Who it’s for / Bone Density & Osteoporosis
Exercise for Osteoporosis and Bone Density — Gold Coast
Written by Lucus Leung, Masters of Physiotherapy, Bachelor of Exercise ScienceLast reviewed 22 August 2026
Progressive resistance training is one of the very few things shown to build bone rather than merely slow its loss. Programmed carefully, and built up from wherever you are now.
Bone responds to load. When muscle pulls hard against bone, the bone adapts by getting denser — which is why resistance training, and not walking or swimming, is the exercise most consistently associated with bone-density improvements after fifty.
The catch is that it has to be progressive and it has to be heavy enough to matter, while staying well inside what’s safe for your particular bone density. That’s a programming problem rather than a willpower problem, and it’s exactly what we build the first six weeks around.
If you’ve had a DEXA scan, bring the results. If you’ve been diagnosed with osteoporosis rather than osteopenia, we’ll want your GP’s clearance and any movement restrictions they’ve given you before we start loading.
What the evidence says
Australian and international osteoporosis guidelines consistently list progressive resistance training and weight-bearing impact work as core non-pharmacological management. Healthy Bones Australia and ESSA both publish position guidance along these lines. This is general information, not medical advice — your GP or specialist should guide your treatment.
Osteopenia and osteoporosis: what actually changes in the programming
They are two points on one scale, and people are often told the word without being told what it means for training.
With osteopenia, bone density is below normal but not at the osteoporosis threshold. In practice we can progress load close to normally. The priority is building the habit and the strength base now, while there is more room, and getting ahead of the steeper decline that tends to follow menopause.
With osteoporosis, the approach gets more deliberate. We want GP clearance, we want to know about any previous fracture — a vertebral fracture changes the plan more than the T-score does — and we are more conservative with spinal loading. That does not mean light weights forever. It means the route to heavy is longer and the positions are chosen more carefully.
What exercises to avoid with osteoporosis
This is the question people ask most and the one most pages skate over, so here it is plainly. The positions that concern us are the ones that load a compromised spine into flexion or rotation.
Generally avoided
- Weighted sit-ups, crunches and loaded toe-touches
- Heavy lifting from a rounded back
- End-range spinal twisting under load
- High-impact work where density or fracture history rules it out
Generally encouraged
- Loaded carries — grip, trunk and hip in one movement
- Controlled squat and hinge patterns with a neutral spine
- Overhead and horizontal pressing and pulling
- Balance and reaction work, because the fall matters as much as the bone
Treat that as general information rather than a prescription. Your GP or specialist should give you your restrictions, and the program is then built around them.
Spine-specific loading
The spine is where people are most anxious and where the advice is most often unhelpfully vague. “Be careful with your back” is not a program.
What we actually do is load the spine in the position it is strongest in — neutral, braced, upright — and avoid loading it in the position it is weakest in, which is flexed and rotated. That means carries, holds, and controlled hinges rather than sit-ups. It also means training the muscles along the back of the spine directly, because spinal extensor strength is associated with better posture and lower vertebral fracture risk.
If you have had a vertebral fracture, this section is one to go through with your GP or specialist before we start.
How heavy does it actually need to be?
Heavier than most people expect, and heavier than most general classes go.
The bone-loading research that shows density gains generally uses loads in the range of roughly 80% of a person’s one-repetition maximum — that is, sets of around five to eight repetitions where the last one or two are genuinely hard. Three pink dumbbells for fifteen reps will improve your endurance and your confidence, and it will do very little to your bone.
That does not mean starting there. It means that is the destination, and the first six to twelve weeks are spent building the technique and tissue tolerance to get there safely. For most people the progression is small and relentless — an extra kilo or two every week or two, for a long time.
It is also why walking, swimming and cycling, all excellent for other reasons, do not appear in this program. They do not load bone enough to trigger the adaptation.
What we train
- Loaded carries and controlled squat and hinge patterns
- Progressive weight, added in small increments each week
- Direct work for the muscles along the spine
- Balance and reaction work, because avoiding falls matters as much as bone density
- Positions and ranges adjusted around any restrictions you have been given
Good fit if…
- You have been diagnosed with osteopenia or osteoporosis.
- You were told to "do some weights" and had no idea where to start.
- You have a family history of fracture or early bone loss.
- You are post-menopausal and want to get ahead of bone loss.
Who should be supervising this
It is a fair question and worth being direct about, because the honest answer is not always “a personal trainer”.
If you need assessment, diagnosis, or hands-on treatment, the right people are a physiotherapist or an accredited exercise physiologist. If you have been cleared to exercise and what you need is someone to write and supervise progressive strength training around your restrictions, a trainer is appropriate — provided they genuinely understand loading around low bone density, which many do not.
I’m a physiotherapist by training, with a Masters of Physiotherapy, a Bachelor of Exercise Science, and Certificate III and IV in Fitness. Through Alpine I coach strength. I don’t assess, diagnose or treat here, and if that is what you need, tell me and I’ll refer you to someone who does — that referral costs you nothing.
A reasonable thing to ask any trainer before you start: do you regularly work with osteopenia or osteoporosis, what will you avoid, and how will you progress the load?
Bone is only half of it
The other half is not falling over. Most fractures in older adults happen because someone fell, not because bone spontaneously failed — so leg strength, single-leg balance and the ability to catch yourself matter as much as density does, and they improve far faster. That is why balance work is in every session and why single-leg balance is one of the four things we retest at six weeks.
If you are post-menopausal, the menopause and post-menopause page covers the hormonal side of the same problem — falling oestrogen accelerates both muscle and bone loss, and most people arriving here after a DEXA scan are dealing with both at once.
This is personal training, not physiotherapy
Alpine provides strength and conditioning coaching only — no assessment, diagnosis, or hands-on treatment. Please speak to your GP before starting, and if what you need is physiotherapy, tell me and I'll refer you on.
Common questions
Progressive resistance training — loaded squats or sit-to-stands, hinges, presses, pulls and carries — combined with balance work and, where it is safe for you, some weight-bearing impact. The key word is progressive: the load has to keep increasing over months for bone to keep adapting.
The main ones are loaded spinal flexion (weighted sit-ups, toe touches under load, heavy rounded-back lifting), end-range spinal twisting under load, and high-impact work if your bone density or fracture history rules it out.
This is general information rather than advice about you. If you have a diagnosis, your GP or specialist should tell you your specific restrictions, and I will build the program around them.
For most people with a diagnosis, supervised progressive resistance training is not only safe but recommended in osteoporosis guidelines as core non-drug management. What makes it safe is appropriate load selection, controlled technique, and avoiding the specific positions that stress the spine. Get GP clearance first and tell me what they said.
Honestly, no — not in the sense of returning bone density to what it was at thirty. What exercise reliably does is slow the loss, produce modest gains at loaded sites, and substantially improve the strength and balance that determine whether a fall happens at all. Anyone promising reversal is overselling it.
Modest gains are achievable, and they are worth having. The evidence is strongest for the sites you actually load — hip and spine respond to heavy lower-body and trunk work. Expect small percentage changes over a year rather than dramatic ones, and expect strength and balance to improve far faster than bone does.
They are points on the same scale, measured by a DEXA scan. Osteopenia means bone density is below normal but not yet at the osteoporosis threshold. For training, the practical difference is caution: with osteopenia we can usually progress load fairly normally, while with osteoporosis we want GP clearance, any specific restrictions, and a more conservative approach to spinal loading.
There is no quick way, which is the frustrating part. Bone remodels slowly — meaningful change is measured over twelve months or more. What does move quickly is muscle strength and balance, often within six weeks, and those are what reduce fracture risk in the short term while bone catches up.
Bring them if you have them. The T-score tells me how conservative to be with spinal loading, and any fracture history changes the plan more than the number does. If you have not had a scan and have risk factors, it is worth asking your GP about one.
If you need assessment, diagnosis or treatment, see a physiotherapist or an accredited exercise physiologist. If you have been cleared to exercise and need someone to programme and supervise progressive strength training, a trainer is appropriate — provided they actually understand loading around bone density.
I am a physiotherapist by training and coach strength through this business. I do not assess, diagnose or treat here, and if that is what you need I will refer you on.
Yes. I hold a Masters of Physiotherapy and a Bachelor of Exercise Science, and I programme and supervise every session myself. This is the screening question worth asking any trainer before you load a spine with low bone density, and most cannot answer it the way I just have.
The qualification is why I am comfortable programming around a diagnosis. It is not a service I am offering you: through Alpine I coach strength only, and anything needing assessment or treatment gets referred to a practising physiotherapist.
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