#002 - Rethinking Osteoporosis
Why We Should Rethink Osteoporosis – and Pick Up a Barbell
Osteoporosis is often painted as an inevitable part of ageing—a condition that creeps in quietly and leaves us vulnerable to fractures, loss of independence, and long recoveries. As an osteopath, I regularly see the impact it can have on people’s lives. But what if we could not only slow that decline, but actually reverse some of it?
The latest research suggests we can. And the answer doesn’t lie in a new wonder drug—but in something far more old-fashioned: lifting weights.
The Myth of Fragility
It’s long been assumed that people with osteoporosis must avoid anything remotely strenuous. Heavy lifting? Jumping? Absolutely not—too risky. But this cautious approach may be doing more harm than good.
Professor Belinda Beck, an Australian exercise scientist, has led pioneering research that challenges this mindset. Through her LIFTMOR clinical trials, she showed that carefully supervised high-intensity resistance and impact training can not only be safe for people with osteoporosis, but profoundly beneficial.
Her participants—postmenopausal women with low bone density—performed just two 30-minute sessions per week, lifting progressively heavier weights under close supervision. The outcomes included improved spinal bone density, posture, strength, and overall confidence. Many of the women went from feeling fragile to lifting their own bodyweight—and, more importantly, living their lives with fewer limitations.
Bones Are Not Static
One of the most important shifts we need to make is how we think about bone. It’s not static. It’s not fixed. Bone is living, responsive tissue—continually being remodelled by cells that break it down (osteoclasts) and rebuild it (osteoblasts).
This constant turnover allows bones to adapt to mechanical loading—something captured by the principle known as Wolff’s Law. In short: bones respond to stress. The more we load them in the right way, the more resilient they become.
Of course, this works best when we’re younger. In fact, up to 80% of our peak bone mass is genetically determined and largely reached by our early twenties. But Beck’s work shows that meaningful gains are still possible later in life—especially at the spine—and that we should stop accepting rapid bone loss in middle age as inevitable.
How Do You Know Your Bone Density?
If you’re concerned about osteoporosis, the first step is to get a bone density scan. The most commonly used method is a DEXA scan (Dual-energy X-ray Absorptiometry), which measures bone mineral density and compares it to standardised norms. It’s quick, painless, and gives a reliable indication of fracture risk—especially at the spine and hip. However, it does use low-dose ionising radiation, and the results can be affected by degenerative changes in the spine.
A newer, radiation-free alternative is a REMS scan (Radiofrequency Echographic Multi Spectrometry). This ultrasound-based technology provides detailed analysis of bone quality and strength, particularly at the femur and lumbar spine. It’s increasingly used in clinical settings because it avoids radiation and is more portable. That said, REMS is not yet as widely available as DEXA, due to it’s portability it’s seen as a useful tool for tracking changes over time or for those unable to access DEXA easily.
Whichever method you use, knowing your bone density can be a powerful motivator—and a critical baseline for planning appropriate treatment and exercise.
The Power of Supervised Resistance Training
Let me be clear: this is not about people with osteoporosis rushing out to the gym and trying to deadlift 70 kilos. The programme Beck developed is delivered in a clinical setting and is supervised by trained professionals. That’s key.
Supervision can be undertaken by suitably trained physiotherapists, exercise physiologists, osteopaths, and S&C coaches, as long as they understand the risks and needs of individuals with low bone mass.
What matters is not just the load, but the way it’s introduced. Good coaching focuses first on movement quality and safety, gradually increasing intensity over time. With proper technique and support, even those with established osteoporosis can train confidently and effectively.
Movement Is Medicine—At Any Age
Perhaps the most exciting part of this research is how it redefines what’s possible for people who have already been diagnosed with osteoporosis. We’re not just talking about preventing decline—we’re talking about rebuilding strength, balance, and independence.
Patients in the LIFTMOR trials didn’t just improve their bone density; they stood taller, walked more confidently, and reported being able to lift grandchildren, carry shopping, and hike with partners again. It’s difficult to overstate how transformative this can be for someone who had resigned themselves to frailty.
We also know that improved strength reduces the risk of falls, which is crucial—because a fall is often the catalyst for a downward spiral in older adults. Exercises like squats and deadlifts don’t just build bone; they train the muscles, joints, coordination, and grip strength that keep us steady on our feet.
What About the Rest of Us?
If you’re reading this and you’re in your 30s or 40s, male or female, you might be thinking this is all a bit premature. But I’d argue there’s no better time to act.
Bone loss begins subtly in midlife, accelerating for women around menopause due to the sudden drop in oestrogen. Men are not immune either—testosterone decline affects their bones too, albeit more gradually. The good news is that weight-bearing and resistance exercise can help preserve bone mass—and muscle—well into later life.
This isn’t about becoming a powerlifter. It’s about moving with purpose, using your body in ways that challenge it safely, and doing so consistently. Whether it’s through bodyweight training, resistance bands, or lifting weights, the message is the same: your bones need a reason to stay strong.
A Message for Parents and Carers
We can’t talk about osteoporosis without talking about prevention—and that starts in childhood.
As parents, we should be doing everything we can to help our children reach their genetic potential for peak bone mass. That means a calcium-rich diet, regular time outdoors for vitamin D, and physical activity that includes jumping, sprinting, climbing, and resistance-type movements.
It also means encouraging variety. Swimming and cycling are excellent for cardiovascular fitness, but they’re not particularly bone-stimulating. Sports that involve impact and change of direction—like football, gymnastics, or basketball—are far more beneficial for skeletal development.
Final Thoughts
Osteoporosis doesn’t have to be a sentence of decline. The evidence is mounting that exercise—specifically, resistance and impact training—is not only safe but vital for those at risk. As an osteopath, I believe it’s time we reframe osteoporosis not as a condition to tiptoe around, but as one we can tackle head-on—with the right support.
So if you’re worried about bone loss, or already managing a diagnosis, don’t just sit with it. Speak to someone qualified. Book a scan. And consider picking up a barbell—under the guidance of someone who knows what they’re doing.
Because bones, like the rest of us, are stronger than we think.
Refs:
1. Watson SL, Weeks BK, Weis L, Horan SA, and Beck BR: High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women with Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research 33(2):211-220, 2018 doi: 10.1002/jbmr.3284. PMID: 28975661
2. Watson SL, Weeks BK, Weis L, Harding A, Horan SA, and Beck BR: High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: The LIFTMOR trial Osteoporosis International, 30(5):957–964, 2019 doi: 10.1007/s00198-018-04829-z. PMID: 30612163
3. Watson SL, Weeks BK, Weis L, Horan SA, and Beck BR: Heavy resistance training is safe and improves bone, function and stature in postmenopausal women with low to very low bone mass: Novel early findings from the LIFTMOR trial. Osteoporosis Int. 26(12): 2889-2894, 2015 doi: 10.1007/s00198-015-3263-2. PMID: 26243363