How Should You Exercise With Osteoporosis? An Exercise Prescription
By Dr. Yi-Cheng Wu · Reviewed June 21, 2026
With proper assessment, appropriate exercise brings benefits that outweigh the risks for people with osteoporosis. Arrange resistance, aerobic, and flexibility training according to severity, keeping early sessions at low intensity.
People with osteoporosis are not unable to exercise — research shows that appropriate exercise brings benefits that far outweigh the risks. Before exercising, assess activity limitations caused by any fracture history, balance and proprioception, muscle strength, current medications, and chronic conditions such as cardiovascular disease and osteoarthritis. The prescription is divided into three types — resistance, aerobic, and flexibility — with early sessions kept at low intensity. People with mild to moderate osteoporosis can do aerobic, weight-bearing, and large-muscle-group exercise; those with severe osteoporosis (very low bone density, multiple fractures, or a marked change in spinal angle) should start mainly with low-intensity, low-impact exercise and avoid explosive movements or excessive trunk twisting.
A patient of mine had worked in the US for years and came back to Taiwan last year because of the pandemic. After we sorted out her back pain in clinic, she said she wanted to exercise but didn’t know how. Because of her long-standing osteoporosis, she was rather afraid to exercise, and would stop the moment she felt any discomfort.
She kept remembering a statistic: in older adults, the death rate in the three months after a hip fracture increases fivefold.
We talked at length in clinic, and her worries gradually eased.
The truth is that people with osteoporosis often avoid exercise because of long-standing back pain or worry that too much intensity will cause further injury. But the benefits of appropriate exercise far outweigh the risks those worries are about. With a proper assessment beforehand, people with osteoporosis actually very much need to exercise.
Things to check before exercising
- Whether there is limited joint range of motion or activity restriction from a fracture history (for example, a hip fracture reducing exercise capacity)
- Whether there are balance or proprioception issues
- Whether there is a problem with muscle weakness
- Current medications and other chronic conditions: cardiovascular problems, osteoarthritis, and so on
Benefits of exercise and points to note
- The stress from weight-bearing can increase muscle strength, which in turn improves bone mass and bone density
- It improves balance and proprioception, lowering the risk of falls and fractures
Points to note
- People with severe osteoporosis sometimes also have vertebral compression fractures; note that once the spine deforms, the body’s center of gravity shifts forward, so balance during walking and exercise needs care
- For severely affected patients, maximal strength testing may not be suitable
- A balance or fall-risk assessment before exercise is recommended
Types of exercise and the prescription
Exercise is mainly divided into three types: resistance training, aerobic training, and flexibility training. Because most people with osteoporosis have not trained before, early sessions are best kept at low intensity, and can be adjusted from the middle phase onward according to the severity of the osteoporosis. The main principles are:
- People with mild to moderate osteoporosis should include aerobic, weight-bearing, and large-muscle-group exercise
- People with severe osteoporosis (very low bone density, multiple fractures, or a marked change in spinal angle) should consider starting mainly with low-intensity, low-impact exercise and avoiding explosive movements or excessive trunk twisting
Afterward, my patient began exercising actively. At least four to five days a week she chose aerobic exercise and basic yoga with friends, and she also started resistance training, which she had never tried before, no longer overly anxious about whether she could exercise at all.
Further reading:
How much bone must you lose before osteoporosis shows up?
Choosing calcium supplements for osteopenia and osteoporosis
Further reading
Frequently asked questions
What should be assessed before someone with osteoporosis exercises?
Before exercise, assess whether there is limited joint range of motion or activity restriction from a fracture history (for example, a hip fracture reducing exercise capacity), whether there are balance or proprioception issues, whether there is muscle weakness, and current medications and other chronic conditions such as cardiovascular problems and osteoarthritis.
What are the benefits of exercise for people with osteoporosis?
The stress from weight-bearing can increase muscle strength, which in turn improves bone mass and bone density. Exercise also improves balance and proprioception, which, depending on the individual, can help lower the risk of falls and fractures.
What should people with osteoporosis be especially careful about when exercising?
People with severe osteoporosis sometimes also have vertebral compression fractures; once the spine deforms, the body's center of gravity shifts forward, so balance during walking and exercise needs care. Maximal strength testing may not be suitable for severely affected patients, and a balance or fall-risk assessment before exercise is recommended.
What types make up an exercise prescription for osteoporosis?
Exercise is mainly divided into three types — resistance training, aerobic training, and flexibility training — with early sessions kept at low intensity. People with mild to moderate osteoporosis should include aerobic, weight-bearing, and large-muscle-group exercise; those with severe osteoporosis should consider starting mainly with low-intensity, low-impact exercise and avoiding explosive movements or excessive trunk twisting.
This article is also available in the original Chinese, with the full reference list.
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