Strong Bones Don't Come from Being Careful — They Come from Loading

Strong Bones Don't Come from Being Careful — They Come from Loading 

Let me tell you about Heather. 

I assessed her in clinic about a month ago, and her story has stayed with me; because it happens far too often. I was treating Heather for urinary leakage and a back wall prolapse, and as part of our routine assessment, we asked about osteoporosis risk factors. Her mother had severe osteoporosis. Years ago, her mother broke her hip — the doctor said the bone broke before she even hit the floor — and she ended up in a wheelchair before her seventies. 

Heather is active. She thought she was doing all the right things. Her GP knew her mother's history and had never once screened Heather for bone health. 

I contacted her GP and requested a DEXA scan. Heather is 61. It came back showing severe osteoporosis — a T-score of -3.9. She was terrified. Told she shouldn't even lift a kettle. 

This is what we have to change.  

Osteoporosis is a silent disease. It is not normal ageing, and it is one of the most significant public health challenges we face — yet it remains routinely under-screened, under-discussed, and under-treated. Two thirds of people with osteoporosis are women. One in two women over 50 will suffer an osteoporotic fracture. A hip fracture at 65 carries a 50% chance of losing independent living within a year, and a 40% chance of never walking independently again. 

And yet routine screening remains rare. 

Bone is dynamic — your entire skeleton is replaced roughly every ten years. Bone loss begins quietly in your thirties, accelerates significantly during menopause (women can lose up to 15% of bone mass in just a few years), and continues at 0.5–1% per year thereafter. This is not inevitable decline. It is a modifiable process. But only if we catch it. 

Every woman over 65 not on bone-protective treatment should have a DEXA scan. So should anyone with a risk factor — family history, early menopause, steroid use, low body weight, lifestyle factors. Simple screening tools exist. The Royal Osteoporosis Society has one on its website. At Menopause Movement, we've integrated bone health screening into our Menopause MOT pre-assessment tracker, because I made a decision: I will let no opportunity go past. For many years  of clinical practice, I didn't screen all women routinely. I wish I had.  

Here's what I want every movement specialist reading this to hear: exercise is medicine for bone health, but we need to prescribe the right dose. 

Low-level physical activity is not enough. The evidence is now undeniable. Findings from the LIFTMOR trials (Watson et al.) and other studies demonstrate that high-intensity resistance and impact training significantly improves bone mineral density in postmenopausal women — including those with osteopenia and osteoporosis — without increasing fracture risk. Progressive strength training and impact loading stimulate bone remodelling in ways that gentle movement simply cannot. 

A supervised resistance training programme is indicated, not contraindicated, even with low bone density. The shift from caution to capability is the most important transition we can make for people with an osteoporosis diagnosis. 

We must move past the "walking and light weights" era.  

For Heather, we are now working with her rheumatologist and local fitness professionals who have the confidence to deliver progressive loading safely. She will need anabolic treatment given her fracture risk. But she will also train. She will stay mobile and active. Because that is what the evidence tells us to do — and because she deserves more than a life organised around fear. 

DEXA scans should be as routine as mammograms for anyone with a risk factor. Bone health screening should be part of every movement specialist's intake process. 

At the Therapy Show this year, under the theme Every Age, Every Body, we'll be exploring exactly this — because strong bones are not about being careful. They're about being loaded, supported, and seen.  

Christien Bird is co-founder of Menopause Movement, presenting at Therapy Show 2026 and exhibiting at the Menopause Movement trade stand.