Exercise guide
Exercise is safe and recommended with osteoporosis and osteopenia. It will not rebuild your skeleton, but strength training and impact can slow bone loss or add a little bone, balance work cuts falls, and back exercises help posture. Most broken bones in later life follow a fall.
If you have had a spinal (vertebral) fracture or several broken bones from minor falls, get a physiotherapist's advice at the start and keep impact low. After any new fracture, wait until the bone has healed before building up strength work. Exercise works alongside bone medicine, not instead of it.
This guide follows the UK consensus, Strong, Steady and Straight, and the trials behind it, including the supervised heavy lifting of the LIFTMOR trial. It does not replace advice from your doctor or physiotherapist.
A combination. Strength training on 2 to 3 days a week, working towards a weight you can lift 8 to 12 times, up to 3 sets. Moderate impact, such as heel drops, jogging or small jumps, on most days if you have no spinal fractures. Balance exercise at least twice a week. And back-muscle exercises for posture. Strength and impact together work better for bone than either alone.
Modify or avoid exercises that round your back deeply or repeatedly, especially with a weight: sit-ups, toe touches, Pilates roll-downs and curl-ups, and extreme yoga forward folds. Bend from the hips instead. You do not need to avoid bending, twisting or lifting altogether: move smoothly and keep your upper back straight.
Not usually. In trials, exercise raised spine density by a few per cent at best, and hip density mostly stays steady. It still matters: it slows loss, builds muscle and balance, and reduces falls, which cause most fractures. It works alongside bone medicine, not instead of it.
If you have no spinal fractures, build up to about 50 moderate impacts on most days, such as heel drops, jogging on the spot or small jumps, and add strength training. Walking is weight-bearing but low impact, and on its own it does not raise bone density. Swimming and cycling are not weight-bearing.
Yes, for most people. The UK consensus found little evidence of significant harm and judged that the benefits outweigh the risks. In 62 trials, 5.8% of people who exercised had a fracture, against 9.6% of those who did not, and none reported a symptomatic spinal fracture from impact or moderate to high-intensity strength training. A scan result on its own is not a reason to restrict exercise.
Keep moving. Do gentle back-muscle exercises every day, keep impact to the level of brisk walking, and ask for a physiotherapist's advice, at least at the start.
The UK consensus recommends strength and impact exercise for bone, strength and balance work against falls, and back extension exercise for posture. The UK national osteoporosis guideline strongly recommends weight-bearing and muscle-strengthening exercise. An international consensus strongly recommends a programme with strength and balance training, and says aerobic exercise should not replace them.
In 62 bone trials, fractures happened in 5.8% of people who exercised and 9.6% of those who did not. A review found that flexion moves, such as some yoga poses and sit-ups, were linked to spinal fractures, but rarely. Trials report harms poorly, which is why this is graded emerging.
In a Cochrane review of 43 trials in 4,320 women after the menopause, exercise had a small but possibly important effect on bone density: about 3.2% at the spine for combined programmes, and about 1.0% at the hip (femoral neck) for leg strength training, compared with no exercise. It could not show fewer fractures.
Higher-intensity training gave bigger gains at the spine, though only 4 high-intensity programmes were analysed. At the hip, density stays "stable, at best", even with high-intensity training.
In one trial, 50 jumps a day raised hip density by 2.8% in women before the menopause but not in women after it. That is one reason to combine impact with strength training.
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Walking and non-weight-bearing exercise such as cycling and swimming do not improve bone density. They are still good for your heart and general health.
In older people living at home, exercise cut the rate of falls by 23%, with high certainty, and may cut fractures from falls by about a quarter (low certainty).
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In 20 trials, exercise cut low-trauma fractures by about a third and major osteoporotic fractures by about 30%, and supervised programmes did about twice as well. Few of these trials were designed to count fractures, and the UK national guideline still calls clear evidence that exercise reduces fractures "wanting".
A 6-month trial of spine strengthening and posture training reduced the upper-back curve by about 3 degrees. In one small study, women who strengthened their back muscles for 2 years had fewer spinal fractures 8 years later. In LIFTMOR, heavy supervised training also improved the curve.
After a spinal fracture, exercise probably makes a timed test of getting up and walking (the timed up-and-go) about a second faster. Its effects on further fractures, falls, pain and quality of life are uncertain.
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Where medicine is needed, exercise should be seen as an addition to it rather than an alternative: medicine has much stronger evidence for preventing fractures.
On 2 to 3 days a week, with at least a day's rest between, for 20 to 30 minutes. Choose a weight you can lift 8 to 12 times with good technique: that is one set. Build up to 3 sets. Go lighter if you cannot do 8 well, heavier if 12 feels easy.
Each session, include one hinge, one push, one pull and one squat, and once or twice a week add a brace (a plank) and a lunge or step. Work all the major muscle groups, including the back muscles.
If you have no spinal fractures, build up to about 50 moderate impacts on most days, such as jogs, hops, low jumps or stamping: for example 5 sets of 10, with a walk or rest between. You can spread them across the day.
Moderate means no landing from height. High impact is not specifically recommended, but if you already do it you can usually carry on.
The Royal Osteoporosis Society sorts impact into three levels:
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And strength into three levels:
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If you are 65 or over, feel unsteady or do not exercise regularly, do balance exercises at least twice a week and build up to daily. Tai chi, dance, yoga and Pilates count.
3 to 5 repetitions, each held for 3 to 5 seconds, at least twice a week (the 2022 consensus paper). The 2018 quick guide allows up to 10 repetitions on 2 to 3 days a week, so treat 3 to 5 as the start and 10 as the ceiling.
Be active every day, spread across the day, and avoid long spells of sitting.
Source 1
Osteopenia means bone density lower than average for your age but not low enough to count as osteoporosis, and it does not always progress. The consensus says exercise does not need adapting for bone density alone, and the LIFTMOR trial included women with osteopenia. The same doses apply: what changes the advice is a spinal fracture or several fractures, not the scan number.
Preventing falls may come first.
Call 999 for either of these:
Get advice soon for any of these:
Stop the session for any of these:
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Some stiffness or soreness for a few days after new movements.
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These change what is right for you:
Body weight and bands, for everyone, including after a broken bone (ROS). Each session, one hinge, one push, one pull and one squat: 8 to 12 repetitions, building to 3 sets. Hold the knee side plank 10 to 20 seconds, 2 to 3 times each side (editorial). Learn the hip hinge before any deadlift.
3D demoGlute bridgeBeginner · No equipment
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoSit to stand from a chairBeginner · A bench or box
3D demoKnee side plankBeginner · No equipment
3D demoSplit squatIntermediate · No equipment
3D demoStep-upBeginner · A step
3D demoHip-hinge practiceBeginner · No equipment8 to 12 repetitions, building to 3 sets (ROS). Keep your back long and hinge from the hips; stop a set before your back rounds. Learn the level 3 lifts, such as the overhead press, the single-arm row and the heavier deadlifts, with a qualified instructor (ROS). Press seated if standing feels unsteady.
3D demoKettlebell deadliftBeginner · A kettlebell
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell
3D demoKnee push-upBeginner · No equipment
3D demoPush-upIntermediate · No equipment
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box
3D demoStanding overhead pressIntermediate · A barbell + A dumbbell
3D demoTrap bar (hex bar) deadliftIntermediate · Other / check instructions
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell101 women after the menopause with low bone mass trained twice a week for 30 minutes over 8 months. The heavy-lifting group built up to 5 sets of 5 deadlifts, squats and overhead presses at more than 85% of the most they could lift once, plus jumping chin-ups with firm landings.
Their spine density rose by 2.9%, while a home-exercise group lost 1.2%. One minor back spasm was reported, spine scans showed no new or worse fractures, and the upper-back curve improved.
In a semi-randomised trial of 93 men averaging 67 years, the same kind of supervised training raised spine density by 4.1% and improved muscle, strength and function. The heavy-training group had no new spinal fractures.
Every session was supervised by a qualified exercise professional, after 2 weeks of light technique practice, and people with a spinal fracture in the past 12 months were not included. The UK consensus notes that supervised heavier training probably does most for bone density, but chose 8 to 12 repetitions because they are easier to use outside a trial.
If you want to lift heavy, learn the lifts with a physiotherapist or qualified instructor first, and do not copy the trial dose on your own.
If you have no spinal or multiple fractures, build up to about 50 moderate impacts on most days, for example 5 sets of 10 (UK consensus), starting with 20 to 30 (editorial). With them, keep to low impact, such as marching, gentle heel drops and brisk walking (ROS level 1), and ask a physiotherapist before anything harder. Jumps from height are not recommended, and if you leak on impact, treat that first.
At least twice a week, building to daily, next to a counter (ROS). One-leg stands: build from 10 seconds with support to 30 seconds without. Side-stepping: 10 steps each way along the counter.
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSingle-leg standBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoTibialis raiseBeginner · No equipment
3D demoHeel walkBeginner · No equipment3D demoSit to stand from a chairBeginner · A bench or boxEasiest first; the first four need no floor. 3 to 5 repetitions, each held 3 to 5 seconds, at least twice a week, building to 10 (UK consensus); after a painful spinal fracture, daily, at low effort. Use the same short holds for the elbows-back move, not its 30-second stretch. The 45-degree back extension is for people without spinal fractures: move slowly and never fling into the top.
3D demoChin tuckBeginner · No equipment
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoElbows backBeginner · No equipment
3D demoWall angelBeginner · A wall
3D demoProne Y-T-W raisesBeginner · No equipment
3D demoLow cobra (Bhujangasana)Beginner · No equipment
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoBack extension on a 45-degree benchIntermediate · A bench or boxThese train the trunk with the spine still, in place of sit-ups and crunches; the plank is the brace in the ROS strength plan. Hold planks 20 to 30 seconds, 2 to 3 times (editorial), and keep breathing.
"Bending forward is generally safe and won't cause a spinal fracture", says the Royal Osteoporosis Society. What the UK consensus asks you to modify or avoid is sustained, repeated or end-range rounding of the spine, and any exercise that curves the back excessively, especially with a weight.
Examples named by the consensus and the Royal Osteoporosis Society include sit-ups, toe touches, the Pilates roll-down and curl-up, lifting weights with a rounded back, end-range yoga poses, and fast or loaded twisting without control, as in golf.
"Think straight": keep your upper back straight and your neck in line, bend from the hips (the hip hinge), move smoothly within a comfortable range and engage your tummy muscles. The consensus recommends safe lifting technique rather than "don't lift", and the ROS says no weight is universally safe or unsafe.
If you feel strain in your back, put the weight down, then lighten it or change your technique.
Twisting should be safe if you do it smoothly and comfortably. Slow down and shorten fast or forceful twists, and leave out the added weight.
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The ROS's own exercises for back pain after spinal fractures include the cat, a slow, small rounding of the back on all fours. Keep moves like this slow and comfortable.
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This is our editorial checklist, built from the consensus and ROS advice. Ask four questions:
If the answer to all four questions is no, the move is usually fine. If you are experienced and flexible and move comfortably and smoothly, you can carry on, as long as you are fit enough to manage with ease; as a precaution, consider alternatives to the Pilates roll-down and curl-up.
After a spinal fracture, apply the checklist more strictly and get individual advice, and choose yoga or Pilates led by an instructor trained to work with osteoporosis.
Both can help balance, posture and strength, and the consensus counts them as balance exercise. But case reports describe spinal compression fractures after yoga poses with deep forward bending: 9 people (median age 66) in one series, and 13 compression fractures among 89 people with yoga injuries in another, mostly from extreme bending forwards or backwards.
Swap deep forward folds, roll-downs and curl-ups for flat-back and head-down versions.
The main study behind it is from 1984: 59 women aged 49 to 60 with spinal osteoporosis and back pain were taught extension, flexion, both or no exercises. New spinal fractures followed in 16% of the extension group and 89% of the 9 people in the flexion group. It was small and not randomised.
A later review found flexion-linked fractures were rare, and the UK national guideline says forced, repeated forward bending should be done with care, but the risk of serious harm is very low.
Contact sports, riding and skiing carry a risk of falls and impact. If you do them regularly, the benefits probably outweigh the risks, unless you have had several fragility fractures or painful spinal fractures. If you leak urine on impact, treat that first with pelvic floor training.
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Sit-ups and crunches: the dead bug or knee plank. Toe touches: hip-hinge practice. Seated forward folds, the plough and the shoulderstand: a lying hamstring stretch with a strap, back flat. Weighted crunches and Russian twists: the Pallof press or a farmer's carry. The Jefferson curl: leave it out.
3D demoDead bugBeginner · No equipment
3D demoKnee plankBeginner · No equipment3D demoHip-hinge practiceBeginner · No equipment
3D demoSupine hamstring stretch with a strapBeginner · No equipment
3D demoHalf-kneeling Pallof pressBeginner · A band + An anchor point3D demoFarmer's carryBeginner · A dumbbell + A kettlebellMovement does not affect healing, and staying active helps prevent chest infections, constipation and blood clots. Wait until the bone has healed, which can take up to 3 months, before you build up strength work. Research on exercise after a spinal fracture is thin, so individual advice matters.
Keep impact low, up to brisk walking, and build to 20 minutes on most days (150 minutes a week). This is a precaution, because of theoretical, unproved risks of another spinal fracture.
Moderate impact may be possible later if your fractures caused no pain, the bone has healed and any pain has improved, you are generally fit, and you did moderate impact before.
Do gentle back-muscle exercises daily, for pain and posture, at low effort to build endurance: holds of 3 to 5 seconds, building up to 10 repetitions. Chin tucks, the seated upper-back lift and wall angels need no floor.
The same strength principles apply, with care over technique and a physiotherapist's advice, at least at the start.
If a marked curve in your upper back makes symptoms worse, breathing and pelvic floor exercises can help, and exercise in warm water (hydrotherapy) may improve quality of life. The 3D figure cannot show the pelvic floor, so the pelvic floor workout below relies on written steps.
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Sudden new back pain, often after a bend, lift, cough or minor fall, can be a spinal fracture, and not all spinal fractures hurt. Height loss and a change in the curve of your upper back are other signs: the UK national guideline uses height loss of 4 cm or more, or a curved upper back, as reasons to check for spinal fractures. See your GP.
The bone workout suits people without spinal fractures who have gym kit or the equivalent at home; its balance work is small, so add the balance routine on two other days. With a spinal fracture, follow each workout's fracture notes, keep impact to brisk walking and ask a physiotherapist; check the foam roller in the posture routine with your clinician first.
Impact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 10-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
10 minBeginner7 movesA foam roller, A wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightPelvic floor exercises in 5 minutes: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallFor people without recent spinal fractures.
A weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner3 days a weekA 3-day strength plan for men over 40 with power and bone work, two cardio days and mobility, built on research on ageing muscle.
3 training days45 minBeginnerOne in five men, and one in two women, will have a fragility fracture, and a third of fragility fractures in the UK happen in men.
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Research in men is limited but points the same way. In the LIFTMOR-M trial, men averaging 67 years who did supervised heavy lifting and impact training gained 4.1% in spine density and improved strength and function. Men need the same mix of strength, impact and balance.
Gains are modest: a few per cent at the spine in the best trials, and the hip stable at best, and in small studies the gains faded after people stopped. Exercise helps most through strength, balance and fewer falls.
Walking is low impact, and reviews find it does not raise bone density. Add strength training and, if you can, moderate impact. Walking is still good for your health, and it is the right level of impact after a spinal fracture.
They are not weight-bearing: good for fitness, not for bone.
The consensus recommends safe lifting technique, not weight limits. Supervised heavy lifting in LIFTMOR was safe and improved spine density.
Bending is generally safe. It is deep, repeated or loaded rounding to modify. Use the hip hinge.
Smooth, comfortable twisting is safe; fast or loaded twisting needs control.
Without spinal or multiple fractures, moderate impact is recommended on most days. With them, keep to low impact as a precaution.
The consensus says not to restrict exercise by bone density alone. Fractures and falls matter more.
They help balance, posture and strength, but there is no strong bone-density evidence for them, and extreme forward-bending poses need swapping.
Exercise is an addition. Medicine has much stronger evidence for preventing fractures.
They can reduce the curve a little, about 3 degrees in a 6-month trial, but a broken vertebra heals in its compressed shape.
One in five men will have a fragility fracture, and a third of UK fragility fractures happen in men.
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A combination: strength training on 2 to 3 days a week, working towards a weight you can lift 8 to 12 times, up to 3 sets; moderate impact such as heel drops, jogging or small jumps on most days if you have no spinal fractures; balance exercise at least twice a week; and back-muscle exercises for posture. Strength and impact together work better for bone than either alone.
Exercises that round your back deeply or repeatedly, especially with a weight: sit-ups, toe touches, Pilates roll-downs and curl-ups, and extreme yoga forward folds. Bend from the hips instead. You do not need to avoid bending, twisting or lifting altogether; move smoothly and keep your upper back straight. With spinal fractures, also keep impact to brisk-walking level unless a physiotherapist advises otherwise.
Not usually. In trials, exercise raised spine density by a few per cent at best, and hip density mostly stays steady. That still matters: exercise slows loss, builds muscle and balance, and reduces falls, which cause most fractures. It works alongside bone medicine, not instead of it.
Walking is good for your health and counts as low-impact, weight-bearing activity, and it is the right level of impact if you have spinal fractures. On its own it does not raise bone density. Swimming is good for fitness, and water exercise may help pain and quality of life after spinal fractures, but it is not weight-bearing, so it does not load bone. Add strength training and, if you can, some moderate impact on land.
Yes, with good technique. The consensus recommends progressive strength training and safe lifting technique rather than weight limits. In the LIFTMOR trial, women with low bone mass did heavy deadlifts, squats and overhead presses (5 sets of 5, above 85% of their maximum) twice a week for 8 months; their spine density rose 2.9% while the comparison group lost 1.2%, and only one minor back spasm was reported. That training was closely supervised and taught step by step, so start with sit-to-stands and a light kettlebell deadlift, and learn heavier lifting with a physiotherapist or qualified instructor.
The UK consensus suggests building up to about 50 moderate impacts on most days, for example 5 sets of 10, with a pause between sets, and you can spread them across the day. Start with 20 to 30 and build up. Heel drops are a gentle start; in one trial, 50 small jumps a day did not raise hip density in women after the menopause, so combine impact with strength training.
Yes, with changes. Both can help balance, posture and strength, and the consensus recommends them. Swap the deep forward folds, roll-downs and curl-ups for flat-back and head-down versions: case reports link extreme forward-bending poses to spinal fractures. If you have had a spinal fracture, choose a teacher trained to work with osteoporosis.
Keep moving as much as you can: movement does not affect healing, and staying active helps prevent chest infections, constipation and clots. Do gentle back-muscle exercises daily, with holds of 3 to 5 seconds, keep impact to brisk-walking level, and ask for a physiotherapist. Wait until the bone has healed, which can take up to 3 months, before building up strength work. The research on exercise after spinal fracture is thin, so individual advice matters.
Yes. One in five men will have a fragility fracture, and a third of UK fragility fractures happen in men. In the LIFTMOR-M trial, men averaging 67 years who did supervised heavy lifting and impact training gained 4.1% in spine density and improved their strength and function. Men need the same mix of strength, impact and balance.
No. The UK consensus says exercise should be seen as an addition to medicine, not an alternative, where medicine is needed, because medicine's evidence for preventing fractures is much stronger. The Royal Osteoporosis Society says the same. Do both.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
