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Osteoporosis, Osteopenia, & the Role of Physical Therapy

Osteoporosis, Osteopenia, & the Role of Physical Therapy

Written by Caiden McPherson; published February 27, 2025

Osteoporosis, Osteopenia, and Bone Health

Diseases that affect bone health have far-reaching implications, negatively impacting hbmultiple areas of life. Osteoporosis and osteopenia are two of the most common skeletal disorders in older adults. Osteoporosis is a condition in which bone reabsorption exceeds bone remodeling, leading to porous, fragile bones that are prone to fracture (Rowe, 2023). These porous fragile bones are characterized by low bone density, a hallmark of the disease. Osteopenia, a precursor to osteoporosis, is characterized by decreased bone mineral density, however the decrease seen in osteopenia is not as severe as the decrease seen in osteoporosis (Varacallo, 2023). Both conditions increase the likelihood of bone fracture, especially after a fall. 

Fractures related to osteoporosis and osteopenia occur more than most realize. A peer-reviewed study published in 2016 revealed that across Europe and the United States, 40% of postmenopausal women and 30% of men will experience an osteoporotic fracture (Sozen, 2016). These fractures can significantly impact independence and quality of life, and create financial strain due to hospitalization and rehabilitation costs. Additionally, the fear of falling is a significant cause of anxiety in older adults, often leading to increased inactivity and further bone density loss (Bae, 2023). Given the widespread prevalence of osteoporosis, extensive research has been conducted on its prevention and management. Exercise programs crafted by certified physical therapists have proven to be valuable treatment options, leading to reduction in bone mineral loss and fall risk. 

Exercise and it’s Effect on Osteoporosis and Osteopenia 

The ability of exercise to prevent and manage osteoporosis lies in the mechanism of bone development. Bone remodeling follows a principle known as Wolff’s Law, which states that the more mechanical loading — or physical force — applied to a bone through muscle and tendon activity, the more the bone will mineralize in the loaded area (Rowe, 2023). Clinical studies have demonstrated that exercise programs — especially those tailored to the individual by a certified physical therapist — can increase bone mineral density in key areas where osteoporotic fractures commonly occur, such as the lumbar spine and the hip (Hartley, 2022). In contrast, immobilization and low levels of physical activity are significant contributors to osteoporosis, as bones fail to receive the stimuli needed for growth and mineralization. Lifelong exercise decreases the risk for developing osteopenia and osteoporosis, but once an individual is diagnosed with osteoporosis, exercise is still a useful tool for managing the condition and preventing falls. 

 Exercise is not the only factor that contributes to the development of osteopenia and osteoporosis. Bone health is also heavily influenced by estrogen levels. In postmenopausal women, estrogen declines, leading to a decrease in bone remodeling and placing them at the highest risk for osteoporosis and osteoporotic fractures (Rowe, 2023). Because of this, osteoporosis prevention strategies are crucial for postmenopausal women, although men can also develop the disease. Other risk factors that contribute to osteoporosis include alcohol abuse, smoking, high salt intake, and Vitamin D and/or calcium deficiencies (Sozen, 2016). Addressing these risk factors and following an exercise program created by a physical therapist can effectively manage osteoporosis and reduce the risk of fractures.

The Role of Physical Therapists in Prevention and Management 

Certified physical therapists play a vital role in helping individuals manage osteopenia and osteoporosis to prevent falls and fractures. The Journal of Geriatric Physical Therapy provides guidelines on how physical therapy can be used to treat and prevent osteoporosis across various patient populations, including premenopausal and postmenopausal women at high risk, as well as men at risk for developing osteoporosis (Hartley, 2022). Among the most effective interventions are resistance training and weight-bearing exercises. 

Resistance training strengthens muscles and places beneficial mechanical load on bones, promoting bone density maintenance. It includes both external resistance exercises—such as free weights or resistance machines—and bodyweight exercises like push-ups. A meta-analysis found that exercise prescriptions incorporating resistance training, along with weight-bearing activities like jogging, walking, or stair climbing, helped slow bone mineral density loss in areas prone to osteoporotic fractures (Hartley, 2022). Another meta-analysis highlighted that resistance training combined with impact-based activities—such as jumping, stomping, and even impact-heavy dance styles like Zumba—also contributed to reduced bone loss (Bae, 2023). The mechanical strain produced by these exercises is a key factor in preventing further bone deterioration. By following a physical therapist-prescribed exercise plan, individuals can significantly reduce their risk of falls and fractures.

Because strength, balance, and mobility levels vary between individuals, customized exercise plans are essential in preventing injury. Many older adults express concerns about exercising due to fear of injury (Hartley, 2022). Physical therapists are trained to assess fall risk and prevent injury when prescribing exercise. Additionally, physical therapists help guide clients through exercise and demonstrate healthy adaptations to make exercise accessible and beneficial to people of all ages and abilities. Physical therapists use clinical reasoning to develop personalized exercise programs that help manage osteoporosis, address barriers to exercise, and ensure safety. 

Financial barriers can also discourage participation in regular exercise. Some older adults cite gym membership costs as a challenge to maintaining a fitness routine (Hartley, 2022). Physical therapists can recommend and demonstrate effective at-home exercises that require minimal or no equipment, making osteoporosis management more accessible and affordable. Physical therapists provide valuable insight that can help individuals managing osteoporosis do so in a way that is safe, affordable, and sustainable. 

In Summary 

Osteoporosis and osteopenia are common conditions that increase fracture risk and can significantly impact quality of life. Fractures from osteoporosis lead to pain, financial strain, and can result in decreased independence. Furthermore, osteoporosis-related anxiety about falls and injuries can lead to decreased activity, further exacerbating bone loss. Individualized exercise programs are clinically proven to increase strength and reduce decline in bone mineral density, leading to reduced risk of fractures and falls alike. With the guidance of a certified physical therapist, individuals can effectively manage osteoporosis and osteopenia, reducing the likelihood of fractures and falls.

At Synergy Physical Therapy and Wellness, we are committed to providing holistic care that benefits both body and mind. Our physical therapists use clinical reasoning and evidence-based practices to promote the health and well-being of our clients and community. If you or a loved one is experiencing inactivity or anxiety related to osteoporosis, osteopenia, or an injury, call today to receive individualized care that will help you live your best life!

Works Cited: 

Bae S, Lee S, Park H, Ju Y, Min SK, Cho J, Kim H, Ha YC, Rhee Y, Kim YP, Kim C. Position Statement: Exercise Guidelines for Osteoporosis Management and Fall Prevention in Osteoporosis Patients. J Bone Metab. 2023 May;30(2):149-165. doi: 10.11005/jbm.2023.30.2.149. Epub 2023 May 31. PMID: 37449348; PMCID: PMC10345999.

Hartley, G. W., Roach, K. E., Nithman, R. W., Betz, S. R., Lindsey, C., Fuchs, R. K., & Avin, K. G. (2022). Physical Therapist Management of patients with Suspected or Confirmed Osteoporosis: A Clinical practice guideline from the Academy of Geriatric Physical Therapy. Journal of Geriatric Physical Therapy, 44(2), E106–E119. 

Rowe, P., Koller, A., & Sharma, S. (2023, March 17). Physiology, bone remodeling. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499863/

Sozen, T., Ozisik, L., & Basaran, N. C. (2016). An overview and management of osteoporosis. European Journal of Rheumatology, 4(1), 46–56. https://doi.org/10.5152/eurjrheum.2016.048

Varacallo, M. A., Seaman, T. J., Jandu, J. S., & Pizzutillo, P. (2023, August 4). Osteopenia. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499878/

image retrieved from freepik.com

 

As we age, maintaining health and independence becomes a top priority. Strength training, a type of resistance exercise often overshadowed by cardio or flexibility exercises, is a cornerstone of healthy aging. Whether you’re in your 30s or 80s, incorporating strength training into your routine can help you live a longer, more vibrant life. Here’s why everyone needs to embrace strength training and how to overcome common barriers to getting started.

1. Avoiding Frailty

Frailty, marked by reduced strength, endurance, and physical function, is a growing concern with age. According to the National Institute on Aging, frailty increases the risk of falls, disability, and hospitalization. For women, who face a higher risk of osteoporosis, frailty can also lead to fractures with prolonged recovery. Strength training combats frailty by building muscle mass and bone density. 

A 2021 study in the Journal of Clinical Medicine found that resistance training significantly improved muscle strength and reduced frailty markers in older adults. For women, this is especially critical, as stronger muscles and bones reduce the risk of osteoporotic fractures. Exercises like weightlifting, bodyweight workouts, or resistance bands enhance physical resilience, making daily tasks like carrying groceries or climbing stairs safer and easier.

(Want to know more about osteoporosis and PT’s role in it’s prevention and treatment? Check out our previous article for more information: Osteoporosis, Osteopenia, and Physical Therapy) 

2. Staying Able to Do the Things You Love

Strength training ensures you can keep enjoying activities like gardening, hiking, or playing with grandkids. According to an article in Harvard Health Publishing, muscle strength can begin to decline by about 1-2% per year after age 35 due to sarcopenia, also known as age-related muscle loss. This muscle loss accelerates as our bodies age. This loss can limit your ability to perform daily tasks or pursue hobbies, particularly for women who may experience accelerated muscle loss during menopause due to declining estrogen levels. 

Regular strength training preserves functional capacity, and benefits multiple domains of health. A  2019 study published in Frontiers in Physiology showed that resistance exercise not only improved musculoskeletal health, but also helped patients manage chronic conditions like cardiovascular disease and diabetes (Mcleod et al., 2019). Older adults who participated consistently in resistance strength exercise maintained better mobility, overall health, and independence than those who did not. Additionally, the same study found that those using light weight or only body weight while strength training was just as effective as heavy weights (McLeod et al., 2019). The most important factor of strength training for healthy aging is finding a routine that is suited to your body and your ability. A consultation with a physical therapist can help you find the right routine and guide you through proper exercise form to ensure your exercise is preventing injury, not causing it.  Strength training empowers you to stay active, healthy, and independent.

3. More Muscle Mass Equals Improved Blood Sugar Control

Building muscle isn’t just about strength—it’s about metabolic health. Muscle tissue helps regulate blood sugar by improving insulin sensitivity, which is vital for preventing or managing type 2 diabetes, a condition more prevalent with age (Mcleod et al., 2019). Increased muscle mass enhances glucose uptake, reducing blood sugar spikes. This is particularly important for women, who may face increased risks for diabetes complications. Researchers have found that  resistance training improved glycemic control in older adults with type 2 diabetes (Mcleod et al., 2019). In their review of resistance exercise and blood sugar management, resistance exercise performed for 8 weeks resulted in clinical improvements in A1C management and improvements in insulin resistance. These findings are relevant not just to individuals living with diabetes, but also those with insulin resistance, metabolic disorders, or a family history of diabetes. More muscle mass means greater glucose storage capacity, supporting overall metabolic health. Even moderate strength training, like lifting weights twice a week, can make a significant difference.

Common Barriers to Starting Strength Training

Despite its benefits, many hesitate to start strength training. Here are common barriers and solutions:

  • Lack of Knowledge: Many feel intimidated by unfamiliar exercises. 
    • Solution: Start with simple bodyweight moves like squats or push-ups. Online resources from the American Council on Exercise (ACE) offer free beginner guides, or consult a certified personal trainer for a tailored program.
  • Fear of Injury: Older adults, especially women with lower bone density, may worry about getting hurt. 
    • Solution: Begin with low weights or resistance bands under professional guidance. A 2018 study in Journal of Strength and Conditioning Research confirms supervised strength training is safe and effective for all ages when done correctly.
  • Time Constraints: Busy schedules can make exercise feel daunting. 
    • Solution: Short, 20-minute strength workouts 2-3 times per week still deliver impactful benefits, per American College of Sports Medicine guidelines.
  • Gym Intimidation: Gyms can feel overwhelming for beginners. 
    • Solution: Try home workouts with minimal equipment or join small group classes for older adults, which foster a supportive environment. Women-only classes can also provide a comfortable starting point.

Getting Started with Strength Training

To reap the benefits, aim for 3 sessions per week. Focus on compound movements—exercises that work multiple muscle groups at once, like squats, deadlifts, lunges, assisted pull-ups, and pushing-pressing motions. These maximize efficiency and functional strength. Start with light weights, resistance bands, or bodyweight exercises, gradually increasing intensity.

Safety Tip: Deadlifts, a powerful and functional movement, we commonly integrate this into out-patient rehabilitation strategy, but it does require proper technique to avoid injury. Begin with no weight, using a broomstick or similar tool to master form under a skilled coach’s guidance before adding weight. This is especially important to protect against lower back strain or injury.

Always consult a healthcare provider before starting a new exercise program, especially if you have chronic conditions like osteoporosis, chronic low back pain or shoulder problems. If you do struggle with any of these, one of our physical therapists can design a program tailored to your needs, and we’re here to support you every step of the way. If you are free from chronic conditions or pain a skilled coach or trainer can also be a great fit to get you started safely.

Strength training isn’t just for bodybuilders—it’s for everyone who values aging gracefully, staying active, and feeling their best. By building strength now, you’re investing in a healthier, more independent future.

References:

Harvard Health. (2023, February 14). Age and muscle loss. https://www.health.harvard.edu/exercise-and-fitness/age-and-muscle-loss

Mcleod, J. C., Stokes, T., & Phillips, S. M. (2019). Resistance Exercise training as a primary Countermeasure to Age-Related Chronic Disease. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.00645

Talar, K., Hernández-Belmonte, A., Vetrovsky, T., Steffl, M., Kałamacka, E., & Courel-Ibáñez, J. (2021). Benefits of Resistance training in Early and late Stages of Frailty and sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of Clinical Medicine, 10(8), 1630. https://doi.org/10.3390/jcm10081630

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