Osteoporosis Exercise: Strength, Balance and Safe Physiotherapy

An osteoporosis diagnosis can make exercise feel risky, especially if you have already had a fracture. In reality, most people with osteoporosis can exercise safely, and the right combination of strength, weight-bearing activity and balance work can support bone health, confidence and independence.

The important word is right. Exercise should match your fracture history, balance, current strength, pain and other health conditions. This guide explains what usually helps, what may need adapting and when to speak to a doctor or physiotherapist first.

What is osteoporosis?

Osteoporosis is a condition in which bones become less strong and more likely to break. It can affect women and men and is often silent until a fracture occurs. Common sites for fragility fractures include the wrist, hip and spine.

A DEXA scan measures bone density, but treatment decisions are not based on the scan alone. The NHS explains that age, sex, previous fractures and other risk factors also matter. Tools such as FRAX or QFracture may be used to estimate future fracture risk.

Exercise is an important part of bone health, but it does not replace prescribed osteoporosis medicine when medication is indicated. Medical treatment, nutrition, smoking cessation, sensible alcohol intake and physical activity work together to reduce risk.

What exercise is best for osteoporosis?

Three broad types of activity are particularly useful: weight-bearing or impact exercise, progressive strength exercise and balance training. The mix depends on your individual risk and ability.

1. Weight-bearing and impact activity

Weight-bearing activity is done on your feet, so force travels through the legs and skeleton. Walking and stair climbing are lower-impact examples. Dancing, jogging, small jumps and some sports provide more impact.

More is not automatically better. The Royal Osteoporosis Society advises that high-impact exercise is not specifically required for bone strength. People with spinal fractures or several previous fractures may be advised to stay with low-impact exercise. If you are new to impact activity, start at a level that feels steady and controlled.

2. Progressive strength training

Strength exercise makes muscles work against resistance from body weight, bands, machines, dumbbells or other weights. As muscles pull on bone, the skeleton receives a useful training stimulus. Stronger legs, hips, trunk and upper body can also make everyday tasks easier.

A programme might include a squat or sit-to-stand pattern, a hip hinge, a push and a pull. The starting version may be a chair sit-to-stand, wall press-up and light resistance-band row. Someone already experienced with weights may need a more challenging plan.

Start with a resistance you can control and progress gradually. Good technique matters, particularly if you have spinal fractures, back pain or a history of multiple fragility fractures. There is no single weight that is safe for everybody.

3. Balance and falls-prevention exercise

Bone strength is only one part of fracture prevention. Reducing the chance of falling is also important. Balance work may include controlled sit-to-stands, heel raises, tandem standing, stepping in different directions or supported single-leg balance.

NICE recommends that falls-prevention exercise programmes are progressive, tailored and focused on relevant components such as balance, coordination, strength and power. If you feel unsteady, practise near a stable surface and seek individual guidance rather than attempting difficult exercises alone.

For more practical ideas, read our guide to improving balance and reducing falls risk.

Are bending and lifting unsafe with osteoporosis?

Bending is a normal part of daily life and is not automatically dangerous. The concern is repeated, sudden or heavily loaded bending through a rounded spine, particularly for someone with vertebral fractures or a high fracture risk.

A hip-hinge strategy can make lifting more controlled: bend from the hips and knees while keeping the load close, rather than rounding and twisting the back under load. Exercises such as loaded sit-ups, repeated toe touches or fast Pilates roll-downs may need modifying if your spine is vulnerable.

That does not mean avoiding movement or keeping the spine rigid all day. Fear and inactivity can reduce strength and confidence. The aim is to move well, choose an appropriate load and build capacity gradually.

How can physiotherapy help?

A physiotherapist can help turn general osteoporosis advice into a plan that suits your body and goals. This is particularly useful if you have painful spinal fractures, several previous fractures, repeated falls, poor balance or another health condition that makes exercise difficult.

Physiotherapy may include:

• reviewing your fracture history, pain, mobility and confidence;
• testing functional strength and balance safely;
• selecting weight-bearing activity at an appropriate impact level;
• teaching strength exercises and lifting technique;
• adapting exercise after a healed fracture;
• addressing posture and movement after vertebral fractures;
• building a realistic home programme and monitoring progress.

Online physiotherapy can be useful for observing sit-to-stand, walking, balance and home exercises; reviewing the space where you train; and progressing resistance with household equipment or bands. It cannot diagnose osteoporosis, order a DEXA scan or assess a suspected new fracture.

What progress should you expect?

Muscles and balance often change more quickly than bone density. You may notice improved confidence, steadier movement or easier daily tasks over several weeks, while meaningful gains in strength usually require consistent training over months.

Bone health is a long-term project rather than a short rehabilitation deadline. A useful programme should be sustainable, progressive and enjoyable enough to continue. Missing an occasional session matters less than returning to the routine.

If you are recovering from a fracture, follow the advice of the team managing it. Many fractures heal over roughly six to eight weeks, but healing and return to loading vary by fracture type, treatment, age and health. The Royal Osteoporosis Society notes that strength progression after a broken bone may need to wait until healing, which can take up to three months in some cases.

When should you get medical advice before exercising?

Speak to your GP, osteoporosis service or physiotherapist before starting a new programme if you have had spinal fractures, several fragility fractures, a recent broken bone, repeated falls or uncertainty about which movements are suitable.

New back pain with noticeable height loss or a new change in spinal shape may indicate a vertebral fracture and should be assessed. After a fall or injury, seek urgent advice if pain is severe or worsening, you cannot put weight through a limb, there is major swelling or deformity, or you suspect a fracture.

Stop exercise and seek appropriate help for chest tightness, severe shortness of breath, faintness, clamminess or sudden unexplained symptoms. Call 999 for emergency symptoms. New leg weakness, loss of bladder or bowel control, or numbness around the saddle area also needs emergency assessment.

This article provides general information and is not a diagnosis or a substitute for personalised medical advice.

Sources

• NHS: Osteoporosis
• NHS: Osteoporosis prevention
• NICE NG249: Falls assessment and prevention
• Royal Osteoporosis Society: Exercise for bones
• Royal Osteoporosis Society: How to exercise safely for bones

Sources checked 27 October 2026.