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July 22, 2022

When it comes to osteopenia, exercise is one of your strongest weapons against further bone loss. For this reason, it is one of your most important tools in the prevention of osteoporosis, a more severe form of bone loss. In order to prevent or manage osteopenia, you'll want to include a regimen of proven bone-building exercises that slow or help reverse the progression of bone loss in your body. You'll also want to include exercises that keep you strong and steady on your feet so that you can keep debilitating falls at bay. But it's important to note that not all exercises are equally beneficial for your bones. Doing the correct type of exercises can help slow the loss of bone and build new bone mass while improving strength,  posture and balance. Use this guide as your starting point for understanding the best exercises for people with osteopenia or those who are determined to prevent osteopenia from developing in the first place.

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. This article contains information from peer-reviewed research, medical societies and governmental agencies; however, this guide is not a substitute for professional medical advice, diagnosis, or treatment.

The best exercise program for someone with osteopenia strengthens bones, preserves bone mass, and improves balance to reduce the risk of fracture. The best routine for strong bones includes three types of exercise:

  • Weight-bearing exercise: These types of exercises use your body weight for resistance. These programs typically involve aerobics, walking, running, tai-chi or yoga. 
  • Resistance exercises: ​Resistance exercises usually (but not always) involve using an external force to improve muscle strength. Free weights, resistance bands, machines, and even bodyweight are all considered strength training.
  • Balance exercises: Balance exercises challenge the ability to hold yourself upright when you move or presented with uneven surfaces. Often seen in physical therapy, these exercises can help prevent falls that lead to a bone fracture. In addition, balance exercises are very beneficial for those with low bone density in order to decrease the risk of falls.

The Bone Health & Osteoporosis Foundation has specific recommendations on how often to perform each type of exercise:

  • Weight-bearing exercise for 30 minutes a day on most days of the week.
  • Muscle-strengthening 2-3 days per week.
  • Balance exercises every day.

Weight-Bearing Exercise

Weight bearing exercises are easy to do, because they can be done anywhere and often require minimal equipment. This type of exercise loads the weight of your own body on your bones which stimulates bone growth.  This slow or prevents bone loss. Weight-bearing exercises can be classified into low or high-impact exercises.

  • Low-impact: Meaning that the load put on the bones is generally slow and progressive. Examples include tai chi, walking, gardening, and yoga.
  • High-impact: Typically involves a quick bouncing movement off of the ground. Examples include stair climbing, running, and jumping.

These exercises are considered aerobic exercises because they get you breathing harder and benefit your cardiovascular health. However, not all aerobic exercises are weight-bearing. Swimming for example is non-weight bearing since your body weight is being supported by the water. Although it is great for other reasons, swimming does not reap the weight-bearing benefits for bone health.

Resistance Exercises

Strength training with resistance exercises promotes healthy bones by preserving bone mineral density and helping build bone. These exercises also build muscles that surround and support the bones.

Oftentimes, people think that strength training has to involve heavy weights. But in fact, you can use just bodyweight movements to build strength. Bodyweight movements such as push-ups, squats, planks, and lunges are great ways to build strength without the use of equipment. You can create endless types of workouts using those simple movements. If you’ve mastered those, you can add resistance to them by holding a weight or using a resistance band.

Balance Exercises

Balance exercises provide a weight-bearing benefit but challenge the body to stay upright when presented with uneven ground, turns, or unexpected perturbations. These exercises are so important for preventing falls. Some older adults, regardless of bone health status, may be advised to work with a physical therapist on these exercises. 

Balance exercises work your body’s ability to maintain equilibrium as well as strengthening certain muscles that make you more stable. 

Balance training is often coupled with postural training since maintaining an upright posture is crucial for maintaining an upright and balanced body.  Exercises for the shoulders, upper back, core, and hips can improve posture and take pressure off of the spine. An extra perk of postural training:  it can help relieve any back pain you might have!

How This Differs From Exercises For Osteoporosis

There is a lot of overlap with what to do for osteopenia and osteoporosis, since both conditions involve low bone mineral density. Because osteopenia is a less severe version of osteoporosis, those with osteopenia can handle a slightly wider range of exercises. For example, those with a higher bone mineral density can safely handle more high-impact exercises, where as those with advanced osteoporosis will be limited to low-impact exercises only. This is because those with lower bone mineral density are at a higher risk of a compression fracture. 

If you have osteoporosis, it is best to stick to low-intensity activities and avoid movements that involve rapid flexion and extension of the spine, such as sit-ups. There are a handful of exercises you should avoid if you have osteoporosis, that will be okay with osteopenia. 

If you have a T-score that puts you on the border of osteopenia, or between osteopenia and osteoporosis, where to start can be confusing! It is best to seek medical advice before moving forward with an exercise program. You can also meet with a physical therapist to address concerns with the types of exercises that are best for you, and how to perform exercises with the correct form.

​Lifestyle Factors Are Also Important

Physical activity alone isn’t enough to improve bone health. In order to optimize bone strength, your body needs the right fuel to build new bone. This is why getting enough vitamins such as calcium and vitamin D is just as important in the fight to avoid developing osteopenia and osteoporosis. Your doctor may even suggest using a supplement to ensure adequate levels of these vitamins. It is also important to avoid certain foods that might slow the bone-building process. 

Lifestyle choices such as smoking and drinking also play a role in poor bone health, so quitting or cutting back on those activities can help as well.

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How much exercise do you need? Bone Health & Osteoporosis Foundation. (n.d.). Retrieved February 13, 2022, from https://www.bonehealthandosteoporosis.org/patients/treatment/exercisesafe-movement/how-much-exercise-do-you-need/

Osteopenia (low bone density): What is it, prevention, symptoms, causes & treatment. Cleveland Clinic. (n.d.). Retrieved February 13, 2022, from https://my.clevelandclinic.org/health/diseases/21855-osteopenia

Testing your balance. Bone Health & Osteoporosis Foundation. (n.d.). Retrieved February 13, 2022, from https://www.bonehealthandosteoporosis.org/patients/treatment/exercisesafe-movement/testing-your-balance/ 

U.S. Department of Health and Human Services. (n.d.). Bone mass measurement: What the numbers mean. National Institutes of Health. Retrieved February 13, 2022, from https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measure.

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