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Improving Bone Strength Before Surgery: A Guide for Older Adults

Improving Bone Strength Before Surgery: an older woman talks with a female doctor before a procedure

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Strong bones can provide the strength and resilience to bounce back quickly from surgery and prevent common injuries as you age. Improving your bone strength starts with increasing bone density, which is essential for maintaining strong, healthy bones. 

As we get older, conditions caused by a loss of bone density, like osteoporosis and osteopenia, become more common, making injuries more frequent.  But there are ways to lower your risk. 

By taking proactive steps to maintain your bone health, you can stay safe and independent longer.  This article will provide you with effective strategies for boosting bone health and ensuring a smoother recovery from surgery.

Let’s explore how regular physical activity, a nutritious diet, and a few key lifestyle changes can significantly enhance your bone strength and overall well-being. 

Understanding Bone Health and The Aging Process 

Improving Bone Strength Before Surgery

Improving your bone strength starts with increasing your bone density—the amount of minerals in your bone tissue. 

Higher levels of bone density are correlated with stronger bones. Think of bone minerals like the concrete that makes up the foundation of a house.  When concrete is denser, it can support more weight. The same is true for your bones. 

Conditions like osteoporosis and osteopenia are caused by the loss of bone density, which happens naturally with age, making bone injuries more common for older adults. Staying safe and maintaining independence are huge reasons why it’s so important to be proactive about your bone health as you age. 

If you’re not sure about your bone health, you’re not alone.  Many of the patients I’ve treated in my physical therapy practice have never learned about bone density, nor do they know what their bone density is.

How Is Bone Density Measured?

Bone density is measured using a Dual-Energy X-ray Absorptiometry (DEXA) scan. During the test, you lie on a padded table while a scanner passes over your body, focusing on areas like your hips and spine. The scanner uses low-dose X-rays to measure bone density.

The results are given as a T-score:

  • -1.0 or above: Normal bone density
  • -1.0 to -2.5: Low bone density (osteopenia)
  • -2.5 or below: Osteoporosis

This score helps you and your doctor make informed decisions about your bone health.

Identifying these issues is the first step in having important conversations about bone density that can lead to big improvements in your health later. In the next section, we’ll explore how a less-than-ideal T-score can lead to problems with surgery.

Why Pre-Surgical Bone Strength Matters 

Improving Bone Health for Surgery: Image of a doctor visiting his happy senior patient in her hospital bed.

Surgery can be stressful no matter who you are.  It’s even more daunting if you have concerns about how your body will handle the procedure and if the recovery process will go as planned. 

When we’re younger, it’s much easier to bounce back from injuries or invasive procedures.  As we get older, it takes our bodies a little bit more time to heal and recover.  

For this reason, proper preparation for surgery is essential for older adults.  This might mean consulting with a physical therapist for bone-building exercise routines or, at the very least, getting a DEXA scan to monitor your bone health.

Getting your body in the best possible shape for the stresses of surgery requires more preparation work, but a successful outcome that avoids complications is seriously worth the effort. 

Risks of Weak Bones During Surgery

Bone health is vital not only for injury prevention but also for recovery from many procedures.

Going into surgery when your bones aren’t strong enough can present a variety of risks, influencing the success of the procedure itself, or even leading to post-operative complications. 

Here are a few examples: 

  • Increased risk of fractures: During surgery, especially when the procedure involves manual manipulation or inserting hardware, weak bones are more easily fractured.1
  • Complications with hardware: Implants have a harder time anchoring into weak bones, so hardware like screws and cages are more likely to become loose or fail altogether. 
  • Suboptimal healing: Bone weakness, especially in surgeries that require bone fusion, can lead to delayed recovery and a less effective healing process.
  • Longer recovery time: Weak bones can mean spending more time in postoperative braces or supports, which extends how long it takes to recover. 
  • Additional procedures: Poor bone quality can cause your initial surgery to be unsuccessful, and may lead to riskier or more complex surgeries down the road. 

Undergoing a surgical procedure with weak bones can make the procedure, and your entire recovery process unnecessarily complicated. 

I’ve seen this firsthand with many of my patients who have needed a major bone procedure after a fall. Bone health can make a world of difference in situations like these.

Benefits of Strong Bones for Surgical Success

On the other hand, going into surgery with strong bones allows your body to better handle the stress of surgery and supports a quicker, easier recovery. 

Strong bones provide a strong foundation that improves your resilience in times of stress. Here are some of the benefits of strengthening your bones before surgery:  

  • Less risk of fracture: The risk of complications like fractures during and after surgery is much lower when you have strong bones before the procedure. 
  • Better surgical outcomes: Patients with healthy bone density experience more successful outcomes, such as implants and hardware having the right support. 
  • Shorter recovery process: Strong bones heal and adapt more easily after surgery, leading to shorter recovery times. 
  • Lower rate of complications: Improved bone density before a surgical procedure, such as spinal fusion surgery or to repair deformities, can greatly reduce the risk of complications during surgery. 
  • Avoid additional procedures: Stronger bones provide a stable foundation for your body to heal and reduce the risk of complications during the healing process that may lead to further surgeries. 

Generally speaking, my patients who are more active tend to do better with surgeries than those who are sedentary. Let’s look at why physical activity is great preparation for surgery—and for general health.

Physical Activity for Bone Health

Improving bone health before surgery: an older woman lifts weights at the gym, smiling.

So, we know that strengthening your bones before surgery offers plenty of benefits for older adults, but how do you work out your bones? 

Specific types of exercises can have a direct impact on bone density and strength, and engaging in regular physical activity is one of the best strategies to improve your bone health.2

Here are some of the most important ways your activity level can affect your bone strength.

Building and Maintaining Bone Mass

Building and maintaining bone mass is vital for the long-term health of your bones. Bone strength and density make up bone mass, which allows your body to withstand daily physical challenges and procedures like surgery. 

Around the age of 35, your body naturally starts to lose bone density, and this process accelerates as you age. But there are steps you can take to mitigate this loss and help your bones stay healthier over the years. 

Weight-bearing exercises—exercises that force your body to work against gravity—are great at stimulating and encouraging your bones to grow stronger. Low-impact weight-bearing exercises can include walking, running, dancing, gardening, hiking, or low-impact aerobics.

I personally find that the most important part of a successful weight-bearing exercise program is to focus on the things that you enjoy most. This makes you more likely to actually do them. 

Many of my patients enjoy things like hiking or fitness classes because they keep them engaged and coming back for more.

Stronger Bones Through Resistance Training 

Exercises that apply stress to your bones and encourage them to get stronger are called resistance exercises. 

These exercises typically include activities like weight lifting or using resistance bands. They are a great way to help your bones get stronger over time, allowing them to better support your body during surgery and recovery. 

Exercises that build resilience in your hips and spine are particularly important. Since hip and spinal fractures are among the most common injuries people over 50 encounter, bolstering strength in these areas is crucial.

Resistance exercises can look different for everyone, so start with the equipment you have available and start small, gradually working your way to more challenging exercises. 

If you’re unsure which exercises to start with, ask your physical therapist for recommendations!

Exercise Recommendations for Optimal Bone Health

Regular physical activity, including weight-bearing exercises and resistance training, is key for maintaining and even improving bone health.

Regular exercise prevents the loss of bone mass and promotes new bone growth, keeping bones strong and resilient, which is especially important for preventing or delaying osteoporosis.

Find out how to do our favorite bone-building exercises with detailed descriptions and easy-to-follow videos!

It’s important to remember that the exercises you choose should be tailored to your specific needs and abilities, especially if you’re getting ready for surgery and have special instructions from your care team. 

Keep in mind that you should focus on activities you enjoy doing, so it’s easier to stay on track with your exercise routine day after day. 

When starting your exercise routine, 2-3 sessions per week is a good goal. As you gain confidence and recover from your sessions quicker, you can add more sessions to your week.

If you need guidance, consulting with a physical therapist is a great start. They can develop exercise routines based on your current condition and lifestyle that will help you meet your bone health goals.

Enhancing Bone Health Through Lifestyle Changes

Improving Bone Health for Surgery: A senior couple shops for vegetables at the supermarket

We’ve covered how you can increase your bone strength before surgery with physical activity, but are there other ways to increase bone density and promote overall bone health? The answer is yes.

While physical activity is one of the best ways to help your body prepare for surgery, there are lifestyle changes that can also help promote bone growth and strength. Here are a few examples: 

Vitamins and Minerals

Including vitamins and minerals in your diet is an easy way to promote bone health. 

Calcium, vitamin D, magnesium, and zinc are all essential for bone health. Certain foods and supplements make it easy to incorporate them in your daily routine.3

Avoid Smoking

Put simply, smoking has numerous negative effects on your bone density. Try to quit smoking as soon as possible for healthier bones, and join a support program if you’re having trouble quitting.

Maintain A Healthy Weight 

Being overweight puts extra stress on your body and can lead to numerous health problems. However, being underweight can actually increase your risk of bone loss and fractures. 

Staying at a healthy weight helps keep your bones strong while preventing other health conditions. 

Schedule Regular DEXA Scans

DEXA scans are the most reliable way to stop bone deterioration in its tracks.  We recommend follow-up scans even if you are not anticipating any upcoming surgeries.  Talk to your doctor to find out more about getting tested.

In my experience working with older adults, it can be helpful to have an honest discussion about what you’re trying to achieve with your lifestyle changes. After all, you’ll need to know the reason you’re making changes in your life to keep you motivated day after day!

Understanding the importance of healthy bones is the first step toward achieving improved bone density. By taking a proactive approach and thinking about your bone health before it becomes an issue, you’re saving your future self from potential obstacles and complications. 

Healthy bones are a keystone to healthy aging, but entering the operating room with strong bones is important for better surgical outcomes and smoother recovery. 

Key Takeaways

  • Improving bone strength begins with increasing bone density, which is crucial for stronger bones.
  • Conditions like osteoporosis and osteopenia, caused by a loss of bone density, become more common with age, making bone injuries more prevalent among older adults.
  • Proactive bone health maintenance is essential for safety and independence in older adults.
  • Proper preparation for surgery, including consulting a physical therapist and getting a DEXA scan, is vital for older adults to ensure a successful outcome and recovery.
  • Weak bones during surgery increase risks such as fractures, complications with hardware, suboptimal healing, and longer recovery times.
  • Strong bones before surgery reduce the risk of fractures, improve surgical outcomes, shorten recovery times, lower complication rates, and avoid additional procedures.
  • Regular physical activity, including weight-bearing and resistance exercises, is crucial for building and maintaining bone mass and strength.
  • Lifestyle changes such as incorporating essential vitamins and minerals, avoiding smoking, and maintaining a healthy weight also promote bone health.
  • Consulting with a physical therapist can provide tailored exercise routines to meet bone health goals and prepare for surgery.
  • Understanding the importance of bone health and taking proactive steps can prevent future complications and improve overall well-being.


  1. Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone mineral density and fracture burden in postmenopausal women. CMAJ. 2007 Sep 11;177(6):575-80. doi: 10.1503/cmaj.070234. PMID: 17846439; PMCID: PMC1963365. 
  2. Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. 2018 Dec 23;2018:4840531. doi: 10.1155/2018/4840531. PMID: 30671455; PMCID: PMC6323511.
  3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Calcium and Vitamin D: Important for Bone Health