Spinal flexion under load. High-impact jumping. Twisting your trunk while bearing weight. These are the movements most likely to cause a fracture when your bones are already thin.
That is the answer up front. But understanding why these movements are risky, and what to do instead, is what will actually keep you safe and strong.
Osteoporosis reduces bone density to the point where normal forces can cause a fracture. The bones most at risk are the spine, hip, and wrist. Any exercise that puts sudden, uncontrolled, or excessive load through those areas needs to go.
What Two Movements Should Be Avoided by Individuals With Osteoporosis?
If you remember nothing else, remember these two.
1. Spinal flexion under load means bending your spine forward while carrying weight or while your body is resisting gravity. Think of a crunch, a sit-up, or picking something up off the floor by rounding your back. The vertebrae at the front of the spine take enormous compressive force during flexion. With low bone density, that force can cause a vertebral compression fracture, sometimes without any warning pain at all.
One of my clients came to me after her GP flagged low bone density on a DEXA scan. She had been doing Pilates for years and felt fine. When I looked at her program, half of it was forward flexion work. She had no fractures yet, but the risk was real and she had no idea. We rebuilt her program around neutral spine and loaded extension work instead.
2. High-impact twisting and rotation is the second movement to cut. Exercises like golf swings, certain yoga poses that crank the spine into rotation, or any movement that combines a twist with forward bending put shear and torsional force through the vertebrae. The spine is not built to handle those forces well at the best of times. With osteoporosis, the margin for error disappears.
What Exercises Make Osteoporosis Worse?
Beyond those two big ones, here is a clear list of movements to avoid or heavily modify.
- Crunches and sit-ups. These load the spine in flexion repeatedly. Even bodyweight versions carry real risk.
- Toe touches and standing forward folds. Same problem. The spine rounds under the weight of your upper body.
- High-impact jumping. Box jumps, jump squats, skipping at high intensity. The landing force travels up the skeletal system and can exceed what a fragile hip or vertebra can handle.
- Rowing machines with poor form. Most people round their lower back on the return stroke. With osteoporosis, that repeated flexion is a problem.
- Loaded spinal rotation. Twisting with a medicine ball, cable rotations, or any exercise that cranks the spine laterally while under load.
- Contact sports and activities with high fall risk. Skiing, contact football, ice skating for beginners. A fall is the single biggest fracture risk.
I know this because one of my clients tried to keep doing her regular aerobics class after her osteoporosis diagnosis. She modified nothing. Six months later she had a stress fracture in her foot from the repeated impact. She told me afterward she thought she was fine because it did not hurt during the class. Impact accumulates.
What Is the Number One Best Exercise for Osteoporosis?
Resistance training. Specifically, progressive loaded resistance training that targets the hip, spine, and leg muscles.
Bone responds to mechanical load. When a muscle pulls on a bone through a tendon, the bone detects that force and responds by laying down new bone tissue. This is called Wolffs Law, and it is how the skeletal system adapts to stress. No other stimulus does this as well as resistance training.
The research is clear. The LIFTMOR trial out of Griffith University showed that high-intensity resistance training with deadlifts, squats, and overhead press produced significant improvements in bone density at the spine and hip in postmenopausal women with low bone mass. The key word is high-intensity. Low-load, high-rep work does not produce the same signal to bone.
In my experience, the exercises that deliver the most bone benefit are:
- Deadlifts with a neutral spine
- Squats and leg press
- Hip thrusts and glute bridges
- Overhead press
- Rows with a flat back
- Heel drops and calf raises for the heel bone
Walking matters too, but it is not enough on its own. Walking loads the skeletal system through impact, which helps maintain bone, but it does not produce the targeted, high-force stimulus that resistance training does. Think of walking as the floor and resistance training as the ceiling.
What Is One Food People With Osteoporosis Should Eat More Of?
Dairy. Full stop.
Calcium is the primary mineral in bone. Dairy is the most bioavailable source of calcium available. One serve of yoghurt gives you around 300mg of calcium, which is about a third of your daily target. Milk and cheese are in the same category.
People overcomplicate this. Yes, leafy greens have calcium. Yes, fortified plant milks exist. But the absorption rate of calcium from dairy is higher than most plant sources, and the evidence base for dairy and bone health spans decades.
If you cannot eat dairy, tinned salmon with bones, firm tofu set with calcium sulfate, and almonds are solid alternatives. But if you can eat dairy and you are not eating much of it, that is the single highest-use food change you can make.
Vitamin D matters just as much as calcium for absorption. Without adequate vitamin D, your gut cannot absorb the calcium you eat. Most people with osteoporosis are low in both. Get your levels checked.
How Should You Actually Structure Exercise With Osteoporosis?
This is where most articles miss the mark. They list what to avoid and leave you with nothing to do. Here is what a safe, effective program actually looks like.
Two to three resistance training sessions per week. Focus on compound lower body movements, hip hinging with a neutral spine, and upper body pressing and pulling. Start at a manageable load and progress over months.
Balance training every session. Falls cause fractures more often than exercise does. Single-leg work, standing on one foot, and challenging your balance in controlled ways reduces fall risk significantly. This is non-negotiable.
Daily walking. Thirty to forty minutes most days. Not for bone density primarily, but for cardiovascular health, muscle activation, and fall risk reduction from general fitness.
Posture work. The thoracic spine and the muscles that hold it upright are critical. Weakness through the upper back leads to the forward rounding that puts the spine in flexion during daily life. Row variations, thoracic extension over a foam roller, and scapular strengthening all help.
What Most Articles Get Wrong About Exercise and Osteoporosis
Three things come up again and again that are either wrong or incomplete.
First: Gentle exercise is safe exercise. This is not true. Low-load exercise does not stimulate bone growth. If the intensity is not sufficient to challenge the bone, the bone will not adapt. Many people with osteoporosis spend years doing water aerobics and chair yoga, both of which are fine for other goals, but neither will improve bone density. They feel like they are doing the right thing and their bones continue to thin.
Second: Yoga is always good for osteoporosis. Some yoga is fine. But a lot of yoga involves deep spinal flexion, loaded twisting, and poses that compress the vertebrae. Forward folds, seated twists, and plow pose are not appropriate for someone with low bone density. The teacher may not know your medical history. You have to know which poses to skip.
Third: Exercise is only about bones. The real goal is staying upright. Muscle strength and balance are what prevent the falls that cause hip fractures. A hip fracture in a person over 70 carries serious consequences for independence and mortality. Keeping the muscles around the hip and ankle strong is arguably more important than bone density itself. When I work with older clients who have osteoporosis, I spend as much time on single-leg balance and hip stability as I do on loading the spine.
A Note on Working With a Professional
Osteoporosis does not look the same in every person. Your DEXA scan result, your history of fractures, your current medications, and your baseline fitness level all change what is safe and what is appropriate for you.
A personal trainer with experience in bone health can assess your movement patterns, identify where your posture is loading the spine in flexion during daily activities, and build a program that progressively loads your bones without putting you at risk. If you are in South Melbourne, this kind of specialist programming is available through personal trainers in South Melbourne who work with clinical populations.
What I found was that most people with osteoporosis are undertrained, not overtrained. The risk they face is not from pushing too hard in a well-designed program. It is from doing nothing effective for years and arriving at their 70s with weak muscles, poor balance, and bones that have never been asked to do anything.
Frequently Asked Questions
Can I still do cardio with osteoporosis?
Yes. Walking, hiking on flat terrain, cycling, and swimming are all appropriate. Avoid high-impact options like running or jumping until you have built a base of strength and your bone density is assessed. If you do run, do so on soft surfaces and with good footwear.
Is swimming good for osteoporosis?
Swimming is good for cardiovascular health and joint mobility. It is not good for bone density. Water removes gravity, which removes the load on your bones. Swim for fitness if you enjoy it, but do not count it as your bone-building exercise.
Can osteoporosis be reversed with exercise?
Bone density can improve with resistance training. The research shows meaningful gains are possible, particularly at the spine and hip. The earlier you start, the more you can recover. Exercise cannot fully reverse severe osteoporosis, but it can stop progression, improve density modestly, and dramatically reduce fracture risk through muscle and balance gains.
How heavy should I lift with osteoporosis?
Heavier than most people expect. The LIFTMOR protocol used 85 to 90 percent of one-rep max. That is not appropriate for everyone, and you need proper technique first. But the principle holds: you need to challenge the bone to get a response. Working with a trainer to find your appropriate load is the right approach.
Should I avoid deadlifts with osteoporosis?
Not if you can hinge with a neutral spine. A deadlift performed with a flat back and strong bracing is one of the best exercises available for loading the hip and spine safely. The problem is most people deadlift with a rounded back, which changes everything. Learn the movement pattern first, then load it progressively.
What about osteopenia? Are the same rules the same?
Osteopenia is lower bone density than normal, but not as low as osteoporosis. The same exercise principles apply. Avoid spinal flexion under load, avoid high-impact uncontrolled movements, prioritise resistance training and balance work. The urgency is slightly lower, but the direction is identical.
What to Do Now
Stop doing crunches, sit-ups, and any exercise that rounds your spine under load. Start resistance training with a neutral spine focus, two to three times per week. Add five minutes of single-leg balance work every session. Eat more calcium-rich food, especially dairy if you tolerate it, and get your vitamin D level checked.
If you do not know how to deadlift or squat safely with osteoporosis, find a trainer who does. The risk of doing nothing is greater than the risk of a well-run strength program. Your bones need a reason to stay strong. Give them one.
