Bone density peaks in your late twenties and declines from there. For women, the drop accelerates sharply after menopause. By the time a bone density scan flags osteopenia or osteoporosis, you may have been losing bone for years without knowing it.
The good news: this is not inevitable. And one of the most effective tools for slowing, stopping or even reversing bone loss is something most people already have access to. Resistance training.
What the latest research shows
A 2025 meta-analysis of 17 randomised controlled trials involving 690 participants found that resistance training significantly improved bone mineral density at the lumbar spine, femoral neck and total hip in postmenopausal women. The improvements were not small. High-intensity training (at or above 70% of your one-rep max) produced the strongest results, particularly at the femoral neck and hip, the two sites most vulnerable to osteoporotic fractures.
A separate 2025 network meta-analysis of 13 trials in older adults found that training two to three times per week with 9 to 10 repetitions per set was the most effective protocol for improving bone density at the lumbar spine and femoral neck.
These are not fringe findings. They are consistent with decades of research showing that bone responds to mechanical load. When you place stress on a bone through resistance training, it triggers osteoblasts (the cells responsible for building new bone) to lay down more tissue. Remove the load and the process slows down. It is a use-it-or-lose-it system.
What kind of training works best
Not all exercise is equal when it comes to bone. Walking and swimming, while excellent for cardiovascular health, do not provide enough mechanical loading to meaningfully stimulate bone formation.
Based on the current evidence, the most effective approach includes:
- Intensity matters. Training at 70% or more of your one-rep max produces significantly better results than lighter loads. Your bones need to feel the load.
- Two to three sessions per week. This frequency consistently outperforms once-weekly training across multiple bone sites.
- Compound, multi-joint movements. Squats, deadlifts, lunges, overhead presses and rows load the spine and hips directly, which is exactly where bone loss matters most.
- Consistency over months. Studies lasting 48 weeks or longer showed the most meaningful gains at the femoral neck and hip. This is a long game, not a quick fix.
If you are new to resistance training, start with bodyweight exercises or lighter loads and build gradually. The goal is progressive overload over time, not maximum effort on day one.
Where chiropractic fits in
Starting or progressing a resistance training programme when your joints are stiff, your movement patterns are off, or you are already dealing with back, hip or knee pain is a recipe for frustration. You either cannot perform the exercises properly, or you end up aggravating something and stopping altogether.
This is where chiropractic care plays a practical role. We restore normal joint movement, address muscle imbalances and help you move well enough to train effectively. If your thoracic spine will not extend, your overhead press will suffer. If your hips are stiff, your squat depth will be limited and your lower back will compensate. If your shoulders are restricted, you will work around the problem rather than through it.
For patients with existing osteopenia or osteoporosis, we adapt our techniques accordingly, using gentler, low-force methods where needed. We can also guide you on which exercises are safe and appropriate for your current bone health status, and help you build a programme that progresses at the right pace.
The combination of hands-on treatment to keep your joints moving properly, paired with a structured resistance training programme, gives you the best chance of maintaining (and building) bone density as you age.
You do not need to wait for a diagnosis
The ideal time to start building bone density is before you start losing it. But the second-best time is now, regardless of your age or starting point. The research is clear: your bones respond to resistance training at every stage of life.
If you want help getting started, or if pain is stopping you from training the way you should be, book an appointment at our Sandton practice. We will assess how you are moving, address anything that needs attention, and help you build a plan that keeps your bones strong for the long run.
References
- Li Y, et al. Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025;20:528.
- Xiao Y, et al. Optimization of high-intensity resistance exercise protocols for improving bone mineral density in the elderly without chronic diseases: a systematic review and network meta-analysis. Frontiers in Physiology. 2025;16:1589200.
- Kemmler W, et al. Effects of high-intensity resistance exercise on osteopenia and osteoporosis: a meta-analysis. Journal of Bone and Mineral Metabolism. 2022;40:491-504.