Exercising Safely With Osteoporosis: What Helps Bone, What to Modify
Written by Nicolas Marchant, Registered Physiotherapist. Before founding PhysioHome, I worked as a physiotherapist with Vancouver Coastal Health, where I treated both ends of this problem: people trying to protect their bones, and people recovering from the fracture that happened because nobody had raised the subject.
Osteoporosis does not hurt. There is no ache that warns you, no stiffness that builds. Most people find out from a bone density scan, or from a wrist that broke in a fall that should not have broken anything.
That silence produces two opposite reactions. Some people carry on exactly as before. Others quietly stop doing things, out of a reasonable fear of breaking something. Both cost bone and muscle. The evidence sits in between, and it is more specific than "stay active."
How common this is
Osteoporosis Canada reports that more than 2.3 million Canadians live with osteoporosis, that roughly one in four women and one in eight men over the age of 50 have it, and that over 80 percent of fractures in people aged 50 and older are related to it.
The practical point: a fracture after a fall from standing height is rarely just bad luck. It is worth asking your doctor about bone density.
What the Canadian guideline says about exercise
The 2023 clinical practice guideline for the management of osteoporosis and fracture prevention in Canada, published in CMAJ by Osteoporosis Canada, is unusually clear about exercise. Three points matter most for anyone building a home program:
- Progressive resistance training more than twice per week, including work for the back extensor and abdominal muscles.
- Balance and functional training at least twice per week, which is where the falls reduction comes from.
- Modify movements that involve rapid, repetitive, sustained, weighted or end range twisting or flexion of the spine, particularly for people at high risk of fracture.
Note what is not on that list. Nobody is prescribing rest or telling people to avoid exercise. The guideline is about choosing the right loads and positions, then progressing them. You can read it through Osteoporosis Canada's guidelines page or the full text in CMAJ.
The three jobs of an osteoporosis program
1. Load the skeleton. Bone responds to force. Resistance training, done with enough effort to be genuinely challenging by the last few repetitions, is the part most home programs skip. Light ankle weights and long sets of easy movements maintain a habit, not bone. Progression is the mechanism, so the weight, the repetitions or the difficulty has to keep moving.
2. Stop the fall. Most fragility fractures happen because someone falls. Balance work, stepping strategies and leg strength do more to prevent a broken hip than any single bone exercise. Our article on falls, hospitalisation and prevention for BC seniors covers the wider picture.
3. Hold the spine up. Guideline evidence suggests exercises targeting the abdominal, back extensor and shoulder muscles can produce small improvements in spinal curvature, function and back strength in people with increased thoracic kyphosis. Small is honest, and still worth doing.
Movements to modify, not fear
The guidance about spinal flexion is the most misunderstood part of this. It does not mean never bending forward. What changes is how you bend, how much you carry, and how often you load the spine at its end range:
- Bending to lift. Hinge at the hips, keep the load close, and avoid rounding hard at the bottom under weight. Most people learn this in a session or two.
- Repeated end range flexion. Long sets of sit ups and toe touches are worth swapping for planks, bird dogs and hip hinge patterns.
- Twisting under load. Turning with a full laundry basket or watering can is a common story behind a sudden back pain episode.
- Yoga and Pilates. Both are fine with modifications. Deep forward folds, spinal rolls and loaded twists are the positions to adapt, so tell your instructor about the diagnosis.
- Impact. Walking, stair climbing and similar weight bearing activity is generally encouraged. High impact jumping depends on your fracture risk, so ask first.
Which category you fall into is an assessment question. The guideline itself advises seeking advice from exercise professionals trained in osteoporosis, especially after a recent fracture or when fracture risk is high.
Why doing this at home works
A home visit puts the program where it has to survive. We see the actual stairs, the tub, the loose rug in the hallway, and the chair you get out of thirty times a day. Those are the real load and balance demands, and a home safety review usually happens in the same visit.
Autumn in Greater Vancouver adds a seasonal layer. Wet leaves on North Shore stairs, rain slicked lanes in Burnaby and New Westminster, and dark afternoons all shrink how much people walk, right when balance training matters most. November is Fall Prevention Month in Canada, which is a reasonable prompt to start rather than a reason to wait.
Equipment stays realistic too. Bands, a sturdy chair, a counter to hold and a small set of weights cover most first programs. For more frequent supervised practice between physiotherapy visits, kinesiology and rehab assistant sessions are a lower cost option.
If you have already had a fracture
A previous fragility fracture changes the plan. Loading is introduced more carefully, positions are screened more closely, and timelines follow your surgeon or physician rather than a generic protocol. Our fracture recovery program and the guide to hip fracture recovery at home cover that in detail.
Exercise also does not replace medical management. Medication, vitamin D, calcium and whether any of them apply to you belong with your doctor.
Red flags: when to seek medical care
Physiotherapy supports your medical care, it does not replace it. Contact your doctor, or seek urgent care, if you notice:
- Sudden, severe back pain, particularly after a minor fall, a lift or even a cough or sneeze, which can indicate a vertebral fracture
- Noticeable loss of height, or a back that is becoming visibly more rounded
- Pain after any fall that you cannot put weight through, or an obviously deformed limb
- Back pain that wakes you at night, or comes with fever or unexplained weight loss
- New numbness, leg weakness, unsteady walking, or any change in bladder or bowel control, which needs emergency assessment
- Repeated falls, or dizziness on standing
If you have broken a bone from a standing height fall and nobody has assessed your bone health, ask about it directly. Post fracture follow up gets missed often.
Costs and booking
PhysioHome is a fully mobile practice across Greater Vancouver: Vancouver, North and West Vancouver, Burnaby, New Westminster, Coquitlam, Port Coquitlam, Port Moody, Surrey and Richmond. Visits are $180 for 45 minutes and $210 for 60 minutes, travel included, with kinesiology and rehab assistant visits from $130.
Bone health work is usually private pay or extended health benefits, and no referral is needed. A fall related injury at work runs through WorkSafeBC instead, and a motor vehicle claim runs through ICBC, both handled separately. More on our work with older adults is on the seniors physiotherapy page.
Book an in-home assessment, call 778-488-5934, or email info@physiohome.ca. We are open Monday to Friday 8am to 7pm and Saturday 9am to 3pm.
Frequently Asked Questions
Can exercise reverse osteoporosis?
Exercise is not a cure and will not normalise a bone density score on its own. Its established value is building strength, balance and function, reducing falls, and supporting bone alongside whatever medical management your doctor recommends.
How heavy should resistance training be if I have osteoporosis?
Heavy enough to be genuinely challenging, and progressed over time, rather than fixed at a light weight forever. The right starting load depends on your fracture risk and current strength, which an assessment establishes before you begin.
Is walking enough?
Walking is worth doing, but on its own it is not a strong enough stimulus for bone or leg strength. Canadian guidance pairs weight bearing activity with progressive resistance training and balance work at least twice a week.
Should I stop doing yoga or Pilates?
Usually not. Most classes can be modified. The positions to adapt are deep forward folds, loaded spinal twists and repeated end range spinal flexion. Tell your instructor about your diagnosis.
Do I need a referral to see a physiotherapist for bone health?
No, you can book directly. If you have had a recent fracture or fall, or have not had your bone health reviewed, we will ask you to loop in your family doctor as well.