Managing Osteoporosis with Physical Therapy
Osteoporosis is a bone disease characterized by low bone mineral density, decreased bone strength, and changes in bone structure that cause thin, brittle bones and an increased risk of bone fractures. Osteoporosis is more common in women than men with the prevalence increasing significantly in women after menopause. Physical therapy plays a critical role in managing osteoporosis, helping those with osteoporosis maintain and build bone density through a customized therapeutic exercise program. Research has shown that aerobic and resistance exercise effectively stimulate bone osteogenesis in osteoporosis patients, improving bone density and reducing fall risk.
Understanding Bone Loss & Remodeling
Your bones are dynamic tissues that are constantly rebuilding and remodeling, while storing important minerals like calcium and phosphorous. Bones respond to changes in mechanical loads, altering bone mass, structure, and strength to withstand future loads to prevent a bone fracture. Over time, bone cells become desensitized to repetitive loading, meaning that the capacity of the bone to respond to continual loading diminishes over time or with increasing repetitions. This means that it is essential to engage in regular and progressive aerobic and strength training especially as you age to maintain good bone health, density, and remodeling for strong, resilient bones.
Up until your mid-thirties, your body naturally builds more bone than you lose during bone remodeling. However, after age 35, bone breakdown happens faster than your body can replace it, which causes a gradual loss of bone mass. This imbalance in the rebuilding and breaking down of bone tissue is accelerated in the first five years after a woman experiences menopause, as the estrogen hormone declines, which provided a protective effect on bone health up until menopause (the cessation of menstrual cycles).
Osteoporosis FAQ
Osteoporosis is a bone disease that is characterized by low bone mineral density, decreased bone strength, and changes in bone structure, which increases the risk of bone fractures. With osteoporosis, bones gradually become thin and brittle. Nearly 10 million Americans have osteoporosis and another 43 million American have low bone mass. Osteoporosis is more common in women than men, with the prevalence increasing significantly in women after menopause. In fact, research has shown that approximately 30% of all postmenopausal women in Europe and United States are reported to have osteoporosis and at least 40% of these women will sustain one or more osteoporotic fractures in their lifetime.
Osteoporosis can increase the risk of fragility fractures, which are bone fractures that occur from low-trauma forces that would not normally result in injury, such as breaking your wrist or hip during everyday situations. Osteoporosis is a silent disease, in which the most common “symptom” is suddenly breaking a bone after a small fall or minor accident that wouldn’t normally cause a fracture. Other signs of osteoporosis can include losing an inch or more of your height, changes in natural posture (stooping or bending forward more), or shortness of breath (if the discs in the spine are compressed enough that it reduces your lung capacity).
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Risk factors for osteoporosis can include:
Being over the age of 50, especially for women after menopause
A family history of osteoporosis
Those who are naturally thin or have smaller frames
Smokers
Endocrine disorders such as thyroid disease or diabetes
Conditions such as IBS, celiac disease, and autoimmune diseases like rheumatoid arthritis
Taking certain medications like diuretics, corticosteroids, seizure medications, hormone therapy for cancer, or proton pump inhibitors
A diet low in calcium or vitamin D
A sedentary lifestyle
Regular drinking of alcohol
Managing Osteoporosis with Physical Therapy
Physical therapy plays a critical role in managing osteoporosis, helping those with osteoporosis maintain and build bone density through a customized therapeutic exercise program. Research has shown that aerobic and resistance exercise effectively stimulate bone osteogenesis in osteoporotic patients, improving bone density and reducing fall risk. The physical therapist designs an osteoporosis treatment program customized to the patient’s specific needs and physical abilities, helping the patient gradually build strength and aerobic capacity safely through a progressive exercise program.
Physical therapy interventions for osteoporosis include:
Aerobic exercise: Weight-bearing aerobic exercise such as brisk walking, jogging, climbing stairs, or dancing uses the combination of gravity and the movement of large muscle groups to produce stress on joints and bones to stimulate osteoblast activity and bone building while increasing aerobic capacity.
One study found that moderate to vigorous aerobic exercise performed 3-4 times per week was associated with a considerably lower incidence of fragility fractures in men and women.
Another study on water-based aerobic exercise, which can be helpful and safer for those with severe osteoporosis or at a high fall-risk, found that water-based training reduced age-related bone loss at the hip and lumbar spine, though land-based training was more effective in enhancing bone health overall.
A study on postmenopausal women found that aerobic impact exercises can increase bone mineral density (BMD) in the hip and spine. Postmenopausal osteopenic women participated in a 24-week aerobic exercise program consisting of treadmill walking followed by stepping exercises. These women experienced increased BMD in the lumbar spine and the femoral neck of the hip joint as well as improved quadriceps strength, muscular endurance, and peak exercise oxygen consumption. The control group who did not participate in the exercise intervention experienced declining BMD.
Resistance training: Resistance training involves building muscle and bone strength using body weight, hand weights, resistance bands, or weight machines to increase muscle mass. When strength training, the force produced by the muscle contracting combined with the ground reaction forces during weight-bearing loads the skeletal system and strengthens bones while building muscle mass.
Research has found that a resistance program involving moderate to high intensity loads (2-3 sets of 8-12 reps at 70-85% max muscle strength) that increased progressively over time and targeted large muscles in the hip and spine improved BMD in older women.
Another study of 53 postmenopausal osteopenic women found that twice weekly power training maintained hip and lumbar spine BMD compared to traditional progressive resistance training over 12 months and these benefits persisted in the spine after 2 years.
Researchers have noted that progressive resistance training in the lower limbs is the most effective type of exercise intervention for BMD of the hip.
Balance training: Static and dynamic training is essential to reduce the risk of a fall in those with osteoporosis.
Posture and body mechanic instruction: Physical therapists also provide instruction on proper posture and body mechanics when engaging in daily activities to minimize stress on vulnerable joints, reduce the risk of a fall, and support overall joint health by decreasing the stress on joints and bones from poor posture.
Exercise interventions incorporating a multi-modal program, such as weight-bearing aerobic exercise, power training, resistance training, and balance training, are effective in preventing osteoporosis and osteoporosis-related fractures. A year-long study of 162 older adults found that a multi-component exercise program including traditional and high velocity progressive resistance training combined with multi-direction, weight-bearing aerobic exercises and balance training three times a week was effective in improving hip and lumbar spine BMD, muscle strength, functional muscle power, and dynamic balance when compared to the usual care control group.
A recent 2022 study assessed the effect of three types of exercise interventions on BMD in 39 postmenopausal women to prevent the onset or progression of osteoporosis. One group received high-impact training, another group did high-impact training combined with increased Vitamin D and calcium intake, and the last group walked at an intense pace while supplementing with calcium and Vitamin D. While all groups experienced improvements, the second group who did high impact training with supplementation saw the largest improvements in BMD with a baseline improvement of over 20% in their T-scores (which measures BMD) and had the lowest percentage of fractures following the intervention.
If you have osteoporosis or are concerned that you may be at risk for the condition, work with a physical therapist who will guide you through a safe, effective exercise program to restore healthy movement and function and rebuild bone strength.
