Osteoporosis and osteopenia

Also called: Low bone density; thin bones

Exercise is the main treatment Strength Balance

Bone that has lost mineral and become fragile, silently, until something breaks. Bone responds to mechanical strain and to nothing else nearly as well - which makes loading it the only intervention that builds it as well as protecting it.

How common: Roughly 19% of women over 50 have osteoporosis and about half have low bone mass

Open the Strength & Bone for Aging routine All problems

What it is

Bone is living tissue in constant turnover, and how much it keeps is governed largely by the strain put through it. Without loading, resorption outpaces formation and density falls. Oestrogen restrains that resorption, which is why loss accelerates sharply after menopause.

The condition is silent until a fracture, and the fractures that matter - hip, spine, wrist - carry serious consequences. A hip fracture in an older adult substantially raises the risk of death within a year, which is why prevention is worth taking as seriously as the treatment of the fracture itself.

What it feels like

Nothing at all, until something breaks
A fracture from a fall that should not have caused one, or from no fall at all
Height loss over years, sometimes several centimetres
A gradually increasing curve of the upper back
Sudden severe back pain, which can be a vertebral compression fracture

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Lack of mechanical strain: Bone adapts to the loads placed on it. Without impact or heavy loading it has no reason to maintain density, and it does not. This is the single most modifiable factor.
Oestrogen loss at menopause: Oestrogen restrains bone resorption. Its withdrawal at menopause produces rapid loss - often several per cent a year for the first few years - which is why postmenopausal women are the largest risk group.
Age: Bone formation slows with age in both sexes. Men are affected too and are substantially under-diagnosed, partly because it is thought of as a women's condition.
Low calcium and vitamin D: Calcium is the raw material and vitamin D is what allows it to be absorbed. Deficiency in either limits what any amount of loading can build.
Corticosteroids: Long-term or repeated steroid courses are one of the most common causes of secondary osteoporosis, and the loss is fastest in the first months of treatment.
Smoking and alcohol: Both reduce bone density measurably and independently. Smoking also lowers oestrogen and brings menopause forward.
Low body weight and low energy availability: Very low body weight, eating disorders and the relative energy deficiency seen in some athletes all suppress bone formation and, in women, menstrual function - which removes the oestrogen protection early.
Medical conditions: Coeliac disease, inflammatory bowel disease, rheumatoid arthritis, overactive thyroid and chronic kidney disease all contribute, mostly through inflammation and absorption.
Family history: A parent with a hip fracture roughly doubles risk. It is one of the strongest single predictors and it is a reason to be assessed earlier rather than a reason to accept it.
Long periods of immobility: Bed rest, immobilisation and reduced mobility cause rapid bone loss - faster than the age-related rate by a wide margin.

Who tends to get it

Postmenopausal women, particularly in the first decade after menopause
Anyone who has taken corticosteroids long term or repeatedly
People with a parent who fractured a hip
Anyone with a fracture from a minor fall after the age of about fifty
Men over seventy, who are commonly overlooked

What makes it worse, and what settles it

Makes it worse

Long periods of inactivity or bed rest, which accelerate loss substantially
Doing only swimming or cycling, which are excellent exercise and do almost nothing for bone
Smoking and regular heavy drinking
Very low body weight or chronic under-eating
Avoiding loading out of fear of fracture, which removes the only stimulus that builds bone

Settles it

Progressive resistance training, heavy enough to be a genuine stimulus - this is the intervention that builds bone rather than only slowing loss
Impact loading where it is safe - hopping, jumping, brisk walking with heel strike
Adequate calcium and vitamin D, checked rather than assumed
Balance training, because preventing the fall prevents the fracture
Stopping smoking and moderating alcohol

What actually helps

The short version: Bone loses mineral without mechanical strain; estrogen loss accelerates it after menopause

Strength work: Heavy compound lifting - deadlift, squat, overhead press at high intensity plus impact work; Legs: Quads; Back: Spinal Erectors; Glutes; Full Body

Stretching: Avoid loaded end-range spinal flexion

Massage: General relaxation only

Also worth doing: Impact - jumping or heel drops; balance work to prevent the fall that causes the fracture

What the evidence says: LIFTMOR RCT: 8 months of twice-weekly high-intensity resistance and impact training increased lumbar spine BMD and was safe and well tolerated in postmenopausal women with osteopenia and osteoporosis.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineStrength & Bone for Aging

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

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Get it checked if…

Known vertebral fracture, very low T-score or recent fracture needs supervised programming; avoid loaded spinal flexion and twisting under load

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Density changes slowly - it takes six to twelve months of consistent loading to show on a scan, and the gains are modest in percentage terms. The fracture risk reduction is larger than the density change suggests, because strength and balance prevent falls in the first place. Exercise works alongside medication rather than instead of it, and in established osteoporosis the programme should be designed with someone who knows the condition: heavy spinal flexion and twisting under load carry real risk of vertebral fracture.

Prevalence basis: DXA-based national estimates

Others the same routine covers

These share the Strength & Bone for Aging routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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