Weight lifting for bone density is one of the most effective, research supported strategies for slowing and reversing age related bone loss. Bones respond to progressive resistance and impact by adapting to new mechanical forces, which is why appropriately heavy strength training matters more than low load activity alone.
Menopause, reduced muscle mass, and decreased loading in daily life accelerate bone loss, making progressive overload essential. In my physical therapy practice, I help women use simple, whole body strength training to safely build stronger bones and maintain independence.
Strength training also supports balance, metabolism, cognitive health, and injury resilience, making it a high return investment for long term function. Starting with challenging but manageable weights and gradually progressing creates the stimulus bones need to adapt.
Have you received a diagnosis of osteopenia or osteoporosis?
Many of the patients I see in my physical therapy practice and small group strength classes for women ages 65+ are active New Yorkers. They walk 6,000 – 10,000 steps a day and have been practicing yoga for decades. These clients typically have a similar reaction after receiving the results for their first DEXA scan that shows osteopenia or osteoporosis: They are pissed off and want to know what they can do about it.
If you’ve been diagnosed with osteopenia or osteoporosis, there’s no time to waste in getting started with methods that actually work. Methods that will save you a lot of time and unnecessary effort.
There are two researched-backed strategies for building stronger bones with exercise
- Progressive Resistance Exercise: Lifting weights that are appropriately heavy (for you, right now) and gradually increasing the weight, or reps, or both over time.
- Power and Impact: Applying forces to the body with speed, bouncing, jumping, and landing.
Women’s health in menopause is saturated with unhelpful advice
There’s a lot of noise out there, my friend.
By noise I mean too much emphasis placed on things that probably don’t matter very much in the movement and exercise space.
I often encounter beginners plagued by optimization paralysis—feeling like everything needs to be perfect before even getting started. When is this ever possible in learning something new?!
Optimization advice gets particularly convoluted when it comes to women’s health, menopause related changes, and building stronger bones.
The internet (my niche corner of the internet, anyway) is oversaturated with bone building programs that emphasize a whole long list of qualities that “need to be addressed” with the aim of improving bone density.
The list often includes things like:
- Posture
- Mobility or flexibility
- Core stability
- Coordination
- Agility
- Muscle activation
- Balance
- Falls prevention
- Walking strength and endurance
I’ve seen programs that complicate movement and exercise so much that it’s suggested one must focus on each of these qualities individually.
Focusing on all of these different qualities makes for a behemoth of an exercise plan that is confusing, hard to learn, offers too much variety to make any real progress in strength, and isn’t going to provide the resistance stimulus needed to make any meaningful change in bone density.
While it’s wonderful to spend some time improving these qualities if you enjoy it and it aligns with your specific goals, this type of training plan will have you spending hours every week spinning your wheels with little to no reward in actually building bone.
There’s no time to waste in getting started with weight lifting for bone density
Unfortunately, a lot of so-called bone building programs out there will encourage you to focus on training qualities that don’t improve bone density as a prerequisite to even getting started with strength training.
This is a major bummer.
If you’ve been diagnosed with osteopenia or osteoporosis, there’s no time to waste in getting started with methods that actually work. Methods that will save you a lot of time and unnecessary effort.
Want to know what is supported by research for building stronger bones?
Strength training.
Want to know what also improves posture, mobility, flexibility, core stability, coordination, agility, muscle activation, balance, falls prevention, and walking strength and endurance?
You guessed it. Strength training.
Not only could you be doing a simple program of 3 or 4 whole-body strength exercises twice a week to improve all of these qualities in one shot and actually benefit your bones, strength training is supported by research to improve these big deal health measures:
- Sustains functional independence
- Improves metabolism
- Helps manage blood sugar
- Decreases risk of cognitive decline
- Improves immune function
- Makes everyday life feel easier
- Boosts mood and helps manage anxiety and depression
- Mitigates injuries and helps you bounce back faster after injury
- Decreases aches and pains with daily activities
Add a bit of power (a version of strength training that involves moving light to moderate weights or your own bodyweight with speed) and you’ve got the biggest bang for your buck in improving your walking speed, decreasing your risk of falling, and staving off one of the first and fastest age-related declines in functional ability: Quick, responsive balance correction.
Plus, you’ll go from fragile and afraid to feeling like an indestructible badass. So that’s fun.
How do I know I’m lifting heavy enough weight, doing the right amount of sets/reps, or doing the right form of impact training to build bone?
First off, it’s important to understand a few concepts from exercise physiology as they relate to the ways forces on muscles and bones create adaptation for stronger bones.
Bones grow stronger in response to novel forces
Mechanical stimulation is vital to maintaining and improving bone health. Bones are mechanosensitive. This means that they “pay attention” to new and unfamiliar forces placed upon them.
Normal age-related changes that result in loss of bone density include:
- Loss of strength and muscle mass
- Decreased estrogen in menopause (read more here)
- A reduced level of bodyweight loading, and decreased lifting/carrying in daily activities from becoming more sedentary overall
Bone cells respond to mechanical stress by way of:
- Muscle contractions that make the tendons pull on the bones. This can be achieved with slow, moderate to heavy weight lifting.
- Quick muscle contractions that apply sudden, high intensity forces on bone. Acquired through fast motions like bouncing, moving weight with speed, sprinting, jumping and landing.
- Impact forces. The stress placed on bone when landing from any height.
The stubborn thing about bones is that they only “pay attention” to novel forces.
Your bones have become bored with the same old activities you’ve been doing all this time. Sorry to be the bearer of bad news, but your yoga and walking routines aren’t going to keep pace with normal age related bone loss. And doing more of the same won’t help.
Weight lifting for strength and bone density requires progressive overload
Progressive overload is an important concept to understand when you begin a new strength training routine. In short, it means that you must gradually increase the weight you are lifting (intensity), or the number of sets/reps you’re doing (volume) over time to send a strong enough adaptive signal to your body to build strength and improve thickness/density in muscles, tendons, and bones.
If you’ve been lifting weights that are too light for too long, or have only been bearing your own body weight, you’re at best maintaining your current strength. At worst, you’re losing strength because the resistance exercise you’ve been doing fails to keep pace with unchecked strength loss as you age.
Progressive overload means that as soon as an exercise begins to feel too easy, it’s time to squeeze out a couple extra repetitions or increase the weight so that it feels appropriately challenging again.
But how do you know how much weight to lift, and how many sets and reps to do?
Reps in reserve can tell you if you’re currently lifting the appropriate amount of weight for strength adaptation
This is a skill that takes time, experience, and—errrr—reps to figure out for yourself. Determining reps in reserve is a matter of asking yourself this question:
“How many repetitions do I have left in the tank after I’ve completed my set?”
For most people with a goal to build strength, I recommend training with 1-2 reps in reserve.
For example, if my aim is to complete 3 sets of 10 repetitions for a particular exercise, I would ask myself at the end of 10 reps, “how many more do I think I could complete?”
If I can do 11 and then add an iffy 12th rep, but definitely not 13, I have 2 reps in reserve. 2 repetitions that I could have barely squeezed out but I stopped at 10 so that I have energy to complete 3 or more sets of 10 repetitions.
Reps in reserve is a guess. A guess that becomes more accurate with practice.
It’s also a guess that could be tested by doing a max reps test. Every once in a while when the weight is feeling easy, I recommend doing your second set to failure, where you truly can’t complete the last rep. This is a check to see how many reps you actually can do, which may come as a surprise. Completed 23 reps and it’s feeling fatiguing but still pretty comfortable? Whoops! Time to increase the weight and decrease the reps to the 10-15 rep range (or fewer reps).
Long story short: A good rule of thumb for a beginner is to complete 3-4 sets of an exercise with 8-10 repetitions, leaving only 1 or 2 reps in reserve.
This is the sweet spot.
If the resistance is appropriately heavy to leave you with only 1 or 2 reps in reserve, it’s a heavy enough weight to make gains in strength, muscle mass, and bone density.
Time of day and duration of exercise matter when using impact to stimulate bone
Back to this idea of bones being mechanosensitivity—getting stronger in response to forces…
Bones are the most mechanosensitive first thing in the morning because you’ve spent the whole night non-weight bearing. For this reason, you’re going to get more out of impact training for bone density if you do it early in the day (before walking or doing other activities).
Further, bones get bored and stop “listening” / stop adapting to repetitive forces when they are exposed to more of the same. It’s novel forces that are important for maintaining and improving bone health. For this reason, long duration cardio exercise will do little to improve bone density.
While endurance cardio like brisk walking or jogging for 30-60 minutes is extremely beneficial across multiple fitness and health measures, only the first 1-2 minutes of that weight bearing activity will help to improve your bone density.
It’s counterintuitive, I know. This is a major case of more is not better, better is better.
A short hopping session with bouncing and/or slightly heavier landings than what you get with walking, done early in the day, will give you the best bone building stimulus.
What’s better for building bone density, weight lifting or impact training?
While both strength and impact training are supported by research for improving bone density, I typically recommend lifting weights with progressive overload as your best, most accessible first option.
Impact and power training are highly beneficial for anyone at any age, especially as people are aging and rapidly losing power (the ability to move with speed). However, there are a few more barriers for entry with these particular skills.
- The forces are higher and more difficult to scale appropriately in the beginning with impact and power training.
- Common joint pain conditions, such as knee osteoarthritis or tendon pain, may make jumping and landing inaccessible early on.
For this reason, I recommend focusing on resistance exercise with weights as there’s always something you can do as an on-ramp towards other exercise options in the future.
There are no prerequisites for strength training!
You can begin right now. At any age. Exactly the way you are.
You can begin working confidently and effectively on building bone density with progressive resistance exercise. It’s all about starting with weight that feels appropriately challenging and gradually progressing from there.
You can do any version of the basic movement patterns: Squat, lunge, hip hinge, push, and pull. Start with a weight that feels moderate, successful, comfortable. Gradually build up the weight over time.
Ignore the people who try to sell you a program that argues the need to focus on all of these things before strength training with weights: Posture, mobility, flexibility, core stability, coordination, agility, muscle activation, and balance.
Nope. You can just start strength training.
Strength training will improve all of these things.
Trust your body’s ability to adapt and self-organize.
The weight clarifies the form. The added resistance informs direction of motion. Training with weights will demand that your body self-organize for greater efficiency and better force output.
The options available to you will expand… with practice.
The resistance will make your form more efficient… with practice.
So how do you get started? Start… and practice.
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 Osteoporosis
For those local to New York City (Nomad, Flatiron, and Chelsea neighborhoods), Durability for Life is Practice Human’s signature small group strength training course. Designed for women ages 65+ who want to feel more confident and capable in daily life and with more demanding physical activity. Appropriate for people with osteopenia, osteoporosis, knee and hip arthritis, and persistent low back pain. Led by physical therapist and strength & conditioning coach Caitlin Casella.
Next on your reading list: Everything You Need to Know About Menopause
