Here’s a conversation that plays out constantly after a DEXA scan comes back with a number somebody doesn’t like. Walking through the moment, they discuss what the result means.
What should I be doing?
Weight-bearing exercise. Walking’s good. Maybe some light weights. Be careful with anything jarring.
It sounds sensible. It’s the advice most people receive. And for building bone, it is largely ineffective — which is a strong claim, so let me show you where it comes from.
What Bone Actually Requires
Bone is living tissue that adapts to mechanical load, but it’s fussy about what kind. Three things determine whether a given activity produces a bone response.
Magnitude. The strain has to be large. Bone doesn’t respond to loads it already handles comfortably every day.
Rate. The load has to be applied quickly. High-magnitude strains delivered at high rates are what drive adaptation — slow, gradual loading is a much weaker stimulus.
Novelty. Bone habituates. A load pattern your skeleton has experienced ten thousand times stops being informative.
Hold those three requirements up against the standard advice and the problem becomes obvious.
Auditing the Usual Recommendations
Walking has been a habitual pattern for decades, shaping your skeleton.
It is excellent for cardiovascular health, mood, and general function.
As a stimulus for bone, it fails all three requirements.
The magnitude is low, and the rate is low.
There is nothing novel about it.
I’m not telling you to stop walking. I’m telling you it isn’t a bone program.
Light weights and resistance bands. Better than nothing, but if the load is comfortable, the magnitude requirement isn’t met. Twenty repetitions with a two-pound dumbbell is endurance work.
Swimming and cycling. Genuinely good exercise. Non-weight-bearing, so essentially no bone stimulus. Worth knowing if these are your main activities.
Water aerobics. Same issue.
Golf and pickleball. Real benefits — movement, balance, social connection, and in pickleball’s case some genuine impact. Neither delivers the sustained high-magnitude loading that bone responds to.
So the average person following the standard advice is doing a great deal that’s good for them and very little their skeleton notices.
The Trial That Challenged This
For years, high-intensity training simply wasn’t studied in this population — not because it had failed, but because nobody was willing to try it.
The researchers behind the LIFTMOR trial put it bluntly: exercise guidelines for osteoporosis typically recommended moderate-intensity exercise despite a lack of notable efficacy, because of a perceived risk of fracture from high-intensity loading. Safety concerns alone had prevented the well-recognised preferential response of bone to high loads from being applied to the people who stood to benefit most.
In other words, the caution wasn’t based on evidence that heavy loading was harmful. It was based on the assumption that it would be.
So they tested it. Postmenopausal women with low bone mass — T-scores below −1.0, covering both osteopenia and osteoporosis — were randomised to one of two programs for eight months:
The intervention: twice-weekly, 30-minute supervised sessions of high-intensity resistance and impact training. Five sets of five repetitions at over 85% of one-repetition maximum.
The comparison: a home-based, low-intensity exercise program — essentially the standard advice.
What Happened
The high-intensity group showed significantly greater improvements in bone mineral density at both the lumbar spine and the femoral neck — the hip site that matters most for the fractures people fear.
They also improved on measures of physical function.
And on the safety question, which was the entire reason nobody had tried this: a subsequent analysis reported that the high-intensity exercise did not cause vertebral fractures, and improved thoracic kyphosis — the rounding of the upper back. An earlier report from the same trial concluded that heavy resistance training was safe and improved bone, function, and stature in women with low to very low bone mass.
Better posture, better function, better bone density, no fractures.
What This Means Practically
Five sets of five at above 85% of your maximum is heavy. That’s not a gentle program with slightly bigger dumbbells. It’s genuinely demanding resistance training — deadlift, squat and overhead press patterns, loaded progressively.
For most people over 60 who’ve been told to be careful, that’s a considerable psychological leap.
The word “supervised” is doing important work here. The LIFTMOR participants were screened, then trained under supervision, with technique taught and load progressed by someone who knew what they were doing.
That’s the honest caveat, and it’s not a small one. The finding isn’t “go and lift heavy things.” It’s “appropriately supervised, progressively loaded, high-intensity training was both safe and effective in this population.”
Which is precisely the sort of thing worth doing properly rather than improvising from an article.
The Second Half of the Equation
Building bone is one half of fracture prevention. Not falling is the other, and it’s at least as important — because the overwhelming majority of hip and wrist fractures happen when somebody hits the ground.
So a complete program addresses both:
Bone loading, as described above.
Balance training that’s genuinely challenging rather than comfortable.
Leg strength and power, which determines whether a stumble becomes a fall.
Reaction and recovery work — the ability to catch yourself.
There’s a pleasant efficiency here: the heavy resistance training that loads your skeleton also builds the leg strength that keeps you upright, and the LIFTMOR participants improved on functional measures as well as bone density.
What I’m Not Saying
I’m not telling you to skip your medication. Osteoporosis medications have solid evidence behind them for reducing fracture risk, and for many people they’re an important part of management. That decision belongs with your physician, and exercise works alongside it rather than instead of it. Anyone suggesting you can lift your way out of a prescription is going well beyond the evidence.
I’m not saying every person with low bone density should be doing this program. Existing vertebral fractures, certain spinal conditions, very low bone density, and other medical factors all affect what’s appropriate. LIFTMOR screened its participants for a reason.
And I’m not dismissing walking. Walk. It’s good for you. Just don’t count it as your bone program.
Getting Assessed Properly
Osteoporosis is a medical diagnosis based on a DEXA scan and your clinical picture, and that belongs with your physician. If you haven’t had bone density measured and you’re over 65, have had a fracture from a minor fall, have lost height, or have other risk factors, that’s a conversation to have.
Your physician will also consider vitamin D, calcium, and any underlying conditions or medications affecting bone.
Seek prompt medical attention for sudden back pain, particularly after a minor fall, a lift, or even no clear event — vertebral compression fractures can occur with minimal trauma and are frequently missed. Also for any noticeable loss of height, a new stooped posture, or pain in the hip or groin after a fall.
Let’s Build You a Program Your Bones Notice
If you’ve been given low-intensity advice for a high-intensity problem, there’s considerably more available — and it needs to be built and supervised properly rather than guessed at.
Berman Health Club offers a free discovery visit at no cost and no obligation. You’ll get an assessment of your strength, balance, and current capacity, an honest read on what’s appropriate given your bone density and medical history, and a plan that loads your skeleton meaningfully while managing your fall risk.
Staying on the golf course and the pickleball court at 80 depends on a skeleton that can take a knock. That’s built deliberately.
