An exercise program is one of the best means of osteoporosis prevention for people with osteopenia. Doing the correct type of exercises, and knowing what those are, can help slow the loss of bone and build new bone. That's why we created Wellen -- so all the exercises you need are in one place. But before beginning any unsupervised exercise program, consult with your healthcare professional, as they know your body best.
Osteopenia and bone health
Osteopenia is the loss of bone mineral density, which leads to a weakening of the bones. Loss of bone is a normal part of the aging process. In fact, by age 35, the body starts to break down bone faster than it can rebuild it (Cleveland Clinic, 2021). This becomes an issue when there is so much bone loss that the bones become too weak to support the body for daily activities. This can lead to pain or compression fractures.
Osteopenia becomes a significant concern when it progresses to osteoporosis, which is diagnosed as a substantial loss of bone mineral density.
Both osteopenia and osteoporosis can be measured with a bone mineral density scan, known as a DXA scan. The score from this test is known as a T-score. The varying ranges of T-scores will determine where one is on the scale of bone health (NIAMS, 2023).
Risk factors for developing osteopenia include:
- Postmenopausal women over 50 years old
- Poor nutrition, especially diets low in vitamin D and calcium
- Certain medications such as cancer treatment medications, steroids, blood pressure medications, and more
- Certain medical conditions such as thyroid conditions or gastrointestinal conditions that lead to poor absorption of nutrients
- Unhealthy lifestyle choices, such as lack of exercise, smoking, drinking alcohol, and poor diet
Although you cannot control age, gender, menopause, and past medical history, there is plenty that you can change to decrease your chances of developing or progressing osteopenia. For one, a workout program can significantly impact your bone health.
The best exercise program for someone with osteopenia strengthens bones, preserves bone mass, and improves balance to reduce the risk of falls and fractures. The best routine for strong bones includes three types of exercise:
- Weight-bearing exercises: These types of exercises use your body weight for resistance. These programs typically involve aerobics, walking, running, or Tai Chi.
- Resistance exercises (strength-training exercises): These activities 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 are 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 (Bone Health & Osteoporosis Foundation, n.d.)
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, thus slowing and preventing bone loss. Weight-bearing exercises can be classified into two categories: low or high-impact exercises.
- Low-impact: Meaning that the load put on the bones is generally slow and progressive. Examples include tai chi, cardio on elliptical training machines, walking, and gardening.
- High-impact: Typically involves a quick bouncing or bounding movement off of the ground. Examples include stair climbing, running and jumping.
It should be noted that not all exercises are appropriate for everyone. Recent studies have shown that high-impact exercises can benefit your bones, but they may not be appropriate for someone with a history of fractures (Brooke-Wavell, 2022; Kistler-Fischbacher, 2021; Manaye, 2023). One study found that high-impact and high-intensity exercises can help maintain and improve bone density in the lumbar spine and femur (Manaye, 2023). However, keep in mind that the latest guidelines advise starting high-impact exercise with supervision or only after a thorough physical exam (Manaye, 2023; Brooke-Wavell, 2022).
It should also be noted that not all exercises are weight-bearing exercises. Swimming for example is non-weight-bearing since your bodyweight is being supported by the water. Although it is great for other reasons, swimming does not reap the weight-bearing benefits you need to maintain bone density.
Strength training with resistance exercises promotes healthy bones by preserving bone mineral density and helping build bone. These exercises also build the muscles that surround and support the bones.
How much weight do you need to strengthen your bones? Oftentimes, people think that strength training has to involve heavy weights. But in fact, you can use just bodyweight during strengthening exercises and still get results.
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 challenge the body to stay upright when presented with uneven ground, turns, or unexpected perturbations. They also benefit your bones because they require you to hold up your body. 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. That's because 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 neck, shoulder or back pain.
How this differs from exercises for osteoporosis
There is a lot of overlap in suggested exercises for people with osteoporosis and exercises for those with osteopenia. The similarity is that both conditions require improving bone mineral density. The difference is that one is more severe bone loss than the other.
Because osteopenia is less bone loss than osteoporosis, those with osteopenia can handle a slightly wider range of exercises. For example, those with a higher bone mineral density can safely handle high-impact exercises. 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's also best to avoid movements that involve rapid flexion, extension and twisting 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, it can be confusing to figure out where to begin. It is best to seek medical advice before moving forward with an exercise program. A physical therapist can discuss the best exercises for you and how to perform them correctly.
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 also critical 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. Quitting or cutting back on those activities can help as well.
By cutting out the things that harm bone health and adding in the things that improve it, such as Wellen's personalized exercise program for osteopenia, you are setting yourself up for success.