Osteoporosis is a significant global health challenge leading to an increased risk of fragility fractures, loss of independence, and reduced quality of life.
By Professor Belinda Beck, Griffith University
While pharmacological interventions can play an important role in managing osteoporosis, exercise offers a vital non-pharmacological strategy that provides additional benefits such as improved balance, functional capacity and overall health.
An evidence-based exercise program specifically designed to combat osteoporosis by enhancing bone density and reducing fracture risk is the new gold-standard of treatment.
Science of stronger bones
This treatment is grounded in research, including the LIFTMOR (Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation) and MEDEX-OP (Medication and Exercise for Osteoporosis) trials, conducted at Griffith University and The Bone Clinic.
These studies demonstrated that postmenopausal women and older men with low bone mass could safely perform high-intensity resistance and impact training (HiRIT), resulting in significant improvements in bone mineral density (BMD), muscle strength and functional performance.
These findings challenged the long-standing misconception that individuals with osteoporosis should avoid high-impact or heavy-load exercises.
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Understanding bone loading
Bone tissue responds to mechanical stress through a process called mechanotransduction, wherein the cells within the bone sense strain and initiate remodelling to adapt to the load. However, not all forms of exercise stimulate bone growth effectively.
Bone loading requires clinically supervised exercises that involve:
- Exercises performed with heavy weights to stimulate the skeletal system
- Impact loading – activities that create ground reaction forces sufficient to elicit bone adaptation
These principles are central to the design of any beneficial program, ensuring optimal bone health outcomes while maintaining participant safety.
Program delivery must be under the supervision of accredited exercise physiologists, physiotherapists, or other appropriately trained and accredited exercise medicine professionals to ensure safety and efficacy.
Participants undergo an initial assessment to determine their baseline bone health, functional capacity, and risk factors. Based on these findings, they then initiate the exercise program according to their individual capacity keeping the following principles in mind:
- Progressive overload: gradually increasing the resistance or intensity of exercises to continue stimulating bone and muscle adaptation
- Proper technique: emphasising correct form/movement pattern to minimise injury risk while maximising load on the skeleton
- Targeted exercises: prioritising weight-bearing activities that load the hip, spine, and other critical fracture sites
- Injury prevention: incorporating balance and functional training to reduce the likelihood of falls, which are a major contributor to osteoporotic fractures.
Participant benefits
The benefits of an exercise program extend beyond improved BMD. Participants often report enhanced physical strength, better posture and increased confidence in performing daily activities.
The program also addresses comorbidities associated with osteoporosis, such as sarcopenia (age-related muscle loss), and contributes to overall functional independence.
Dispelling myths
A common misconception is that individuals with osteoporosis should avoid high-intensity or high-impact exercises due to fracture risk. However, research has demonstrated that when appropriately prescribed and supervised, these exercises are not only safe but also necessary for bone health.
The program bridges the gap between evidence and practice, empowering individuals with osteoporosis, or those at risk of developing it, to take an active role in managing their condition.
Putting it in clinical practice
Healthcare practitioners play a crucial role. Referring patients to accredited exercise professionals and educating them about the benefits of bone-loading exercises are essential steps.
Furthermore, a program needs to align with current clinical position statements that recommend exercise as a first-line treatment for osteoporosis prevention and management.
Empowering patients with the tools and knowledge to enhance their skeletal strength, offers a pathway to healthier ageing and improved quality of life. Exercise programs have the potential to significantly reduce the societal and economic burden of osteoporosis.
Key messages
- A new program can improve bone health and reduce fractures in osteoporosis.
- The program emphasises high-intensity resistance and impact training under expert supervision.
- It is proven to offer a safe, effective strategy for people to take an active role in managing osteoporosis.
Author competing interests – Creator ONERO Program, owner and Director of The Bone Clinic.
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