Strength Training and Bone Density: How to Load Your Skeleton Properly

Somebody has mentioned bone density to you. Perhaps it was a scan result, perhaps it was a comment at a check up, perhaps it was watching a parent break a hip and never quite recover. Either way you have been told to do weight bearing exercise, advice that sounds clear until you try to work out what it means in practice.

It is one of the vaguest instructions in health. Most people hear it and start walking more, which is a good thing to do but is not what the advice was reaching for. Here is a plain explanation of how bone responds to load, which movements matter, and how to build up to them without doing anything daft.

Bone is living tissue and it responds to demand

Bone is not inert scaffolding. It is active tissue that is constantly being broken down and rebuilt, and the rate of each is influenced by the mechanical stress placed on it. Load a bone in a way it is not used to and the cells within it get a signal to reinforce. Remove the load and the signal disappears, so the body sees no reason to maintain material it is not using.

This is why astronauts lose bone density in orbit. Take gravity away and the skeleton simply becomes efficient. The logic runs in reverse too, though more slowly than it does with muscle, because bone remodels over months and years rather than weeks.

Two features of the load seem to matter most. It has to be reasonably heavy relative to what you are used to, and it has to be something your body is not already accustomed to. Novelty and magnitude, in other words. That combination is the single most useful thing to understand about this whole subject, and it explains most of what follows.

Why walking on its own is not enough

Walking is genuinely good for you. It helps your heart, your mood and your sleep, and I would happily see you doing plenty of it. I want to be clear about that before I say the next bit.

Walking is a poor stimulus for bone. Your skeleton has been carrying your body weight around at walking pace for your entire adult life. There is nothing novel about it and the forces involved are modest. From the point of view of your femur, a walk is not a demand, it is Tuesday.

The same applies to cycling and swimming, which are excellent exercise in every other respect but load the skeleton very little because your body weight is supported. If your entire exercise routine is made up of walking, cycling or swimming, your bones are not being asked to do anything they have not been comfortable with for decades.

The movements that actually matter

Bone responds locally, not globally. Loading your legs does very little for your wrists. That means the movements worth prioritising are the ones that load the sites that matter most, which for most people means the hips, the spine and the wrists, because those are the areas where a fracture is most life changing.

• Squats. Loaded squats put force through the hips and spine in a controlled, progressive way. Goblet squats to begin with, moving to a barbell on the back or front over time if that suits you.
• Deadlifts and hinges. Picking a heavy weight up off the floor or from mid shin loads the hips and the whole length of the spine. It is one of the most valuable exercises there is for this purpose, and one of the most commonly avoided out of nervousness.
• Loaded step ups and split squats. Single leg work puts high force through one hip at a time, which is a stronger local stimulus than the same total weight split across two legs.
• Overhead pressing. Loads the spine from above and works the shoulders and upper back, which matters for posture as well as bone.
• Rows and pulling work. Builds the muscles across the upper back that support the thoracic spine, which is a common site for the small compression fractures that quietly change posture over time.
• Loaded carries. Walking with something heavy in each hand loads the spine, the hips and the wrists at once, and it is about as safe an exercise as exists.

Notice that this is the same list I would give anyone for general strength. There is no separate bone workout. The exercises that build muscle are the exercises that load bone, because muscle pulling hard on its attachments is itself one of the main forces bone responds to.

Where impact fits in

Impact, meaning things like hopping, skipping, jumping or brisk stair climbing, is a well recognised part of the picture because it produces short bursts of force that bone responds well to. Small amounts done regularly appear to be more useful than long sessions.

This gets its own section because it is where individual circumstances matter most. If you already have a diagnosed bone condition, a history of fractures, joint replacements, or significant knee or hip pain, impact work is exactly the sort of thing to ask your GP or a physiotherapist about before you start adding it. For a healthy person in their forties or fifties with no such history, a few sets of hops or some stair work each week is a reasonable and useful addition.

Sensible progression

The principle is easy to state and easy to get wrong. The load has to increase over time, and it has to increase slowly enough that the surrounding tissues keep up.

In practice, that looks like this:

• Spend the first few weeks learning the movements with weights that feel too easy. This is not wasted time. Technique is what makes heavy work safe later.
• Add small amounts often rather than large amounts occasionally. A couple of kilograms on a lift every week or two adds up to a great deal over a year.
• Progress one thing at a time. If you add weight, do not also add sets, extra sessions and a new exercise in the same week.
• Two strength sessions a week, done for years, will do more than five a week done for a month. Bone remodels slowly, so the timescale that matters here is measured in years.
• Deload when life is busy. Reduce the volume, keep the movements, come back to it. Losing a few weeks of progress is nothing. Losing the habit is expensive.

There is no shortcut to compress this. What you can do is start earlier and be more consistent, which is worth more than any clever variation in the programme. If you want a sense of what that consistency looks like in practice, I have written about the way I structure coaching.

If you have been told you have osteopenia or osteoporosis

Then this article is background reading, not a programme. A diagnosis changes the picture in ways that need to be handled by the people who made it. Some movements may need modifying, particularly loaded spinal flexion and certain twisting patterns, and the right adjustments depend on your scan results, your history and any medication you are taking.

Ask your GP directly what is and is not sensible for you, and ask whether a referral to a physiotherapist would help. Bring specifics, because a specific question gets a specific answer. Asking whether loaded squats and deadlifts are appropriate for you gets you further than asking whether exercise is a good idea.

What I would gently push back on is the assumption that a diagnosis means being careful with everything forever. Appropriately supervised resistance training is widely recommended for people with low bone density, not forbidden. The instruction is usually to train differently rather than to stop, so being told to avoid lifting altogether is worth clarifying.

The rest of the picture

Training is the part I can help with, but it is not the whole story. Adequate protein supports both muscle and the protein matrix that bone is built on. Calcium and vitamin D matter, and in the UK a vitamin D supplement over winter is widely recommended, though your GP or pharmacist is the right person to advise on that. Smoking and heavy drinking work against bone, which is worth knowing even though nobody enjoys reading it.

For women, the years around and after menopause are when bone loss tends to accelerate, which is why this conversation becomes more urgent then. That is also a medical conversation worth having properly rather than one to navigate from articles online.

Starting from nothing

If you have never lifted a weight, none of the exercises above are out of reach. They all have entry level versions, and the entry level version done well is worth more than the advanced version done badly. Nobody starts with a heavy barbell. People start light, with a lot of repetition and someone watching what their hips are doing.

Beginners and people coming back after years away are my normal client. I train people one to one from a private setup, so there is no room full of strangers and no expectation that you arrive knowing any of this already.

If you are in Cuckfield, Haywards Heath or Balcombe and want to talk about what sensible loading would look like for you, the first step is a free consultation with no obligation. We go through your history, anything you have been told medically, and what would realistically fit into your week. You can read more about how I work, or get in touch and we will find a time.