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Osteoporosis Strong: Building Bone and Muscle in the Proactive Stage - Reading Physiotherapist Led
The Royal Osteoporosis Society “Strong” Pillar – Building Bone and Muscle in the Proactive Stage
Even if you have recently had a DXA scan and been told you have osteopenia or osteoporosis, you are feeling generally well, don’t have any other medical conditions, we still need to complete a Physiotherapist Assessment in Reading or via Telehealth before we go ahead with treatment.
So, if you feel fit, healthy, and steady on your feet, and that’s supported by our tests, you may be in what we call the “Proactive Stage.”
At this stage you haven’t had a fall, or history of a fall and fracture or osteoporosis related fracture, you aren’t unsteady walking on different surfaces, you don’t use a mobility aid, can walk half a mile, just under a kilometre, on your own and your main goal is to stop your bone density from dropping further.
In the Royal Osteoporosis Society (ROS) guidelines, your primary focus at this stage is the “Strong” Pillar
Being “Proactive” means taking the fight to osteoporosis. Your bones are living tissue, and just like your muscles, they get tougher when they are given a job to do.
To build bone strength and keep your skeleton resilient, you need to master two types of activity: weight-bearing impact and muscle resistance.
Impact – The "Healthy Shock" for Your Bones
To make a bone stronger, you need to “load” it. This means the bone needs to support your body weight and experience a bit of a “thump” or “shock.”
When you land from a jump or even just take a firm step, it sends a signal to the bone-forming cells to start building more “honeycomb”
What is “Moderate Impact”?
For the Proactive Stage, the guidelines recommend moderate impact. This isn’t about running a marathon; it’s about short, sharp bursts of activity.
Remember you may need to slowly build up to doing new levels of activity and that’s why it’s important to have a Physiotherapist Led Assessment at start.
Moderate impact includes:
- * Jogging or Running:
- A steady trot is excellent for loading the hips and spine.
- * Low-Level Jumping:
- Small jumps off the ground.
- * Skipping and Hopping:
- These provide a higher “load” in a short amount of time.
- * Stamping:
- Literally stamping your feet firmly on the ground as if you are crushing a can.
- * Dancing:
- High-energy styles like Zumba, Scottish dancing, or aerobics are perfect because they involve moving in different directions.
- * Racquet Sports: Tennis or badminton involve quick starts and stops that help bone.
How Much and How Often?
The goal for someone in the Proactive stage is to aim for about 50 moderate impacts most days of the week.
You don’t have to do all 50 at once.
You can do 5 sets of 10 impacts with short breaks in between.
For example, when we design you a programme we may recommend you start with 10 hops while waiting for the kettle to boil, or a quick minute of “stamping” while watching the news.
Muscle Resistance – The "Push and Pull"
While impact is great for the bones, muscle strengthening is equally important.
Your muscles are attached to your bones. When a muscle works hard, it “pulls” on the bone it’s attached to. This pulling action is one of the strongest signals your body has to keep your bones dense.
The Rule of Three for Muscle Building
To get the most benefit, the sources suggest a specific routine:
Note: After our assessment we will recommend a plan for you, these routines don’t apply to everyone!
- * 2-3 Days a Week:
- Give your muscles a day of rest in between sessions.
- * 3 Sets of Each Exercise:
- Don’t just do one round; do three.
- * 8 to 12 Repetitions:
- Use a weight or resistance level that is heavy enough that you can only do it 8 to 12 times before your muscle feels tired.
What Should It Feel Like?
This is where many people get nervous and why we always start working one to one with you.
To build bone, you need to feel a “push or pull” on the muscle. You should reach a point of “muscle fatigue”—where that last repetition feels quite difficult.
The guidelines want you to know that mild discomfort or “warmth” in the muscle afterward is normal and is actually a sign that the exercise is working.
Specific Exercises for the Proactive Stage
The Royal Osteoporosis Society guidelines provide a “menu” of exercises to ensure you are strengthening the right areas—specifically the hips and the spine, which are the most common places for fractures.
For Your Hips and Lower Body:
- Squats and Lunges:
- These use your own body weight to strengthen the legs and hips.
- Sit-to-Stands:
- Simply standing up from a chair without using your hands, then sitting back down slowly.
- Leg Press: (with good form)
- If you have access to a gym, this is a very effective way to use “maximum weight” safely.
- Hip Abduction:
- Moving your leg out to the side against a resistance band
- .
For Your Spine and Upper Body:
- Back Extensions:
- Strengthening the muscles that keep you upright.
- Wall Presses:
- Like a push-up, but standing and pushing against a wall.
- Bicep Curls and Tricep Presses:
- Using hand weights or even cans of soup.
- Overhead Press:
- Lifting weights toward the ceiling to strengthen the shoulders and upper spine.
Royal Osteoporosis Society Reassurance: Why You Should Do "More Rather Than Less"
A common fear if you are new to exercise is that lifting a heavy weight or jogging will cause a bone to snap.
The ROS guidelines reassure that:
*Fractures are rarely caused by exercise.
In fact, the most dangerous thing you can do for your osteoporosis is to do nothing. Inactivity and prolonged sitting are some of the worst enemies of bone health.
The benefits of being active—having stronger muscles to support your joints and denser bones to resist breaks—far outweigh the tiny risk of an injury during a workout.
The mindset should be: something is always better than nothing.
Progressing Your Plan
Even though your focus is on being “Strong,” you shouldn’t ignore the other pillars. We are with you every step of the way to ensure you have a combined programme that fits your needs and goals.
As you get comfortable with your impact and weights, the evidence suggests you should “consider balance exercises (Steady) and posture/lifting advice (Straight) if not yet included”.
For example, we may add in some Tai Chi or more advanced FAME moves into your practice for balance, or some Fractal Feldenkrais to expand your body awareness and ability to practice the “hip hinge” (bending at the hips, not the waist) when you are picking up grandchildren or shopping at the supermarket.
By combining these, you aren’t just building a “dense” skeleton; you are building a body that is less likely to fall and a spine that is protected during daily life.
Summary for the Proactive Stage
If you have low bone density but you are still mobile and steady:
- 1. Don’t be afraid to move.
- Your bones need the “load” to stay healthy.
- 2. Aim for 50 moderate impacts (like jogging, dancing, or stamping) most days.
- 3. Work your muscles hard with weights or resistance bands 2-3 times a week.
- 4. Listen to your body, but don’t be scared of a little muscle “warmth” or effort.
By taking this “how-to” approach, you are doing more than just managing a diagnosis—you are actively building a stronger, more resilient future for your bones.
And we are here to support you at the practice in Reading, in London and across the UK via Telehealth.
Do you want a tailored strength programme to improve your bone health?
We have a practice in Reading at- 218 Tilehurst Road Reading, RG30 2NE and provide Teleheath consultations across the UK
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Author:
Jill Wigmore-Welsh MSc HCPC FRSPH Founder, Positive Healthspan™ & OsteoProSisters™ · Creator of Juven Systems™
Article publication date: 25 June 2026
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