Exercise for Osteoporosis: Strength, Balance and What to Avoid

What exercise can and cannot do

• Can: slow bone loss and, in some people, modestly increase bone density, particularly with weight-bearing and strengthening work; build muscle that supports the spine and hips; improve balance, coordination and posture; reduce the risk of falls; improve confidence and independence.
• Cannot: replace medicines and nutrition where these are needed; repair a bone that is already very fragile; remove the risk of fracture entirely.

Medical treatment, calcium and vitamin D (as advised), protein and falls prevention all work together; see osteoporosis home care guide, osteoporosis medicines and supplements, calcium and vitamin D guide and vitamin D deficiency in India.

See a doctor first

Ask a doctor, ideally with your bone density result and fracture history in hand, before starting or changing exercise if you have:

• a diagnosis of osteoporosis, particularly with previous fractures, especially vertebral (spine) fractures;
• a recent fracture, surgery or a hip or knee replacement; follow your team's plan; see rehabilitation after fracture or surgery: physio plan and hip fracture recovery at home;
• severe pain in the back that is new, or after a fall or minor strain;
• loss of height or a stooped back;
• heart disease, uncontrolled blood pressure, breathlessness or dizziness; see exercise with heart disease;
• balance problems or repeated falls;
• long-term steroid use, or conditions that weaken bones.

Your doctor or physiotherapist may advise a particular intensity and movements to avoid. If your bones are very fragile, even some everyday movements need care.

Types of exercise that help

1. Weight-bearing exercise. Activities in which you support your own weight against gravity, stimulate bone. Examples: walking, gentle stair climbing with a rail, low-impact dance, standing exercises. Walking is a good start; see walking programme for older adults. High-impact activities such as jumping or running may stimulate bone more, but are unsuitable for many older adults, particularly with fractures or severe osteoporosis; only do them under professional advice.

2. Muscle-strengthening (resistance) exercise. Pulling or pushing against resistance puts load on bone through muscle. Bands, light weights, bodyweight and machines can be used, two or three days a week, with progressive, controlled loading. Priority areas are legs, hips, back and upper back muscles. See resistance band routine for seniors, dumbbells guide for seniors and strength training after 60: how much is enough. Heavier loads may help bone but must be supervised and introduced gradually.

3. Balance training. Reducing the chance of falling is the single most important protection against fracture; see balance exercises for seniors and falls risk assessment at home.

4. Posture and back-extensor exercises. Strengthening the muscles that keep the spine upright, such as gentle shoulder blade squeezes, chin tucks and, when cleared, careful back extension, can reduce stooping and may reduce the risk of vertebral fractures. A physiotherapist should teach these.

5. Flexibility and breathing. Gentle stretching of the chest and hips; see stretching for stiff older bodies. Avoid forceful stretching.

Movements and activities to be cautious about

Particularly if you have osteoporosis with vertebral fractures, or very low bone density, ask your doctor or physiotherapist before doing:

• Forceful forward bending of the spine (flexion), such as toe touches, sit-ups, crunches, or bending forward to lift;
• Twisting the spine with force, such as golf-type swings, strong rotation stretches or twisting while lifting;
• Heavy lifting, especially with a rounded back;
• High-impact activities, jumping, running, skipping, and sudden stopping;
• Deep spinal folds in yoga, such as plough, full forward fold and some twists; ask for supported or adapted versions;
• Contact sports and activities with a high risk of falling;
• Exercising on slippery or uneven ground;
• Hard coughing or straining with a full bladder or bowel; see a doctor about persistent cough.

Everyday ways to protect the spine: bend at the hips and knees, not the waist; keep the back straight; hold loads close; avoid reaching and twisting at once; use a reacher; push rather than pull; see reacher grabber guide and how to lift and transfer safely.

Starting safely

1. Get medical clearance and, ideally, a physiotherapy assessment of strength, balance, posture and spinal flexibility. 2. Begin gently: 10 to 15 minutes of walking or chair exercises, three to four days a week, with a few strengthening exercises, building slowly. See chair exercises for seniors and exercise at home for seniors: a safe starter guide. 3. Set up safely: sturdy support beside you, clear non-slip floor, supportive footwear, good light, a phone nearby; see choosing shoes for older feet. 4. Prefer standing and seated exercises over floor work until you are strong and steady; getting down to and up from the floor is risky; see yoga mats and floor exercise safety. 5. Move slowly and with control; breathe normally. 6. Progress slowly: a little more each week or two, as feels easy. 7. Include rest days. 8. Warm up and cool down. 9. Stop if you have new or sudden back pain, sharp pain anywhere, dizziness, chest symptoms or breathlessness; call 112 for emergencies.

Fall prevention is fracture prevention

Most fractures in older adults follow a fall. Alongside exercise:

• Review medicines that cause dizziness or drowsiness; see polypharmacy and deprescribing.
• Check eyes and ears; see hearing and vision checkup schedule.
• Treat dizziness and low blood pressure; see dizziness and low blood pressure when standing.
• Make the home safe: lighting, clear floors, grab bars, non-slip bathrooms; see bathroom safety checklist and flooring, rugs and trip hazards.
• Use a walking aid if advised; see walking aids for osteoporosis.
• Wear sensible shoes.
• Have a way to call for help; see panic pendant buying guide.
• Know what to do after a fall; see what to do after a fall.

Nutrition and bone health

• Calcium: from food (dairy, ragi, leafy greens, sesame, fortified foods) and supplements if advised.
• Vitamin D: from sunlight and supplements if low; very common deficiency in India.
• Protein: supports muscle and bone; see how much protein do seniors need.
• Avoid smoking and limit alcohol.
• Do not start high-dose supplements without medical advice; see supplements and medicine interactions.

Warning signs of a fracture

Seek medical attention promptly for:

• sudden, severe back pain, especially after a minor strain, cough or lift, which may signal a vertebral fracture;
• pain in the hip, groin or thigh after a fall, or inability to bear weight; call 112 after a fall with severe pain;
• wrist or shoulder pain after a fall, with swelling or deformity;
• new loss of height or a rounded back;
• numbness, weakness or loss of bladder or bowel control with back pain: emergency.

Do not exercise through suspected fracture pain.

After a fracture

After a spine, hip or other fracture, exercise must follow the surgeon's and physiotherapist's plan. In general, return to movement is encouraged as soon as safe, since bed rest weakens bones and muscles further; see supports and braces after a fracture. Do not self-direct recovery.

Indian home and climate notes

• Many older Indians have vitamin D deficiency despite sunshine; ask about testing.
• Floor sitting and squatting are common; with osteoporosis, deep forward bending and getting up from the floor carry risk. Use chairs and raised toilet seats; see raised toilet seat guide.
• Marble floors and wet bathrooms are fall risks.
• In the heat, exercise indoors in the cool hours; see exercising indoors in Indian summer and monsoon.
• Carrying water buckets, grain sacks and children involves loads that strain the spine; share and use trolleys.
• Traditional bone-strengthening foods and remedies are fine alongside medical care, but do not replace it.

When to ask a professional

Ask a doctor to confirm bone health, treatment and exercise safety. A physiotherapist can assess and supervise a programme tailored to bone fragility. An occupational therapist can advise on safe movement and home changes. A dietician can advise on nutrition. In an emergency, call 112.