How to Train for Bone Health

Weak bones are a ticking time bomb.

They won’t cause pain or dysfunction themselves, but they predispose you to breaking a bone from one misstep or one heavy lift.

Once that happens, the road back to a normal life is a long and hard one.

I write the introduction to this article so dramatically because the problem is bigger than people realize.

What’s worse: the only time most people realize the magnitude of the problem is when it’s too late.

This article is meant to serve as a brief and to-the-point blueprint as to why this is and what to do about it.

Our topics of discussion is as follows:

• The problem

• Wolff’s law

• Vulnerable areas

• Training protocols for bone health

• Example training session for bone health

• Final point to make

• References

The problem

Osteopenia and osteoporosis both describe states of decreased bone mineral density, with the latter being more severe bone loss than the former.

The problem isn’t necessarily the loss of bone itself, but the subsequent vulnerability that results from it.

Bones of lesser bone mineral density are at a greatly increased risk of fracture. This could be from trauma, such as a fall, or it could be a compression fracture where your bones become too weak to hold yourself up without crumbling.

Some of this is out of our control.

There is some degree of innate age-related loss of bone mineral density.

Current guidelines state everyone over the age of 50 should be monitored closely with regard to bone health.[1]

Women have it particularly difficult, as decreased estrogen subsequent to menopause causes an even more rapid loss of bone.

However, much of the osteopenia and osteoporosis that people experience is preventable and in our control.

The following principle describes how.

Wolff’s law

Wolff’s law is the underlying principle describing how bone responds to loading.[3]

It states that bone will remodel itself and become stronger in response to mechanical loading (such as picking up weights).

It’s obvious to most people that muscles must grow and get stronger in order to handle bigger weights.

The same is true for bones. As the weights increase, the strength of the bones must also increase to accomodate the load.

Conversely, it also states that bone will also adapt to an absence of mechanical loading.

You can think of your body as an accountant, and it can be quite a frugal one.

Instead of managing money it is managing energy expenditure.

Bone, like muscle, costs energy (calories) to maintain. If you do not give your body a reason to build and maintain strong bones, then it’s not going to do so.

In fact, it will go in the opposite direction and proactively decrease bone mineral density. Not good.

As I mentioned before, there is some decreased resiliency of our bones as we age.

However, the bone loss many people experience isn’t necessarily a result of this.

Rather, it is simply the result of the needed stimulus not being applied and time going by (a sedentary lifestyle, in other words).

This age-related bone loss can also be overridden.

The LIFTMOR trial studied the effect of a specific exercise protocol on bone mineral density in post-menopausal women with osteopenia.[4]

They found that subjects undergoing this protocol were actually to increase their bone mineral density; something that wasn’t thought to be possible in this population before this trial.

The specifics of the exercise protocol will be discussed soon.

Wolff’s law also describes some specificity to how your bones remodel themselves.

That is, the type and direction of loading impacts where on the bone it will remodel itself.

Moreover, loading of one bone does not mean other bones will get stronger.

If the only exercise you ever do is leg press, and you never do anything that loads your spine, then your vertebral bodies will not adapt and become stronger.

Vulnerable areas

While Wolff’s law applies to your entire skeleton, there are certain areas that tend to be more problematic than others.

Specifically: the bony structures of the hip and spine tend to be more prone to osteopenia and osteoporosis than other areas.

As a result, they are the most common areas of compression fractures or fractures endured from a fall in an older adult.

Thus, an appropriate training program oriented toward bone health will include exercises that load these areas.

Because, as we discussed previously, if they are not loaded they will not adapt.

Training protocols for bone health

There are a few boxes that should be checked for a program to be effective for bone health.

These include:

• Performing the appropriate type of training

• Exercise selection

• Frequency

Types of training for BMD

The three kinds of exercises that have been shown to have unique benefits to bone health are:[1][2][4]

• Resistance training

• High-velocity training

• Impact training

Resistance training

This refers to your stereotypical lifting in the gym.

Barbells, dumbbells, machines, those sorts of things.

This form of training is the bread and butter of a bone health program.

They key for this to be effective for increasing bone strength is intensity.

In other words, you need to get ~2-3 reps shy of failure to get all of the benefits that you are after.[2]

• Failure = the point in which your muscles cannot perform any more reps

It does not seem to matter if you do 5 reps and could have done 7 or if you do 15 reps and could have done 17.

As long as your effort in the set is high, you will benefit.

High-velocity training

When you do regular resistance training, the weight starts to move more slowly as the set goes on.

This is because as your muscles fatigue they can’t work as quickly.

High velocity training takes a different approach.

Here, you are trying to teach your muscles how to contract as fast as possible.

This type of training isn’t something you would take to failure, per se, because the speed is the stimulus you’re after.

Going to failure on a set will cause you to slow down and it will fatigue you for later sets; causing them to not be has high-velocity as they could be.

The easiest example of this is to take any exercise you’d perform as part of resistance training routine, use lighter weight, and lift the weight as fast as you can.

For instance, let’s say you can perform goblet squats with 40 pounds and hit failure at 10 reps.

A high-velocity approach would look like this:

• Use 20 pounds

• Stand up from the bottom of the squat as fast as possible

• Perform 5 reps only

Another common example of this is box jumps.

Here, you are jumping as high as you can, using a box to soften you’re landing.

In order to get you off the ground, the muscles of your legs must contract and their highest speed possible.

See below:

Impact training

There is this common misconception that high-impact training is bad for you.

More impact than you are ready for you is bad for you, but this does not mean that impact training is bad for you altogether.

However, your body can adapt to impact, and one of the ways it does so is through increasing bone mineral density.

For example, post-menopausal women are the hardest population to increase bone mineral density in because they are at a significant hormonal disadvantage.

The only training interventions that have been show to actually increase bone mineral density in this population are those that include impact training (such as in the LIFTMOR trial).[4][5]

Conversely, pilates has routinely failed to increase bone mineral density in the research.[6]

The easiest entrance to this type of training is through extensive pogos.

Your cues are:

• Keep your knees mostly straight

• Bounce mostly through your ankle

• Land on the balls of your feet

• Get off the ground as quickly as you can but do not worry about jumping high

See below:

The easiest way to progress this is by moving into intensive pogos.

All the cues are the same, except with each jump you are trying to jump as high as you can.

See below:

After this, you can move into depth drops or depth jumps.

The increased height causes an increased impact; and therefore a more potent stimulus (if you are ready for this and progressed appropriately).

Here, you will need to bend at the knees as you land as the impact would be excessive with straight knees.

See below:

Exercise selection

The primary consideration here is making sure you are selecting exercises that:

• Provide load to the bones in need of adaptation

• Particularly at the hip and spine

• Load the bones of interest in different directions

To highlight the second point, let’s compare the effect of barbell back squats, deadlifts, and planks on your spine.

All three movements load the spine. However, they do so from different angles.

Barbell back squats will provide a mostly top-down, parallel loading to your skeleton.

• And, there is arguably no exercise better for achieving this.

Deadlifts will provide this type of loading intermittently, while also loading the spine in a bent over, perpendicular loading to the spine.

Planks will provide only a perpendicular loading to the spine but in the opposite direction of the deadlifts.

Bottom line: the bone mineral density that you will have from incorporating all three will be much greater than it would be from only doing one.

Frequency

For increasing the strength of your bones, the research tends to suggest that higher training frequencies are more beneficial.

In other words, doing short workouts more times per week will lead to greater increases in bone mineral density than longer workouts less times per week.

To put it in numbers, 3 sessions per week, performed on non-consecutive days, tends to be the most effective dosing strategy.[2]

2 sessions per week is usually still sufficient, but not quite as much as 3x/week when looking at the whole body of evidence.

1 session per week, in most trials, is insufficient to elicit change.

Example training session for bone health

To make this all look a bit more real, let’s go over an example session that would be appropriate for increasing bone mineral density.

Before we get into that, though, there are a few points I need to make:

• For a person with a bone mineral density that would place them as osteopenic or osteoporotic, a significantly greater amount of personalization is required to ensure that lifting itself does not induce a fracture.

• I am going to leave many details out that I would be unable to provide without knowing more about you.

• To keep things short and to the point, I am not including a warm-up (which you should absolutely do).

All that said, here is an example workout appropriate for bone health for someone who is a beginner:

• Extensive pogos

  • 2 sets

  • 10-20 reps

  • 60 seconds of rest

• Box jumps

  • 2 sets

  • 3 reps

  • 60 seconds of rest

• Goblet squats

  • 2 sets

  • 10-15 reps

  • 2:00 of rest

• Dumbbell Romanian deadlifts

  • 2 sets

  • 8-12 reps

  • 2:00 of rest

• Planks

  • 2 sets

  • Performed until effort level of 8/10 is reached

  • 2:00 of rest

• Side planks

  • 2 sets

  • Performed until effort level of 8/10 is reached

  • 2:00 of rest

When you are ready, the extensive pogos can be progressed to:

• Intensive pogos

• Depth drops

• Depth jumps

• Repeated vertical jumps

Once you reach repeated vertical jumps (or similar exercises), you can do away with the box jumps as both the high velocity and impact components are being addressed in the sam exercise.

The rest of the training session is designed to load the bones of the spine & hips from different directions; and these may be progressed through simple weight or repetition increases.

Final point

I cannot emphasize enough the degree of personalization needed in people with pre-existing osteopenia or osteoprosis.

It is one of the few times I would say unsupervised weight training carries risk.

The proper starting point and proper means of progression matters, a lot.

For more detailed help in this regard, consider inquiring about 1:1 coaching and let’s say if we can develop a plan that’s appropriate for you.

References

1. O'Bryan SJ, Giuliano C, Woessner MN, et al. Progressive Resistance Training for Concomitant Increases in Muscle Strength and Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis. Sports Med. 2022;52(8):1939-1960. doi:10.1007/s40279-022-01675-2

2. Zhao F, Su W, Sun Y, Wang J, Lu B, Yun H. Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis. J Orthop Surg Res. 2025;20(1):523. Published 2025 May 27. doi:10.1186/s13018-025-05890-1

3. Frost HM. Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod. 1994;64(3):175-188. doi:10.1043/0003-3219(1994)064<0175:WLABSA>2.0.CO;2

4. Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. 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. J Bone Miner Res. 2018;33(2):211-220. doi:10.1002/jbmr.3284

5. Pinho JP, Forner-Cordero A, Rodrigues Pereira RM, et al. A High-Intensity Exercise Intervention Improves Older Women Lumbar Spine and Distal Tibia Bone Microstructure and Function: A 20-Week Randomized Controlled Trial. IEEE J Transl Eng Health Med. 2020;8:2100108. Published 2020 Jan 3. doi:10.1109/JTEHM.2019.2963189

6. de Oliveira, Raphael Gonçalves PhD, PE1,2; Anami, Gustavo Eiji Ueno PT2; Coelho, Edilaine Aparecida PE1; de Oliveira, Laís Campos PT, PhD1. Effects of Pilates Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis. Journal of Geriatric Physical Therapy 45(2):p 107-114, April/June 2022. | DOI: 10.1519/JPT.0000000000000309