Strength training for bone density in menopause: what works
How resistance and impact training support bone in perimenopause and menopause, what the LIFTMOR trial found, and how to progress safely.
Eggsports Editorial8 min read
Quick take: Bone responds to load. UK experts recommend progressive strength training on two or three days a week, plus moderate impact such as jogging or hopping on most days when it suits you. In a trial of women with low bone mass, carefully supervised heavy training improved bone density at the spine and hip.
Bone is living tissue. It's constantly being broken down and rebuilt, and it adapts to what you ask of it. Around menopause, that rebuilding shifts, and strength and impact training become some of the most useful things you can do for your skeleton. This is one of the clearest places where movement makes a measurable difference, at any age.
Why does bone density change around menopause?
The Study of Women's Health Across the Nation (SWAN) followed women of several ethnic backgrounds as they went through menopause. Bone loss at the spine and hip began about a year before the final menstrual period and slowed, though it didn't stop, about two years after it.[1] Over the 10 years studied, average bone density at the lower spine fell by 10.6%, and 7.38% of that happened during those three transitional years.[1]
Those numbers can sound alarming. The useful part is what they point to: this is a window when what you do matters. A meta-analysis of 11 trials found that programmes combining different types of exercise helped preserve bone density at the spine, hip and whole body in postmenopausal women.[5]
The science: The SWAN bone study in detail
The analysis included 862 women (242 African American, 384 white, 117 Chinese and 119 Japanese) who were pre- or early perimenopausal when they joined and whose final period could be dated.[1]
At the femoral neck (part of the hip), cumulative 10-year loss averaged 9.1%, with 5.8% lost during the transition. A higher body mass index and African American heritage were linked to slower loss, while Japanese and Chinese ancestry were linked to faster loss.[1]
What kind of exercise builds bone?
The UK consensus "Strong, steady and straight" recommends resistance and impact exercise to maximize bone strength, and notes that the combination of impact and progressive resistance training best promotes bone strength.[3] It also points out that general aerobic exercise may not include enough loading through the skeleton to increase bone strength.[3]
Intensity matters. A meta-analysis of 53 trials in postmenopausal women found that high-intensity exercise had a larger effect on spine bone density than low or moderate intensity, and that resistance training, possibly combined with impact, appeared to be the most effective stimulus for the spine and hip.[4]
Exercise also does something medication can't. Targeted training is the only strategy that improves bone and fall-related risk factors such as muscle strength, power and physical function at the same time.[6]
| Type of exercise | What it does for bone | Examples | How often |
|---|---|---|---|
| Progressive resistance training | Strongest evidence for spine and hip | Squats, hip hinges, lunges, step-ups, rows, presses | 2 to 3 days a week, building to 3 sets of 8 to 12 heavy reps |
| Moderate impact | Quick, brief loads that bone responds to | Jogging, hopping, stamping, skipping, small jumps | Most days, about 50 impacts, such as 5 sets of 10 |
| Back extensor strengthening | Supports posture and the spine | Lying face down and lifting your chest slightly, standing back extensions | At least twice a week, 3 to 5 reps held for 3 to 5 seconds |
| Balance work | Makes falls, and so fractures, less likely | Single-leg stands, tai chi, dance | At least twice a week |
| Brisk walking | Heart and mood; light bone loading | Walks, hikes, stairs | Most days, alongside the above |
The frequencies come from the UK consensus.[3] The WHO separately recommends muscle-strengthening activity on two or more days a week for all adults.[7]
What did the LIFTMOR trial find?
For years, heavy lifting and impact were considered too risky for people with low bone mass. The LIFTMOR trial in Australia tested that assumption directly. Women with low bone mass, average age 65, were randomized to either supervised high-intensity resistance and impact training or a low-intensity home programme.[2]
After eight months, spine bone density rose by 2.9% in the training group and fell by 1.2% in the home group. At the femoral neck it rose by 0.3% versus a fall of 1.9%. The training group also improved in every functional test, and even gained a little height.[2]
Before you load a barbell, note the context. Participants were screened, otherwise healthy, and trained under close supervision with careful technique coaching. The lesson isn't to lift heavy alone tomorrow. It's that bone can respond strongly at this stage of life, and that with good guidance and gradual progression, heavier loads are a realistic goal.
The science: How LIFTMOR was designed
Participants were postmenopausal women with T-scores below -1.0, screened for conditions and medications that affect bone. The training group did twice-weekly, 30-minute supervised sessions of 5 sets of 5 repetitions at more than 85% of their one-repetition maximum, alongside impact training.[2]
Compliance was high (92% in the training group, 85% in the control group). The single adverse event was a minor lower back spasm that cost two missed sessions.[2]
How do you start strength training if your bone density is unknown?
You don't need a scan to begin. The UK consensus concluded that exercise is unlikely to cause a fracture, and that there's little evidence of significant harm from physical activity.[3] It recommends lower intensity with good technique before increasing intensity, and individual advice from a physiotherapist when starting a new programme.[3]
The same statement recommends avoiding postures with a high degree of spinal flexion, especially weighted, in exercise and daily life, and favours a positive "how to" approach over long lists of things not to do.[3] Its guiding idea for bending and lifting is "think straight": keep your upper back long and your neck in line with your spine, and hinge from the hips.[3]
A simple starting set, done two or three times a week:
- Sit-to-stand from a chair, slowly, without using your hands if you can.
- Hip hinge with a broomstick along your back, touching your head, upper back and tailbone.
- Wall or counter push-ups.
- Band rows or rows with a light weight, squeezing your shoulder blades back.
- Step-ups onto a low step.
- Calf raises, holding a counter for balance.
- Back extensions: lying face down, lift your chest slightly and hold for 3 to 5 seconds.
How should you progress over weeks and months?
The UK consensus describes progressive resistance training as the maximum weight you can lift 8 to 12 times, building up to three sets for each exercise, and targeting all muscle groups, including the back.[3] For people without vertebral fractures, it recommends brief bursts of moderate impact, about 50 impacts with easier movement in between, such as a walk-jog.[3]
| Stage | Strength | Impact |
|---|---|---|
| Weeks 1 to 4 | Learn the movements with bodyweight or light weights; 1 to 2 sets of 10 to 12 | Heel drops and stamping, a few sets of 10 |
| Weeks 5 to 12 | Add load until the last few reps feel hard; build to 2 to 3 sets of 8 to 12 | Add small hops on the spot or a short walk-jog |
| Month 3 onward | Keep adding small amounts of load; consider supervised heavier training | About 50 moderate impacts on most days, such as 5 sets of 10 |
On days after a poor night or with achy joints, it's fine to repeat last week's loads or swap to mobility and balance. The bone-health movement planner can help you balance strength, impact and balance across your week.
When should you get advice before lifting or jumping?
The UK consensus recommends that people with a vertebral fracture or multiple low-trauma fractures usually keep impact to an intensity no higher than brisk walking, aiming for around 150 minutes over the week, while still doing strength and balance training.[3] Gradual, individually tailored progression under supervision is often appropriate.[3]
UK guidance also asks clinicians to discuss bone health with people going through menopause and to explain the importance of maintaining muscle mass and strength through physical activity.[8] If you're unsure about your fracture risk, that's a good conversation to start with your doctor.
Stop and seek medical advice if you feel sudden, severe back pain, especially after a lift or a minor fall.
Bone is patient and so is this work. Every set you do is a message to your skeleton, and it listens. For the partner skill to strong bones, read balance and fall prevention, or go back to the full perimenopause and menopause guide.
Frequently asked questions
Is walking enough to protect my bones?
Walking is excellent for your heart and mood, and it's the right level of impact for some people. On its own, though, it may not load bone enough to build strength. UK experts recommend adding progressive strength training and, where suitable, moderate impact such as jogging, hopping or stamping.
Can I lift heavy weights if I have osteopenia or osteoporosis?
Many people can, with the right support. In the LIFTMOR trial, women with low to very low bone mass trained heavy under close supervision and improved their bone density with only one minor adverse event. UK guidance recommends individual advice from a physiotherapist at the start, and extra care if you've had a spinal fracture.
How long does it take to see a change in bone density?
Bone adapts slowly, so trials usually run for many months. LIFTMOR measured its results after eight months of training twice a week. Think in seasons rather than weeks, and notice the other changes along the way, like carrying shopping more easily or rising from a chair without using your hands.
Are yoga and Pilates good for my bones?
They're valuable for balance, posture and strength, and UK experts include them among activities to do at least twice a week to reduce falls. They don't replace progressive strength and impact work for bone. If your bone density is low or unknown, skip or adapt poses that round your spine deeply, especially under load.
Sources
- Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ, et al. (2012). Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). Journal of Bone and Mineral Research. doi:10.1002/jbmr.534
- Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR (2018). 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. doi:10.1002/jbmr.3284
- Brooke-Wavell K, Skelton DA, Barker KL, Clark EM, De Biase S, Arnold S, et al. (2022). Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. doi:10.1136/bjsports-2021-104634
- Kistler-Fischbacher M, Weeks BK, Beck BR (2021). The effect of exercise intensity on bone in postmenopausal women (part 2): A meta-analysis. Bone. doi:10.1016/j.bone.2020.115697
- Zhao R, Zhang M, Zhang Q (2017). The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2017.6969
- Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW (2019). Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Brazilian Journal of Physical Therapy. doi:10.1016/j.bjpt.2018.11.011
- Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. doi:10.1136/bjsports-2020-102955
- National Institute for Health and Care Excellence (2015). Menopause: identification and management (NICE guideline NG23). NICE. www.nice.org.uk/guidance/ng23
Wellness information, not medical advice. Read our editorial policy.
Keep reading
Does exercise help hot flashes? What the evidence really says
The honest evidence on exercise and hot flashes in perimenopause and menopause, plus practical ways to stay comfortable when you move.
Joint pain in perimenopause: why it happens and how movement helps
Aches and stiffness are common in perimenopause. What the research says, how mobility and strength work can help, and when to see a doctor.
Balance training in menopause: why it matters and how to start
Why balance is worth training in perimenopause and menopause, what the falls research shows, and simple progressions you can practise at home.