Osteopenia of the hip is diagnosed when there is decreased bone density at the hip joint. If bone density continues to decline, this will develop into osteoporosis. Those diagnosed with osteoporosis are at increased risk for bone fractures. However, this progression from osteopenia to osteoporosis can be slowed or avoided with certain interventions.
This article will review the diagnosis of osteopenia of the hip and introduce exercises that can help prevent it from developing into osteoporosis.
What is osteopenia of the hip?
Osteopenia is diagnosed when bone density is lower than what it should be. As we age, the rate of bone growth can slow down. Osteopenia is usually a result of bone breaking down at a faster rate than it can regrow, therefore making bones weak (Cleveland Clinic, 2021). Risk factors for developing osteopenia include:
- Postmenopausal women over 50 years old
- Poor nutrition, especially diets low in vitamin D and calcium
- Certain medications, such as cancer treatment medications, steroids, blood pressure medications, and more
- Certain medical conditions, such as thyroid conditions or gastrointestinal conditions that lead to poor absorption of nutrients
- Unhealthy lifestyle choices, such as lack of exercise, smoking, drinking alcohol, and poor diet
Some of these factors can’t be avoided, while others can be modified. This is important to note because if bone density continues to decrease, osteopenia can develop into osteoporosis. Osteoporosis is when the loss of bone is so substantial that bones can easily break (Cleveland Clinic, 2021).
A DXA scan can diagnose osteopenia by measuring bone density. The scan looks at the lumbar spine, the hip joints, and the wrists, where fractures are most likely to occur. The results from a DXA scan are called T-scores. A T-score measures how many standard deviations your bone density is from that of a normal, young adult of the same sex. A T-score between -1 to -2.5, is classified as osteopenia, while values less than -2.5 are classified as osteoporosis (Varacallo, 2023).
It is possible for these areas to vary in bone density, meaning that one area can be stronger than the other. You can even have a diagnosis of osteopenia in one hip and not the other, for example (Hamdy, et. al, 2006).
Improvements in diet and certain exercises can help improve bone strength and prevent the progression of osteopenia to osteoporosis.
Best exercises for hip osteopenia
The best exercises for osteopenia involve weight bearing, strengthening, and balance. This combination of exercises can slow the loss of bone growth and build new bone. They also strengthen the muscles that support the hip joint and decrease the risk of falling.
Strength training exercises for osteopenia of the hip
Strength training exercises, or resistance exercises, challenge your muscles so that they get stronger. In addition to muscle building, when the body moves against resistance, it stimulates bone growth in that area. Strengthening exercises can be done with machines, dumbbells, resistance bands, or bodyweight.
The best strengthening exercises for hip osteopenia should involve moving the hip joint and focusing on the muscles around the hip. This means targeting the gluteal, hamstring, quadricep, and core muscle groups. Improving the strength of these muscles will create a strong protective support around the hip joint. Many movements that strengthen these muscles move the hip joint and will stimulate bone growth in that area as well.
Weight-bearing exercises for osteopenia of the hip
Weight-bearing exercises involve moving your body weight against gravity. Bone growth is stimulated when your bones are continually being challenged by gravity or an external force pushing on it. In terms of the hip joint, this mainly involves standing exercises. Walking, squats, lunges, and planks are examples of weight-bearing exercises.
Weight-bearing exercises can also be resistance exercises. For example, a squat requires you to stand upright. With or without holding a weight, if you perform multiple repetitions of a squat, your muscles will be taxed in a way that will tire them and make them stronger.
Does walking increase bone density in the hips?
Walking is a weight-bearing exercise, so it is beneficial for bone health compared to being sedentary. However, it should not be the only exercise in your preventative plan. According to a recent meta-analysis of walking-only intervention studies, walking alone does not slow the rate of bone loss (Palombaro, 2005). This is likely because joint range of motion and the muscles used while walking are limited. It’s a great place to start in your journey to improve bone density, but should also be performed in combination with other exercises such as resistance training or varying the intensity of walking.
There are also ways to make walking more challenging for an extra bone-building boost. Walking briskly (Lan & Feng, 2022) with a weight vest, or walking up or down hills will further challenge your bones and muscles and can be more beneficial than a simple leisurely walk.
5 strength exercises for hip osteopenia
Below are 5 exercises that improve the strength and bone density of the hip. Some are more challenging than others, so pick the ones that make sense for you and your current fitness level. Perform 2-3 sets of 10-15 repetitions of each exercise. Your muscles should feel tired at the end of each exercise. If not, add more repetitions or sets, or follow the suggested progression.
1. Bridge with 5-second hold
The bridge with 5-second hold strengthens the gluteus maximus and hamstring muscles. Both are important for pelvic alignment and stability during daily activities such as standing and walking.
- Difficulty level: Beginner
- Start by lying on your back with your knees bent and feet flat on the floor, hip-width apart.
- Your arms should be down by your sides, with your palms facing down.
- Slowly lift your hips up toward the ceiling.
- Hold for 5 seconds.
- Then, slowly lower your hips back down to the starting position.
2. Quadruped alternate hip extension
Quadruped alternate hip extension improves the strength of the core and glutes while also targeting the muscles and bones of the upper body. These muscles work together to help keep your body stable and upright. The glutes are important for stability with standing and transferring weight from one leg to the other, such as when walking or climbing stairs.
- Difficulty level: Beginner
- Begin by getting into a hands and knees position (quadruped) on your mat.
- Your hands should be directly below your shoulders, and your knees should be directly below your hips.
- Your back should be in a neutral position as if forming a tabletop.
- Engage your lower abdominal muscles and elevate one leg backward.
- Hold this position for 5 seconds.
- Then return to the starting position and repeat with the other leg.
3. Squat with weight
The squat with weight strengthens your quads, glutes and hamstrings. The weight adds additional resistance to further challenge your body. These muscles encompass the hip from the front, back and outside protecting the joint. The squat is also a very effective weight-bearing exercise.
- Difficulty level: Intermediate
- Begin standing with your feet hip width apart.
- Hold a weight in each hand.
- Bend your elbows so that your hands are holding the weights just above shoulders.
- Bend your hips and knees as if you are going to sit down in a chair.
- Return back up to the starting position.
4. Lateral squat walks
Lateral squat walks is an exercise that challenges your balance while also helping to strengthen the muscles of the lateral hip. This is another resistance and weight-bearing exercise.
- Difficulty level: Intermediate
- Place a loop resistance band around both ankles.
- Stand tall with your feet hip-width apart and a slight bend in both knees.
- Keeping your knees bent in a mini squat position and your pelvis level, reach your leading leg out to the side.
- Control your trailing leg and bring it to a hip width position.
- Repeat to the same side so that you are essentially walking sideways for 5 repetitions as space allows.
- Then reverse direction.
5. Lateral lunge
The lateral lunge exercise strengthens the large muscles of the hips and legs. In addition to strengthening the glutes and quads, lunges promote good hip and knee mobility, improving one's ability to perform daily activities such as going up and down stairs and getting up from a low chair.
- Difficulty level: Advanced
- Begin standing with your feet hip width apart.
- Place your hands on your hips or straighten your arms out in front of you.
- Step the right leg out to the side and sit back like you're going to sit in a chair, bending the right knee while keeping the left leg straight out to the side.
- Most of your weight should be in the right leg.
- Then return to the starting position with your feet hip width apart.
- Perform 10 reps to the right. Then return to the center, and perform 10 reps to the left.
Hip Osteopenia FAQ
Can osteopenia cause hip pain?
Yes, osteopenia can contribute to hip pain as it is a condition characterized by lower-than-normal bone density, making the bones more susceptible to fractures and joint issues.
How can I strengthen my hips with osteopenia?
To strengthen your hips with osteopenia, focus on weight-bearing and resistance exercises that target the hip muscles, such as squats, resisted lateral walks, and side lying leg lifts, for example. There are many exercises for the hip in Wellen’s exercise library, to help get you started.
Can hip osteopenia be reversed?
While osteopenia can be managed and progression slowed down through lifestyle changes, such as exercise and proper nutrition, it is challenging to fully reverse. However, these measures can help improve bone density and overall bone health.
