a fracture from a fall from standing height or less. Pain that wakes you at night or does not settle with position change should be reviewed by your GP alongside any physiotherapy input.

If you have not had a DEXA scan and you have risk factors such as early menopause, long-term steroid use or a parental hip fracture, that conversation belongs with your GP, and the scan result then shapes how a program is built.

If you would like it assessed, you can book a free injury assessment.