Bone Health & Fall Prevention
Updated: Oct 20
Osteoporosis (OP) and osteopenia are conditions where the bones lose strength and density. Approximately two-thirds of Australians over the age of 50 have osteopenia or more severe osteoporosis. Check out your risk factors here. Yes, many lifestyle and medical risk factors contribute more than age to a yearly decrease in bone health. The most common preventable outcome of age-related, lifestyle-related, or medically induced bone loss is a bone break or “fracture,” mainly caused by falls.
Many of our members have asked how to improve their bone health as they age. Here is our guide for exercising to increase your bone health with or without pre-existing osteoporosis:
Seek guidance from our healthcare professionals before commencing challenging exercise, especially if you have or are supporting someone with advanced bone loss. They can give you the best dosage (sets x repetitions x weight) and how to progress each week/month at any age.
Weight-bearing and resistance exercise at least three times per week is safe and recommended. This is true even for people with severe osteoporosis and with known medically stable spine or hip fractures with or without persistent pain. Exercise doesn't have to take place at a gym if you don’t like that environment. However, current evidence suggests that supervised weight-lifting exercises are twice as effective at reducing OP-related fractures as non-strength-training modes such as Pilates, stretching, yoga, or running. It is common for people to avoid vigorous exercise due to fear of bone injury. It is doubtful, however, that exercise will cause a bone fracture injury (fractures of the leg or back after exercise are very rare, even with vigorous strength training), and avoidance of intense exercise is a risk factor for bone fractures and many other health problems (see our 45 benefits of strength training article). If prescribed correctly and progressively over time, be assured that exercise reduces the risk of bone fractures.
Walking or running at home or on flat ground is inadequate to prevent bone loss or maintain balance with age. We still encourage walking and running to improve your general health at all ages, but add some steps/stairs, hills, or bushwalking to improve your bone health outside of strength training. Ban yourself for life from using lifts (as much as realistically possible); instead, always look for the stairs.
What to complete each week in the gym to strengthen all your bones- make sure you complete one of each category 3x weekly. Exercises include:
A lower body squat pattern = weighted squat, leg press, leg extension
A lower body single leg exercise = weighted lunge, step-ups, or rear foot elevated split squats
A lower body hinge pattern = stiff leg deadlift, deadlift, hip thrust
An upper body push movement = bench press, overhead press
An upper body pull pattern = pull-lat pulldown, pullup, cable row
A rotation movement = cable rotations, medicine ball throws
Ask any of our staff about these exercises if you don’t recognize the name.
Here are some home-based options/categories. - Make sure you complete one of each category 3x weekly. Exercises include:
Leg exercises- Double leg squat. Use an external weight as soon as tolerable(make a long-term health investment into home weights, a backpack of sand, or use a child/grandchild- as they get bigger, you’ll get stronger). Single-leg squats from a chair, lunges, and single-leg heel raises with weight are single-leg exercises that are great for improving your balance and bone health.
Upper arm exercises – Complete kitchen bench, bed, or floor pushups and hanging or pullups of your bodyweight from anything you can or with a ring/TRX attachment.
Back and leg exercises: Pick up something heavy off the floor, like a heavy pot plant, a heavy sand/cement bag, a pool salt bag, or your favorite grandchild as they grow each month. Come speak to Tom, the physiotherapist, if you are concerned about lifting for your back health. He can help take you out of “movement jail.”
Whole body exercises - Getting on and off the floor from your stomach and back. Getting off the ground can reduce the fear of falling and is a full-body exercise. If you have a fear of falling or/and/or are unable to get on and off the ground independently without assistance, seek guidance from an exercise professional. We will guide you through progressive exercises to assist your strength in completing the components involved in getting on and off the floor.
Jumping exercises can be done at a gym or at home.
Upwards, forwards, sideways, single-leg, or double-leg jumping. Add a jump from a box or stairs for extra healthy progressive bone stress. If you are not sure you will tolerate jumping, start with stomping on the spot or stepping off stairs or boxes. You can start your jumping in water or in a pool, or pulling on resistance bands tied above you to make initial jumping easier.
This series of images (Figure above) shows an example of a female who has reduced upper back rounding during lifting, achieved over 7 months. Even though you don’t need to change your posture to improve your pain, upper back posture changes related to OP are not inevitable and can be reversed to a small degree with exercise (High‐Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women).
Fall and bone injury prevention
For fall- and fall-related fracture risk reduction, progressive, challenging balance exercises must be added to the weekly strength and jump training exercises listed above to be fully effective. Preventing falls through challenging weight-bearing balance exercises won't improve your bone health, but it will reduce the risk of fall-related fractures. Sports that require frequent direction changes, such as racquet sports and dancing, count as balance exercises and are also great for fall prevention and bone health, and can be done at all ages. Find a way to progress to over 2 hours of balance practice weekly. This may not sound realistic, but the minimum effective dose is less than 18 minutes per day. Starting with less is fine, but aim for 2 hours a week of challenging balance exercises. Less is not protective. Some great balance exercises that could be completed include:
Walking on a flat, tight-rope-like object placed on the floor.
Sideways stepping while stepping over or behind your feet.
Being able to step or hop in each direction like standing inside a clock. Stepping, hopping, and jumping over obstacles is a progression of this.
Going up and down steps without holding the handrails.
Standing or walking on uneven surfaces- grass, sand, or gravel trails out in the bush or at the beach.
Complete dual tasking during these tasks as a progression = talking, turning your head, lifting a weight above your head, throwing, and catching a ball.
Expect 2-3 months before you feel the benefits of balance and bone-strengthening exercises.
Remember, if the balance exercise doesn’t make you uncomfortable or require you to practice a saving response (like stepping out to the side to protect yourself with your leg), the exercise is too easy to improve your balance and protect you from falls.
What about nutrition and hydration for bone health and reducing fall-related fracture risk?
Nutrition recommendations support eating a variety of calcium-rich foods and maintaining adequate vitamin D blood levels. However, supplementation has little benefit for people who already consume a balanced diet. Visit Osteoporosis Australia for more information on calcium and vitamin D, as well as regular weekly exposure to sunlight.
Current evidence indicates that isolated supplementation with protein, vitamin K, or magnesium does not prevent bone fractures.
It is common for people to avoid drinking fluids before bedtime to reduce the need to go to the bathroom at night. However, dehydration irritates the bladder and stimulates the need to use the bathroom. Hydration should be maintained to prevent dehydration-related bladder irritation, which can lead to frequent nighttime bathroom visits that increase the risk of falls.
Other suggestions:
Avoid smoking and excess alcohol (> 2 standard drinks/day).
Questions for your doctor
Will any of my medications increase my risk of falling?
How often should I have my vision checked?
If you want access to cheaper group-based options, ask, “Can you help me seek exercise-based options for bone health in my community?”
Note, though, that these bone health recommendations and exercise may not be encouraged by doctors due to their limited understanding of the benefits relative to medication. Also, your doctor may need more optimism that you will adhere to a long-term weekly exercise habit necessary to achieve this outcome. If you are reading this, that will not be the case!
This pair of graphs shows that medication has a greater effect on changes in bone mineral density than exercise but exercise reduces the risk of falls better than any medication. Seek both exercise and bone medication to support bone health if you currently have low bone density (Avoiding falls and broken bones (Youtube.com)).
Come talk to our staff and physiotherapists for any further consultation, coaching and advice. See you around the gym.
Resources for bone health
Too Fit To Fracture: Managing Osteoporosis Through Exercise - Bone Fit™
RACGP - Executive Summary Osteoporosis prevention, diagnosis, and management in postmenopausal women and men over 50 years of age
Osteoporosis Explained – Low Bone Mass Causes & Treatments | 25-Minute Webinar
Bone Health: Symptoms, causes, treatments, and your questions answered.
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