Exercise and sports for people with osteoporosis

Photo of a sports group outdoors

Certain exercises are recommended for the treatment of osteoporosis. They help to keep the bones stable. They also strengthen your muscles and improve your balance. The most suitable exercises will depend on your personal situation.

It is a good idea to keep physically active, both for the prevention and treatment of osteoporosis. Strengthening your muscles and bones improves your mobility and also reduces your risk of falls in older age.

The most suitable choice and frequency of exercises will depend on your personal situation and overall health.

The main aim of doing exercises for osteoporosis is to try to prevent bone fractures. Osteoporosis-related bone fractures can even be caused by strains on the bones that would be harmless for healthy bones. Doctors call them “fragility fractures.”

Wrist or hip (femoral neck) fractures are usually caused by falls. But spinal bones (vertebrae) may already fracture due to excessive or incorrect strain for instance, when lifting something too heavy or the wrong way. Because of this, not all exercises and sports are suitable for women and men with osteoporosis in their spinal bones.

Which activities strengthen the bones?

Activities that repeatedly strain the bones by using your own body weight are especially good for strengthening your bones. These include climbing stairs, jogging and hiking, but not swimming or cycling. Swimming and cycling can have other advantages, and improve stamina and muscle strength, though.

As well as keeping active in daily life, special exercises are also a good idea. They are chosen to strengthen your bones and muscles, and to improve balance. The exercises are not just a good idea for preventing and treating osteoporosis. They can also lower the risk of falls (the main cause of fractures in older age).

What kinds of exercises are a good idea?

The exercises that are suitable for people with osteoporosis depend on various individual factors, including

  • your physical condition (strength, agility, balance and coordination),
  • any other medical conditions, or medications you are using,
  • your risk of falls,
  • your risk of bone fractures, and
  • previous age-related falls or bone fractures.

It is best to talk to a doctor, physical therapist or sports scientist to work out which exercises are suitable for you personally. This is especially important if you have already had osteoporosis-related fractures or have other medical conditions. A medical professional can also test your strength, agility and balance. That can help to get a better overall impression of your physical condition.

Personal preferences are also important when choosing the types of exercises. Exercise should be a regular part of your everyday life, so it’s easier if you enjoy it.

Do exercises make sense if the spine is already affected?

Yes, specific exercises can still help. Strong back muscles are needed for lots of everyday activities, and they can protect the spine.

Isometric exercises are well suited for strengthening the back muscles if you have osteoporosis. Isometric back exercises tense the muscles without the back being bent. That puts less strain on the spine. You can do these exercises lying down on your front or back, or standing or sitting with your back against a wall.

Be careful with exercises that involve bending or twisting your spine

It is best to avoid exercises where you have to curve your back a lot or bend your upper body a long way forward. They increase the risk of vertebral fractures. Those kinds of exercises include common stomach muscle exercises like “sit-ups,” “crunches” and “jackknives.”

Sports where you have to rotate a lot or very quickly (like golf and tennis) are not suitable either. Some yoga and pilates exercises also involve similar sequences of movements. People who do yoga or pilates should let their instructor know about their osteoporosis to find suitable exercises.

Good to know:

It is best to have someone show you how to do the exercises, and to know your limits. Take signals like pain seriously.

Professional advice and instruction is important when finding suitable exercises and learning how to do them correctly.

What kinds of courses are available?

There are various prevention and treatment options for osteoporosis. The statutory insurer coverage mentioned here refers to the situation in Germany. Other countries may have similar offers:

  • Prevention courses offered by statutory health insurers (prevention)
  • Physical therapy instruction (treatment)
  • Functional training courses in groups (treatment)

Prevention and health care courses offered by statutory health insurers include courses to strengthen muscles, bones and joints, as well as to improve balance and coordination, such as tai chi. Some of these courses are also offered online. Statutory health insurers regularly publish information about their courses.

Physical therapy is an option if you have already been diagnosed with osteoporosis. The goal is to learn exercises that you can then do on your own. They might include exercises using your own body weight or using exercise equipment.

Physical therapy is offered individually or in groups. In Germany, doctors can prescribe up to three lots of six 20-minute sessions of physical therapy for people with osteoporosis, or more if there are medical reasons for it. A new prescription for physical therapy can be issued after six months. It is a good idea to learn exercises that you can do on your own over the long term, whether at home or in a gym. You can also learn how to protect your spine in everyday life – for instance, by learning how to lift heavy objects correctly.

Functional training is another option. This is a special kind of exercise class or water aerobics class for people with conditions like osteoporosis. The courses are led by qualified instructors and take place once or twice a week in groups. They include exercises to strengthen the bones and muscles, as well as exercises to prevent falls.

If the course provider has been approved by statutory health insurers, the costs of functional training courses are covered for up to two years. Doctors can prescribe functional training using a special form without it affecting their budget. Regional osteoporosis support groups also organize and offer functional training courses.

What exactly might a training course involve?

The following table shows an example of an osteoporosis training course. It is based on recommendations for the prevention of bone fractures in people with osteoporosis.


These recommendations are intended for people who are otherwise healthy and don’t have any particular limitations. They are only meant to serve as a guideline.

It might be necessary to make adjustments to the training plan if you have other conditions such as arthritis, rheumatism or a heart or nerve disease.

These exercises are not suitable or possible for everyone, either. But even if you can’t do all of them, it is important to keep active and move about as much as possible in everyday life.

Who are these recommendations for?
  • People with osteoporosis who want to prevent bone fractures
  • People with no particular medical limitations
What is the goal of the exercises?
  • Maintain and improve muscle strength, balance and bone stability
  • Strengthen the back
  • Prevent falls and bone fractures
What do you have to keep in mind when doing the exercises?
  • First, it’s a good idea to have a healthcare professional show you how to do the exercises.
  • It is important to do the exercises exactly as instructed.
  • The exercises should be challenging but you shouldn’t overexert yourself.
  • They shouldn't cause any pain – or only cause very little pain.
  • It is best to increase the sets, repetitions, and intensity of the exercises over several weeks.
  • Do the exercises on a non-slip, stable surface with the right shoes.
  • Avoid exercises where you have to bend your back or your upper body too far forward, or that twist your spine.
  • Be careful about doing exercises where falling is likely.
  • Balance exercises: Start off holding on to a rail or stable chair and only increase the difficulty once you have mastered the exercise (especially if there is an increased risk of falls).
  • Build up muscles for several weeks before considering strenuous exercises for bone stability (e.g. jumping exercises).
Muscle strength training: Which exercises are recommended?
Examples (with increasing difficulty):
  • Getting up from a chair without help
  • Calf raises
  • Squats
  • Back-extensor exercises
  • Lunges
How often are muscle strengthening exercises recommended?
  • At least two days per week
  • 6 to 8 exercises per training session
  • Per exercise: 2 to 3 sets of 8 to 12 repetitions each

Illustrations for muscle strengthening

Illustration: Getting up from a chair without help
Illustration: Squats
Balance and coordination training: Which exercises are recommended?
Examples (with increasing difficulty):
  • Standing on one leg
  • Placing your feet next to each other and rocking back and forth on your feet
  • Imaginary tightrope walking
  • Walking backwards or sideways
  • Walking on the balls of your feet
  • Tai chi exercises
How often are balance and coordination exercises recommended?
  • 4 to 7 days per week
  • Time for each exercise: around 30 to 60 seconds
  • Total time: 15 minutes
  • You can incorporate exercises into daily activities, such as standing on one leg when brushing your teeth
  • Start with exercises like standing on one leg and then progress to exercises with movement, like imaginary tightrope walking

Illustrations for balance/coordination

Illustration: Imaginary tightrope walking
Illustration: Standing on one leg
Bone stability training: Which exercises are recommended?
Examples (with increasing difficulty):
  • Going up and down stairs
  • Step-ups using a step-board
  • Jumping onto the floor from a step-board
Depending on your fitness level, also
  • Jogging
  • Hiking
  • Jumping and hopping exercises
  • Skipping
How often are bone stability exercises recommended?
  • At least two days per week
  • Per session: 2 to 3 exercises, or a longer activity such as jogging
  • Per exercise: 3 to 5 sets of 10 repetitions each

Illustrations for bone stability

Illustration: Walking up and down stairs
Illustration: Step-ups using a step-board

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on April 26, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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