January 19, 2024

A Guide to Physical Therapy for Osteoporosis

Osteoporosis affects more than 8.9 million people annually1, particularly women and older adults. While it is often referred to as a "silent disease" due to its lack of symptoms until a fracture occurs, various treatment options are available for you, including physical therapy.

In this article, we will delve into those various treatment options for osteoporosis and how physical therapy can help strengthen bones, increase mobility, and decrease fall risks.

Table of Contents

Understanding Osteoporosis

Osteoporosis is a condition that results in weakened bones and an increased risk of fracture(s). Bone weakness is caused by an imbalance between new bone formation and old bone breakdown.

As we age, bone density naturally decreases, however, it's accelerated in those with osteoporosis. This is particularly the case with post-menopausal women, who experience a drop in the bone-breakdown-preventing hormone, estrogen.

Another similar condition preceding osteoporosis is called osteopenia.2 In osteopenia, the bone density is decreased, but not to the extent of osteoporosis. It is often a warning sign that warrants proactive measures like physical activity. Like osteoporosis, you can seek physical therapy for osteopenia to prevent the progression of the condition by participating in strength, aerobic, flexibility, and balance training.

What are the Most Common Risk Factors of Osteoporosis?

Osteoporosis is a multi-factorial condition3, meaning it involves the interaction of multiple bodily systems and your environment. Some common risk factors of osteoporosis include:

  • Increased age
  • Gender (more common in women than men)
  • Family history
  • Decreased body weight
  • Decreased bone mineral density
  • Decreased physical activity
  • Decreased hormones including estrogen in women
  • Decreased Vitamin D and Calcium uptake
  • Systemic illnesses like rheumatoid arthritis4
  • Long-term use of steroids
  • Smoking
  • Alcohol abuse

Symptoms of Osteoporosis

What are some signs and symptoms of osteoporosis? Let's review.5:

  • Fracture: The most common sites of osteoporotic fractures include the spine, the hip, and the wrist6. In the spine, these fractures are termed vertebral compression fractures, or fractures of the bones that make up the spinal column. Hip-related osteoporotic fractures may require surgery as they can significantly impact your mobility and independence. Wrist fractures can occur after a fall on an outstretched arm, impacting one or multiple bones of the wrist and hand.
  • Pain: Pain can manifest in multiple ways. It is most commonly seen in mid to lower backs after a compression fracture. Other common areas include the hip, the groin, and the wrist/hands.
  • Decreased body height: As bones become weaker, they can start to collapse or compress resulting in the appearance of a shorter stature. This compression of the spine is also associated with hyperkyphosis or stooped posture.
  • Breathing complications: Stooping of the spine can restrict the available space for the lungs to expand causing shortness of breath during everyday tasks like walking, cooking, carrying and lifting objects, or performing self-hygiene tasks. These breathing complications can result in excessive fatigue requiring you to take frequent rest breaks to perform daily tasks.
  • Depression: Osteoporosis can extend beyond the physical realm and impact mental health. Depression can be a symptom of osteoporosis that may result in a sense of hopelessness and loss of interest in activities that you previously enjoyed.

Diagnosing Osteoporosis

Diagnosis of osteoporosis is made through dual-energy X-ray absorptiometry (DEXA or DXA)7 allowing early screening of bone densities after suspected density losses in plain X-rays or CT scans.

DXA scans offer several key values including a T-score to compare the severity of the condition to healthy adults. For example, if you have a T-score of -1 or above is considered normal, while a T-score between -1 and -2.5 indicates osteopenia, and a T-score of -2.5 or below signifies osteoporosis.

The U.S. Preventative Services Task Force (USPSTF)8 recommends that screening be performed in:

  • Women aged 65 years or older: At this age, the risk of osteoporosis increases in women after menopause
  • Men aged 70 years or older: While men generally have a higher peak bone density than women, they also experience bone loss with age. By age 70, the risk of osteoporosis increases for both sexes
  • Post-menopausal women aged 50 years or older with a history of systemic illnesses, a history of smoking, or pose additional risk factors predisposing to fractures

It's important to note that these recommendations are general guidelines, and your screening decisions should be made on an individual basis in consultation with your healthcare provider.

What to Expect from Physical Therapy

Physical activity is one of the most impactful preventative measures and treatment options for osteoporosis. Physical activity refers to both traditional activities that we all know and enjoy like walking, dancing, swimming, cycling, and playing traditional sports, and non-traditional activities that are newer, more unique like high-intensity interval training (HIIT) and pilates.

It's always advisable to consult with a qualified practitioner to determine which activities are suitable for your specific condition.

Here at CityPT, we can help you create an individualized program to implement physical activity into your daily routine. During the first visit, your CityPT therapist will ask a series of questions related to your condition and perform a thorough examination evaluating safety, strength, range of motion, joint mobility, balance, and overall function.

After the examination, you and your physical therapist will collaborate to address your goals by carefully creating a treatment plan to address:

  • Pain through manual techniques, modalities, and specific exercises
  • Bone and muscle strength through resisted and weight-bearing exercises
  • Endurance through aerobic exercises
  • Balance, posture, and gait to prevent fall risk
  • Flexibility and range of motion of the surrounding joints
  • Overall well-being

Other treatment options may include:

  • Recommendation on self-management techniques to promote independence including prescription of assistive devices or temporary supportive braces
  • Education on lifestyle modifications to empower individuals to an active role in recovery
  • Recommendation to seek additional guidance from other healthcare providers

What If Conservative Treatment Doesn't Work?

As previously mentioned, osteoporosis is a multifactorial disease that requires a more comprehensive approach to treatment with physical activity being one of those treatment options. In some cases, your therapist may refer you to a physician who can provide further medical treatment9:

  • Antiresorptive medications, like Fosamax, and injectable treatments, like denosumab, to decrease the rate of bone breakdown
  • Over-the-counter pain medications including nonsteroidal anti-inflammatory drugs (NSAIDs) to provide temporary pain relief
  • Hormone Replacement Therapy (HRT) for post-menopausal women
  • Calcium and Vitamin D supplements
  • Surgical interventions

Preventing Osteoporosis

Physical activity plays a crucial role in the management and prevention of osteoporosis.

The American College of Sports Medicine (ACSM)10 recommends adults (18-55 years) participate in at least 150 minutes of moderate-intensity aerobic training per week with 2 days of resistance training. Or, 75 minutes of vigorous-intensity aerobic training per week with 2 days of resistance training.

A physical therapist can help you achieve these numbers through an established custom program.

Outside of engaging in regular physical activity with a combination of strength, flexibility, balance/fall training, and aerobic exercise, other preventative options that complement physical activity include:

  • A rich diet consisting of protein, Vitamin D, and Calcium
  • Smoking cessation
  • Limiting alcohol consumption
  • Limiting caffeine consumption
  • Hormone Replacement Therapy (HRT) for post-menopausal women

Is It Time to Seek Treatment?

Hopefully now with a better understanding of osteoporosis, you can take the next step to see a licensed physical therapist to talk about treatment options to achieve your goals.

At CityPT, our licensed physical therapists understand that everyone is unique and your unique situation needs a customized treatment plan to ensure the most effective and safe approach to managing your osteoporosis. With expertise in bone and muscle health and a deep understanding of osteoporosis management, we can offer specialized treatment plans tailored to your unique needs, goals, and abilities. You can schedule an initial evaluation with our experienced professionals to kickstart your road to recovery.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.



  1. Hartley GW, Roach KE, Nithman RW, et al. Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy. J Geriatr Phys Ther. 2022;44(2):E106-E119. doi:10.1519/JPT.0000000000000346

  2. Varacallo M, Seaman TJ, Jandu JS, Pizzutillo P. Osteopenia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 4, 2023.

  3. Akkawi I, Zmerly H. Osteoporosis: Current Concepts. Joints. 2018;6(2):122-127. Published 2018 Jun 14. doi:10.1055/s-0038-1660790

  4. Chauhan K, Jandu JS, Brent LH, Al-Dhahir MA. Rheumatoid Arthritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 25, 2023.

  5. Li S, He H, Ding M, He C. The correlation of osteoporosis to clinical features: a study of 4382 female cases of a hospital cohort with musculoskeletal symptoms in southwest China. BMC Musculoskelet Disord. 2010;11:183. Published 2010 Aug 16. doi:10.1186/1471-2474-11-183

  6. Osteoporosis: What You Need to Know as You Age. www.hopkinsmedicine.org. Published June 17, 2022.

  7. Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J. 2007;83(982):509-517. doi:10.1136/pgmj.2007.057505

  8. Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE. Diagnosis and Management of Osteoporosis. Am Fam Physician. 2015;92(4):261-268.

  9. Tu KN, Lie JD, Wan CKV, et al. Osteoporosis: A Review of Treatment Options. P T. 2018;43(2):92-104.

  10. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359. doi:10.1249/MSS.0b013e318213fefb

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