How to Increase Bone Density: Tips From Physical Therapists

Your bones are an intricate part of who you are. They support your body and allow you to move and do all your daily activities. They also protect all your organs — including your brain and heart — from injury. 

But like everything else in your body, your bones change over time. During childhood and teen years, and into your 20s, new bone is added to your skeleton faster than old bone is removed, so you’re building bone density during that time, says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. But after about age 30, bone withdrawals generally go faster than deposits. As a result, you’re less likely to build new bone, and may even lose bone. “But there’s still a lot you can do to keep your bones healthy and strong and minimize bone loss,” reassures Dr. Kimbrough. And it starts with movement. 

Read on to learn more about how to increase bone density and get tips — including exercises — from Hinge Health physical therapists.

Why Is Bone Health Important?

It may surprise you to learn that bones are living, growing tissue. “They’re not just a completely solid mass like many people might think,” says Dr. Kimbrough. Bones are made up of two main materials: collagen (a protein that provides your bones’ framework) and calcium (a mineral that adds strength and hardness), explains Dr. Kimbrough. This combo is what makes your bones both strong and flexible, so you can do everything from walking and running errands to cycling and hiking.

But like everything else in your body, your bones need to be taken care of in order to stay healthy. Otherwise, they can get weaker over time — just like a muscle if it’s not used enough. This puts you at higher risk for osteoporosis, or low bone density. 

Osteoporosis is often called a “silent disease” because it typically progresses without any noticeable symptoms in its early stages. Many people are unaware they have it until they experience a bone fracture. “That’s why it’s important to focus on preventative measures you can take — not the least of which is staying active — to keep your bones healthy and build up bone density,” says Dr. Kimbrough.

Factors That Affect Bone Density

There are many different factors that affect bone density, notes Dr. Kimbrough. Some you can control, and some you can’t. Just remember: Even though you can’t control everything that impacts bone health, there’s always something you can do to help keep your bones strong and healthy. 

Factors that affect bone density include: 

• Age. You achieve peak bone mass between the ages of 25 and 30. After 40, you slowly begin to lose bone density as a normal part of getting older. Women are particularly prone to this right after menopause, due to a decrease in estrogen levels. They can lose up to 20% of their bone density in the first five to seven years after menopause starts, according to the Bone Health & Osteoporosis Foundation.

• Diet. Getting enough calcium from your diet is very important to help your body break down and create new bones. Other important nutrients for bone health are vitamin D, magnesium, and phosphorus. You can find these nutrients in fatty fish (salmon, mackerel, tuna), egg yolk, leafy greens, nuts and seeds, legumes, dairy products, and whole grains. 

• Activity level. “Exercise works on bones just like it does on muscles — it makes them stronger,” explains Dr. Kimbrough. Since bone is living tissue, it responds to force placed on it. “When you exercise regularly, your bones adapt by building more bone,” Dr. Kimbrough notes. In contrast, there’s a clear link between being sedentary and low bone density, according to a 2023 review published in the journal Scientific Reports.

• Racial or ethnic background. Whites and Asians are more likely to have lower bone density than people who are Hispanic or Black.

• Weight. People who are considered underweight (a BMI of 18.5 or lower) often have lower bone density. The theory is that people who have a BMI of 18.5 or higher may have higher levels of hormones such as estrogen, which helps to increase bone density.

• Medications. Certain drugs can reduce bone density. They include:

  • Steroids such as prednisone

  • Blood clotting medications like heparin

  • Anti-seizure medicines like phenytoin or carbamazepine

  • Aromatase inhibitors (to treat breast cancer) such as letrozole or anastrozole

7 Healthy Habits to Increase Bone Density

What is the fastest way to increase bone density? There’s no magic formula to create super strong bones. But Hinge Health physical therapists have many recommendations on how to increase bone density naturally. They include:

• Stay active. When it comes to increasing bone density, movement is key. Groups like the American College of Sports Medicine recommend weight-bearing aerobic exercise such as walking or running most days of the week, as well as at least 30 minutes of resistance exercise two to three times a week. A 2022 review published in the British Journal of Sports Medicine found that regular weight-bearing and resistance exercise helped improve bone strength and reduce fall risk in people with osteoporosis. 

• Try yoga. Some research suggests that a regular yoga routine can help to improve bone density. It also helps to boost balance, which reduces your risk of having a fall, notes Dr. Kimbrough.

• Eat a well-balanced diet. An eating pattern that’s rich in fruits, veggies, whole grains, and some dairy may help to increase bone density, according to a 2023 review published in the journal Nutrients. These foods are all rich in calcium, potassium, and magnesium, which help to build and maintain bone, points out Dr. Kimbrough.

• Focus on calcium and vitamin D. Groups like the Bone Health and Osteoporosis Foundation recommend that women under the age of 50 and men under 70 consume at least 1,000 mg of calcium per day. (That recommendation goes up to 1,200mg per day as you get older.) If possible, try to get calcium from food, which is absorbed best by your body, advises Dr. Kimbrough. Good sources of calcium include dairy products like milk, cottage cheese, and yogurt, and leafy green veggies like kale. In addition to calcium, all adults under the age of 50 should get 800 IU of vitamin D daily, while those older should aim for 1,000 IU. Good sources include fatty fish (salmon, mackerel, tuna), egg yolks, and fortified orange juice, dairy products, and cereal. Talk to your doctor about supplements if you’re concerned about getting enough of these nutrients from your diet alone.  

• Limit alcohol. More than two drinks a day can impact bone density. Opt for non-alcoholic options when possible. 

• Avoid smoking. Smoking cigarettes speeds up bone loss. Research suggests that women who smoke a pack of cigarettes a day through adulthood have up to a 10% reduction in bone density by the time they enter menopause.

• Check your medications. If you take medicine that can cause bone loss, talk to your doctor. There may be things you can do to reverse the effects, like take in more calcium, or you may be able to switch to a different drug. You may also benefit from a consultation with a physical therapist, who can help you add bone strengthening exercises into your workout routine (see below for more details.) You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The above exercises are recommended by Hinge Health physical therapists for a full body workout that will keep bones strong. How long does it take to build bone density? There’s no clear answer. The best way to increase your bone density is simply to stay active with weight-bearing activities such as the ones above, advises Dr. Kimbrough.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Do Shoulder Blade Squeezes 

“As we age, we have a tendency to develop rounded shoulders and a hunched upper back that can put more pressure on our spines,” explains Dr. Kimbrough. There’s no right or wrong posture, since everyone is different. “But being in a rounded position — or any one position — for long periods without a break can change your center of gravity and make you more likely to experience a fall that causes a bone fracture.” She recommends people perform shoulder squeezes periodically throughout the day. “Imagine that there’s a pencil between your shoulder blades that you’re trying to squeeze,” she suggests. This can help take stress off of your spine.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. What Women Need to Know. (n.d.). Bone Health & Osteoporosis Foundation. Retrieved from https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/ 

2. Zhang, L., Shi, G., Liao, X., Huang, J., Yu, M., Liu, W., Li, X., Zhan, H., & Cai, X. (2023). Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and Nutrition Examination Survey, 2011–2018. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-35742-z

3. Thomas, P. A. (2007). Racial and Ethnic Differences in Osteoporosis. Journal of the American Academy of Orthopaedic Surgeons, 15, S26–S30. https://doi.org/10.5435/00124635-200700001-00008

4. Hou, J., He, C., He, W., Yang, M., Luo, X., & Li, C. (2020). Obesity and Bone Health: A Complex Link. Frontiers in Cell and Developmental Biology, 8. https://doi.org/10.3389/fcell.2020.600181

5. Bae, S., Lee, S., Park, H.-J., Ju, Y.-I., Min, S.-K., Cho, J., Kim, H., Ha, Y.-C., Rhee, Y., Kim, Y.-P., & Kim, C. (2023). Position Statement: Exercise Guidelines for Osteoporosis Management and Fall Prevention in Osteoporosis Patients. Journal of Bone Metabolism, 30(2), 149–165. https://doi.org/10.11005/jbm.2023.30.2.149

6. Brooke-Wavell, K., Skelton, D. A., Barker, K. L., Clark, E. M., Biase, S. D., Arnold, S., Paskins, Z., Robinson, K. R., Lewis, R. M., Tobias, J. H., Ward, K. A., Whitney, J., & Leyland, S. (2022). Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine, 56(15). https://doi.org/10.1136/bjsports-2021-104634

7. Lu, Y.-H., Rosner, B., Chang, G., & Fishman, L. M. (2016). Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Topics in Geriatric Rehabilitation, 32(2), 81–87. https://doi.org/10.1097/TGR.0000000000000085

8. Chen, H., & Avgerinou, C. (2023). Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review. Nutrients, 15(19), 4255–4255. https://doi.org/10.3390/nu15194255

9. Rosen, H. N. (2023, February 1). Patient education: Osteoporosis prevention and treatment (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/osteoporosis-prevention-and-treatment-beyond-the-basics/print#:~:text=Smoking%20%E2%80%94%20Avoiding%20or%20quitting%20smoking

10. Huang, M.-H., Barrett-Connor, E., Greendale, G. A., & Kado, D. M. (2005). Hyperkyphotic Posture and Risk of Future Osteoporotic Fractures: The Rancho Bernardo Study. Journal of Bone and Mineral Research, 21(3), 419–423. https://doi.org/10.1359/jbmr.051201