It was a Tuesday, she remembers, and she was walking down the carpeted steps of her home to the kitchen on the ground floor. She miscalculated – there was one more step where she expected none, and her feet slipped out from under her. Just that quickly, it went from a normal Tuesday to the last normal day she’d see in a long time, as that misstep cost her two broken ankles.

Osteopenia and osteoporosis

Osteoporosis is a condition in which bones lose density, becoming weak, brittle, and less able to withstand impacts. Worldwide, one in three women and one in five men are at risk of an osteoporotic fracture, and the older we are, the higher our risk can be.

Most of our bones’ mass is created in our youth, and we reach peak bone density in our early 20s. After that, bone formation slows. In some, bone loss can outpace replacement, making bones porous and vulnerable.

When bone density is less severely compromised, it’s called osteopenia; when bone mass is even more reduced and risk of fracture is higher, it’s osteoporosis.

While neither condition can be cured, there are lifestyle and exercise modifications you can take to prevent osteopenia from becoming osteoporosis (or slow down the process) or to manage osteoporosis to reduce your risk of breaking a bone.

To understand how we can deal with bone density issues, we talked with our awesome physical therapists, Meagan and Brianna.

I’m a woman over 50; what do I need to know about bone density?

The first thing to understand, according to our PTs, is that there are no outwards signs of osteoporosis or osteopenia. Often the first time someone realizes their risk is when they’ve broken a bone. And while women are at higher risk, a significant number of men suffer bone loss, so everyone can and should take steps to have healthier bones, even if they feel fine.

Second important note from our PTs: a diagnosis of osteoporosis or osteopenia doesn’t mean that your active life is over and it’s time to break out the bubble wrap.

Just the opposite, actually, Bri says. People with bone loss need to be exercising to stay mobile, build strength, restore or maintain good balance, and retain a decent quality of life. Continuing to move is a key factor in staying more independent longer and later in life.

Lifestyle and exercise modifications for bone density

Straighten up! Posture and alignment are really important, say our PTs. Those of us who work at computers especially spend a lot of time in a “kyphotic,” leaning-forward posture, with our backs rounded. The vertebrae are constantly being compressed on one side, which can really put a lot of strain on those bones. As Meagan says, think of your spine as a stack of jelly donuts. If one side of those donuts is constantly being squished, you’re increasing your risk of spinal compression fractures, one of the most common fractures among people with osteoporosis. Exercises can help you maintain a more upright posture, strengthening back, shoulder, and butt (glutes) muscles to pull you out of the hunched posture that makes you more vulnerable for fractures.

Celebrate gravity. Gravity takes a lot of heat for its effects on us as we age, but here’s one time gravity can be a real help. As Meagan says, “bone gets laid down in lines of stress. Our bones are strong in the way we use them, so let gravity assist.” How? Think of your bones, like the long bone of the thigh, the femur. Lengthwise, from knob to knob, the bone is strong, and using it vertically against gravity, like climbing stairs or walking, builds bone. But if you stress it horizontally, it’s like taking an end in each hand and trying to break it across the middle. Introduce force along the length of the bone, the way nature intended; don’t bend, twerk, twist, or rotate along a different axis and risk a break, particularly if you’re already dealing with weakened bones.

Embrace resistance. Using your own body weight (plus our new friend gravity) in impact exercise is a great way to build bone. Squats, lunges – done correctly, these are safe exercises that don’t require twisting and can help with balance. Balance is critical when bones are weakened, since a fall can do a lot more damage than when bones are stronger.

Get lifting. According to Bri, both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, but research indicates that resistance training may have a more profound, site-specific effect than aerobic exercise. Translation: get lifting (but don’t give up running).

While lifting weights is slowly gaining in popularity among young women, Bri says we should all be lifting weights at least a couple of times a week. Previously, many women avoided weights, not wanting to “bulk up,” but strength training can improve BMD (bone mineral density), and therefore improve bone strength. So add it to your exercise regimen, Bri says, but carefully. Free weights of anywhere from one pound to 10 or 15 pounds are probably sufficient for most of us, and weighted lunges or squats or light dead lift can give us the extra resistance. Consider getting professional help to learn how to lift, and how much, she says.

Work from where you are. If you don’t move much, now is the time to get going. But increase gently, especially if you’re already osteopenic or think you might be. Start with a 5 – 10 minute walk, Meagan says. Walk on a treadmill if balance is an issue. Add in stairclimbing or step-ups. Work the back side to improve posture, then walk some more to cool down. Ideally, you should be doing at least 30 minutes of exercise 5 days a week. If you’re doing things like yoga, Pilates, swimming, or biking, those are great, but they don’t generate enough impact to build bone; add in impact exercise such as walking or stairs to get a more fully rounded workout.

Breathe out and in, not up and down. We talked about breathing in the blog on avoiding prolapse, so here’s yet another reason to breathe right. Diaphragmatic breathing (from the belly) and core control help with posture and lung function to maintain mobility in your neck bones (“thoracic spine”) and ribcage. Since the thoracic spine is the biggest victim of spine compression fractures, this is a good place to work on.

Be your body’s best friend. Eat your calcium-rich leafy greens. Ditch cigarettes. Reduce or eliminate caffeine and carbonation. And advocate for yourself – insist on a bone density test. Since osteoporosis and osteopenia have no symptoms, this may be your only way to know if you’re at risk (short of breaking a bone, and let’s not count on that, shall we?). Get tested every other year, starting with this one, so you have a baseline to compare to in future. Eat right, and that includes eating enough calories. Women with a too-low BMI are also at an increased risk of osteoporosis.

Listen to your doctor. We’ve only addressed lifestyle modifications here, but there are medical interventions that can help you manage this condition. If you have osteoporosis or osteopenia, or think you might, seek professional advice before adding exercise or changing your diet to be sure you’re moving forward safely.

Finally, one really great thing you can do is to start educating the younger women in your life. Bone building mostly happens early, so you can do someone a huge favor by helping them maximize those years.

If you have osteoporosis or osteopenia, how are you handling it? We’d love to hear your story, so share in the comments below, on genneve’s Facebook page, or in our closed Facebook group, Midlife & Menopause Solutions.



Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.


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