Exercise is one of the most powerful tools for bone health — and one of the most underused. The right exercise program can slow bone loss, improve balance to prevent falls, and meaningfully reduce fracture risk. Here's what the evidence says and how to apply it.
Bone is living tissue that responds to mechanical stress. When force is applied to bone — through impact, weight-bearing, or muscle contraction — bone-forming cells (osteoblasts) are activated and new bone tissue is laid down. Without that stimulus, bone continues to be resorbed without being adequately replaced, accelerating the bone density decline that comes with aging.
For people already diagnosed with osteoporosis or osteopenia (low bone mass), exercise remains important — but the priority shifts from building bone to maintaining what you have and, critically, preventing the falls that cause fractures.
Weight-bearing exercise means any activity where you're on your feet supporting your own body weight. The impact and loading create the mechanical signals bones need. Not all weight-bearing exercise is equal — higher-impact activities generate stronger bone signals.
Resistance training (strength training with weights, resistance bands, or bodyweight) builds bone through muscle force — when a muscle contracts forcefully, it pulls on the bone at its attachment point, stimulating bone formation. This is separate from and additive to the benefits of impact exercise.
For osteoporosis, resistance training targeting the hip and spine — the fracture sites that matter most — is particularly valuable. Key exercises include:
Aim for 2–3 resistance training sessions per week, with 8–12 repetitions per set at a challenging but controlled weight. Progressive overload — gradually increasing resistance over time — is essential; bones adapt and stop responding to the same level of stimulus.
Some exercises carry elevated risk for people with osteoporosis, particularly those with significant bone density loss (T-score below −2.5) or prior vertebral fractures. Discuss specific limitations with your physiotherapist or doctor, but general cautions include:
Most osteoporotic fractures don't happen because bones spontaneously break — they happen because someone falls. Falls are actually more preventable than bone density loss, and fall prevention programs have strong evidence for reducing fracture rates in older Canadians.
Balance deteriorates with age but responds well to training. Exercises that challenge your balance system — standing on one leg, walking heel-to-toe, Tai Chi — improve reaction time and reduce fall risk. Research on Tai Chi in older adults shows 20–45% reduction in fall rates, making it one of the best-evidenced fall prevention interventions available.
Weak hip flexors and glutes contribute to shuffling gait and reduced ability to recover from a stumble. Specific exercises targeting the glutes (clamshells, hip abductions, bridges) and hip flexors are core components of any fall prevention program.
OsteoFit is a community-based group exercise program developed specifically for people with osteoporosis. Originally developed in BC, it has been adopted across Canada and is offered through many recreation centres and health authorities. The program combines weight-bearing exercise, resistance training, and balance work in a group setting supervised by trained instructors. It's evidence-based and designed to be safe for people with low bone density. Contact your local health authority or recreation centre to find OsteoFit classes near you.
STRONG is a supervised group exercise program for older adults with osteoporosis, developed and researched at the University of British Columbia. It focuses on progressive resistance training, balance, and posture. Research on the STRONG program has demonstrated improvements in bone density, strength, and balance in participants. It has been delivered through community fitness centres and hospital outpatient programs in BC.
Osteoporosis Canada (osteoporosis.ca) offers exercise videos and guides for people with osteoporosis, including a series of safe strength and balance exercises you can do at home. Their resources are evidence-based and specifically address the modifications needed for people with low bone density or prior fractures.
If you've been diagnosed with osteoporosis, a physiotherapist (PT) can assess your balance, strength, posture, and fracture risk to build a personalized exercise program. Physiotherapy for osteoporosis is covered under provincial health insurance in many contexts (hospital outpatient, WorkSafeBC, etc.), and private PT sessions are covered by most extended health benefit plans.
| Day | Activity | Duration |
|---|---|---|
| Monday | Resistance training (lower body focus) | 30–45 min |
| Tuesday | Brisk walking + balance exercises | 30 min + 10 min |
| Wednesday | Rest or gentle yoga (spine-safe) | — |
| Thursday | Resistance training (upper body + spine) | 30–45 min |
| Friday | Brisk walking or low-impact cardio | 30 min |
| Saturday | Tai Chi or group exercise class (OsteoFit) | 45–60 min |
| Sunday | Rest or light activity | — |
If you have a diagnosis of osteoporosis or osteopenia and haven't exercised regularly in some time, don't start with high-impact exercise. Begin with walking and gentle resistance work, get a physiotherapy assessment if possible, and progress gradually. Consistency matters far more than intensity at the outset.
The goal isn't to become an athlete — it's to give your bones enough mechanical stimulus to slow the remodelling imbalance, and to build the strength and balance that keeps you upright and fracture-free. Both are achievable for the vast majority of people.