Osteoporosis physiotherapy may help you build strength, improve balance, and stay confident with daily movement through safe, progressive exercise.

Low bone density (osteopenia or osteoporosis) can increase the risk of a fragility fracture, often affecting the spine, hip, wrist, ribs, or shoulder after a minor fall or knock.

If you feel unsteady, structured balance training or a supervised Balance & Falls Prevention Class may help reduce falls risk while improving confidence.

Osteoporosis & osteopenia

What is osteoporosis?

Osteoporosis occurs when bones lose density and strength. As a result, fractures may happen with lower-impact events than expected. Some people notice no signs until they develop sudden back pain, lose height, or sustain a fracture.

What is osteopenia?

Osteopenia means bone density is lower than ideal but not low enough to meet the criteria for osteoporosis. Even so, it’s a useful early warning sign to take action with exercise, nutrition, and medical review.

Common signs and red flags

• New or worsening mid-back pain, especially after a minor strain or cough
• Loss of height over time or increasing stooped posture
• Fractures after a low-level fall or minor trauma
• Reduced confidence on stairs, uneven ground, or when carrying loads

Why does low bone density happen?

Bone constantly remodels. Over time, bone breakdown can outpace bone building. Menopause can accelerate this due to reduced oestrogen. Meanwhile, ageing, low activity, low protein intake, smoking, higher alcohol intake, and some medical conditions or medicines may contribute.

Who is more at risk?

• Women after menopause and adults over 50
• Previous fracture after a low-level fall
• Long periods of low activity or long-term sedentary habits
• Low calcium or vitamin D intake, low protein intake, or poor appetite
• Smoking and higher alcohol intake
• Some chronic conditions (for example inflammatory or gut conditions)

How is osteoporosis diagnosed?

Your GP may recommend a bone density scan (DEXA). Clinicians also consider age, fracture history, falls risk, and medicines when planning treatment. If you have sudden back pain, a recent fall, or noticeable height loss, book an assessment promptly.

How physiotherapy may help

Most programs focus on three goals: build strength, improve balance, and gradually increase safe loading through weight-bearing activity. Your plan should match your fracture risk, symptoms, and confidence.

The RACGP guidance highlights progressive resistance training, weight-bearing impact exercise (when appropriate), and challenging balance work as core parts of care for bone health and falls prevention. RACGP osteoporosis exercise guidance

Phase 1: Foundation (technique, balance, posture)

• Walking: build consistency and confidence
• Balance drills: single-leg stance, heel-to-toe walking, step control
• Posture and hip hinge: safer lifting mechanics and spinal loading control
• Gentle mobility: maintain hip and thoracic mobility (as needed)

Phase 2: Strength and capacity

• Resistance training: sit-to-stand, step-ups, rows, loaded carries
• Progressive loading: increase load over time with good technique
• Back and hip strength: support posture and everyday tasks

Phase 3: Higher challenge (only if appropriate)

• Heavier strength work: increased resistance with strict form
• Selected impact work: small hops, skipping, or step drops when safe
• Sport and function: tennis, hiking, or gym programs matched to goals

If you have mid-back pain, rib pain, or postural fatigue, you may also benefit from thoracic loading guidance. See thoracic pain for related information.

People also ask: Can exercise make osteoporosis worse?

Exercise can flare symptoms if the load increases too quickly, technique breaks down, or the exercise choice does not match your fracture risk. However, many people do well with a graded plan that starts conservatively and builds over time.

FAQs

What exercises help bone strength?
Most plans combine progressive strength training, weight-bearing activity, and balance work. The best option depends on your fracture risk, current fitness, and what you can keep doing consistently.

Do I need to stop bending or lifting?
Not always. Many people can lift safely with better technique, graded loading, and a sensible exercise progression. Your physiotherapist can coach safer strategies for your spine and hips.

Should I avoid high-impact exercise?
Some people should limit impact, especially with higher fracture risk or recent fractures. Others can include carefully selected impact work. Your plan should align with your medical advice and capacity.

When should I see a physiotherapist?
Book in if you have low bone density, a recent fall, new back pain, reduced balance, or you want a structured plan for gym, walking, or sport.

What to do next

• Book a GP review to discuss DEXA results, nutrition, and medicines if needed.
• Start a progressive strength and balance plan that matches your risk level and goals.
• If you feel unsteady or unsure, train under supervision until your technique and confidence improve.

References

1. Mohebbi R, et al. Exercise training and bone mineral density in postmenopausal women: a systematic review and meta-analysis. Front Physiol. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10282053/
2. Zhao F, et al. Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12107943/
3. Giangregorio LM, et al. Strong, steady and straight: consensus statement on physical activity and exercise for osteoporosis. Br J Sports Med. 2022. https://bjsm.bmj.com/content/56/15/837