Physiotherapy for Osteoporosis: Exercises, Safety, Benefits

Osteoporosis is a condition that develops from a decrease in bone mineral density that makes bones thin, brittle and more susceptible to fractures.

While people with osteoporosis need to be careful in their daily activities to avoid breaking a bone, regular exercise is crucial for increasing bone and muscle strength.

This article will discuss the benefits of physiotherapy for osteoporosis, exercises that are beneficial, exercises to avoid, and finding treatment.

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Does exercise impact bone density?

Bone cells become thicker and stronger in response to the beneficial stress of exercise. This response of bone cells is stimulated by:

  • Joint Response Forces: Forces of contraction of the muscles which pull on the bones to which they are attached
  • Ground reaction forces: Forces through the bones (mainly the leg bones) from contact with the ground when standing and moving on your feet

Physiotherapy for osteoporosis will involve a selection of therapeutic exercises tailored to your individual needs. These exercises are designed to strengthen key muscle groups that support and stabilize areas of weakness. These exercises protect your bones and improve your balance to reduce your risk of falls.

Misconceptions About Exercise

Pain, fear of falling, and lack of interest are some of the main reasons people with osteoporosis stop exercising, but avoiding exercise and physical activity can make osteoporosis worse. and increase the risk of bone fractures.

Not being active causes muscle stiffness and atrophy (breakdown), resulting in muscle weakness. It also leads to poor balance and bone weakness, which accelerates the loss of bone mineral density. Exercise and physical activity are essential for rebuilding muscle and maintaining proper bone health.

Who can benefit from physiotherapy?

Bone density naturally decreases over time with age, especially in people over 65, which increases the risk of developing osteoporosis. Since estrogen, a female hormone, protects bone cells, the natural decline in estrogen levels that occurs in postmenopausal women also significantly increases the risk of osteoporosis.

Other risk factors for osteoporosis include:

  • Low body mass
  • Certain medications, especially prolonged use of corticosteroids
  • Low testosterone levels in men
  • Smoking
  • Malnutrition
  • Vitamin D deficiency or insufficiency
  • Excessive consumption of alcohol
  • Family history of osteoporosis

People with the lowest bone mass and lowest previous level of exercise are likely to benefit the most from increased exercise load (the amount of exercise you do) to strengthen bones.

Physiotherapy exercises for osteoporosis

A physiotherapist will be able to provide you with an individualized exercise plan tailored to your specific needs following a physical exam.

While there are no definitive guidelines on the exact amount, intensity, and duration of exercises to increase bone strength, weight-bearing exercises that work multiple muscle groups are generally the most beneficial. Setting goals and choosing exercises that you enjoy will help you sustain your workouts for the long haul.

Weight-bearing exercises

Weight-bearing exercises are important for slowing bone loss and improving bone mineral density. Weight-bearing exercises also significantly strengthen the muscles to work together to stabilize and support the joints.

Specific weight-bearing exercises that can increase muscle and bone strength include squats, step-ups, lunges, and jumping rope. Other weight-bearing activities include jogging, hiking, and stair climbing. Note that if you have osteoporosis, you will need to work up to higher level exercises, such as plyometrics, jogging, and jumping rope.

Since bone cells adapt to repeated loading patterns, such as the force of running, modifying your movements and exercises is beneficial.

Exercises without weight bearing

Non-weight-bearing exercises are those in which your limbs can move freely without being in contact with the ground. Non-weight bearing exercises isolate specific muscle groups to help improve balance and stability.

Specific non-weight-bearing exercises that can help strengthen leg and arm muscles include:

  • Legs: multi-directional leg rests and clam shells
  • Arms: Bicep curls, tricep crunches, shoulder press, lateral raises and rows

While non-weight-bearing activities like swimming and cycling are good for improving cardiovascular fitness and general health, these types of activities are not specifically recommended for patients with osteoporosis because they don’t do much. something to improve bone mineral density.

Balance and flexibility

A good balance is crucial for people with osteoporosis to prevent falls and the risk of fractures that follow. Balance exercises include:

  • Standing on one foot
  • Standing on an unstable surface
  • Avoid
  • Reverse
  • Front and side risers
  • Moving weight in different directions

Flexibility is also important to allow muscles to contract properly within their range of motion. Key muscles to stretch to prevent imbalances and improve strength include the hip flexors, hamstrings, quadriceps, and calf muscles.

Movements to avoid

Avoid exercises that involve repetitive bending and twisting, especially while carrying an object, such as sit-ups and crunches, rowing, lifting with a bent spine, certain yoga poses and dance moves, and heavy work at home and in the yard.

These positions increase pressure and friction in the spine, which can cause a fracture. Spinal compression fractures are also more likely to occur when your abdominal muscles are weak and cannot properly stabilize your spine. High-impact exercises like golf and tennis, which require powerful twisting movements, are also to be avoided.

Where to find a physiotherapist

Although you may have direct access to physiotherapy services without a prescription from a primary physician, some facilities, especially hospitals, still require a prescription from a health care provider to treat you at their facility.

Ambulatory physical therapy, which is performed in private clinics, hospitals, and health care providers’ offices, is generally suitable for most people with osteoporosis, especially for the prevention of falls or following a bone fracture.

Outpatient centers typically see a high volume of patients, so you need to be able to have some level of independence to perform exercises and activities under supervision. If you have difficulties and mobility limitations preventing you from getting to an outpatient facility safely, home care services may be a better option for you.

Financial costs

Physiotherapy costs vary depending on your insurance coverage. Sessions are usually two to three times a week for four weeks. After one month of physiotherapy, you will be reassessed to determine if you need more treatment. Coverage for physiotherapy services is generally based on medical necessity.

Additional support

Having a sedentary (inactive) lifestyle of sitting or lying down for long periods leads to muscle weakness and atrophy, poor balance, decreased bone mineral density, and increased risk of falls. It’s important to do something physical every day, even if it’s just a light activity like walking around the house, cooking, or cleaning.

Relying on friends and family for social support can keep you motivated to stick with an exercise routine. Starting your exercise routine with the help of a physical therapist can give you encouragement.


Osteoporosis is a decrease in bone mineral density, which leads to thinning of the bones, which makes you more vulnerable to fractures. Regular physical activity is important for increasing bone and muscle strength. Incorporating weight-bearing exercises (squats, jogging, stair climbing), non-weight-bearing exercises (leg raises and bicep curls), and balance and flexibility movements will help improve bone density and muscle strength. A physiotherapist will help you develop a treatment plan that works best for you.

A word from Verywell

Exercise is one of the most important and effective treatments for osteoporosis, the weakening of bones that occurs naturally with aging and sedentary behavior. When beginning the exercise, remember to listen to your body and start slowly to avoid injury. Having a strong support system can also help you stay motivated to incorporate regular exercise into your daily life.

Frequently Asked Questions

  • How long should you do physiotherapy for osteoporosis?

    Physiotherapy for osteoporosis will typically last four weeks, after which you will be reassessed to determine next steps. Sometimes you can benefit from more physiotherapy or you will be sent away with a home exercise program to do on your own.

  • Does health insurance cover physiotherapy for osteoporosis?

    Insurance plans typically cover physical therapy for osteoporosis to increase muscle strength, endurance, and balance to reduce the risk of falls and injuries. Physiotherapy costs vary depending on your individual insurance coverage.

  • Which Exercises Make Osteoporosis Symptoms Worse?

    Repeated bending and twisting of the body can increase the risk of vertebral fractures and should be avoided.

  • How do you know if you have weak bones?

    Osteoporosis and osteopenia, conditions categorized by low bone mineral density and brittle bones, are diagnosed by a dual-energy X-ray absorptiometry (DEXA) scan. The most common sign of brittle bones is if you break your bones easily, especially from mild impact.

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Richard V. Johnson