Bone Health and Strength Training: What the Guidance Says
Bone responds to load. The mainstream UK guidance on bone health asks for two things: muscle-strengthening exercise on two or three days a week, worked hard enough that the last few repetitions are genuinely difficult, and some form of impact, such as brisk stepping, small jumps or stair work, on most days if your bones and joints allow it. Walking and swimming are good for you, but on their own they do little for bone. The load has to be more than your skeleton is used to, it has to progress over months, and it has to keep going, because bone adapts slowly and loses its gains when the stimulus stops.
Why bone needs load at all
Bone is living tissue that is constantly broken down and rebuilt. When muscles pull hard on it, or when the ground pushes back through your heels, bone cells sense the strain and lay down more material where it is needed. When the strain disappears, the body quietly removes what it no longer thinks it needs. Astronauts and people on long bed rest lose bone for exactly this reason.
Two features of that process shape how you should train. First, bone responds to strain that is unusual, not strain that is familiar. A daily walk you have done for ten years is not news to your hips. Second, it responds better to relatively high loads for few repetitions than to light loads for many. Twenty reps with a 2kg dumbbell builds some endurance; it is a weak signal to the skeleton.
What the UK guidance actually recommends
The most useful document here is the Royal Osteoporosis Society’s consensus statement, Strong, Steady and Straight, written with clinicians and exercise scientists for people with or at risk of osteoporosis. The NHS gives broadly the same advice on its osteoporosis prevention page. Stripped down, the recommendations are:
- Strong: muscle-strengthening exercise two to three days a week, building up to loads that feel hard by the end of a set of around eight to twelve repetitions, progressed gradually.
- Impact: moderate impact on most days for people who can tolerate it, such as heel drops, stamping, jogging on the spot, skipping or stepping. People with vertebral fractures or frailty are advised to keep to lower-impact options.
- Steady: balance and coordination work, because fewer falls means fewer fractures, which is the outcome that matters.
- Straight: good posture and spinal extension strength, and care with movements that load the spine in deep flexion if you already have spinal fractures.
This sits on top of the UK Chief Medical Officers’ general advice for all adults: strengthening activity on at least two days a week, plus 150 minutes of moderate activity across the week. The bone-specific guidance simply tells you what kind of strength and impact work is worth doing.
What “heavy enough” means in practice
Most people who say they do strength work for their bones are using weights that are too light. A useful test is reps in reserve: at the end of a set, how many more clean repetitions could you have done? For bone and muscle, you want most working sets to finish with one to three left in the tank. If you could have done ten more, the set was a warm-up.
The exercises that load the hips and spine most usefully are the big standing movements:
- Squat variations: goblet squat first, then a barbell back or front squat when technique is solid.
- Hip hinges: Romanian deadlift and trap-bar or barbell deadlift.
- Loaded carries: a heavy dumbbell in each hand, walked with good posture.
- Overhead press: standing, so the load travels through the spine and legs.
- Rows and pulldowns: they build the upper back muscles that help keep you upright.
Wrists and forearms matter too, since a wrist fracture is a common early fracture after a fall. Carries, rows and pressing all load the forearm without needing anything special.
A sample week for a beginner over 40
This is the shape I would use with a healthy adult who has not lifted before and has no diagnosed bone condition. It takes around 45 minutes, twice a week, plus a few minutes of impact on other days.
| Exercise | Sets x reps | Notes |
|---|---|---|
| Goblet squat to a box | 3 x 8 | Box height sets a safe, repeatable depth |
| Romanian deadlift (dumbbells) | 3 x 8 | Hinge at the hips, neutral spine |
| Seated cable row | 3 x 10 | Squeeze the shoulder blades, sit tall |
| Standing dumbbell press | 3 x 8 | Ribs down, no leaning back |
| Farmer’s carry | 3 x 30 metres | Heavy enough that grip is the limit |
| Single-leg balance | 3 x 30 seconds each side | Near a rail, then without |
On three or four other days, add a few minutes of impact: 20 to 50 heel drops (rise onto your toes and drop sharply onto your heels), stair climbing at a brisk pace, or small hops on the spot if your joints are comfortable. Build up over weeks. Impact does not need to be exhausting; it needs to happen often.
Add load whenever every set feels comfortable at the top of the rep range. For most beginners that means small increases most weeks for the first few months. Our guide to progressive overload explains how to do that without guessing.
How long before anything changes
Be patient. Muscle strength improves within weeks, mostly because your nervous system gets better at using the muscle you already have. Bone is much slower. A full bone remodelling cycle takes several months, and changes on a DEXA scan, if they show at all, are measured over a year or more and are often modest. That is not a reason to stop. Holding on to bone density through midlife, when the trend would otherwise be downward, is a good result in itself, and the strength, balance and confidence you build reduce the chance of falling in the first place.
It also explains why consistency matters more than intensity. Two solid sessions a week for three years beat a hard twelve-week block followed by nothing.
Who needs to be more careful
Strength training is recommended for people with osteoporosis, not ruled out, but the details change. If you have a diagnosis or a previous fragility fracture, especially in the spine, avoid sudden loaded twisting and repeated deep forward bending under load, and keep impact lower until a clinician says otherwise. Many people with osteoporosis lift well and safely with the right exercise choices.
Check with your GP first if you have osteoporosis or osteopenia, have had a fracture from a minor fall, are on long-term steroids, have a heart condition, are pregnant, or are returning to exercise after a long break. Women around and after menopause have a particular reason to start: oestrogen helps protect bone, and its fall speeds up bone loss. We cover the wider training picture in weight training after menopause.
Food, vitamin D and the rest
Training is one input among several. Bone needs calcium and protein to rebuild, and vitamin D to absorb calcium. In the UK, the government advises everyone to consider a daily vitamin D supplement in autumn and winter, because the sun is too weak for skin to make enough between roughly October and March. Our post on vitamin D in a UK winter covers the detail. Smoking and heavy drinking both work against bone, and very low body weight or long periods of severe dieting do too.
Training for bone in the studio
Our basement studio on Archway Road has the kit this kind of training needs: a squat rack and barbell, a full dumbbell rack, cable station and lat pulldown, and enough clear floor for carries and balance work. Because the room is booked to you alone, there is no queue for the rack and no audience while you learn to squat. In private 1-1 sessions I choose exercises around any diagnosis your GP has given you, set loads by reps in reserve rather than guesswork, and progress them slowly enough that your joints keep up. If you want to see how a first session runs, the personal training page explains it, and the Highgate House homepage has everything else.
Questions we get asked
Is walking enough to protect my bones?
It helps your heart, mood and balance, but for most adults it is too familiar a load to stimulate bone much. Add strength training twice a week and some brisk impact if you can.
Can I lift weights if I already have osteoporosis?
Usually yes, and the Royal Osteoporosis Society encourages it. Exercise choice matters more, particularly if you have had a spinal fracture, so get your GP’s view and work with someone who will adapt the plan.
Are machines as good as free weights for bone?
Machines load muscles well and are a sensible start. Standing free-weight exercises also load the spine and hips through your own frame and train balance, so most plans use both.
Is it too late to start at 60 or 70?
No. Strength, balance and confidence all improve at any age, and fewer falls is the result that matters most.
Book with The Highgate House
Ready to start training properly? Email us at [email protected] with the service and the day that suits you, and we will come back to you with times.
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