Can I still do squats? Can I pick up my grandson? Is gardening off the table now? Should I give up golf?
These are some of the most common questions people ask after an osteoporosis diagnosis, and they show up in search data for this site week after week. I understand why. After my own spine fractures, I had the same questions. I remember holding a two-pound dumbbell and honestly not knowing whether lifting it would help my bones or break another one.
So here is the answer I wish someone had given me. For most people with osteoporosis, squats and lifting aren't the danger. They're part of the treatment. What matters is how your spine is positioned while you do them.
The One Movement That Deserves Respect
If you remember one thing from this post, make it this: avoid rounding your back forward while it's carrying a load. That's the movement pattern linked to spine fractures, and nearly every safety rule below comes back to it.
Much of the caution traces back to a small study published in 1984. Mehrsheed Sinaki and her colleague followed 59 women with spinal osteoporosis who were assigned different back exercise programs. In the group that did forward-bending exercises, like sit-ups, 89 percent had new spine fractures during follow-up, which averaged under two years. In the group that did back-extension exercises, which strengthen the muscles that hold you upright, only 16 percent did (Sinaki and Mikkelsen, 1984).
It was a small study, and it's more than 40 years old. But the lesson has held up, and it's why you'll see sit-ups and crunches on nearly every list of exercises to skip, including in my post on posture and osteoporosis.
Where that lesson went wrong was in how far it spread. Somewhere along the way, "don't load a rounded spine" turned into "don't lift, don't bend, don't twist, don't move much at all." That version isn't supported by the evidence, and it does real harm.
What Newer Research Shows About Lifting
The most striking study here is the LIFTMOR trial from Australia. Researchers took 101 women with an average age of 65, all with low bone density, and put half of them through a supervised program of heavy lifting twice a week for eight months. The exercises were deadlifts, back squats, overhead presses, and a jumping exercise. These were real weights, not soup cans (Watson and colleagues, 2018).
Spine bone density went up about 3 percent in the lifting group. In the comparison group, which did gentle exercises at home, it went down about 1 percent. The only problem reported was one woman's minor back spasm. A follow-up look at spine images found no new spine fractures in the lifting group, and their upper-back posture actually improved (Watson and colleagues, 2019).
There's an important catch. Every rep in that study was taught and watched by a trained exercise professional. The women learned the movements light and only added weight once their form was solid. That's the part people skip when they read the headline.
The broader picture is reassuring too. When the UK's Royal Osteoporosis Society brought experts together to review the evidence, they looked at fractures reported across exercise trials. About 6 in 100 people in the exercise groups had a fracture during those studies, compared with about 10 in 100 in the groups that didn't exercise. The panel found that fractures were rarely caused by the exercise itself. Their conclusion was that exercise is unlikely to cause a spine fracture, and that inactivity is the bigger risk (Strong, Steady and Straight consensus, 2022).
The same panel noted something I recognized right away. People with osteoporosis reported being frustrated by advice that was all "don't do" and no "how to." The experts recommended flipping that around. I agree with them.
How to Bend: Learn the Hip Hinge
The single most useful skill for anyone with osteoporosis is the hip hinge. It's how you bend forward without rounding your spine, and both the UK consensus and the international Too Fit To Fracture panel point to it as the core technique for daily life (Too Fit To Fracture, 2015).
Here's how to practice it:
- Stand with your feet about hip-width apart, a few inches in front of a wall, with your back to it.
- Soften your knees slightly.
- Keep your chest lifted and your back long, and push your hips straight back until your bottom touches the wall.
- Your upper body tips forward as a unit. Your spine shouldn't curl.
- Squeeze your buttock muscles to stand back up.
The UK group has a simple phrase for this: "think straight." Keep your upper back straight and your neck in line with your spine whenever you bend or lift. Your natural curves stay where they are. You're just not adding a hunch on top of them.
Once the hinge feels natural, you'll use it dozens of times a day without thinking, whether you're loading the dishwasher or lifting a bag of potting soil out of the car.
Squats: Yes, With Good Form
Squats load the hips and spine in an upright position, which is exactly what bone needs. The UK consensus specifically lists squats and deadlifts as ways to build strength two or three days a week.
If you're new to them, start with a chair. Stand in front of a sturdy chair, cross your arms or reach them forward, and sit down slowly using the hip hinge. Then stand back up without using your hands. When ten of those feel easy, try lowering until you just touch the chair and standing again. After that, you can progress to holding a light dumbbell at your chest.
A few things keep squats safe:
- Keep your chest up and your back long, all the way down and all the way up.
- Only go as deep as you can without your lower back rounding at the bottom. For many people that's chair height, and that's fine.
- Learn every new version light. Add weight only once the movement is automatic.
- Move slowly and with control. Don't bounce at the bottom.
Heavier barbell work, like the LIFTMOR program, can be appropriate for some people. It's something to build toward with a physical therapist or a trainer who works with osteoporosis, not something to start on your own.
Lifting in Everyday Life
You've probably been told to never lift more than ten pounds. The Too Fit To Fracture experts specifically recommended against generic limits like that. They suggested teaching people spine-sparing techniques instead, and the UK consensus said the same thing: safe lifting technique, rather than "don't lift" or a fixed weight limit.
That's good news, because life is full of heavy things. Grocery bags, a full watering can, a suitcase, a grandchild who wants to be picked up. A few habits make all of them safer:
- Get close to the object before you lift it. The farther it is from your body, the harder your spine works.
- Hinge at the hips and bend your knees. Keep your back long.
- Tighten your belly muscles gently before you lift, as if you're bracing for a cough.
- Split heavy loads. Two lighter grocery bags, one in each hand, beat one heavy bag on one side.
- For a child, crouch down to their level, bring them in close, and stand up with your legs.
If you've had a spine fracture, your weight limits may be stricter for a while, and that's a decision for your own doctor or physical therapist.
Twisting: Smooth Is Fine, Fast and Forceful Isn't
Turning your body isn't the problem. The UK consensus says gentle rotation is safe when it's smooth and within a comfortable range. What causes trouble is fast, forceful twisting, especially with weight in your hands or combined with bending forward.
When you need to reach for something behind you, turn your feet first so your whole body comes around. Getting out of the car, swing both legs out together before you stand.
Golf comes up a lot. There are case reports of spine fractures happening mid-swing. But the UK panel concluded that for people who already play regularly, the benefits of a sport they enjoy usually outweigh the risks, unless they've had multiple fractures or a painful spine fracture. If golf is your joy, talk with a physical therapist about your swing rather than giving it up by default.
Bending in the Garden, the Laundry Room, and Everywhere Else
Gardening and heavy housework are actually on the UK consensus list of activities that build strength. The only caution is the same one: avoid staying folded forward for long periods or bending all the way to your toes over and over.
Some swaps that help:
- Kneel or half-kneel to weed instead of bending at the waist. A kneeling pad or a garden seat makes this easier.
- Use long-handled tools when you can.
- Raise your laundry basket onto a chair or table so you're not reaching down to the floor.
- Put your foot up on a low step to tie your shoes.
- Use a hip hinge to make the bed, with one knee on the mattress if that helps.
Yoga and Pilates are generally fine with some changes. The UK panel suggests alternatives to the Pilates "roll down" and "curl up," and the same thinking applies to deep forward folds in yoga. A teacher who works with osteoporosis can show you swaps.
When the Answer Changes
Everything above applies to most people with osteoporosis or osteopenia. If you've already had a spine fracture, especially more than one, or you have significant pain or a rounded upper back, the Too Fit To Fracture experts say the risks of many activities may outweigh the benefits, and they recommend seeing a physical therapist. That's not a reason to stop moving. It's a reason to get personal guidance first. My post on exercise after a fracture walks through what changes.
And whatever your situation, one session with a physical therapist who understands osteoporosis is worth more than anything I can write here. Ask them to watch your squat and the way you pick up something heavy. Small corrections now can save you a lot of trouble later.
For a deeper look at how strength training and weight-bearing exercise each help bone, see weight-bearing vs. resistance training.
Your bones get stronger when you ask them to work. The goal is to ask in a way your spine can handle.