Exercise for Osteoporosis: What Actually Builds Bone
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Quick answer: what's the best exercise for osteoporosis in Australia?
Walking and swimming are good for your heart and joints, but they do not meaningfully build bone: Australian clinical guidance is explicit that walking alone does not prevent bone loss, osteoporosis or fracture, and may even increase fracture risk in people with poor balance. What actually builds and protects bone is a combination of three things: progressive resistance training at moderate-to-high intensity, weight-bearing impact loading, and challenging balance training to prevent falls. For anyone with diagnosed osteoporosis or a previous fracture, this needs medical clearance and an individualised, often supervised, program, not a generic routine.
Why don't walking and swimming build bone?
Bone adapts to loads higher than what it's used to, a jolt of impact, or a muscle pulling hard against it, to trigger new bone formation.
The RACGP and Healthy Bones Australia clinical guideline is direct: "walking and non-weight-bearing activities including cycling and swimming, have minimal effects on bone mineral density (BMD) and no significant effects on falls risk", and may increase fracture risk, particularly walking in people with poor balance, frailty or low muscle mass (RACGP/Healthy Bones Australia clinical guideline, 2024). Swimming and cycling support the body's weight, so there's no meaningful gravitational load on the skeleton, gentle on joints, but not enough stimulus to strengthen bone.
This doesn't make them a waste of time. They're good for cardiovascular fitness, and health.gov.au still recommends 30 minutes or more of moderate-to-vigorous activity most days for older Australians. They just belong alongside bone-specific exercise, not instead of it.
What does actually build bone?
Healthy Bones Australia and the RACGP guideline point to three components, used together: progressive resistance training, weight-bearing impact loading, and balance training (Healthy Bones Australia, Exercise & Bone Health; RACGP/Healthy Bones Australia clinical guideline, 2024). The guideline states plainly: "the most important exercise components for osteoporosis prevention are moderate- to high-intensity progressive resistance training combined with weight-bearing impact exercise and challenging balance training". The ESSA position statement on exercise for osteoporosis agrees: bone responds to impact activities and high-intensity progressive resistance training, while balance and mobility work reduces falls risk.
Resistance training and impact loading stimulate bone itself. Balance training, on its own, does not increase bone density, but it reduces the chance you'll fall and fracture the bone you have.
| Component | What it targets | Australian guidance |
|---|---|---|
| Progressive resistance training | Builds bone via muscle pulling on the skeleton | At least twice a week, moderate-to-vigorous, progressive |
| Weight-bearing impact loading | Builds bone via gravitational/impact force | Most days, at least 50 moderate impacts per session |
| Balance training | Reduces falls (not bone density itself) | Challenging, at least 2–3 hours per week |
What intensity does the guidance actually recommend?
This is the detail most general advice leaves out, and it matters, because light weights are not the same exercise for bone purposes.
For resistance training, the RACGP/Healthy Bones Australia guideline specifies two to three sets of 8–10 repetitions at moderate-to-high intensity, progressing to 70–85% of peak muscle strength (1RM), targeting the major muscle groups attached to the hip and spine, at least twice a week (RACGP/Healthy Bones Australia clinical guideline, 2024). Healthy Bones Australia's consumer brochure gives comparable figures: 2–3 sets of 8 reps at 80–85% of 1RM, with perceived exertion of 8 or higher out of 10 (Healthy Bones Australia, Exercise and Bone Density).
For impact loading, the guideline recommends short, intermittent bouts: around 50 moderate impacts per session, on most days of the week, in different directions, with a magnitude of roughly 2–4 times body weight (RACGP/Healthy Bones Australia clinical guideline, 2024; Healthy Bones Australia, Exercise Prescription to Support the Management of Osteoporosis, 2024). For balance training, guidance calls for challenging, individualised, ideally supervised programs delivering at least three hours per week for a minimum of four months.
Why does intensity matter so much?
Bone follows a "use it or lose it" rule. A load that's too light doesn't register as a stimulus worth adapting to. The guideline notes there is "minimal evidence of benefit for low-intensity resistance or low-impact weight-bearing aerobic exercises" (RACGP/Healthy Bones Australia clinical guideline, 2024). This is why sets of light hand weights, on their own, rarely change bone density. The ESSA position statement frames it the same way: bone responds to "high intensity progressive resistance training", not resistance training in general (ESSA position statement, 2017). Healthy Bones Australia adds a reassurance, though: it's "not necessary to use very heavy weights" from day one. The point is progressive overload, built up over 6–12 months, with gains lost if you stop (Healthy Bones Australia, Exercise and Bone Density).
Is building bone the same as preventing a fracture?
No. Fracture is the outcome that actually matters, and falls cause most of them. Balance training does not meaningfully change bone density on its own, but a challenging, well-dosed program measurably lowers the risk of falling, and a fall is what turns low bone density into a broken hip or wrist (RACGP/Healthy Bones Australia clinical guideline, 2024). The greatest reduction in falls risk comes from individualised, supervised programs including stepping and multimodal balance training, delivered two to three times a week for a minimum of four months.
Someone who never increases bone density but dramatically improves balance may be at lower fracture risk than someone who builds bone but keeps falling. For many older adults, falls prevention is the higher-leverage intervention. Health.gov.au reflects this, recommending balance and coordination activities on three or more days per week for older Australians, alongside muscle-strengthening on two or more days (health.gov.au, 24-hour movement guidelines).
What's the right exercise for osteoporosis with a diagnosis or previous fracture?
Guidance is unambiguous that people with osteoporosis should be encouraged to "do more" and not "less", inactivity is not the safer option (RACGP/Healthy Bones Australia clinical guideline, 2024). But type, intensity and progression need to be individualised to fracture risk, not copied from a general program.
For people at high fracture risk, Healthy Bones Australia's guide still recommends the same three components, scaling impact down to "moderate" activities, built up gradually towards roughly 50 repetitions per session (Healthy Bones Australia, Exercise and Bone Density). After a hip fracture, extended and supervised exercise therapy improves mobility, strength and physical performance, though no regimen has been shown to prevent a further hip fracture. Evidence after a vertebral fracture is more limited, but supervised resistance training may build bone once healed, alongside back-strengthening, posture and falls-risk work (RACGP/Healthy Bones Australia clinical guideline, 2024).
Are there movements to approach with caution?
Yes, particularly for people with spinal osteoporosis or a history of vertebral fracture. The guideline advises that rapid, repetitive, weighted and end-range forward flexion or twisting of the spine should be avoided or minimised: for example, loaded toe-touches, sit-ups with a heavily rounded spine, and fast, forceful twisting motions (RACGP/Healthy Bones Australia clinical guideline, 2024).
Healthy Bones Australia's consumer brochure gives concrete examples: avoid activities involving twisting of the spine and hip, golf, tennis, bowling, and extreme forward curving of the spine, such as toe touches and sit-ups (Healthy Bones Australia, Exercise and Bone Density). Fast, forceful lifting ("power lifting") may also raise fracture risk in low bone density, so a measured, controlled tempo is recommended instead.
Guidance instead points towards exercises that strengthen the back extensors and support posture, at lower intensity emphasising muscle endurance and control, particularly with a vertebral fracture history. None of this is a program to build from a blog post. It needs a clinician who has assessed your bone density, fracture history and current strength.
Why is supervision recommended?
Because the exercises that work for bone are, deliberately, higher-intensity than most people's comfort zone, and in someone with fragile bone, getting the intensity or technique wrong carries real risk. Healthy Bones Australia's guide is explicit: exercise should be supervised, especially when starting out, and "for high-risk individuals, supervision by an exercise physiologist is recommended" (Healthy Bones Australia, Exercise and Bone Density). The RACGP guideline similarly states that programs for very frail older people, and those with high vertebral fracture risk, should be supervised, modified and tailored to minimise the risk of falls, injury and further vertebral fracture (RACGP/Healthy Bones Australia clinical guideline, 2024).
A qualified professional, a physiotherapist or an ESSA-accredited exercise physiologist (AEP), can assess bone density and fracture risk, teach correct technique, set an appropriate starting intensity, and progress the load gradually. Programs should start low, never jump straight to the target intensity.
What about medication, calcium and vitamin D?
Exercise is one part of osteoporosis management, not a replacement for treatment. These are conversations for your GP, not something to self-manage.
The RACGP guideline recommends calcium intake of 1,300 mg/day for women over 50 and men over 70 (1,000 mg/day for men 50–70), with supplementation if dietary intake falls short, and vitamin D correction if blood levels are below 50 nmol/L (RACGP/Healthy Bones Australia clinical guideline, 2024). Several medication classes are used to treat osteoporosis, including bisphosphonates, denosumab, and osteoanabolic agents such as teriparatide and romosozumab. Whether medication is appropriate, and your specific calcium and vitamin D targets, are decisions for your GP, ideally alongside an exercise physiologist or physiotherapist for the movement side of your plan.
What does this mean if you're over 50 and active?
Many of the people we see for golf, tennis, running and surf longevity work are in exactly the age bracket where bone density starts to matter, whether or not it's been diagnosed. General fitness and sport-specific conditioning are valuable, but they don't substitute for a program that specifically targets bone and falls risk if that's a genuine concern for you.
If you're managing osteoporosis or osteopenia alongside an active life, that's the kind of individualised program an AEP builds. Have a look at our sport longevity work or the full list of services at Atleta.
Common questions
Can I improve my bone density after menopause or in my 60s and 70s?
Yes. Healthy Bones Australia says it's "never too late to start exercising", and the RACGP guideline's recommendations apply across older adulthood (Healthy Bones Australia, Exercise and Bone Density). Gains take time, 6–12 months of regular training, and are lost if you stop.
Is walking still worth doing if it doesn't build bone?
Yes. Walking supports cardiovascular health and remains part of the health.gov.au physical activity guidelines for older Australians. It just isn't, on its own, a bone-building or falls-prevention strategy, those need resistance, impact and balance work too.
How heavy do the weights need to be to help my bones?
Australian guidance points to moderate-to-high intensity, progressing towards roughly 70–85% of your one-repetition maximum, for two to three sets of around 8 repetitions, at least twice a week (RACGP/Healthy Bones Australia clinical guideline, 2024). That's a target to build towards under supervision, not a starting point.
I have osteoporosis. Is it safe for me to lift weights or jump?
Guidance says people with osteoporosis should generally do more, not less, but type and intensity need to be individualised to your fracture risk (RACGP/Healthy Bones Australia clinical guideline, 2024). Get medical clearance and an individualised, supervised program from your GP and an exercise physiologist or physiotherapist first.
What exercises should I avoid with a spinal fracture or spinal osteoporosis?
Guidance advises avoiding or minimising rapid, repetitive, weighted, end-range forward bending or twisting of the spine: loaded toe-touches, fast sit-ups, forceful twisting sports movements (RACGP/Healthy Bones Australia clinical guideline, 2024). Back-strengthening at a controlled, lower intensity is favoured instead, set by a clinician who knows your history.
Does balance training actually make a difference, or is it just about bone?
It doesn't meaningfully change bone density on its own, but a challenging program reduces the risk of falling, and falls cause most osteoporotic fractures (RACGP/Healthy Bones Australia clinical guideline, 2024). For many older adults, that matters as much as, or more than, bone density.
Do I need my GP involved, or can I start a bone-strengthening program myself?
If you have diagnosed osteoporosis, osteopenia, or a previous fracture, see your GP first. Guidance recommends individualised, supervised programs for anyone at higher fracture risk, and your GP can address calcium, vitamin D and medication in the same plan (RACGP/Healthy Bones Australia clinical guideline, 2024).
Where Atleta fits in
Neil Russell is an ESSA-accredited Exercise Physiologist working with people at every stage of bone health, from general prevention through to diagnosed osteoporosis and post-fracture rehabilitation. Building the resistance, impact and balance components above safely, at the right starting intensity and progressed properly, is exactly what an AEP is trained to do.
If you have osteoporosis, osteopenia, or a previous fracture, the right first step is a conversation with your GP about clearance and any medication, calcium or vitamin D needs, then an individual assessment before any program starts. Get in touch with the Erina clinic if you'd like to talk through what that would look like for you, and if it turns out you need something we don't provide, we'll say so.
Last reviewed August 2026. This article is general information, not personal medical advice. It does not describe a specific exercise program. Anyone with diagnosed osteoporosis, osteopenia or a previous fracture should get medical clearance and an individualised, professionally supervised program before starting or changing exercise. Always speak with your GP about medication, calcium and vitamin D needs specific to you.