Table of Contents

Today’s lesson will cover the osteoporosis exercise guidelines and fundamental principles of an effective osteoporosis exercise program.

These principles will benefit you if you have been diagnosed with osteoporosis, osteopenia, or low bone density.

Today’s exercise is a strength training exercise that challenges the muscles and bones of your hips.

Osteoporosis Exercise Guidelines

Studies have shown that effective osteoporosis exercise programs incorporate the following four principles:

  1. Exercise needs to be site specific. In other words, if you want to increase bone density in your arm, you should do exercises that stress or target the arm.
  2. The weight needs to be heavy enough to challenge you. Passive exercise is not effective.
  3. Weight-bearing exercise is more effective than non-weight-bearing exercise for building bone.
  4. Change and novelty is important. Keep changing your exercise patterns to challenge your bones.

Guideline 1: Site Specific

One of the first guidelines is that exercises need to be site-specific. By that, I mean that if you want to build the bones in your arms, you need to stress the muscles in your arms so that the muscles are pulling on the bone, and hence you build bone in the arms.

Similarly, if you want to stress the muscles in your hip and the bones in your hips, you need to do exercises that specifically target your hip. Exercises to consider to strengthen the hips are squats and lunges.

reverse fly exercise

Guideline 2: Weights Need to be Heavy

The second principle that studies have shown needed for bone building is that the weight needs to be heavy. You need to feel challenged when you’re lifting that weight.

Guideline 3: Weight Bearing More Effective Than Non Weight Bearing Exercises

The third principle is that weight bearing is far more effective than non-weight bearing exercises when it comes to bone building.

Guideline 4: Exercises Need to be Novel

The fourth principle is that our skeletal system benefits from change. If you do the same thing day in and day out, your muscles and the bones they are attached to get the same stress each time. Switching things up provides new strain directions for your muscles and bones.

Today's Exercise

The video includes step-by-step instructions as well as suggested modifications to allow you to make the exercise feel right for you.

This exercise is best started without a weight. 

When you’re ready, a soft ankle with a longer strap will allow you to adjust it to the width you need to succeed.

Core Strength Foundation

We don’t have enough time in today’s tutorial to go into each of the four principles in great detail, but what I’d like to go through right now is the foundation that these principles need to build on.

As you know, yoga and Pilates are very popular these days and for good reason. They’re built on a strong foundation of breathing and activation of your deep abdominals or using your core.

A couple of the key principles that are essential to a bone building program are:

  • Proper breathing technique.
  • Activation of your deep abdominals or incorporating your deep abdominal muscles into an exercise program.

Those two elements alone are very essential to the foundation of a strength training program. In lesson seven I will go into more detail on Core Strength and Osteoporosis. This is an important, but often overlooked, part of a comprehensive exercise program. I cover core strength for people with osteoporosis in my book Strengthen Your Core … more on that later!

strengthen your core book Margaret Martin

20 Minute Sample Workout

This 27 minute sample workout is taken from the Beginner level title for Stronger Bones, Stronger Body. Give it a try! You can find the complete Stronger Bones, Stronger Body — Beginner Level here.

Tomorrow’s Lesson • Comprehensive Exercise Program Components

Well, that’s all for today and tomorrow we’re going to be covering the components of a comprehensive exercise program when it comes to osteoporosis and low bone density. Look forward to seeing you tomorrow.


June 26, 2017 at 12:35pm

Rebecca Olson

Hi Margaret,
The one issue that I am unable to find information is exercising to build bone when you have existing osteoporosis. I have osteoporosis in my hips and in my lower spine. The worst number is in my lower spine which was -3.9 one year ago. With that in mind, I am assuming there are some exercises that I should not be doing unless that -3.9 number improves due to the risk to my spine. You discuss weight bearing exercise, but I haven't seen any discussion related to proper weight bearing exercise if you have numbers similar to mine. Will you please provide me with some feedback on this issue?

July 4, 2017 at 9:03pm

Margaret Martin replies

Hi Rebecca,
In my book, Exercise for Better Bones, the cardiovascular exercises are categorized by low, moderate or high fracture risk. Reading the section entitled Cardiovascular Exercises should provide you with the information you are looking for.
Keep well.

July 4, 2017 at 9:55pm

Margaret Martin replies

Hi Rebecca,
Please refer to the chapter titled Cardiovascular Exercises in my book Exercise for Better Bones. There are lists of recommendations based on fracture risk.
Take care.

January 28, 2018 at 4:55pm


I have osteoporosis in my throaic spine and have multiple fractures. Can I still do exercises. I have no follow up in my area.

March 17, 2018 at 5:38pm


I have recently been diagnosed with severe osteoporosis 73 never broken a bone, and do not want to take Prolia or Actenol. Is it absolutely necessary to take a drug as well as doing bone strengthening exercises! Thanks

March 21, 2018 at 4:29pm

Margaret Martin replies

Hi Glenise, The diagnosis of "severe osteoporosis" is reserved for individuals who have already had a fragility fracture. Is it possible that you have compression fractures in your spine that your doctor did not mention? If the term of "severe osteoporosis" was given you by your doctor this indicates that both your bone density and your bone quality is less than optimum. I encourage you to discuss this with your MD. I cannot make the decision for you about whether or not you should take a pharmaceutical drug but know that you can exercise and have a positive effect on your bone quality whether you take a drug or not even with severe osteoporosis.

June 28, 2018 at 9:46am

Susan Johnson

Ms Martin, I’m having trouble finding information on what scores mean as far as exercise is concerned. With a vertebra score of -3.4 do I need to modify normal exercise or not?

July 4, 2018 at 11:30am

Richard Martin replies

Hi Susan

You can determine your exercise level by following the instructions in the book and visiting this page:

July 4, 2018 at 12:48pm

Margaret Martin replies

Hi Susan,
A score of -3.4 certainly indicates a need to modify exercises discussed in my book, Exercise for Better Bones. Within the book you will also find a link to daily activities with specific suggestions with photos of all the modifications to keep your spine safe.
All the best, Margaret

June 28, 2019 at 8:41am

droli bibi

hi Margaret
I have been diagnosed with low bone density in my hip and spine can you please what I can do to prevent osteoporosis. I am on hrt img a day. I am 8st does this mean I will get osteoporosis without further medication as I get older.

July 3, 2019 at 3:50pm

Margaret Martin replies

Please clarify your question. It looks like you typed the wrong letters. Thank you.

July 24, 2019 at 2:58pm

Pat Thornton

I cannot do lunges because of my knees but need to strengthen my legs and hips. Besides walking, what do you suggest?

July 25, 2019 at 6:42am

Margaret Martin replies

Hi Pat, Here is an exercise you can do without stressing your knees:
You will find other exercises in Exercise for Better Bones Beginner Level.

August 22, 2019 at 10:39am

Ann Zilinsky

I was just informed that I have osteoporosis in my lower back and osteopenia in both hips, but I don’t know the degree of the damage as of yet. I want to start exercising but don’t want to cause an injury. Are there any restrictions on any of the exercises you do because of my lower back problem? Thank you.

September 8, 2019 at 3:46pm

Margaret Martin replies

Hi Ann, I am sorry for your diagnosis but you should feel some level of comfort knowing that whatever you have been doing up to this point has been helpful for your hip. Many of my clients have the same scenario. They walk or run regularly, do some aerobic classes all effective for preserving and building the hip but not the spine.
I encourage you to understand more about the importance of good posture with your diagnosis and to consider starting a strengthening program targeting your spine. The blog link below will help you to understand exercise and movement restrictions to keep your spine safe.

There are more examples in Exercise for Better Bones on exercises restrictions.
All of the strength exercises in Exercise for Better Bones are categorized by intensity and identify which target the bones of the spine. All other exercises (balance, flexibility and safe for you to do) so you do not have to worry that you might cause yourself any harm.

I wish you all the best. Please take this new diagnosis as an invitation to move more but to move wisely.

October 24, 2019 at 7:53pm

Susan March

I have your book Yoga for Better Bones and have shared with with both my Pilates and Yoga teachers. It is very informative and helpful. I’m making the recommended adjustments.
I just ordered and received the book Exercise for Better Bones and it looks great. I love the photos demonstrating the exercises and the way you’ve organized the information.
I have a question about how best to lift grandchildren. I have 5 and they’re all under 2 1/2!
I’ve already eliminated unnecessary lifting with the oldest but still need to get him in and out of bed and bathtub. I’m using a stool for him to help me and trying to lift with bent knees and straight back holding him close to my body. When I lower down to the floor to lift up one of the young babies, I try to gather him/her close to my chest and then come straight up but would love your advice. You referred to a place where everyday activities was discussed but it doesn’t look like it’s covered in the book. Open to your advice!

November 7, 2019 at 9:59pm

Margaret Martin replies

Hi Susan, Thank you for sharing my Yoga book with your Yoga and Pilates teacher
Your quest to lift safely is timely. My neightbor has kindly offered her baby and toddler for me to borrow. I will create a video on what I feel would be your safest approach in lifting little ones. I will let you know as soon as they are done (aiming for November 10th). They will then be posted on my site under the daily Activity Guide.

In the meantime it sounds like you are doing a lot of good lifting. I might be able to just add a few more alternatives for the older ones.
Wishing you many joyful grandmother moments.

November 8, 2019 at 4:48pm

Susan March

Thanks Margaret!
I will look for that on your site soon!

November 20, 2019 at 2:38pm

Jane Stankus

Hi Margaret,
I've been reading your books and have a question regarding the determination of an exercise plan. The FRAX risk assessment asks whether a parent broke a hip. While my mother did not break a hip, she had numerous vertebral fractures requiring kyphoplasty, two separate pelvic fractures and a broken shoulder. Do you suggest that I enter yes or no to that question in the FRAX risk assessment?


November 25, 2019 at 10:05pm

Margaret Martin replies

Hi Jane,
Thank you for your question. I would definitely enter yes to the question referring to a parent having a hip fracture.
I am sorry that your mother suffered so many fractures.
Keep well,

January 7, 2020 at 11:32am


Can you speak to the benefits or cons of using a rebounder trampoline to build bone post diagnosis of osteoporosis? Thank

January 7, 2020 at 5:26pm

Richard Martin replies

Hi Kate. Thanks for contacting us. Margaret wrote an extensive blog post on rebounders and bone health.

May 24, 2020 at 11:41am


Good morning Margaret:
Thank you for your first 3 lessons you e-mailed to me.
I was very hopeful when I found your site and the exercise programs you recommend. As a result, I determined myself to following your program diligently.
Unfortunately with my -4.6 T Score on the spine, I need the whole set of exercise. I can see that what I receive from you is not's more an introduction, as you yourself refer the readers of your website.
Please guide me as to what I need to do to benefit of your full sessions.
Many thanks!
Have a nice day!

May 24, 2020 at 12:36pm

Richard Martin replies

Hi Greg. Thanks for following us and your questions. Most people us Exercise for Better Bones as their osteoporosis exercise source. They can choose a program based on fracture risk and current activity level. It is a very economical and safe way to start. You can learn about that here.

If you need an assessment and specific treatment program and you reside in Ontario you can use Margaret's telehealth service:

If you live outside of Ontario, I suggest you consult a Physical Therapist who is knowledgeable in bone health in your area. Thanks.

May 26, 2020 at 10:55am


Thank you Rich!
My wife, Lyn, has ordered the book you recommended, plus the one called, Strengthen your Core. I might get them in a couple of days.
When I get them, what is your recommendation-to follow the program you propose in the books alone, or to go to other places to your site for additional exercises?
What I would needed, for the rest of the year, is to focus on my spine (-4.T Score) and on my core.
Many thanks!
Have a great day!

May 27, 2020 at 9:17pm

Richard Martin replies

Hi Greg. Thanks for ordering the books. You are on the path to stronger bones and a stronger body. Each of the books provide clear instructions on the path best for you. The important thing is to read the book carefully before you start the exercise program and access the free resources on this site. Congrats and good luck. Keep us posted.

August 17, 2021 at 1:36am

Debra Nelson

Hi Margaret, I have just started receiving your daily emails with exercises, thank-you so much. I have a question that I cannot seem to find answers to. My bone density came back last week as -2.0 in my femur and -3.9 in my lumbar spine! I was shocked because I am 63 yrs old, no fractures, I have been practicing hot yoga for 10 years 5 times a week, I do camel pose, forward bends, basically everything at each and every class with no problems and now I'm being told I cannot do those poses. Why do I not already have fractured vertebrae then? After a few days of depression and fear and cancelling my yoga classes, I have gone back to hot yoga (I certainly need it for my mental state) but I have cut out camel poses, forward bends and all poses that cause flexion in my spine, it is very hard for me because I feel great and don't understand why I hadn't had a fracture yet. So my question to you is, if I have been doing those poses for 10 years do I really have to quit now? And one more question, have you heard of incorrect DEXA test results? Thank-you for your time.

August 17, 2021 at 9:29am

Richard Martin replies

Hi Debra. Margaret cannot provide medical advice in the absence of an assessment. You can learn about her coaching service here:

September 4, 2021 at 4:02pm

Kathy K.

Hi, At 51, I was just diagnosed with osteoporosis, -2.8, lumbar (average of the L1, L2, L3, L4 - I noticed on the scan that certain areas are higher than -2.8, so I am guessing the final # is the average). Two years ago I was also diagnosed with Grade 2 Spondylothesis of the Lumbar (L4/L5) spine, on the cusp of Grade 3. I ordered you book, but am anxious to know how limited movement should be considering both conditions. Are leg presses safe? I want to avoid medications and hope that I can keep this from getting worse. Thank you so much!

September 5, 2021 at 5:56pm

Richard Martin replies

Thank you for purchasing our book.
Sorry that you have been diagnosed with osteoporosis at such a young age.
Please consider discussing hormone replacement with your doctor to help boost the effect of exercise to build bone.
As far as both your conditions are concerned all the exercises at the beginner and Active Level are safe.
I do however suggest that you consult with a local therapist to help you fine tune the exercises for you.
All the best.

February 24, 2022 at 12:06pm

Penny Evans

Hi Margaret, I have recently bought your book, and it has given me renewed hope about improving my bone quality and density! I had an early menopause (late 30's) due to breast cancer so couldn't go on HRT. I was put on alendronic acid for years in my 50's, but having read up on it, decided to come off it about 5 years ago (I'm now 65). The doctor has prescribed it after my recent DEXA scan which came out as -2.6 on the spine and -2.2 on the hips. The hips had slightly improved compared to my last scan. I think this is because I do a lot of walking/hiking. My fracture risk on the FRAX is 8.7%. Do you think I can safely avoid the drugs if I follow your exercise programme. I am keen to find a way to build bone density through exercise and diet. I'm vegan and I'm very careful to get the nutrients I need.

February 24, 2022 at 2:55pm

Richard Martin replies

Margaret cannot provide medical advice in the absence of an assessment.

April 1, 2023 at 5:11am


Hi Margaret
You suggested not doing certain exercises such as sit ups and crunches. I currently do them along with weight training and do not experience any discomfort. Do you suggest stopping?