Osteoporosis and Osteopenia

This guide is for educational purposes only, and should not be used as a substitute for professional medical advice, diagnosis, or treatment. The guidance here is general, and you should always listen to the advice of your personal healthcare provider.

Getting a diagnosis of osteoporosis or osteopenia can be a real shock. It’s certainly understandable that it might make you feel nervous about exercise.

We want to be very clear: This diagnosis is not a life sentence. It is a powerful call to action.

This video covers everything important you need to know about osteoporosis and how to build stronger bones:

They key message is, you absolutely can improve your bone density, and exercise is one of the most effective tools you have. This guide will walk you through the "what, why, and how" of exercising safely and effectively for stronger bones.

What Are Osteoporosis and Osteopenia?

"Osteoporosis" literally means "porous bone." It's a condition where your bones become less dense and, as a result, more fragile. "Osteopenia" is the label for a milder, earlier stage of bone density loss.

It's diagnosed using a bone density scan (often called a DEXA scan), which gives you a "T-score." This score compares your bone density to that of an average, healthy 30-year-old (when bone density is typically at its peak).

T-score of -1.0 or higher: Normal bone density
T-score between -1.0 and -2.5: Osteopenia
T-score of -2.5 or lower: Osteoporosis

The following video explains DEXA and T-scores in more detail:

Why Is This Diagnosis Important?

The main concern with low bone density is the increased risk of a fracture (a broken bone).

It can also make the skeleton less resilient, which can lead to issues like compression fractures in the spine (which can cause back pain and a "stooped" or "hunched" posture).

The great news is that a diagnosis allows you to be proactive. You can immediately implement strategies to slow, stop, or even reverse bone loss.

Your 3-Part Treatment Plan

A solid plan to tackle osteoporosis usually involves three key areas:

Dietary & Lifestyle Changes: This includes getting enough protein, calcium, and vitamin D, as well as stopping smoking and limiting alcohol. (We recommend a discussion with your doctor or a registered dietitian for specific advice).
Medications: This is a crucial conversation to have with your doctor, as medications for osteoporosis can be very effective and worthwhile for many people.
Specific, Targeted Exercise: This is our area of expertise, and it's a non-negotiable part of the plan. Read on to learn more.

What Is the Best Exercise for Bone Density?

This is the most important part of this guide. Not all exercise is created equal when it comes to building bone. There are two specific types of exercise that work best:

High-Intensity Resistance Training
Impact Training

Let's break those down.

1. High-Intensity Resistance Training (Strength)

This is any exercise where you move your muscles against a strong, challenging resistance (like lifting weights or your own body weight).

When we say "high-intensity," we do not mean puffing, panting, and sweating (like with cardio). We mean the resistance you are lifting must be heavy and challenging for you. Each set of each exercise should feel difficult to complete. It should always feel hard.

Why does this work? When your muscles have to contract powerfully to move a heavy weight, they pull hard on the bones they're attached to. This strong pull sends a loud, clear signal to your bones: "We need to get stronger and denser to handle this!"

2. Impact Training

This means exercises that involve landing with a purposeful impact. The most common example is jumping.

Why does this work? When you land from a jump, a force is sent from the ground up through your legs and skeleton. This "impact" is a different but equally powerful signal for your bones to adapt and build new density.

The following video explains impact training in more detail, with specific progressions to follow:

Research has shown time and again that this combination of high-intensity resistance training and impact training, is very effective. Studies that have control groups doing low-intensity resistance exercise (e.g., starting with small, light dumbbells, and never progressing to heavier weights) show no improvement in bone density. The "challenging" part is the key ingredient.

But Is This Type of Exercise Safe?

We get it. Hearing "high-intensity," "heavy," and "jumping" when you've just been told your bones are fragile may sound scary, and it’s only natural to wonder whether or not this is safe.

It’s hard to give a simple "yes or no” answer to the complex question of whether anything is truly "safe". All exercise does carry certain risks.

We believe in taking a measured "risk vs reward" attitude to this situation, and honestly evaluating the risks involved in each scenario. Ask yourself:

What is the risk of NOT doing this exercise? Progressively weaker bones, weaker muscles, poorer balance, a higher risk of falls, a higher risk of fracture, and lower quality of life.
What is the risk of DOING this exercise? The risk is actually very low. The major studies looking at this exact type of training in post-menopausal women with osteoporosis had virtually zero injuries or adverse events.

You might assume that the best way to avoid injury when it comes to exercise is to make sure you’re doing it with “correct technique”. But the very idea of “correct technique” is actually vague, arbitrary and not backed-up by evidence. Everybody is different and every body moves differently. There’s no such thing as a perfect technique that will work for everyone. The best way to reduce injury risk is actually very simple; start with an exercise variation and a weight level which you can comfortably manage, and progress gradually.

In a nutshell, the key to doing it safely is one of our favourite mottos: "Start low, go slow."

You don't start by lifting 30kg. You start at a level that feels manageable for you—even if that's just your bodyweight—and you gradually get stronger and more confident over time. The key here is the gradual progression over time to higher loads (essentially, heavier weights).

So when it comes to bone density, the rewards of resistance and impact training clearly outweigh the risks.

In the following video, we have an important discussion about “safe” exercises for osteoporosis:

What Exercises Should I Avoid?

You may have heard that you should "never bend or twist your spine" if you have osteoporosis.

This advice, while common, is not based on good scientific evidence.

Your spine evolved to bend and twist, those are important parts of its functionality. Completely avoiding these movements can, in the long run, make your back less resilient. If you always try to avoid bending and twisting, your spine will be unprepared for it when at some point you inevitably need to. Instead, we ought to build the strength and confidence required to bend and twist safely. The only way to do that is exercise.

Our approach, once again, is to apply the "start low, go slow" rule.

The key points are:

We believe it is generally safe and healthy to practice bending and twisting, as long as you do it in a controlled way and build up the intensity gradually (start low, go slow).
If you are already doing exercises in the program that involve bending and twisting and they feel fine, you are okay to continue.
If you still feel nervous about those movements and would just rather not do them, that’s okay too. You can modify or substitute them.

For a detailed guide on how to modify some common abdominal exercises which may involve bending or twisting, check out this article:

Link: How to Modify Abdominal Exercises

All that said, once again we must reinforce that this guide is for educational purposes only and should not replace specific advice from a medical professional. If your doctor has told you to avoid bending and/or twisting, then we encourage you to follow their advice.

The Takeaway: You Are in Control

Getting a diagnosis of osteoporosis or osteopenia can feel like a setback, but it's not. It's your call to action.

You are not fragile. Your bones are living, adaptable tissue, and you have a clear, evidence-based plan to make them stronger. Remember the key principles:

You can build bone. It is absolutely possible to slow, stop, or even reverse bone loss.
The right exercise is the key. Your goal is high-intensity resistance training and impact training. This is what signals your bones to grow stronger. But you don't have to start there, you can build up to it gradually.
You can do this safely. The "start low, go slow" approach is your pathway to building strength and confidence.

Want to Learn More?

We have lots of other great videos about osteoporosis related topics , check them out:

Top 3 strategies to reduce fracture risk: resistance training, impact training, balance training - https://youtu.be/hqorBDDD6dM
Tips for bone-building exercise when you have painful joints (knees, hips, etc) - https://youtu.be/VKa4ve_uJGk
Hip bone strengthening exercise - https://youtu.be/KYBKwqNfT-0
The truth about “hunchback” posture - https://youtu.be/eedf5VE0-lE