Exercising for bone strength: getting started

Since you can't see your bones or skeleton, they're often "out of sight, out of mind" until you break a bone or your doctor mentions that you have low bone density. But being proactive about your bone health will pay off in the future, helping you avoid fractures that may result from osteoporosis.

Exercise is one of the pillars of bone care. When you exercise, your muscles tug on your bones; your body responds over time by strengthening them. Similarly, when you engage in high impact exercise such as running or jumping, the repeated pounding causes the body to build up the bones that bear the brunt of the activity.

However, there are some factors to consider before starting an exercise program to strengthen your bones.

Injuries or health conditions

You should talk to your doctor  before starting to exercise if you have not been active recently or if you have any injuries or a chronic or unstable health condition, such as any of these:

• heart disease (or multiple risk factors for it, such as high blood pressure or high cholesterol)
• a respiratory ailment such as asthma
• joint or bone disease, such as arthritis or osteoporosis
• a stroke or neurologic illness diabetes musculoskeletal problems such as back, knee, or shoulder problems
• balance problems or medication that can make you dizzy or lightheaded
• recent surgery. 

These conditions may not preclude you from working out, but your doctor may suggest additional precautions or might wish to modify certain moves or suggest substitutions. In some cases, he or she may suggest you meet with a physiatrist, physical therapist, or certified personal trainer. 

Low bone density risk factors

If you have risk factors for low bone density, talk to your doctor or another health care professional about having a bone density test before beginning any vigorous, high-impact exercise or performing any of the moves in these workouts. Any of the following factors increases your risk for low bone density: 

• Over age 65
• Have broken a bone after age 50
• A family history of osteoporosis or broken bones after age 50
• Smoking
• Underweight for your height
• Not consistently consuming enough calcium (about 1,000 to 1,200 mg a day)
• Drinking more than two alcoholic beverages a day, several times a week
• Not active
• If you're a woman, these factors increase your risk as well: 

• You entered menopause before age 45. 
• You have gone 12 months or more without a period at some point in your life (except when you were pregnant or menopausal). 

Medical conditions that can impair bone health

Certain medical conditions can impair bone health—some severely. For example, a number of congenital disorders—such as Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta—affect bone over a lifetime and increase the risk for osteoporosis. Other conditions that damage bone include: 

• celiac disease 
• Cushing's syndrome 
• hyperparathyroidism 
• hyperthyroidism 
• inflammatory bowel disease 
• liver or kidney disease 
• multiple sclerosis 
• rheumatoid arthritis 
• vitamin D deficiency. 

Medications

Certain medications can also cause bone loss. The most important of these are corticosteroids (such as prednisone), the aromatase inhibitors taken to prevent breast cancer recurrence—anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)—and androgen-suppressing drugs used to treat prostate cancer—including apalutamide (Erleada), enzalutamide (Xtandi), and abiraterone (Zytiga).

For tips on workouts that maximize bone strengthening while minimizing the risk of injury, check out  Exercises for Bone Strength , a Special Health Report by Harvard Medical School. 

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