Weight Lifting? How Heavy with Osteoporosis or Osteopenia?
Weight lifting with bone loss? Whether you’re in the osteoporosis or low bone density range, commonly called osteopenia, a weight limit for free weights will sometimes be suggested when beginning a strength training program designed to strengthen bones. In the past, the National Osteoporosis Foundation has recommended a conservative 10 pound limit with any bone loss because, for some people, simply bending over at the waist or taking 10 lb. turkey out of the oven can cause a fracture.
However, knowing that too many restrictions create too much fear and ultimately less physical activity, which causes more bone loss, the Too Fit to Fracture advisory panel (endorsed by the NOF) has given exercise guidelines depending on if a person has fractured or not. Check it out…it’s the latest advice from world renowned bone health experts, 2 years in the making, and worth the read. Note that these guidelines apply to anyone with bone loss, whether in the osteoporosis or osteopenia category.
Unless a person has had a fracture, Too Fit to Fracture recommends going by the national physical activity guidelines with the adaptations of not rounding the spine or twisting to the point of strain.
In the US, these guidelines are 150 minutes of aerobic exercise, plus strength training 2 or more times a week, with 8-12 repetitions, using resistance bands, free weights, or body weight for resistance. It should be a progressive strength training program with increased resistance when the exercises are no longer challenging.
For those who’ve had a spinal fracture, the Too Fit to Fracture panel suggests seeing a qualified instructor (or a healthcare provider, certified personal trainer, or physical therapist). With fractures, it’s suggested to focus on good form and body alignment, rather than on how hard you are working, using resistance bands or body weight for resistance.
Still, you’re probably wondering how heavy a weight is safe for you! It’s one of those individual “consult with your healthcare provider” questions. I haven’t seen any specifics lately, even from the National Osteoporosis Foundation.
In my strength training exercise classes, I have participants consult with their healthcare provider for a weight limit. Unless they’ve had a fracture, they are usually told to listen to their body, not overdo it, and keep good body alignment. They use a wide range of free weights, from 0 to 25 pounds, depending on the exercise as well as their own individual risk factors and situation.
It has worked well over the years to follow the safety precautions of keeping a neutral spine with no forward flexion or twisting to the point of strain.
Moving within those parameters while exercising helps my class participants maintain good body alignment throughout their day. American Bone Health has a fabulous downloadable exercise brochure called, Do It Right! And Prevent Fractures!
Here are more Moving Safely articles from the National Osteoporosis Foundation.
Still have questions? Drop me a line about lifting weights in the “Comment” section below, then click “Post Comment.”
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Cheers!
Susie
Hello Susie! I was looking for some info on osteopenia and weightlifting/powerlifting. I have osteopenia and borderline for osteoporosis. I have been a Powerlifter since August 2015 and deadlift 130 lbs, bench press 62 lbs and squat 45/50 lbs. Is this too much? Should I limit the weight amount to a certain number? I told my doctor that I was a powerlifter and she said I was doing everything I am supposed to do to help my bone density but she did not specify a weight limit. After reading more info on the spinal column and weight bearing exercises, I am worried about compression fractures of the spine. I would like your take on this. I hope to hear from you soon. Thanks.
Hi Susan,
Usually, it’s best to speak with your healthcare provider about exercise programs, but your doctor may not be familiar with power lifting, which can be very risky with bone loss. It’s the heavy barbells and quick, jerky moves that can put the spine at risk. There are many ways to strength train that are challenging and good for bones, and some only need small weights with body weight movements–back extensions, for example. Planks keep the spine in a neutral position, strengthening abdominal muscles without risk to the spine, as with crunches. There are many dumbbell moves, done with slow repetitions that help add intensity. Eliminating momentum in a lift makes your muscles work much harder. I completely acknowledge that slow strength training is not as exciting as power lifting, but nevertheless, will do the job in keeping your body and bones strong and slowing down bone loss.
It would be so nice to have a set formula on how much weight is too much. Unfortunately, it’s not possible to accurately predict if a person will fracture or when, although in general, your risk is lower the younger you are. Some people with osteoporosis never have a fracture and some with low bone density (osteopenia) do. Actually, more people with low bone density fracture, simply because it’s a much bigger group.
If you could get a referral from your doctor for a one-on-one appointment with a physical therapist who is also an athletic trainer (they can often be found at university hospitals where they work with their athletic teams), that would be ideal. You could review the exercises that you do with the PT and she or he could give you alternate moves that would be strengthening, yet safer.
The precautions for movement with osteoporosis and low bone density are the same.
• There shouldn’t be too much pressure on the spine, from above or from below. Large barbells could certainly qualify as too much pressure from above.
• Don’t round forward with your spine, instead hinge back with the hips and keep a neutral spine. Physical therapists who give these precautions also advise not leaning forward with a heavy load, as in a dead lift.
• Don’t twist or do deep side bends to the end range of movement or point of strain.
• No crunches. Keep spine in contact with floor for all abdominal exercises.
• Be careful during transitions. For example, keep a neutral spine while getting in and out of position with the bench press. Keep your spine in contact with the bench and don’t ever round your back.
The following two resources will give you an idea of safe movement with bone loss. The exercises will seem tame to you, after power lifting, but know that you can always find ways to increase intensity and also stay safe.
National Osteoporosis Foundation’s Moving Safely section at nof.org.
https://nof.org/live/moving-safely
Osteoporosis Canada’s Too Fit to Fracture program is excellent.
https://www.osteoporosis.ca/osteoporosis-and-you/too-fit-to-fracture/
All the best,
Susie
Susan, I am 53, with osteopenia, I also have DOUBTS about the accuracy of dexa scan and whether they tell the whole story about bone health. I can deadlift 209 lbs, squat 120 and BP 115. I also do jumps twice a week from a 2.8 box because I know the impact is good for bones, I push my body to the max but with good form. So far I have had no fractures or injuries other than normal muscle fatigue. I think if we progress gradually and use good technique our bodies will continue to strengthen.
Good points, Helen! Yes, it’s always possible for our bodies to continue to strengthen, especially gradually with good technique. It’s excellent that you’re focusing on keeping good form. The National Osteoporosis Foundations stresses that even those with low bone density heed the safety precautions of keeping a neutral spine. Whether DXA scores are accurate is a subject that Dr. Lani addresses in her book, Dr. Lani’s No-Nonsense Bone Health Guide. https://amzn.to/2g1fS6p The technicians need to take great care in positioning to get an accurate reading. Also, one never knows if their peak bone mass was lower than “normal” because no one was getting DXA scans at age 30. But doing the best that we can and safely staying fit will sure help keep our bones strong and slow down bone loss now.
Best wishes!
Susie
My wife is 67. She was diagnosed with osteoporosis several years ago and given medication to take. Their has been some slight improvement in the last two years. Most of her readings are -2.6 to -3.3. My concern is that she reads that diet and exercise help bones, but overdoes it in my opinion. She is Asian, and currently weighs 88 lbs. at 4’10.5. Initially she was 107 and 4’11, but two years of exercise every day and a restricted diet has reduced her to almost skeletal. She also never goes out into the sun, mainly to keep her skin wrinkle free. However she gets almost no beneficial sunlight to help her calcium and vitamin d issues. So here is the problem, her exercise routine consists of twisting, aerobics, weight training etc. she takes no precautions and was never given counseling regarding the right types of exercise. This week I finally noticed her on the leg press machine, doing leg extensions with her back bent slightly less than 90 degrees. This 88 pound woman is pressing 260 pounds, many times. I feel so his I say too much for her size and condition. One slip and she will fracture her hip or worse her spine. Her leg presses are you equivalent to someone my size pressing 600 pounds. The machine does not go that high.
It’s worrisome that your wife isn’t making adaptations. If her back is slightly bent forward while doing leg presses, she’s taking some of the force on her spine, putting it at risk for fracture. The NOF has reams of information on safe movement with bone loss.
See Exercise/Safe Movement and be sure to open links at the bottom of the page – “Resources” Click on green box-“Show More+”.
https://www.nof.org/patients/fracturesfall-prevention/exercisesafe-movement/
Yes, a BMI of 14 (that you mentioned on the National Osteoporosis Foundation, NOF, support community) is a very unhealthy range, but using the BMI calculator, I get a BMI of 18.1 with your wife’s weight of 88 and height of 4’10.5”. The US Center for Disease Control says below 18.5 is underweight. Being underweight increases one’s risk for osteoporotic fractures.
The right amount of exercise does wonders for so many health issues. But over-exercising is too much of a good thing and your wife may be doing too much and too intensely.
I would suggest that it is vital for your wife to see her healthcare provider for:
1. Advice on a safe exercise program, how much weight is safe for her to lift, and what would be the ideal amount of exercise for her.
2. A referral to a physical therapist who specializes in osteoporosis who can give her professional advice on how to move safely with bone loss.
3. Equally important would be to get a referral from the doctor to a registered dietician who could help her develop a balanced diet. A diet of sardines and miso soup is too restrictive and doesn’t provide nearly enough nutrients for good health.
Thank you for reaching out on your wife’s behalf.
Best wishes,
Susie
Hello, Susie!
I am glad to see your website! I am 65 and have severe osteoporosis and other health issues. I find it hard to exercise as I have a bad ankle and things bother my back. I really want to try some light weight exercises. Do you think I can safely do some?
I am seeing my rheumatologist soon to see if there is any other treatment option for me. I have been getting the Reclast infusions for a number of years but they are doing no good. I am sacred to get a hip fracture. Thank you.
Dear Marleen,
Taking into consideration your various health issues, the best course of action would be to work with your doctors for more information and, most importantly for exercise, request that they refer you to a physical therapist (PT). The one-on-one instruction a PT can give you will be individualized so you can exercise safely, working around your osteoporosis and ankle problem. When you schedule the physical therapy appointment, make some calls to ensure that you get a PT who is well-versed with osteoporosis. University hospitals have specialists.
Let the PT know you would like to do use light weights without risk of a fracture. She or he will watch your movements and give you guidance and suggestions on how to move in daily life and while exercising. My DVDs have workouts that don’t have any of the contraindicated moves when a person has bone loss and could be fine when you’ve completed physical therapy. But with your many issues, it’s best to first have in-person instruction and not go it alone.
Best wishes,
Susie
Hi Susie,
Thanks for this helpful information. I’m going to share it with my trainer. I started deadlifting a few months ago, and have done a one rep max of 185 lbs. I’m also doing bent over rows (PR 95 lbs) bench presses (PR 75 lbs)and back squats (PR 95 lbs).
I was just diagnosed this week with osteoporosis of the lumbar spine with a T score of -3.2. I also have osteopenia of the left femur neck with a T score of -1.6. My deadlift PR was actually within a week of the dexa scan, but it took weeks for the results to get back to me.
It sounds like deadlifting, especially with higher weights, isn’t an exercise you’d recommend continuing with. In addition to the lifting once a week, I attend 3 60 minute small group classes with a combination of body weight, light weights and cardio in HIIT or circuit classes.
Thank you for your feedback,
Sue
Hi, Susan!
A National Osteoporosis Foundation affiliated physical therapist advised not bending over with weights, even keeping a neutral spine. Part of her reasoning was that people wouldn’t maintain good alignment and would round their backs. Part was that it could strain their spine too much. Finding that right balance is the challenge and she opted for not strengthening the spine or muscles of the back that way because it risks a fracture.
I’ve seen videos of research studies where participants were doing deadlifts and they made me gasp as they put their spines at risk by doing deadlifts and rounding their spines—which wasn’t intentional, it was simply bad form!
I opt for doing all kinds of back extensions for back and spine-strengthening exercises. Much safer!
Your small group classes sound fine, as long as you’re hinging back with the hips and keeping a neutral spine–not bending your spine forward, not side-bending or twisting to the point of strain, and do avoid jerky movements. Let your instructor know these parameters so she or he can keep an eye on you and help modify your moves.
Best wishes,
Susie
Hi I was diagnosed last year with osteoporosis and osteopenia in my hip last year my T score was-1.8, I had a fall just before Christmas and fractured my wrist which ended up with me having an operation therefore I had another DXA scan in June this year which I was told it had improved my T score was -1.7 the reason I contacted you is that I’ve started getting back and hip pain which lasts most of the day so why am I getting now even now that me T score has improved.
Sandra, I’m sorry about your wrist fracture and that you’re experiencing pain. Please speak with your doctor about your pain to determine its cause. You could also discuss your DXA scans and ask for a referral to physical therapy to get you going with a safe bone-strengthening exercise program.
Hi Susie I am a 64 year old female with Osteoporosis Against my Drs advice I decided not to do the drugs just yet I joined Crossfit & have made the trainers aware of my situation It’s been about a month & I feel stronger but do worry I may be doing some harm I get very sore in my upper back area & now my wrists are starting to be somewhat painful This happens the next day Not during Was wondering about your thoughts
Dear Patty,
Are you familiar with the adaptations needed when moving with osteoporosis? They are not bending the spine forward—even slowly—no forward flexion (so no crunches or toe touches), deep twists or side bends to the point of strain, especially if it’s also in combination with bending forward, too much impact, excessive weight on the spine, or quick, jerky movements.
It’s best when first starting an osteoporosis exercise program to work with a qualified physical therapist (PT) who has experience and indeed knows the safety precautions. Not all of them do, nor generally do personal trainers unless they’ve taken specific continuing education courses, such as those offered by the National Osteoporosis Foundation.
Pain in a joint is not a good sign. If it were me, I wouldn’t do any more workouts until I’d seen a good physical therapist. Get a referral from your healthcare provider so it’s covered by insurance. If you’re having pain, physical therapy is usually covered.
PTs in a sports medicine clinic at university hospitals are sometimes strength and conditioning coaches, as well, and could help you change your strength training routine to make it safer. However, make sure they also are aware of the adaptations needed for osteoporosis. Don’t assume anyone is.
Do you have my DVDs? They could be helpful for you because they’re basic strength training with adaptations for osteoporosis, including the warm-up and stretches. There aren’t any of the contraindicated moves for those with bone loss and all moves are with a neutral spine. No forward flexion, twists, side bends, etc. I give instruction throughout with advice on how to make moves easier or more challenging. It would be educational for you so you could make sure you’re adapting whatever other exercises you’re doing.
Best wishes to you,
Susie
Hi,
What are some free weight lifting poses, and exactly which areas of the body do they strengthen? I have lower back osteoporosis and the info would be helpful.
Thanks
Sherry, back extensions like the “Bird Dog” exercise, help strengthen the lower back. There is a video example, as well as other strengthening exercises, on Osteoporosis Canada’s VIDEO SERIES ON EXERCISE AND OSTEOPOROSIS.
https://osteoporosis.ca/health-care-professionals/clinical-practice-guidelines/exercise-recommendations/video-series-on-exercise-and-osteoporosis/
Scroll down to Videos 2, 3, and 4.
But osteoporosis is a full-body condition, so it’s important to strengthen the whole body. The lower back is where DXA scans are targeted because it’s the easiest for the DXA machine to get an unobstructed image.
You might also find the online booklet, TOO FIT TO FRACTURE: MANAGING OSTEOPOROSIS THROUGH EXERCISE, helpful.
http://www.osteoporosis.ca/wp-content/uploads/OC-Too-Fit-To-Fracture-Osteo-Exercise-Book.pdf
Unlike my DVDs, these links aren’t full workouts but will give you some examples of good exercises for your body and bones.
Please be sure to get your healthcare provider’s okay before you begin a new exercise program and make sure it’s a bone-safe one! Thanks.
Best wishes,
Susie
I am 65 and have osteopenia. I have been doind weight machines rather then free weights. I like the machines over free weights. So are machines just as good for osteopenia?
Helen, it’s often said the best exercise is the one that you will actually do. So, if you like weight machines, you’ll get a lot of benefit from them. Free weights have the advantage of adding components of coordination, balance, and simply more movement as you use the weights: picking them up, putting them down, balancing them, etc.
Be cautious with the transitions in and out of the weight machines.
Some examples:
Crawling into a leg press machine can be risky so don’t use one if you must twist excessively or round your back. Also, don’t put downward pressure on your shoulders with a calf raise machine or round your back using a “preacher curl” machine.
If you do start to use free weights, remember that the amount of weight you’re lifting with a machine does not translate to really lifting that much weight. The amount of weight is all relative with weight machines and free weights. They’re so different because, with the free weights, you have to do all the stabilizing instead of the machine. The same goes for a barbell. The bar takes a lot of the force. With free weights, you’ll start with much less weight than a machine.
Kind regards,
Susie
Hi susie , i am taking a perscription estrogen blocker and my doctor told me i could possibly get bone fractures in the future . I have been swimming my whole life and i feel good but i am seeing muscle mass in my arms going. When i took a dexa scan it said i had osteoporosis so i have been walking more .i am going to buy bar bells for my arms because i am getting very concerned how much muscle mass i have lost. is it possible i am losing muscle mass because of the estrogen blocker ? . I spoke to someone and they said 5 lb barbells were good. Since i usually swim i think i might be able to handle a hevier weight . I feel i do not want to waste my money on a 5lb weight if most people can handle more . I am 5 “2 105 lbs . Do you think the estrogen blocker is taking away my body mass ? What lb weight is generally used for woman with osteoporosis 105 lbs ? Allso how do you feel about taking a calcium drug vs pure calcium citrate ? Thank for having your Q and A y sue
I’ll keep this simple. Since my diagnosis of osteopenia I have been lifting free weights. I am 66 and not looking to be the Incredible Hulk. I just want to get and stay fit. My doctor did not tell me how much to lift in weights. What is your conservative estimate?
Hi, Sue!
Over the years, I have taught 10,000+ hours of strength training classes to women 50+ and can tell you a range of dumbbell weight that most of them reach. I hesitate to give exact numbers because there is such a range, depending on health status, age, and activity level.
For the chest press, many work their way (gradually, over months or years) to 12# to 15# dumbbells, some to 20# and others less, 9# to 10#.
For the biceps curl, it can range from 6# to 15# and the bent row might be in the same range. The overhead press would be less, depending on shoulder health. It seems women’s shoulders can have as many issues as knees.
Wrist curls also depend on the health of one’s wrist, whether there have been injuries. Start small and do not expect to go quickly. Wrist muscles can make wonderful gains in strength. Go slow and steady.
The rotator cuff exercise will probably be the smallest weight you use. Do not prop. Use your muscles, instead. Listen to your muscles and go slow and steady. Start small with a 1# dumbbell.
Leg weights: It is a big range. Most women in my class use an adjustable 10# leg weight, starting with ½ pound and often work their way up to over 10#, adding 1#-2# dumbbells to the ankle cuff with Velcro.
There are always outliers, one woman I recall who look amazingly sculpted, but had a hard time lifting more than 6 pounds for a biceps curl. Only two women can lift 25# dumbbells in a chest press and I do not recommend it! Too risky and most of the force is from propping the weight on the bones, not muscle force—the latter is what we want, after all. (A spotter is really needed with that size weight, so I ended up taking those dumbbells home so they would not be used in class!)
Well, that is my squishy answer! Like absolutely everything with exercise questions, the answer begins with, “It depends….”!
Best wishes,
Susie
Sue, I would recommend discussing your medical and supplement questions with your doctor. She or he has the necessary training for the best answers.
Weight-bearing aerobic exercise (where you are on your feet), it the best kind for bones, but has only a modest effect on bones. Walking is not enough to help your bones. Strength training has been shown to help halt or slow down bone loss in post-menopausal women.
For strength training, you will need a variety of dumbbells (not barbells), not just one size. Women in my classes use a variety of weights, starting from 1 pound on up. For some exercises, such as the back extensions, they continue to use those small weights. Participants might get out as many as 8-10 different sizes of dumbbells for one class. (I have lots of weights in my studio!)
Dumbbells are a good lifetime investment. You can start small and work your way up, “treating yourself” to the next weight up when you achieve increased levels of strength. When I was 55 years old, I bought a set of 20-pound dumbbells. The salesman thought I needed help carrying them out of the store and I told him that I had better be able to carry them out because they were for me, not my son!
With osteoporosis, please ask your healthcare provider if you have a weight limit for your dumbbells.
Thanks,
Susie