What Should You Do First?

What Is Osteoporosis?

Osteoporosis is a condition in which bones become less dense and less strong. This makes them more likely to fracture with a relatively minor fall, knock or other load.

Osteoporosis is sometimes called a silent disease because many people have no obvious symptoms before a fracture occurs.

What is osteopenia?

Osteopenia means your bone mineral density is below the expected healthy range but has not reached the bone-density threshold used to define osteoporosis.

Your bone-density result is only part of the picture. Age, previous fractures, falls, family history, medicines and other health conditions can also affect your overall fracture risk.

What Are the Signs of Osteoporosis?

Osteoporosis itself commonly produces no symptoms. However, fractures associated with osteoporosis can cause symptoms such as:

• sudden or persistent back pain
• loss of height over time
• a more stooped spinal posture
• pain after a relatively minor fall or strain
• hip, wrist, rib or other fractures after lower-level trauma.

Why Does Osteoporosis Develop?

Bone is living tissue that continually changes. Osteoporosis can develop when the loss of bone occurs faster than new bone formation.

Ageing is an important factor. Bone loss can also accelerate after menopause because of changes in oestrogen levels.

Who has a higher risk of osteoporosis?

Risk can be influenced by several factors, including:

• increasing age
• menopause
• a previous fragility fracture
• family history of osteoporosis or hip fracture
• low body weight or significant loss of muscle mass
• low levels of weight-bearing activity
• smoking
• higher alcohol intake
• inadequate calcium, vitamin D or protein intake
• some inflammatory, endocrine, gastrointestinal and other medical conditions
• some medicines, including prolonged corticosteroid use.

How Is Osteoporosis Diagnosed?

Your GP will consider your age, medical history, medicines, fracture history and other risk factors. They may recommend a bone mineral density test, commonly called a DXA or DEXA scan.

Bone-density results are then considered alongside your overall fracture risk rather than interpreted in isolation.

If you already have osteoporosis and develop new spinal pain, height loss or pain following a relatively minor injury, further assessment may be needed to check for a fracture.

How Is Osteoporosis Treated?

Osteoporosis management often uses several approaches rather than exercise alone. Your individual plan depends on your fracture risk, health history and test results.

Management may include:

• medical assessment and fracture-risk review
• osteoporosis medicines when clinically indicated
• adequate calcium, vitamin D and protein intake
• appropriate resistance and weight-bearing exercise
• balance and falls-prevention strategies
• management of other health conditions that affect bone health
• review of medicines that may influence bone or falls risk.

Your GP can advise whether osteoporosis medication or further investigation is appropriate for you.

How Can Exercise Help Osteoporosis?

Exercise is an important part of osteoporosis management. However, not every type of exercise provides the same bone stimulus, and not every exercise is appropriate for every person.

An osteoporosis exercise program commonly considers three areas:

• progressive resistance training to improve muscular strength and safely load bone
• weight-bearing or impact exercise where suitable for the person’s fracture risk and physical capacity
• balance training to improve steadiness and help reduce falls risk.

Walking remains useful for general health, fitness and daily activity. However, walking alone usually does not provide the same strengthening or bone-loading stimulus as a well-designed resistance program.

The right program depends on your fracture history, bone density, strength, balance, pain, medical history and previous exercise experience. See the RACGP guidance on exercise and osteoporosis.

How Can Physiotherapy Help?

Physiotherapy may be useful when osteoporosis occurs alongside pain, a recent fall, reduced movement, poor balance or uncertainty about safe activity.

A physiotherapist can assess how you move and identify factors that may affect your exercise plan. Depending on your needs, treatment may include:

• strength and functional assessment
• balance and falls-risk assessment
• guidance following a fracture or painful episode
• safe lifting and movement strategies
• posture and spinal movement guidance
• graded return to walking, exercise or daily activities
• referral or transition to longer-term Exercise Physiology when appropriate.

If you feel unsteady, you may also benefit from dedicated balance training.

Where Does Exercise Physiology Fit?

Exercise Physiology may be particularly useful when you need a structured, progressive exercise program for osteoporosis, osteopenia or reduced physical capacity.

An Accredited Exercise Physiologist can assess your current capacity, prescribe suitable exercise and progress the program over time. Your plan may include:

• progressive resistance training
• balance exercises
• appropriate weight-bearing exercise
• selected impact exercise where suitable
• walking and aerobic conditioning
• functional tasks such as lifting, carrying and stepping
• long-term gym or home exercise planning.

Physiotherapy and Exercise Physiology do not need to be separate pathways. Physiotherapy may lead when pain, injury or assessment is the immediate issue. Exercise Physiology may then help build longer-term strength and capacity.

How Can Exercise Progress Safely?

Can Exercise Make Osteoporosis Worse?

Appropriate exercise is generally encouraged for osteoporosis. Problems are more likely when the exercise does not match the person’s fracture risk or when load, range or difficulty increases too quickly.

People with a history of vertebral fractures or higher fracture risk may require modifications to some movements and loading strategies. Rather than avoiding all bending, lifting or exercise, the aim is to select and progress activities appropriately.

If you have mid-back symptoms, see our information about thoracic pain.

Bone Density Classes for Osteoporosis and Osteopenia

If you have osteoporosis, osteopenia or another low bone-density result, our Bone Density Class provides supervised exercise with an Exercise Physiologist.

The program focuses on progressive strength, balance, posture, functional movement and appropriate bone loading. Exercises can be adjusted to your current capacity and clinical history.

View Bone Density Class Details

Related Osteoporosis Care

Osteoporosis FAQs

What to Do Next

1. Review your bone health

   Discuss your bone-density result, overall fracture risk, nutrition and possible medical treatment with your GP.

2. Get pain or new symptoms assessed

   Arrange medical or physiotherapy assessment if you have new back pain, a recent fall, reduced balance or uncertainty about safe movement.

3. Build an appropriate exercise plan

   Consider Exercise Physiology if you want structured strength, balance and longer-term exercise progression.

4. Consider supervised group exercise

   View the Bone Density Class if you are interested in supervised small-group exercise for low bone density.

References

1. Royal Australian College of General Practitioners. Exercise: Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. RACGP.
2. Healthy Bones Australia. Exercise and Bone Health. Healthy Bones Australia.
3. Mohebbi R, Shojaa M, Kohl M, et al. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporosis International. 2023;34:1145–1178.
4. Zhao F, Su W, Sun Y, Wang J, Lu B, Yun H. Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025;20:523. doi:10.1186/s13018-025-05890-1.
5. Brooke-Wavell K, Skelton DA, Barker KL, et al. Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022;56(15):837–846.