What is the role of resistance training when treating osteoporosis?

Osteoporosis is often described as “weak bones”, but I think that phrase is a little too soft.

Osteoporosis means the architecture of the bone has changed. Bone mineral density has reduced, bone strength is compromised, and fracture risk has increased. That does not mean you are fragile as a person. It means your body needs a better signal.

And one of the most powerful signals we can give bone is load.

Not random load. Not reckless load. Not “go to the gym and hope for the best” load.

But structured, progressive, technically sound resistance training.

That is where the conversation gets interesting.

For years, many people with osteoporosis were told to be careful. And yes, care matters. If someone has low bone mineral density, a history of vertebral fracture, high falls risk, pain, poor balance, or limited lifting experience, they should not just walk into a gym and start deadlifting heavily.

But “be careful” should not mean “do nothing”.

In fact, the “Too Fit To Fracture” expert consensus strongly recommends that people with osteoporosis or osteoporotic vertebral fracture perform a multicomponent exercise programme that includes resistance training and balance training. It also specifically recommends that aerobic exercise should not be done to the exclusion of resistance and balance work.

That matters.

Walking is good. Swimming is good. Cycling is good. But if the goal is to improve strength, reduce falls risk, improve posture, improve confidence, and stimulate bone, then we need to load the system.

Why resistance training matters

Bone is living tissue. It responds to mechanical stimulus. When we load muscle, tendon and bone through resistance training, we create a signal that tells the body: “This structure needs to be stronger.”

That is the foundation.

But the benefits go beyond bone mineral density. A well-designed resistance training programme can improve:

• leg strength

• hip and trunk control

• posture

• balance

• walking confidence

• grip strength

• functional independence

• the ability to get up from the floor

• the ability to carry, lift, bend and move through daily life

In my opinion, this is where resistance training becomes much more than “exercise”. It becomes capacity.

And capacity is what gives people their life back.

What does the research say?

One of the most important studies in this space is the LIFTMOR trial, which investigated high-intensity resistance and impact training in postmenopausal women with low bone mass. The programme included supervised heavy resistance exercises such as deadlift, back squat and overhead press, alongside impact loading. The intervention improved lumbar spine and femoral neck bone mineral density and improved physical function compared with a low-intensity home-based programme.

Now, this is important.

The study was not saying, “Everyone with osteoporosis should immediately lift heavy.”

It was saying that, under the right conditions, higher-intensity resistance and impact training can be safe and effective.

And the right conditions matter.

In the LIFTMOR model, participants were supervised. They were progressed. They were taught movement patterns. They did not simply walk in on day one and get thrown under a heavy barbell.

That is exactly the point.

The issue is not whether lifting is good or bad. The issue is whether the loading is appropriate for the person in front of us.

Heavy is relative

When people hear the word “heavy”, they often panic.

But heavy does not mean dangerous. Heavy means challenging relative to the individual.

For one person, heavy may be a loaded barbell. For another person, heavy may be a kettlebell from a box. For someone else, it may initially be learning how to hip hinge, sit to stand, step up, brace, breathe and control their spine.

At Bone Health Studio, the goal is not to chase numbers for the sake of it.

The goal is to build competence first, then capacity.

That means we care deeply about:

• how you move

• how you tolerate load

• your injury history

• your current strength

• your confidence

• your balance

• your medical history

• your goals

Then we build.

The gym should not be random

This is where I think osteoporosis exercise often gets misunderstood.

It is not enough to say, “Do some strength training.”

What does that mean?

Which exercises?
How heavy?
How many reps?
How many sets?
How often?
What if there is spinal pain?
What if there is hip osteoarthritis?
What if there is a previous wrist fracture?
What if the person has never lifted weights before?

This is why a proper pre-screening process matters.

For osteoporosis, exercise prescription should be specific. It should include resistance training, balance work, movement education and, where appropriate, impact preparation. It should also include spine-sparing strategies, particularly around bending, lifting and twisting. The Too Fit To Fracture recommendations highlight the importance of resistance and balance training, and the need for modification in people with vertebral fracture or higher fracture risk.

That is not fear-based. It is intelligent.

So, what is the role of resistance training?

Resistance training is not a magic bullet.

It does not replace medical care. It does not replace appropriate medication when medication is indicated. It does not replace nutrition, sleep, sunlight, hormone considerations or falls prevention.

But it is a central pillar.

For many people with osteoporosis, resistance training is the missing piece between diagnosis and function.

It helps people stop seeing their body as fragile and start seeing it as adaptable.

That shift is powerful.

Because when someone learns to lift well, stand taller, move more confidently, and feel stronger in daily life, osteoporosis stops being only a diagnosis.

It becomes something we can actively manage.

That is the role of resistance training.

Not reckless.
Not random.
Not macho.

Structured. Progressive. Supervised. Evidence-based.

And for the right person, at the right level, potentially life-changing.

References

Giangregorio LM et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International, 2014.

Watson SL et al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research, 2018/2019.

Fragala MS et al. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 2019.