The answer may seem obvious, but there definitely are some caveats! Can we improve our bone density with exercise?

A recent systematic review and meta-analysis published in Frontiers in Physiology examined this, and here is what they found:

Bone Mineral Density (BMD)

• Exercise significantly increased lumbar spine BMD in women under 30
• Exercise significantly increased femoral neck BMD in women under 30
• Effect sizes were moderate
  • Lumbar spine: SMD ~0.46
  • Femoral neck: SMD ~0.42

Beyond these primary findings, the review showed that the type of exercise performed plays an important role in determining outcomes.

• Programs that combined resistance training with weight-bearing or impact activities consistently produced the largest improvements in bone density.
• These combined approaches appear to create a stronger mechanical stimulus by loading bone in multiple ways, which enhances adaptation.

In contrast, single-mode exercise such as endurance or aerobic training alone resulted in smaller or less consistent changes in BMD. This reinforces the idea that bone responds best to varied and progressively challenging loading rather than repetitive, low-variation activity.

Bone Turnover Markers

The study also examined changes in bone turnover markers, which provide insight into how bone is actively remodeling. Exercise increased markers of bone formation, including osteocalcin and bone-specific alkaline phosphatase, indicating that bone-building processes were being stimulated. Shorter training programs, particularly those under four months, were associated with early increases in markers like osteocalcin and P1NP, suggesting that biological changes in bone can occur relatively quickly, even before large changes in density are measurable. Bone-specific alkaline phosphatase increased with both short- and longer-term training, supporting the idea that continued exercise helps maintain this positive remodeling environment.

Start Young!

One of the more notable findings relates to age.

The review found significant improvements in bone density in women under 30, but not in those over 30.

At first glance, this may suggest that exercise becomes ineffective for bone health after early adulthood, but that interpretation would be misleading. Bone tissue is most responsive during the years leading up to peak bone mass, which typically occurs in the late twenties. After this point, the body becomes less sensitive to mechanical loading, meaning it is harder to produce measurable increases in bone density over shorter study periods.

However, this does not mean exercise is no longer beneficial for women over 30. In this group, exercise still plays a critical role in maintaining existing bone mass and slowing age-related decline. Without regular loading, bone density tends to decrease gradually over time, increasing the risk of osteoporosis later in life. Exercise, particularly resistance and impact training, helps preserve bone structure, improve strength, and reduce fracture risk even if large increases in BMD are not seen.

In other words, while younger individuals may be building bone, older individuals are protecting what they have, which is just as important!

Practical Applications

Exercise can improve bone density in young adult women, but not all exercise is equally effective.

• Programs that combine resistance training with weight-bearing or impact activities produce the best results.
• The largest gains are seen before the age of 30- put as much bone density in the bone bank as possible during your younger years!
• Exercise remains highly valuable afterward by helping maintain bone mass and reduce long-term risk. If you’re over 30, don’t stress about what you may or may not have done in your younger years- work to maintain what you have with resistance training mixed with some impact -oriented cardiovascular exercise!

If you have any questions about how to structure a program to maintain bone density- feel free to contact our Waterloo based chiropractors, physiotherapists or book online HERE.