Osteoporosis is a condition in which bones become weak, brittle and more likely to fracture due to a reduction in bone density and bone quality. Bone density refers to the amount of mineral content within bone and is a key determinant of bone strength. When bone density decreases significantly, even low-force events such as a minor fall or sudden movement can result in fracture.
Osteopenia is a related condition where bone density is lower than normal but not yet low enough to meet the criteria for osteoporosis. Osteopenia is considered a precursor to osteoporosis and represents an important opportunity for early intervention to slow or prevent further bone loss.
Osteoporosis is common, particularly in older adults and postmenopausal women, but it can also affect men and younger people with certain medical conditions or risk factors. Because bone loss occurs gradually and without pain, osteoporosis is often referred to as the “silent disease” until a fracture occurs.
Physiotherapy for osteoporosis and osteopenia plays a critical role in improving bone strength through appropriate loading, reducing falls risk, and supporting safe movement and confidence in daily life.
Key Facts
- Osteoporosis/osteopenia is common in Australia. In 2022, about 853,600 people (3.4%) were estimated (self-reported) to be living with osteoporosis or osteopenia. 🔗
- It becomes more common with age and is more common in women. In 2022, prevalence rose from 0.7% (age 35–44) to 17% (age 75+), and was 5.5% in women vs 1.1% in men (osteoporosis/osteopenia combined). 🔗
- Weight-bearing and strengthening exercise is a key part of rehab for osteopenia and can help reduce fracture risk. 🔗
Risk Factors
- Family history of osteoporosis or fragility fractures.
- Low calcium or vitamin D intake.
- Menopause or low sex hormone levels.
- Medical conditions such as coeliac disease, diabetes, thyroid or parathyroid disorders, rheumatoid arthritis, chronic kidney or liver disease, or eating disorders.
- Long-term use of corticosteroids or certain cancer, epilepsy, HIV or antidepressant medications.
- Smoking.
- Poor nutrition.
- Sedentary lifestyle.
- Increasing age.
Symptoms
- Often no symptoms until a fracture occurs.
- Fractures occurring with minimal trauma or low-impact falls.
- Persistent or severe pain following a fracture.
- Loss of height over time.
- Stooped or hunched posture due to vertebral compression fractures.
Aggravating Factors
- Low levels of physical activity or prolonged sedentary behaviour.
- Poor balance or history of falls.
- Periods of immobilisation following illness or injury.
Causes
Osteoporosis develops when bone breakdown (resorption) occurs more rapidly than new bone formation. This imbalance leads to a reduction in bone mass and deterioration of bone structure, making bones more porous and fragile.
Bone loss occurs naturally with ageing, but certain hormonal changes, medical conditions and lifestyle factors can accelerate this process. After menopause, reduced oestrogen levels significantly increase the rate of bone loss in women.
How Is It Diagnosed?
Osteoporosis and osteopenia are diagnosed using a specialised bone density scan known as a DEXA (dual-energy X-ray absorptiometry) scan. This test measures bone mineral density at key sites such as the hip, spine and forearm.
The scan is quick, painless and involves lying fully clothed on a padded table while the scanner passes over the body. Results are reported as T-scores, which compare bone density to that of a healthy young adult.
Physiotherapists use DEXA results to guide exercise prescription, loading strategies and fracture risk management.
Investigations & Imaging
- DEXA scan
- Measures bone mineral density and classifies results as normal, osteopenia or osteoporosis.
Grading / Classification
- Normal bone density
- T-score above -1.0.
- Osteopenia
- T-score between -1.0 and -2.5.
- Osteoporosis
- T-score of -2.5 or lower, indicating significantly increased fracture risk.
Physiotherapy Management
Physiotherapy management for osteoporosis and osteopenia focuses on improving bone strength through appropriate mechanical loading, reducing falls risk, and maintaining safe, confident movement.
Physiotherapists tailor programs to individual fracture risk, bone density, balance, and medical history.
Exercise
Exercise is a cornerstone of osteoporosis management. Resistance training and weight-bearing or impact-based exercises have the strongest evidence for improving or maintaining bone mineral density.
Exercises may include strength training, stair climbing, controlled impact activities, and posture-specific exercises. Activities such as walking, swimming and cycling support cardiovascular health but have limited effect on bone density alone.
Activity Modification
Activity modification includes education on safe lifting, bending and daily movement strategies to reduce fracture risk.
Manual Therapy
Manual therapy may be used cautiously for pain management but does not directly improve bone density.
Education
Education focuses on bone health, safe exercise progression, posture awareness, and confidence with movement.
Other
Other strategies include balance training for falls prevention and guidance on returning to activity after fractures.
Other Treatments
Medical management includes medications to slow bone loss or improve bone strength. These are prescribed by a GP or specialist and may be subsidised through the Pharmaceutical Benefits Scheme.
Surgery
Surgery may be required if fractures occur, such as fixation of hip or vertebral fractures. Physiotherapy plays a vital role in rehabilitation following fracture or surgery.
Prognosis & Return to Activity
Osteoporosis and osteopenia are long-term conditions, but with early diagnosis and appropriate management, fracture risk can be significantly reduced. Physiotherapy supports ongoing strength, balance and independence.
Complications
- Fragility fractures, particularly of the hip, spine and wrist.
- Chronic pain following vertebral fractures.
- Loss of independence after falls or fractures.
Preventing Recurrence
- Engage in regular resistance and weight-bearing exercise.
- Address balance and falls risk early with physiotherapy.
- Ensure adequate calcium and vitamin D intake.
- Avoid smoking and excessive alcohol intake.
When to See a Physio
- After a diagnosis of osteopenia or osteoporosis.
- Following a fracture to guide safe return to movement.
- If balance problems or fear of falling are present.