Living with Osteoporosis: Understanding how exercise can keep your bones healthy

Osteoporosis is a common musculoskeletal condition characterised by reduced bone mass (bone mineral density) and bone strength, increasing the likelihood of fracture, particularly following falls or sudden impacts. 

At Vitruvian, we support people living with osteoporosis through evidence-based exercise prescription and appropriate lifestyle guidance, working alongside medical professionals who oversee diagnosis and medication decisions.

Understanding living with osteoporosis and its management

Osteoporosis is typically diagnosed using a DEXA scan, which compares your bone mineral density with that of a healthy young adult. This result, combined with factors such as age, fracture history, general health, and falls risk, informs clinical decision-making around treatment.

First-line management commonly includes lifestyle interventions, particularly appropriately prescribed exercise, alongside nutritional considerations and other health-related habits. Where required, medication may also be prescribed by a medical professional. Exercise physiology contributes by addressing modifiable factors that influence bone strength, physical function, and falls risk.

Exercise as the foundation of osteoporosis management

Exercise is one of the most effective non-pharmacological strategies for managing osteoporosis. The goal is not simply to remain active, but to reduce fracture risk by improving bone-loading capacity, muscle strength, balance, and confidence in movement.

Exercise programmes are developed based on your bone mineral density, health history, fracture risk, and current physical capacity. Core components include:

• Progressive resistance training

• Weight-bearing and impact activities as tolerated

• Balance and functional exercises

Mechanical loading through resistance training and weight-bearing/impact exercise stimulates bone tissue to maintain or increase density. Training is most effective when it targets common fracture sites, particularly the hips and spine. For individuals at increased risk of falls, balance training plays a key role in reducing this risk. No intervention reduces falls risk as effectively as appropriately prescribed exercise.

We provide more detailed information on exercise approaches for osteoporosis, including the research that informs our practice, on our dedicated osteoporosis resources.

When prescribed and progressed appropriately, structured exercise can help people living with osteoporosis maintain, and even improve, bone density, move with greater confidence, and reduce the likelihood of falls and fractures. Exercise should be prescribed and supervised by a qualified professional to ensure safety and appropriate progression.

Low-load or non-weight-bearing activities such as swimming or cycling can support cardiovascular and metabolic health, but they place insufficient strain on the skeleton to meaningfully influence bone density. These activities may complement, but should not replace, targeted bone-loading exercise.

Moving well and confidently with osteoporosis

Living with osteoporosis does not mean avoiding movement. It means moving with greater awareness and intention.

Everyday tasks such as bending, lifting, carrying, or navigating uneven ground can place higher demands on bones and/or increase fall risk when bone strength is reduced. Small adjustments can meaningfully reduce risk. For example, education on strategies to protect the spine from excessive strain during lifting and bending may be appropriate for certain individuals.

Falls most commonly occur at home and are often linked to everyday situations such as rushing, carrying items on stairs, poor lighting, or slippery surfaces. Practical measures, including supportive footwear, reduced clutter, and adequate lighting, can significantly lower fall risk.

For some individuals, particularly those with a prior fracture, it may be appropriate to limit repeated heavy lifting from the floor or sustained bending and twisting. This does not mean that exercise should be avoided; rather, the selection of movements and the loading are adjusted within a structured programme.

Regular movement remains important. Avoiding activity altogether can lead to muscle weakness, reduced coordination, and a higher risk of falls. Consistent, considered activity supports strength, balance, and long-term independence.

Diet and lifestyle considerations

While exercise prescription is the primary focus of our role, diet and lifestyle factors also influence bone health.

General nutritional considerations include adequate calcium intake, sufficient vitamin D, appropriate overall energy intake, and adequate protein. We provide general guidance in these areas and work alongside dietitians or medical professionals when more specific input is required.

Lifestyle factors such as smoking and excessive alcohol consumption are known to negatively affect bone health and fracture risk. Addressing these factors, where relevant, forms part of broader health discussions within your care team.

Summary

Osteoporosis management is most effective when approached through a combination of medical care, evidence-based exercise, and supportive lifestyle strategies. Exercise physiology plays a key role in addressing modifiable risk factors by improving bone-loading capacity, muscle strength, balance, and confidence in movement.

Through structured, appropriately prescribed exercise, people living with osteoporosis can move more confidently, reduce falls risk, and support a more active, healthy and independent life.