Daily walking alone is not necessarily enough to protect bones after 40, despite its importance for overall health. Specialists recommend combining it with resistance exercises, weight-bearing activities and balance exercises.
This variety aims to stimulate the bones, preserve muscle mass and reduce the likelihood of falls and fractures with age. Bone health involves more than obtaining calcium and vitamin D, because bones are living tissue also affected by the type of movement and the mechanical stress placed on them.
Osteoporosis involves more than low bone density
Dr Mohammed Abdel-Baqi, a consultant in rheumatology and physical medicine and a certified bone densitometry specialist at Icon Medical Centre in Qatar, says osteoporosis means losing some of the bones’ natural ability to withstand stress, making them more susceptible to fractures.
Abdel-Baqi explains that osteoporosis is linked not only to reduced bone density but also to the quality of its structure. The CCD certification he holds is a professional qualification awarded by the International Society for Clinical Densitometry to practitioners qualified to interpret bone-density tests.
Abdel-Baqi compares long-term bone health with the idea of a “bone bank”. Building strong bone mass during childhood, adolescence and early adulthood gives people a larger reserve to help them cope with the gradual loss that accompanies ageing. Accordingly, he stresses that preventing osteoporosis does not begin after reaching 40, but in childhood.
The US National Institute of Arthritis and Musculoskeletal and Skin Diseases says bone mass reaches its peak in most people by their mid-to-late 20s. The amount of bone mass a person builds during childhood and youth therefore affects their bone health in later stages of life.
Mechanical loading supports bone development
According to Abdel-Baqi, building and maintaining bone requires a healthy diet and adequate calcium and vitamin D, alongside exposure to suitable mechanical loading or stress. Weight-bearing sports, or activities that make muscles pull on bones, provide a mechanical stimulus that helps bones adapt and maintain their strength.
These activities include walking, running, jumping and climbing stairs, as well as using a trampoline for children. They also include resistance exercises performed with weights, equipment or body weight. Abdel-Baqi explains that resistance generates tension transferred by the muscles to the bones, so its benefits extend beyond strengthening muscles to the skeleton.
A systematic review and meta-analysis published in 2023 in Osteoporosis International support the importance of physical activity for bones. The review covered 80 studies involving 5,581 postmenopausal women and linked exercise with improved bone density in the lumbar spine, femoral neck and hip.
Groups most at risk of bone loss
Bone health requires greater attention among postmenopausal women, particularly with advancing age, as well as older men, according to Abdel-Baqi. The risk also rises among people with a family history of osteoporosis, making attention to risk factors and early screening more important for these groups.
Risk factors include prolonged use of certain medicines, particularly corticosteroids, as well as some cancer treatments and hormone therapies. They also include diabetes, endocrine diseases and hormonal disorders, including an overactive thyroid or parathyroid glands, a deficiency of sex hormones and early cessation of menstruation.
Abdel-Baqi adds malabsorption disorders, chronic intestinal inflammation and some rheumatic diseases to the list. He also points to links between osteoporosis and smoking, excessive alcohol consumption, insufficient exercise and poor nutrition — factors that can affect the body’s ability to build bones or maintain their strength.
Bariatric surgery, particularly gastric bypass procedures, requires regular follow-up and adherence to the nutritional supplements prescribed by a doctor. French guidelines published in 2022 in the Joint Bone Spine journal recommended assessing fracture risk in people undergoing bariatric surgery and paying attention to calcium, protein and vitamin D intake, alongside physical activity.
The guidelines called for particular attention to people who had undergone gastric bypass and certain procedures that affect absorption. Abdel-Baqi believes that people at greater risk should focus on early screening for osteoporosis, including bone-density testing when there are medical indications for it.
Doctors call for varied exercise after 40
Dr Firas Ashoury, head of the orthopaedic surgery department at Amaan Hospital in Qatar, says daily walking is very important for bone health and the body in general, but “it is not necessarily enough on its own”. He advises people over 40 to combine walking with resistance exercises and weight-bearing activities instead of relying on one type of movement.
Ashoury explains that no single exercise can be described as the best for everyone. Brisk walking, climbing stairs and weight-bearing activities help stimulate the bones, while resistance exercises strengthen muscles, support the joints and improve balance. Greater benefit is therefore achieved by combining these activities rather than relying on walking alone.
A systematic review and meta-analysis published in the journal Menopause, covering 10 trials, concluded that walking alone had no clear effect on lumbar-spine or whole-body bone density among women in the perimenopausal and postmenopausal stages. By contrast, a benefit appeared in the femoral neck in programmes lasting more than 6 months.
Resistance exercises become more important with age, according to Ashoury, because they help preserve muscle mass and strength while giving bones the mechanical stimulus needed to help maintain their strength. Improving muscle strength, balance and stability can also reduce the risk of falls and injuries.
In 2025, the Journal of Orthopaedic Surgery and Research published a meta-analysis of 17 randomised trials involving 690 postmenopausal women. The analysis found that resistance exercises improved bone density in the lumbar spine, femoral neck and total hip, although study results varied in some areas.
According to Ashoury, resistance exercises do not require lifting very heavy weights. A person can start with light resistance and increase it gradually, while keeping correct technique a priority during training. People unaccustomed to exercise should begin with easy exercises and light resistance, then increase the intensity as their strength and fitness improve.
Ashoury stresses that movement quality and correct technique are more important than the amount of weight used. He warns against suddenly starting with heavy weights or high-intensity exercises, as well as ignoring pain and continuing to train despite it, because the programme should match the person’s ability and health condition.
People with osteoporosis, and those with a previous history of fractures or problems affecting the spine and joints, need to adapt their exercises to suit their condition. Abdel-Baqi adds that some people over 40 may have osteoarthritis, so activities should be chosen that provide loading and resistance without harming the joints or vertebrae when a medical problem is present.
The US National Institute of Arthritis and Musculoskeletal and Skin Diseases considers combining weight-bearing exercises, resistance exercises and balance exercises the most suitable option for supporting bone health and preventing falls and fractures. It recommends consulting a specialist before starting a new exercise programme for people with low bone density or osteoporosis.
Do not wait until you feel your bones or muscles weakening before you start looking after them
Walking therefore remains a useful starting point, but it is part of a more varied programme that includes resistance exercises, weight-bearing activities and balance work, while taking age and health into account.
This combination gives bones and muscles a better chance of retaining their strength, supporting balance and reducing the risk of fractures and injuries linked to falls.
