Osteoporosis and Exercise: What Current Evidence Recommends

An estimated 1.2 million Australians have osteoporosis, though many do not know it yet. Osteoporosis develops without obvious symptoms. For many people, a fracture is the first sign that something has been building for years.

Whether you have just been diagnosed or are managing an established diagnosis, specific, supervised exercise, prescribed for your bone density, strength, and balance, is the most effective response available.

Here is what the evidence says, and what that means in practice.

What is osteoporosis?

Osteoporosis is a skeletal disease characterised by low bone mass and low bone density. The internal structure of bone becomes less dense, which increases fragility and the risk of fractures, sometimes from minor falls, bumps, or everyday movements that would not affect a healthy bone.

The most common sites where fractures occur are the hip, wrist, and spine. Less commonly affected areas include the ankle, leg, forearm, upper arm, and ribs.

Bone density is measured using a DEXA scan (Dual-energy X-ray Absorptiometry), which produces a T-score. The classifications are:

Classification	T-score
Normal	Greater than -1.0
Osteopenia	-1.0 to -2.5
Osteoporosis	-2.5 or below

What causes osteoporosis?

Bone density naturally declines with age, but several factors accelerate that process:

• Being over 50 years of age
• Post-menopausal women
• Family history of osteoporosis or fractures
• Inadequate calcium intake
• Vitamin D deficiency
• Medical history including broken bones, low hormone levels, coeliac disease, diabetes, certain breast and prostate cancer treatments, anorexia nervosa, thyroid conditions, rheumatoid arthritis, or chronic liver or kidney disease
• Prolonged use of corticosteroids
• Low levels of physical activity, particularly weight-bearing activity
• Smoking
• Excessive alcohol intake

How is osteoporosis treated?

A confirmed osteoporosis diagnosis requires individualised treatment prescribed by a GP or specialist. This may include:

• Medication: bisphosphonates (such as alendronate) and denosumab work to slow bone loss, improve bone density, and reduce fracture risk. Menopausal hormone therapy (MHT) and selective oestrogen receptor modulators (SERMs) are other options for eligible patients.
• Nutrition: calcium and vitamin D requirements vary by individual and should be reviewed by a dietitian.
• Exercise: individually prescribed to improve bone mineral density, muscle strength, and reduce fall risk

Exercise is a core component of osteoporosis treatment, prescribed alongside any medication.

Why exercise matters and what kind

For bone health, the type of exercise matters. Swimming and cycling are excellent for cardiovascular fitness but do not load the skeleton in the way needed to stimulate bone remodelling.

The current clinical recommendation for managing osteoporosis is a supervised program delivered by an Accredited Exercise Physiologist (AEP), combining three types of activity:

Impact and weight-bearing exercise

Activities that apply force through the skeleton signal the body to maintain or increase bone density. The program typically progresses from lower-impact activities (heel drops, foot stamps) toward higher-impact movements such as jumping, as capacity builds.

High-intensity progressive resistance training

Exercises where your muscles work against a load (weights or resistance) pull on the tendons attached to your bones. This mechanical tugging stimulates bone-building cells to lay down new mineral content.

For osteoporosis management, the research supports working at a relatively high intensity: around 80 to 85% of your maximum effort (expressed clinically as 80–85% of one-repetition maximum). The focus is on back and leg exercises, two sessions per week, approximately 30 minutes each. This level of intensity is higher than general fitness training, which is why supervision by a qualified professional is strongly recommended.

Balance training

Most fractures in people with osteoporosis result from falls. Improving balance, lower-limb strength, reaction time, and coordination significantly reduces that risk. The target is four sessions per week of around 30 minutes each.

Activities that support balance include tai chi, line dancing, and ballroom dancing. Specific balance challenges can include heel-to-toe walking on foam surfaces, stepping sideways over objects, walking backwards, walking on tiptoe, and standing on one leg while performing another task.

What to avoid

Two categories of movement carry increased fracture risk with osteoporosis and should be avoided or minimised:

• Loaded spinal flexion (bending forward under load): this places high compressive force on the vertebrae and is not recommended as part of an exercise program for osteoporosis.
• Twisting sports and abrupt unusual movements: activities like golf involve significant spinal rotation, and sports like squash involve fast, unpredictable changes of direction. Both carry elevated fracture risk.

How an Accredited Exercise Physiologist can help

The exercise recommendations above are straightforward to describe but require careful application. The exercises that are most effective at building bone density, high-intensity resistance work and graduated impact, are also the ones most likely to cause injury if applied at the wrong intensity, in the wrong sequence, or to someone who is not yet ready for them.

An AEP can:

• Review your DEXA scan results and medical history to establish a safe starting point
• Design a program that applies the right type of load for your current bone density, muscle strength, and balance capacity
• Progress the program safely over time as your capacity improves
• Teach correct form and technique, particularly for spinal alignment under load
• Adjust the program if your medical situation changes

Bodytrack’s exercise programs for bone health are evidence-based and tailored to each individual. Chronic health conditions may be eligible for referral under Medicare’s GP Chronic Condition Management Plan and Private health fund eligibility may apply.

Reviewed by Daniel Harth, Accredited Exercise Physiologist. Last reviewed August 2026.

Sources

• Healthy Bones Australia: osteoporosis and low bone density prevalence in Australia
• Australian Institute of Health and Welfare, Osteoporosis: national prevalence and fracture data
• Benedetti et al., The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients: evidence for impact and weight-bearing exercise
• Manaye, Cheran et al., The Role of High-Intensity and High-Impact Exercises in Improving Bone Health in Postmenopausal Women: evidence for high-intensity resistance and impact training
• Services Australia, GP Chronic Condition Management Plan: Medicare eligibility for allied health referral