Movement
Exercise for osteoporosis: what to do, and what to avoid
By Natura Integrative Care Clinic · Updated · 5 min read
The short answer
Osteoporosis Canada recommends balance training and progressive strength training, each at least twice a week, as the core of exercise for osteoporosis. Walking, yoga and other activities you enjoy can be added on top, not in place of them. Limit repeated, loaded or extreme forward bending and twisting of the spine, especially if your fracture risk is high.
A diagnosis of osteoporosis or low bone density often comes with mixed messages: stay active, but be careful. It is easy to end up doing less than you safely could. Exercise for osteoporosis is not about avoiding movement. It is about choosing the right kinds, doing them often enough, and moving your spine with care.
This guide is based on Osteoporosis Canada’s Too Fit to Fracture recommendations and its 2023 clinical practice guideline, which set out exercise recommendations for people over 50 with osteoporosis or at risk of fracture.
What is the best exercise for osteoporosis?
The Canadian guideline focuses on preventing falls and fractures, and it puts two kinds of exercise first:
- Balance and functional training, at least twice a week. The guideline makes this a strong recommendation, backed by high-certainty evidence in adults over 50.
- Progressive strength (resistance) training, at least twice a week, including exercises for your stomach and back muscles. This is also a strong recommendation.
- Other activities you enjoy, such as walking, yoga, Pilates or pickleball, in addition to (not instead of) balance and strength work. The guideline points to Canada’s 24-Hour Movement Guidelines, which suggest at least 150 minutes of moderate to vigorous activity a week.
| Type | How often | Examples |
|---|---|---|
| Balance and functional | 2 or more times a week, getting harder over time | Standing on one foot, heel-to-toe walking, sideways walking, Tai chi, heel raises, catching and throwing a ball, sit-to-stands, stair climbing |
| Strength | 2 or more times a week, with high effort | Squats, lunges, hip hinges, bridges, rows, pull-downs, push-ups |
| Core and posture | Within your strength sessions | Planks, side planks, bird dogs, back extensor exercises |
| Other activity | Most days, adding up to 150 minutes a week | Walking, cycling, dancing, yoga or Pilates (modified for spine safety) |
Strength training for osteoporosis
Strength training means making your muscles work against resistance, such as your body weight, bands, machines or weights, with enough effort that the last few repetitions feel hard. Over time you increase the weight, sets or difficulty so your body keeps adapting. That gradual increase, called progressive overload, is the key principle.
Exercises for the back extensor muscles (the ones that hold you upright) belong in the program alongside core work such as planks and bird dogs. Technique matters more than load at the start. Osteoporosis Canada’s key principle is to bend with your hips and knees instead of your spine, using slow and controlled movements.
What exercises should you avoid with osteoporosis?
Most activities can be modified rather than dropped. The guideline’s advice is that movements involving rapid, repetitive, sustained, weighted or end-of-range bending or twisting of the spine may need to be modified, especially if you are at high risk of fracture. In everyday terms, Osteoporosis Canada suggests limiting:
- Repetitive bending and twisting
- Bending all the way forward or to the side
- Twisting all the way to the side
- Holding a bent-over or twisted position for a long time
- Bending or twisting while holding something heavy
| Instead of… | Try… |
|---|---|
| Sit-ups or crunches | Planks, side planks or bird dogs |
| Touching your toes with straight legs | A hip hinge: bend at the hips and knees with a long spine |
| Twisting to lift or throw (a shovel of snow, a bag of groceries) | Lifting close to your body, then turning by moving your feet |
| Deep forward folds or full twists in yoga | The same class with modified poses that keep your spine long |
Impact exercise such as jogging, skipping or jumping is a separate question. The guideline notes that its safety is uncertain for people at high fracture risk, including anyone who has had a spine fracture. Build up to it only if your fracture risk and fitness allow, ideally with professional guidance.
How to start exercising safely with osteoporosis
- Know your fracture risk. Ask your doctor whether you are at high risk, for example because of a previous spine fracture. That changes how cautious to be with impact and deep bending.
- Start with two short sessions a week of balance and strength work, at a level that feels challenging but controlled.
- Progress gradually. Add a little more weight, a few more repetitions or a harder balance challenge every week or two.
- Practise the hip hinge everywhere, not just in workouts: loading the dishwasher, lifting a laundry basket, picking up a grandchild.
- Keep the activities you love, adapting any that involve lots of bending or twisting.
In a Manitoba winter, balance and strength sessions can be done indoors when icy sidewalks make walking outside risky, so your routine doesn’t have to stop when the snow arrives.
Questions to ask your doctor before you start
- Is my fracture risk considered high, and have I had a spine fracture?
- Are there movements or activities I should avoid completely for now?
- Is impact exercise, such as jogging or jumping, reasonable for me?
- Do any of my medications affect balance or make me dizzy?
Do you need a supervised osteoporosis exercise program?
Not everyone does. Osteoporosis Canada suggests getting advice from a physical therapist, kinesiologist or exercise physiologist on exercise selection, intensity and progression, or about the safety of other activities, especially if you have had a recent fracture or are at high risk of one. That advice can also cover how to keep your spine safe during daily tasks such as lifting laundry or shovelling, not just during workouts.
Food matters too. Osteoporosis Canada’s guideline suggests calcium-rich foods to meet recommended intakes, and a vitamin D supplement of at least 400 IU a day along with vitamin D-rich foods.
Seeing a clinical exercise physiologist at Natura
At Natura in Steinbach, Lindsay Porter, B.Kin, CSEP-CEP is a clinical exercise physiologist. Lindsay works with people managing osteoporosis, and nobody needs to be fit before they begin. The first assessment looks at posture, strength, balance and mobility, and follow-ups adjust your program as you go, including exercises to do at home.
- Initial assessment: 60 minutes, $125. A conversation about your history, goals and any limitations, and it may include tests of posture, strength, balance and mobility.
- Follow-up: 30 minutes, $70.
- Individual exercise program: a four-week online training program, $200 (call the clinic to book).
- What to bring: comfortable clothes, supportive shoes, a list of your medications, and any bone density or scan reports and medical letters.
Natura doesn’t bill insurers directly, and coverage for clinical exercise physiology varies, so check your plan. If you’re unsure who to see, our guide to kinesiologists and physiotherapists explains how the two professions differ.
Common questions
Is walking good exercise for osteoporosis?
Keep walking if you enjoy it; it counts toward your weekly activity. On its own, though, its effect on falls and fractures in people with osteoporosis is uncertain. Osteoporosis Canada recommends walking in addition to, not instead of, balance and strength training at least twice a week.
Can exercise reverse osteoporosis?
Exercise isn’t a substitute for the treatment your doctor recommends. The Canadian guideline’s exercise advice focuses on preventing falls and fractures, and the evidence on how much exercise changes bone density is less certain. Medication decisions belong with your doctor; exercise goes alongside them, and you should never stop a prescribed osteoporosis medication without talking to them.
Is yoga safe if you have osteoporosis?
Many poses are fine, though yoga’s effect on bone density and fractures is uncertain. Deep forward folds, full twists and holding bent or twisted positions may need modifying, especially if your fracture risk is high. Let your instructor know about your osteoporosis, and keep up balance and strength training too.
Can I lift weights with osteoporosis?
Yes. Progressive strength training at least twice a week is part of Osteoporosis Canada’s recommendations. Good technique matters most, especially keeping your spine long and bending at the hips and knees. If you have had a recent fracture or are at high risk, start with guidance from an exercise professional who works with osteoporosis.
Sources
- Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update — CMAJ
- Too Fit To Fracture — Osteoporosis Canada
- Too Fit to Fracture exercise guide (PDF) — Osteoporosis Canada
- Quick reference guide: 2023 clinical practice guideline — Osteoporosis Canada
- Exercise for individuals with osteoporosis — International Osteoporosis Foundation
- Assessing vertebral fractures — International Osteoporosis Foundation
This article is general information, not medical advice for your situation. If you're unwell or worried, talk to your doctor or call Health Links – Info Santé, Manitoba’s free 24-hour nurse line, at 1-888-315-9257. In an emergency, call 911.
