Are You Lifting Enough? Why the Real Risk to Bone Density Decline Isn't Lifting Too Much
Maddie Cherry - Exercise Physiologist, Move Sports Physio Geelong
At Move Sports Physio, one of the most common fears we hear from our Osteoporosis/Osteopenia clients who are navigating low bone density, is some version of: "If I lift something heavy, won't I fracture?" It's a fair question. But the evidence points to a surprising answer: for most people, the bigger risk isn't loading your bones too much. It's not loading them enough.
Bones are living tissue. Bone density respond to demand
It's easy to think of bone as a fixed, brittle scaffold that only ever wears down. In reality, bone is living, adapting tissue that constantly remodels itself in response to the forces placed on it. This is Wolff's Law: when you load a bone, you signal the production of Osteoblasts to ‘build’. When you stop loading it, that signal fades, and bone is gradually lost through a progressive ‘breakdown’ mechanism driven by Osteoclast cells.
This is why protection alone doesn't strengthen a skeleton. Wrapping a fragile bone in cotton wool and avoiding effort doesn't make it stronger. Instead, it removes the exact stimulus bone needs to adapt. The skeleton strengthens through demand, not through avoidance.
That reframe matters, because so much osteoporosis advice quietly encourages the opposite. "Be careful" becomes "do less," which leads to weaker muscles, poorer balance, and bone density decline.
What the research actually shows
For a long time, heavy resistance and impact training wasn't recommended for people with osteoporosis — the assumption was that the fracture risk was simply too high. Until researchers decided to test that assumption directly.
The landmark study is the LIFTMOR trial (Watson and colleagues, published in the Journal of Bone and Mineral Research in 2018). Researchers took 101 postmenopausal women with low to very low bone mass, essentially women who already had osteopenia or osteoporosis. And put half of them through a supervised program of high-intensity resistance and impact training. This wasn't gentle. It involved lifting at more than 85% of their maximum, just twice a week, for 30 minutes, over eight months.
The results challenged decades of caution:
The lifting group improved their lumbar spine bone density by around 3%, while the comparison group doing gentle home exercise lost density.
They saw benefits at the femoral neck (the hip) — a critical fracture site — as well as improved cortical thickness there.
They got measurably stronger, moved better, balanced better, and even stood taller.
And crucially: in this supervised setting, the heavy training was safe and well tolerated, with high compliance and without the wave of fractures that fear would predict.
In other words, women whose bones were already compromised improved their bone and muscle strength by loading them properly. No doubt there was also many other health benefits including, mental wellbeing, healthy body composition changes and improved cardiometabolic health.
"Progressive overload" is your safety mechanism, not the scary part
Progressive overload simply means gradually increasing the demand on your body over time, so it keeps adapting. Start where you are. Build load, reps, or intensity in small, controlled steps as you get stronger. That gradual, individualised progression is the safety mechanism. It's what allows bone and muscle to adapt without being overwhelmed.
That's exactly why supervision matters.
At Move our Bone Builder program offers a personalised, structured and progressive program specifically for people with osteoporosis and osteopenia. Designed to take out the guesswork, and give you the tools and confidence to safely improve your bone density.
Learn about Bone Builder here: https://www.movesportsphysio.com.au/osteoporosis
Who does need to take extra care?
None of this means everyone should walk into a gym and start deadlifting tomorrow. Some situations genuinely call for caution and a tailored approach. For example; severe osteoporosis, a recent fracture, or a very high fracture risk. As certain movements, particularly loaded bending and twisting of the spine, may need to be modified or avoided depending on your individual picture.
The answer to "is heavy lifting safe for me?" isn't a blanket yes or no. It's "let's assess you as an individual and build the right program." That's what a physiotherapist is for.
How we help at Move Sports Physio
Working with a physio takes the guesswork (and the fear) out of the equation. We can:
Understand your bone density, history, and fracture risk before you load anything.
Screen your movement and technique so you're loading safely from the very first session.
Build a progressive strength and impact program matched to your starting point, not a generic one.
Coach you through it, adjust as you get stronger, and give you the confidence that you're doing enough — without doing too much.
Your bones are not as fragile as fear makes them feel. With the right guidance, strength training is one of the most powerful things you can do for them.
So the real question isn't "am I lifting too much?" It's — am I lifting enough?
Low bone density?
If you've been diagnosed with osteopenia or osteoporosis and aren't sure how to start loading safely, book an assessment with the team at Move Sports Physio. We'll build a plan that fits you.
