Bone-loading exercise, prescribed to your DEXA results and fracture risk.
Walking and pilates don’t build bone. They are good for cardiovascular health, balance, and general strength — but the load they place on the skeleton is below the threshold required to maintain or build bone density.
Bone-loading exercise is. It is high-intensity resistance and impact training, prescribed to your DEXA results, supervised, and matched to your fracture risk.
This is the work of an Exercise Physiologist. Our EP (AEP, ESSA) prescribes bone-loading exercise as part of a treatment plan, working alongside your endocrinologist, GP, and any specialist involved. The program is built around your bone density, your fracture history, and your current medications — including Prolia/denosumab, bisphosphonates, romosozumab, or teriparatide.
Exercise physiology is useful if you have:
Bone is living tissue. It adapts to the mechanical load placed on it. To maintain or build density, the load has to be specific — heavy enough to trigger an osteogenic response, and progressive enough to keep the stimulus above the bone’s habitual level.
Walking, swimming, and cycling are good for cardiovascular health. They do not load bone enough to trigger new bone formation. The stimulus that does is high-intensity resistance and impact training — heavy, progressive loading of the spine and hip, performed with correct technique.
Bone density is one factor in fracture risk. Strength, balance, and posture are the others. Most fragility fractures happen in a fall. Resistance training builds the muscle that supports weakened bone. Balance training reduces the chance of falling in the first place.
Exercise does not replace medical treatment. It is part of the treatment, alongside medication, dietary support, and falls prevention.
First appointment — one hour. A full history of your bone health, your DEXA results, your fracture history, your current medications, and your current strength and balance. From there, a bone-loading program is prescribed to your bone density and fracture risk.
Loading is matched to your bone density. High-intensity loading is the stimulus that works, but only when it is matched to your bones. The exercise physiologist prescribes loading to your DEXA results and progresses it as you adapt. High-risk patients — those with very low bone density, previous fracture, or significant kyphosis — are managed more conservatively, with impact loading introduced cautiously or omitted where it is not appropriate.
Form is taught in person. The first sessions are supervised one-on-one so the correct form is established before you take the work home. This is the part that matters most — loading the right structures without doing more damage. Most of the recurring problems we see have been made worse by doing the right exercises with poor form for several weeks.
Sessions are supervised. Small groups, technique watched every session. Programs are progressed as your body adapts, and as your DEXA results and medications change.
Medication changes are coordinated. If you are on a bone-active medication, the program is timed to support your medical treatment. If you are planning to come off a medication, the program is structured to protect bone density during the transition. Any plan to start, continue, or stop a medication is a decision for your endocrinologist to manage, with the exercise program built around it.
The first appointment is a one-hour assessment. Not a treatment, not a workout. The exercise physiologist takes a full history, reviews your DEXA results and current medications, and assesses your strength, balance, and movement. From there, a bone-loading program is written and a follow-up is scheduled.
If you are unsure whether exercise physiology is the right fit, a discovery call with our team can help clarify this before booking an assessment.
Yes, when the loading is prescribed and supervised. The exercise is matched to your bone density and fracture risk, and progressed gradually. Avoiding heavy loading is the more dangerous option — bone needs the stimulus to maintain density.
No. Exercise and medication do different jobs. Medication reduces the rate of bone loss. Exercise provides the mechanical stimulus the skeleton needs to respond to treatment, and supports the muscle and balance that reduce fall risk. The strongest results come from both.
Yes. The program is adjusted to your fracture history and current capacity. High-intensity loading is introduced cautiously, and the focus is on the loading your skeleton can tolerate safely. Many patients with previous fractures tolerate and benefit from progressive loading.
No. Exercise alongside Prolia supports the bone-density gains the medication is making. If you are planning to come off Prolia, exercise is particularly important — bone density declines on cessation of denosumab, and there is rebound fracture risk in the first six to twelve months. Any plan to reduce or stop is a decision for your endocrinologist to manage, with the exercise program built around it.
Typically two to three supervised sessions per week. Programs are progressed over time, with reviews when your DEXA results change or your medication changes.
Endocrine & Wellbeing Clinic
Phone: (02) 9870 3256
Or book online via the link in our bio
Locations: Balmain (inner west Sydney) and Telehealth Australia-wide
Affiliated with: ESSA (Exercise and Sports Science Australia), ANZBMS, Endocrine Society of Australia
This page is not a substitute for individual medical advice. Book a consult for assessment specific to your situation.
All future appointments will be at 100 Elliott Street Balmain 2041
