Osteoporosis and bone health: why exercise is your most powerful tool, at any age
Most people think of osteoporosis as something that happens in old age, a quiet diagnosis that arrives after a fall, a fracture, or a routine bone density scan. But the reality is that osteoporosis is a condition decades in the making, and the window for meaningful prevention opens far earlier than most people realise.
If you're a woman in your 40s or 50s, reading about bone health now is not premature, it's precisely the right time. And if you already have a diagnosis of osteopenia (low bone density) or osteoporosis, the evidence is clear: the right exercise programme is one of the most effective interventions available to you.
This is a post for both groups. It is also a post about what your exercise physiologist at Colab Health Group can do to help.
Understanding osteoporosis and osteopenia
Bone is a living tissue. Throughout life it is constantly being broken down by cells called osteoclasts and rebuilt by cells called osteoblasts, a process called bone remodelling. In healthy adults, this cycle maintains bone density and structural strength. When breakdown consistently outpaces rebuilding, bone density decreases.
Osteopenia is the term for bone density that is below normal but not yet at the threshold of osteoporosis. Osteoporosis is a more significant reduction in bone density that substantially increases the risk of fractures, particularly at the spine, hip and wrist, from relatively minor forces or falls.
Osteoporosis is more common in women than men, with prevalence increasing markedly after menopause.
Why women are particularly vulnerable and why now matters
The dramatic increase in fracture risk among women is directly linked to the hormonal changes of menopause. As we discussed in our shoulder pain and menopause post, oestrogen has a profoundly protective effect on the musculoskeletal system. In bone specifically, oestrogen suppresses the activity of osteoclasts, the cells that break bone down. When oestrogen levels decline during perimenopause and menopause, bone loss accelerates significantly.
The most critical period of bone loss occurs in the five to ten years following menopause. Women can lose up to 20% of their bone density during this window. This is why building the highest possible bone density before menopause and slowing loss as aggressively as possible during and after it is so important.
Peak bone mass is reached in the late 20s to early 30s. After that, what you have begins to slowly decline. The higher your peak bone mass, the more you have to lose before reaching osteoporosis territory. This is why exercise habits built in youth as we discussed in our building athletes for life post literally pay dividends in bone health decades later.
For women in their 40s who haven't yet reached menopause, the message is straightforward: now is the optimal time to invest in bone health through exercise, nutrition and lifestyle, while the hormonal environment still supports bone building.
Why exercise is uniquely powerful for bone health
Bone responds to mechanical loading the forces applied to it during movement and resistance exercise by stimulating osteoblast activity and building new bone tissue. This is called the osteogenic effect of exercise, and it is site-specific: the bones that are loaded are the bones that benefit.
Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome and the target group.
This is the critical distinction, not all exercise builds bone equally. Walking is excellent for general health but provides relatively modest osteogenic stimulus. The exercises that most effectively maintain and build bone density are those that apply meaningful mechanical loads to the skeleton, particularly resistance training and impact activities.
Moderate to high intensity resistance training is an effective intervention for osteoporosis and provides the greatest effect when combined with weight-bearing impact. Higher strains applied rapidly comprise the most osteogenic load stimuli, and weight-bearing exercise provides a superior stimulus to non-weight-bearing activity.
Emerging clinical trial evidence indicates supervised progressive high-intensity resistance and impact training is efficacious in increasing lumbar spine bone mineral density and is safe and well-tolerated in postmenopausal women with osteoporosis and osteopenia.
This is genuinely important: high-intensity resistance training, done properly, with supervision and appropriate progression, is not just safe for women with osteoporosis; it is one of the most effective treatments available.
What types of exercise help most
The evidence points to a multicomponent approach as the most effective strategy for bone health across all ages and risk levels:
Progressive resistance training - lifting weights or using resistance machines with progressively increasing load. This stimulates bone at the spine, hip and wrist, the sites most vulnerable to osteoporotic fracture. Resistance training has been recognised as an effective method to improve bone health by avoiding decreases in bone mineral density over time for individuals with osteoporosis or osteopenia.
Weight-bearing impact exercise - activities that involve ground reaction forces, such as jogging, jumping, stair climbing and court sports, provide a particularly strong osteogenic stimulus. Even brief, structured jumping programmes have been shown to improve hip bone density.
Balance and functional training - building balance and coordination directly reduces fall risk, which is the proximal cause of most osteoporotic fractures. Multimodal exercise programmes incorporating challenging balance exercises can prevent falls. Exercises that challenge balance including single-leg stance, perturbation training, dynamic stepping, are a critical component of any bone health programme for older women.
Aerobic exercise - while less osteogenic than resistance and impact training, activities such as brisk walking, hiking, dancing and aerobics contribute to overall musculoskeletal health, cardiovascular fitness and body composition, all of which support bone health indirectly.
The role of exercise physiology at Colab Health Group
An accredited exercise physiologist (AEP) is the most qualified health professional to design and supervise an exercise programme for osteoporosis and osteopenia prevention. Their training is specifically focused on prescribing exercise for chronic and complex health conditions, and bone health is one of their core areas of expertise.
At Colab Health Group, your EP will begin with a thorough assessment covering your bone density results if available, your fracture history, your current activity levels, your muscle strength and balance, any medications you're taking, and your overall health and lifestyle. From there they design a programme that is targeted to your bone health goals, your fitness level, your stage of life, and any other conditions that need to be considered.
For women in perimenopause or early postmenopause, whether or not they have a formal osteoporosis diagnosis, an EP led programme means that you can maximise the osteogenic stimulus during the years when bone loss is most rapid, while building the strength and balance that will protect against falls later.
For women already diagnosed with osteoporosis or osteopenia, it means a carefully structured, progressive programme that is both safe and genuinely effective, not the cautious, low-load approach that many women are incorrectly told is their only option.
Your EP also works in conjunction with your GP and any specialist managing your bone health medically. Exercise and medication are not competing options, they are complementary, and the combination is more effective than either alone.
Medicare rebates are available for exercise physiology under a chronic disease management plan. Speak to your GP about whether you're eligible.
Prevention is always better than treatment
The most important message of this post is simple: you do not need to wait for a diagnosis to act. If you are a woman in your 40s or 50s, your bone health decisions now will directly shape your fracture risk for the rest of your life.
The habits built during these years, regular weight-bearing exercise, resistance training, adequate dietary calcium and vitamin D, and maintaining a healthy body weight are among the most meaningful investments you can make in your long-term independence and quality of life.
Come and see the exercise physiology team at Colab Health Group if you:
Have been diagnosed with osteoporosis or osteopenia
Are perimenopausal or postmenopausal and want to protect your bone density
Have a strong family history of osteoporosis or fragility fractures
Have had a recent fracture from a minor force or fall
Want a structured, evidence-based exercise programme tailored to your bone health goals
References
Beck BR, Daly RM, Singh MA, Taaffe DR. Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Brazilian Journal of Physical Therapy. 2017;21(3):170–180. PMC6429007.
Healthy Bones Australia. Exercise prescription to support the management of osteoporosis. healthybonesaustralia.org.au. Updated 2024.
Sattler MC, Junker I, Dimai HP, et al. Exercise for postmenopausal bone health — can we raise the bar? Current Osteoporosis Reports. 2025. https://doi.org/10.1007/s11914-025-00912-7
Mathew M, Zumwalt M, Khemka S. Role of exercise in prevention and treatment of osteoporosis — a narrative review. International Journal of Sports and Exercise Medicine. 2024;10:269.
Park JW, et al. Position statement: exercise guidelines for osteoporosis management and fall prevention in osteoporosis patients. PMC. 2023. PMC10345999.
Zhang L, et al. Effect of different types of exercise on bone mineral density in postmenopausal women: a systematic review and network meta-analysis. Scientific Reports. 2025. https://doi.org/10.1038/s41598-025-94510-3
Watson SL, Weeks BK, Weis LJ, et al. 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. 2018;33(2):211–220.
Küçük Öztürk G, et al. Effects of Reformer Pilates on pain, psychological factors and sleep in chronic musculoskeletal pain. BMC Psychology. 2025. PMC12296691.
Karabacak D, et al. Preventing chronic low back pain: investigating the role of Pilates in subacute management. PMC. 2025. PMC12276093.
