Best Exercises for Osteopenia in Hips

Osteopenia in the hips means that bone density has dropped below normal levels, increasing the risk of fracture at the femoral neck. Targeted strength and impact exercises can stimulate bone growth and improve the durability of the hip joint over time.

This article explains why weight-bearing resistance training is more effective than low-load activities like walking, yoga, or Pilates for reversing bone loss. It highlights three practical exercises that load the hip joint and surrounding muscles in ways that promote bone adaptation.

The guide below also explains how a simple twice-weekly strength routine can support bone health when paired with appropriate progression and nutrition, similar to approaches used in physical therapy and strength & conditioning coaching.

What is Osteopenia?

Osteopenia is lower than normal bone density, a precursor to osteoporosis, and most common in women over the age of 50. Osteopenia can be managed to maintain the bone density you have and stay out of the range for osteoporosis. 

Osteopenia is reversible: Bone density can improve to normal levels without the use of medication, by consistently performing appropriately challenging strength exercises and eating a balanced diet with enough calories to support your level of activity.

Osteopenia in Hips

Bone density scans take measurements at the femoral neck—the area where the top of your thigh bone thins out near your hip socket. This is a crucial region of your skeleton for identifying risk of fracture due to low bone density. 

Hip osteopenia significantly increases the risk of fracture compared to individuals with normal bone density (around 20-30% over the course of 10 years). Specific fracture risk varies based on age, gender, genetics, ethnicity, and overall health.

Why are people with osteopenia at a higher risk of hip fracture?

1. Decreased Bone Density: Osteopenia is characterized by lower bone mineral density compared to healthy bone. This decrease in density means bones are weaker and less able to withstand normal stress, making them more susceptible to fractures.
2. Increased Fragility: Bones affected by osteopenia are more brittle, which can result in fractures from falls or even minor impacts that would not affect healthier bones.
3. Age-Related Factors: Osteopenia often occurs in middle aged and older adults, who may already have decreased muscle strength, balance, and coordination. These factors increase the likelihood of falls, which are a common cause of hip fractures.
4. Menopausal Changes: Hormonal changes and symptoms arising from perimenopause can create disruptions in fitness routines and sleep quality, contributing to the onset of osteopenia. Read more: Everything You Need to Know About Menopause.
5. Reduced Physical Activity: Many individuals with osteopenia may engage in less physical activity, or select less robust exercise options, due to fear of falling or fear of fracture. Unfortunately, this fear avoidance leads to further declines in strength and bone density and increases the risk of falling. 

Exercise is Effective for Reversing Osteopenia in Hips

Exercise bolsters the body’s ability to build bone in two ways:

1. Mechanically: Strength building exercises place deliberate, gradually increasing forces on your muscles, tendons, and bones. Resistive exercise forces drive adaptation to increase the thickness and durability of these tissues, thereby decreasing the risk of falls and fractures. 
2. Metabolically: Strength and cardio conditioning exercises improve whole-system health, decrease the risk of disease, and improve the ways your body utilizes fuel for energy. This bolsters your system on every level to help improve bone health. 

Learn more about the role physical therapy can play in helping you reverse osteopenia in your hips: Physical Therapy for Osteoporosis and Osteopenia

Weight-Bearing Exercises for Hip Bone Health

You’re going to get the best bang for your bone building buck performing land based, weight-bearing exercises. This means standing up, on your legs, on the ground. While swimming, cycling, and rowing are excellent choices for improving aerobic fitness, they will do little to help reverse osteopenia in the hip due to lower weight-bearing forces on the bones of the legs.

Even exercises like yoga, Pilates, and walking can only help to a small extent. One of the major risk factors in developing osteopenia in the hip is low body weight. Performing exercise with your own body weight or very light resistance from Pilates equipment is not going to provide a strong enough adaptive signal to stimulate bone growth. Read more: Weight Lifting for Bone Density.

Only those who have been sedentary will see benefits for beginning a walking, yoga, or Pilates program and those benefits will taper off and plateau after about 6-12 months of repeated exposure. 

Three Best Exercises for Osteopenia in Hips

I’m a physical therapist and strength & conditioning coach who specializes in helping peri-menopausal and postmenopausal women build muscle and bone after decades of bodyweight practices like walking, yoga, and Pilates. 

For anyone setting foot in my clinic for the first time, whether they are coming for physical therapy, strength coaching, or a small group class, I start them on their strength training journey with some scalable version of the three exercises below. 

These are all standing exercises that can be done with minimal equipment, can be gradually progressed over time, and provide maximum bone building stimulus to the hip, specifically the femoral neck.

This program of three exercises is an example for educational purposes. The exercise selection below does not replace individualized evaluation and prescription. Always consult with your doctor, physical therapist, or other health care provider before beginning a new exercise program. 

Twice Weekly Hip Bone Building Plan:

1. Goblet Squat to Chair Seat

Goblet Squat to Chair Seat How To: 

• Place a firm, sturdy chair up against a wall for stability.
• Begin seated at the front edge of the chair seat with your feet a bit wider than your hips and slightly turned out.
• Hold a weight with two hands, high up by your chest, and a little bit out in front of you. 
• Lean forward and stand fully upright. 
• Then, lean forward again to sit your back toward the chair. Pause for a moment as your seat makes contact with the chair seat and stand up again. 
• Start with a weight that feels comfortable and challenging for 3 sets of 10 repetitions. 

Why this squat variation improves bone density in the hip:

• Sitting back to a chair seat creates a strong hip and glute muscle action that places force through the bones of the thigh, pelvis, and low back. 
• There is a large motion at the hip joint, from standing fully upright to deep hip flexion. A large excursion of motion, combined with the resistance forces of body-weight and external weight increase load on the hip in all joint positions.

Bonus benefits of performing this exercise:

• Strengthen the muscles that support your hip joints, knee joint, and low back to decrease pain related to hip arthritis, knee arthritis, and relieve low back pain. 
• Maintain functional independence in daily activities like transitioning from sitting to standing and using the toilet. 
• Build overall lower body strength and muscle mass. Read more about these benefits: Boost Your Health by Packing More Muscle on Your Legs. 

2. Kickstand Deadlift (sometimes called “B stance” deadlift)

Kickstand Deadlift How To: 

• Stand up holding two equal weights by your sides with your arms straight.
• Step one foot back a small amount (about one foot’s length) with your feet hip width apart or wider for increased stability.
• Keep your front foot flat on the floor, as it will receive most of your weight.
• Lift the heel on your back foot and attempt to keep the ball of this foot light on the floor. Ideally, the back foot is for balance support (hence the name “kickstand”) and not receiving much of your weight.
• With a small bend in both knees, hinge at your hips to lower the weights part way down your front shin. Keep the weights close to your shin and avoid letting them get too far out in front of you.
• Once you’ve reached a comfortable and challenging depth, press down into your front foot and return to the upright standing position.
• Make sure you come up all the way with your torso fully upright, your front hip stacked over your front ankle, and the hip fully extended.
• Start with a weight that feels comfortable and challenging for 3 sets of 8-10 repetitions on each side.

Why this deadlift variation is a good choice for reversing osteopenia in the hip:

• As with the squat variation above, this exercise targets the hip joints and surrounding muscles, especially the ones in the back (glutes, hamstrings, and back muscles).
• The kickstand deadlift is a variation on the single leg deadlift. Unlike the single leg deadlift, with the kickstand you receive added balance support from the back foot in contact with the ground through the entire motion. This makes the position stable enough to add more weight resistance than you might standing fully on a single leg.
• Because this is a single leg exercise, you will target the muscles that support your balance while standing on one leg, and increase the overall weight demand (body weight plus external weight) on a single hip. 
• The single leg set-up is a great option for getting more femoral neck loading with less weight through the hands, arms, shoulders, and back. Also valuable if you are limited by the weights available to you (get more direct hip loading out of your lighter dumbbells). 

Bonus benefits of performing this exercise:

• There is some dynamic balance challenge and a major hip strength challenge. Both improve your ability to avoid falls.
• Single leg hip strengthening exercises improve your performance of daily activities like walking and going up and down stairs.
• Strengthen the muscles that support your hip joints and low back to decrease pain related to hip arthritis, gluteal tendinopathy, and relieve low back pain. 

3. Squat Landings

Squat Landings How To: 

• Stand with your feet hip width apart, holding your hands together in front of your chest.
• Hop up a small amount and land in a squat position with your feet wide and toes turned out slightly.
• Return to an upright standing position, re-set your feet hip width apart, and repeat.
• Please note: These are not intended to be continuous squat jumps. Pause for a few seconds in the upright position between each squat landing. The most important aspect is the impact upon landing in the squat which creates a high force on the bones of the hip joints.
• Repeat 3 sets of 5 jumps with body weight only to begin. 
• As you gain exposure to body-weight forces over several weeks, gradually add two weights held by your sides. 

Why this jumping exercise is effective for building bone at the hip:

• It’s accessible! You don’t need any equipment to get started and you don’t need to be able to jump up very far, only land. 
• The landing impact while also in a deep squat places high forces on muscles and bones at the hip, building them up over time.

Bonus benefits of performing this exercise:

• Improve power, the ability to generate force quickly. Power is the quality that declines earliest and most rapidly with age.
• Heavy landings in practice carry over to safer landings in the real world. Improve your tissue durability and ability to withstand sudden forces without injury.

Learn more about jumping for bone density here: Weight Lifting for Bone Density. Scroll down to the paragraph, “What’s better for building bone density, weight lifting or impact training?”

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Ready to start your weight lifting for bone density journey?

If you’re picking up what I’m putting down and could use some individualized support, here are two ways you can work with me.

1. Physical Therapy for Osteoporosis and Osteopenia

If you are local to New York City (Nomad, Flatiron, and Chelsea neighborhoods), come see me for physical therapy. I’ll conduct a thorough clinical examination that covers whole-system health factors as they relate to common musculoskeletal complaints in menopause and post-menopause, a movement screen and physical exam, as well as advice for implementing a strength training program to prevent and treat osteoporosis. Practice Human proudly accepts Medicare and works out-of-network with most insurance plans.

2. Small Group In-Person Strength Classes for Women with Osteopenia

For those local to New York City (Nomad, Flatiron, and Chelsea neighborhoods), Weight Training for Yoga is is designed for yoga teachers and long-time students of yoga who are interested in learning the fundamentals of weight training—including programming, rationale, and equipment options—in a small group environment.

Next on your reading list: Weight Lifting for Bone Density