Yes, exercise is safe for most people with osteoporosis, and it is one of the best things you can do for your bones, your balance and your confidence. The right kind is regular strength work, some impact if you are able, balance practice and good posture. The Royal Osteoporosis Society (ROS) says the aim is to move with care, not to stop moving.
If you have just been told you have osteoporosis or osteopenia, it is normal to feel nervous. This guide explains what to do, what to adapt and when to ask for help. This guide supports World Menopause Day (18 October) and World Osteoporosis Day (20 October).
The myth of "fragile bones, so rest"
Many people hear "osteoporosis" and think "I must be careful with everything". That is understandable, but resting more is not the answer. Bone is living tissue. It responds to the load you put through it. When you move less, your muscles and bones usually get weaker, and your balance can get worse. That raises the chance of a fall.
The UK expert statement on exercise for osteoporosis, called Strong, Steady and Straight and endorsed by the ROS, takes the same view. It says people with osteoporosis should be active. It also says activities should be adapted rather than banned where possible.
Exercise does not replace medicine if your doctor has recommended it. The ROS stresses that medication and healthy habits, including exercise, work best together. If you are unsure about your treatment plan, ask your GP. The NHS osteoporosis page explains the basics.
What bones respond to: strength, impact and balance
The ROS groups its advice under three headings.
- Strong: strength and impact. Muscles pull on bones when they work, and bones respond. Strength exercise, and impact such as brisk walking, tell your bones to stay strong. The ROS exercise for bones pages explain how.
- Steady: balance. Balance practice lowers your risk of falls, and many fractures happen after a fall. Stronger legs help too.
- Straight: posture and your spine. Strong back muscles and good posture help you move well and protect your spine.
The NHS names weight-bearing exercise and resistance exercise as particularly important for bone health. It lists brisk walking as an example. It also notes that swimming and cycling are not weight-bearing. They are still good for fitness, but they do not load your bones in the same way.
Check first if you are newly diagnosed. The NHS advises talking to your GP or health specialist before starting a new exercise programme. This matters most if you have already had a broken bone.
A safe starter routine at home
This routine is for people without recent fractures who are generally well. If you have had a spinal fracture or several broken bones, skip to the section below and get advice first. Stop and seek advice if you feel sharp pain, dizziness or chest pain.
Do the strength exercises on two or three days a week, with a rest day in between. The ROS suggests building up slowly towards a few sets of 8 to 12 repetitions. Start with one set of fewer repeats. Aim for effort that feels like "moderate", not "all out".
1. Strength
- Sit to stand. Sit near the front of a firm chair, feet hip-width apart. Lean forward slightly from the hips, keep your back long, and stand up. Sit down slowly. Use your hands on the chair at first if you need to.
- Wall push-up. Stand an arm's length from a wall. Place your hands on the wall at shoulder height. Bend your elbows to bring your chest towards the wall, then push back.
- Heel raise. Hold a worktop. Rise onto your toes, pause, and lower slowly.
- Seated band row. Sit tall with a resistance band looped round your feet or a fixed point. Pull your elbows back and squeeze your shoulder blades together. Keep your back straight.
Our guide to strength training in your 80s shows how to progress safely at any age. If you want to work on your middle, read about the best core exercises for seniors.
2. Low-impact and weight-bearing
- Brisk walking. Walk fast enough that you can talk but not sing. Little and often is fine.
- Heel drops. Holding a worktop, rise onto your toes and let your heels drop gently to the floor. Start with a small, soft drop.
The ROS suggests building up impact gradually if you are able to. How much suits you depends on your bone health, fracture history and fitness. Ask a physiotherapist before adding jumping.
3. Balance
The ROS recommends balance practice on at least two days a week if you are unsteady, aged 65 or over, or not exercising regularly.
- Feet together stand. Stand next to a worktop with your feet together. Hold for 10 to 30 seconds.
- Heel-to-toe stand. Place one foot directly in front of the other, as if on a line. Hold the worktop at first.
- Single-leg stand. Hold the worktop and lift one foot slightly. Build up the time slowly.
Always do balance work next to something sturdy, such as a worktop, in shoes or non-slip socks. Our guide on why balance worsens with age explains what changes and why practice helps.
4. Posture
- Wall stand. Stand with your heels, bottom and shoulder blades near a wall. Gently lengthen your neck. Hold for a few breaths. Repeat during the day.
- Shoulder blade squeeze. Sit or stand tall. Gently draw your shoulder blades back and down. Hold for a few seconds. Repeat ten times.
- Hip hinge. To bend safely, push your bottom back and bend from the hips while your back stays long. The ROS recommends this for everyday bending.
Movements to adapt or approach with care
You do not need to avoid everything. But some movements put more stress on the bones of the spine, so they are worth adapting.
The Strong, Steady and Straight statement advises avoiding postures that bend the spine far forward, in both exercise and daily life. It notes that very few fractures arise from exercise, though some were linked to extreme, loaded or repeated bending of the spine.
Approach these with care, and ask a physiotherapist before doing them:
- Repeated forward bending. Toe touches, sit-ups, crunches and rounded-back stretches.
- Loaded forward bending. Lifting a heavy bag, laundry basket or shopping off the floor with a rounded back. Use the hip hinge, bend your knees and keep the load close.
- Forceful or loaded twisting. Fast twisting, such as some golf swings or vigorous trunk-rotation machines.
- High impact. Jumping and hard running may not suit you, especially after a fracture.
The aim is to change how you do things. Hinge from the hips, keep things light and close, and build up slowly. The ROS guide to exercising safely and its back-care advice give more ideas.
Menopause and bone loss
Bones lose strength a little faster in the years after the menopause. This is because levels of oestrogen, a hormone that helps protect bone, fall. Not every woman develops osteoporosis, and many things affect your risk. The NHS lists an early menopause, before the age of 45, as one factor. Others include a family history, smoking, heavy drinking and some long-term medicines such as steroids.
If you are going through the menopause, speak to your GP about your bone health. They can talk about your options, which may include a bone density scan or hormone therapy where suitable. The NHS menopause page is a good starting point.
Exercise helps at any stage. Start with advice if you have already had a fracture.
Preventing falls and fractures
Bone strength is only half of the story. Many fractures happen when someone falls, so your balance and your home matter as much as your bones.
- Keep your legs strong. Strength and balance exercise is a main way to reduce falls. NICE guidance on falls recommends a falls prevention exercise programme for people who have fallen and have a gait or balance problem.
- Make your home safer. Remove loose rugs, keep walkways clear, and light stairs and hallways well. Use non-slip mats in the bathroom.
- Wear safe shoes. Choose snug shoes with a flat, non-slip sole. Avoid loose slippers.
- Get checks. Ask your GP or pharmacist about your eyesight, your medicines, and any dizziness when you stand.
Our falls prevention for the elderly page explains how a home falls assessment works.
If you've had a spinal fracture
A fracture in the bones of the spine, called a vertebral fracture, can be painful and frightening. It is still possible to exercise. Care and guidance matter more at this stage.
- See your GP or specialist first. Sudden new back pain, especially after a minor fall, cough or lift, should be checked.
- Keep gently moving as pain allows. Short walks and good posture are usually part of recovery. Your clinician will advise you.
- Keep impact low. The UK statement says people with a vertebral fracture or several fractures from minor falls should usually keep impact to about the level of brisk walking.
- Avoid deep, loaded forward bending. Hinge from the hips and ask for help with lifting.
- Get a tailored plan. A Cochrane review found that exercise probably improves physical performance after a vertebral fracture, but the evidence is limited. Exercises and their intensity may need to be modified.
⚠️ Get urgent help
Go to A&E or call 999 if back pain comes with new numbness around your genitals or buttocks, new bladder or bowel problems, or weakness in your legs. Call NHS 111 if you have severe new pain you cannot manage.
How a physiotherapist tailors this
No two people with osteoporosis are the same. A physiotherapist looks at your whole picture. This includes your bone scan results, any fractures, your medicines, your pain, your balance and what you want to do again.
A good plan will:
- choose the right mix of strength, impact and balance for you,
- teach safe technique, including the hip hinge and getting up from the floor or a low chair,
- show you how to build up slowly and what to do if something hurts,
- check your home for falls risks, and
- give you a simple programme to keep up between visits.
Rehalign provides private home-visit physiotherapy across Birmingham, Solihull, Walsall, Wolverhampton, Coventry, Dudley and Telford. You do not need a GP referral. Your first visit is a 60-minute assessment at £90, with travel included. You can read more about our elderly rehabilitation and falls prevention service.
Frequently Asked Questions
For most people, yes. Exercise helps keep bones and muscles strong and improves balance. The UK consensus statement advises adapting activities rather than avoiding them. If you have had a fracture, or you are not sure, ask your GP or a physiotherapist first.
A mix works best: strength exercises, weight-bearing activity such as brisk walking, balance practice and posture work. The Royal Osteoporosis Society recommends combining strength and impact exercise, with balance work on top. The right level depends on your fracture history.
Yes. Many people start at home with sit to stand, wall push-ups, heel raises, walking and balance practice next to a worktop. A physiotherapist can check your technique and set the right level for you. Stop if you feel sharp pain.
Brisk walking is a good start and is weight-bearing. On its own it may not be enough, because strength and balance work matter too. Adding two or three short strength sessions a week gives your bones more to respond to.
Rather than avoid exercise, adapt it. Take care with repeated or loaded forward bending, forceful twisting and high-impact moves, especially after a fracture. Use the hip hinge for lifting and ask a physiotherapist about anything you are unsure of.