How To Prevent And Treat Osteoporosis: A Physiotherapist’s Guide To Resistance Training And Stronger Bones
As a physiotherapist, I have worked with many patients suffering osteoporosis / low bone density. Osteoporosis can significantly impact people’s lives. It’s the reason my grandfather had to stop skiing, and my aunt had to stop biking. A fall when you have osteoporosis can be devastating. Something that would normally not lead to an injury, now has a high probability of causing a broken bone. This can lead to a loss of independence or a loss of ability to participate in social and recreational activities, with significant impacts on both mental and physical health. For some, it can mean hospitalization and a significantly increased risk of death. It is a sad reality that more than 1-in-5 Canadians with a hip fracture died within a year after the fracture.
Currently, there are 2.5million Canadians aged 40+ are living with diagnosed osteoporosis. The reality is that the risk of osteoporosis diagnosis doubles every 5 years, between the ages of 40 and 65 (Health Canada, 2023). The good news is there are ways to prevent it, ways to improve it, and physiotherapists are part of the solution. In this blog, we are going to explore how physiotherapists can support prevention and treatment of osteoporosis through good resistance training programming.
What Is Osteoporosis?
Before understanding why resistance training is effective for preventing and treating osteoporosis, it’s important to know what osteoporosis is. If you could look inside your bones, you would see that they aren’t solid. Inside, they resemble a honeycomb structure filled with small walls and empty spaces. When you’re young, those walls are thick, heavy, and strong. As we age and hormone levels change during midlife, the body may start to remove old bone faster than it can build new bone. When this occurs, the tiny holes inside the bone expand. The surrounding walls become thin and fragile. This lowering of bone density is a condition called osteoporosis. Because the bones inside become weak like dry chalk, even a small stumble or a gentle bump can lead to a fracture in severe cases.
What Is Resistance Training?
Resistance training means exercising your muscles against some form of resistance or weight. You can perform resistance training using:
Free weights (like dumbbells or kettlebells)
Gym machines (like leg press or cable machines)
Elastic resistance bands
Your own body weight (like squats, push-ups, or step-ups)
When you lift weights, your muscles pull on the bones they are attached to. This pulling creates stress on the bone. Just like when you load a muscle, it gets stronger; the same thing happens in bones. Special cells in your bones sense this stress and immediately start forming new bone tissue to make the bone thicker and stronger. This is one reason why resistance training is effective for treating osteoporosis.
What Does Science Tell Us?
In the past, some doctors were concerned that lifting heavy weights could cause fractures in people with weak bones. However, a well-known clinical trial called the LIFTMOR study showed that heavy lifting can be done safely and effectively. In this study, researchers tested a high-intensity strength and impact training program on postmenopausal women with low to very low bone density (Watson et al., 2018). Under careful professional supervision, the participants performed heavy strength exercises, such as deadlifts, back squats, and overhead presses twice a week for eight months. The results were impressive! The women who did supervised heavy resistance training gained 2.9% bone mineral density in their spine and improved the strength of their hip bones, while women in a light exercise group lost bone density. Even better, the heavy lifting group grew stronger, improved their balance, stood taller, and had no fractures or serious injuries (Watson et al., 2018).
Another review by Benedetti et al. (2018) looked at many exercise trials in older adults. They found that simple activities like casual walking, while good for your heart, are not enough on their own to build dense bone. Instead, Benedetti et al. (2018) discovered that progressive resistance training creates strong muscle pulls and forces in the joints that directly promote new bone growth. Resistance exercise is specific to the area being worked on, meaning that if you strengthen your legs and hips with squats, the bones in your hips become denser. If you strengthen your upper body, your spine and wrist bones benefit too! The researchers concluded that lifting challenging weights two to three times a week helps prevent age-related bone loss and keeps bones strong in areas most prone to fractures, like the hips and spine (Benedetti et al., 2018).
Jumping is also an important part of a program focused on increasing bone density. Jumping places brief, rapid loads on the skeleton, stimulating bone adaptation and potentially helping maintain or increase bone mineral density, particularly at the hips. Research has found that regular jumping can improve hip and femur bone density in premenopausal women. Although jumping is great at stimulating bone growth, it is not appropriate for everyone with osteoporosis, particularly people at high fracture risk or with vertebral fractures (Zhao et al., 2018).
Top Benefits of Resistance Training for Osteoporosis
Makes bones denser and harder to break (Benedetti et al., 2018; Watson et al., 2018).
Helps prevent falls (Watson et al., 2018).
Protects key areas (Benedetti et al., 2018).
Preserves height and improves posture (Watson et al., 2018).
Boosts functional independence (Watson et al., 2018; Beck et al., 2017).
Reduces fear of movement (Watson et al., 2018).
Acts as internal shock absorption (Benedetti et al., 2018).
How to Get Started Safely
If you want to protect your bones or manage osteoporosis, starting safely is essential:
Work with a movement professional, such a physiotherapist to assess your movements, check your posture, and create an exercise routine tailored to your needs.
Learn proper form first: Understanding how to lift weights with reducing rounding or twisting your back helps protect your spine while your bones strengthen.
Start small and build gradually: You don’t need to lift heavy weights right away. Begin with comfortable weights and gradually increase as your body adjusts.
Be patient and consistent: Bone tissue takes time to rebuild. Sticking with your program for at least 6 to 12 months is crucial to seeing real improvements in bone density (Benedetti et al., 2018; Watson et al., 2018).
Conclusion
Strength training should be used alongside interventions such as Nutrition and medication. While these can help, progressive resistance training serves as a direct way to signal your body to build new, strong bone tissue. By working with a physiotherapist, you can strengthen the areas of your body most susceptible to fractures, like your hips, spine and arms. You will learn how to load safely, protect your back, improve your balance, prevent falls, and keep your bones strong for years to come.
If you have any questions or are interested in learning more please call us,email us, or book an appointment online here! We look forward to working with you!
Written By: Kobe Twigg
References
Public Health Agency of Canada. (2023). Osteoporosis and related fractures in Canada 2023 [Infographic]. Government of Canada. https://www.canada.ca/content/dam/hc-sc/documents/services/publications/diseases-conditions/osteoporosis-related-fractures-canada-2021/64-03-19-2536_CCDSS-Osteoporosis-infographic_en-web.pdf
Beck, B. R., Daly, R. M., Singh, M. a. F., & Taaffe, D. R. (2016). Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), 438–445. https://doi.org/10.1016/j.jsams.2016.10.001
Benedetti, M. G., Furlini, G., Zati, A., & Mauro, G. L. (2018). The effectiveness of physical exercise on bone density in osteoporotic patients. BioMed Research International, 2018, 1–10. https://doi.org/10.1155/2018/4840531
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2017). High-Intensity Resistance and Impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284
