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Maintaining and rebuilding strong bones

There are two types of exercises that are important for building and maintaining bone density: weight-bearing and muscle-strengthening exercises. Not all exercises are safe and beneficial and your exercise program should be tailored to meet current level of bone density. If you have osteoporosis or are at high risk of breaking a bone, the National Osteoporosis Foundation(NOF) recommends to avoid movements that increase fracture risk in daily living and exercise such high-impact exercises and twisting and flexing the spine. A bone density scan can help guide the exercise professional develop a targeted exercise training plan that improves core and hip strength and stability, muscle strength, better posture, balance and mobility, or help slow down age-related declines.

Know your bone density

Unless you have done a DEXA scan have have more of an idea of the condition of your bones. This scan can show areas of weakness that are at increased risk for fracture. T-Scores provide details in bone density, most important are the femoral neck, hip, and the vertebra of the lumbar spine. A T-Score for each of these locations (L1, L2, L3, L4) is desired, not an average. When one or two vertebra have a T-Score being osteoporotic and the others have a others T-Score being normal or osteopenia, the average may indicate a T-Score that list you as having osteopenia when in fact you are at high risk for spinal in those one or two vertebra.

Vertebral or spinal fractures

Vertebral fractures or compression fractures may occur with normal daily activities such as a cough, a sneeze, hugging a friend, picking up a grand child, swinging a golf club or as the result of a fall.


Your bone density test results are reported using T-scores. A T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult. A healthcare provider looks at the lowest T-score to diagnosis osteoporosis. T-Scores provide your health fitness professional with important information on what movements to avoid and what areas to target to build stability and strength.

What Your T-score means according to the World Health Organization (WHO):

  • Normal bone density: A T-score of -1.0 or above. Examples are 0.9, 0 and -0.9.

  • Osteopenia or low bone density: A T-score between -1.0 and -2.5. Examples are T-scores of -1.1, -1.6 and -2.4.

  • Osteoporosis or very low bone density: A T-score of -2.5 or below. Examples are T-scores of -2.6, -3.3 and -3.9.


Having good posture is crucial for balance and to prevent compression fractures. Kyphoses, a bend over stooped spine is often the result of spinal fractures that heal in misaligned position. The bend over posture itself increases the risk for increasing spinal fractures that heal in misaligned position and thus the bend and curve worsens.

The NOF states it is important to protect the spine by moving properly during exercise and daily activities. Activities that place stress on the spine can increase the likelihood of breaking a bone. For example, people with bone loss in the spine should not:

  • bend forward from the waist

  • twist and bend at the torso (trunk) to an extreme

  • carry packages that are too heavy

  • bend forward when coughing and sneezing

  • reach for objects on a high shelf

  • do toe-touches, sit-ups or abdominal crunches

Resistance training

These exercises include activities where you move your body, a weight or some other resistance against gravity. Muscle strengthening exercises that load the hip and the spine and the spine. Your medical exercise specialist, personal trainer or physical therapist can develop a targeted and beneficial training program.

Examples of resistance training are:

  • Lifting weights

  • Using elastic exercise bands and resistive tubing

  • Using weight machines

  • Lifting your own body weight

  • Functional movements, such as standing, squatting, stair stepping, and rising up on your toes

Weight bearing exercise

Exercise where you bear your own weight-not being seated such as a bicycle or swimming- can help maintain and rebuild bone density.

Examples of high impact weight-bearing exercises are:

  • Dancing

  • Doing high-impact aerobics

  • Hiking

  • Jogging/running

  • Jumping Rope

  • Stair climbing

  • Tennis

  • Bone facts

Examples of low-impact weight-bearing exercises:

  • Low-impact weight-bearing exercises can also help keep bones strong and are a safe alternative if you cannot do high-impact exercises. Examples are:

  • Using elliptical training machines

  • Doing low-impact aerobics

  • Using stair-step machines

  • Fast walking on a treadmill or outside

Muscle strength

Muscle strength increases at a much faster rate as increases in bone density. You need to exercise consistently for a year before changes show up at a bone density scan. That is why resistance training and weight bearing activity needs to continue for life, to maintain a strong functional body that allows you to live independently and enjoy activities that are meaningful to you.

Balance and osteoporosis

For people with osteoporosis or an increased risk for fracture, preventing falls is a top concern. Balance is a key indicator of physical health and is highly personal. Balance can fluctuate daily, and balance generally deteriorates to an extent over a lifespan. 

Falls prevention and intervention programs

There are many reasons why people fall.We provide falls prevention, intervention, balance and mobility training programs for older adults just beginning to experience changes in gait, balance, posture, strength and endurance, have experienced a fall with or without injury. We also provide targeted interventions for older adults at high risk for falling and history of falling due to moderate to severe decreased strength and balance from multiple risk factors and who require around the clock care.

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