How musculoskeletal physiotherapy can improve outcomes for osteoporosis


How musculoskeletal physiotherapy can improve outcomes for osteoporosis

Osteoporosis is a common condition that affects over one million Australians, particularly middle aged to elderly women, although it occurs in men as well.[1] Osteoporosis is a disease of the bones – causing a decrease in bone mass and density, over time leading to bones becoming increasingly porous and brittle and at greater risk of fracture. In sufferers of osteoporosis, bones observed under a microscope can look like pieces of honeycomb with the disease increasingly causing larger holes as it progresses.

There are two types of osteoporosis – primary and secondary.[2]

What is the difference between primary and secondary osteoporosis?

When osteoporosis is unrelated to other diseases or conditions, such as in post-menopausal women or older men and is caused by age related bone loss (senile osteoporosis) or the cause is unknown (idiopathic osteoporosis) it is said to be the primary form. Primary osteoporosis is the more common of the two and can occur at any age.[3]

Secondary osteoporosis occurs when the loss of bone mass is caused by other diseases, lifestyle behaviours, or medications. The most common causes of secondary osteoporosis in men include low levels of testosterone, alcohol abuse and smoking.

What are the symptoms of osteoporosis?

Osteoporosis has been described as a silent disease, meaning that until a fracture occurs or your posture changes dramatically there may not be many, if any accompanying symptoms. Things to look out for include:

  • Easy breakage of bones or fractures—especially hip and wrist area
  • Episodic back pain – especially low thoracic/high lumbar regions
  • Decrease in height
  • Kyphosis – an abnormal rounding of the upper back


Exercise and bone density

Regular, even light physical activity and exercise plays a critical role in maintaining healthy bones. Hip fractures for example have been found to be as much as 45% lower in older adults who have been physically active in their daily life, compared to less active people.[4] Two types of physical activity have been identified in studies as having a positive effect on bone mass and density in osteoporotic patients. Some exercises were found to delay the effects of bone mass dropping, while others actually improved bone density.

  • Weight-bearing aerobic exercises

Studies have observed the effects of walking, stair climbing, jogging, and Tai Chi on bone density and found positive effects.[5] Walking is a common and usually easy exercise for the elderly as the impact on the body is minimal, however walking alone did not appear to improve bone mass, whilst it was able to limit its progressive loss.

  • Strength and resistance exercises

Strength and resistance training are the most studied techniques to increase bone mass in the elderly. These are exercises such as lifting weights and include swimming and cycling. Studies have found that for strength and resistance exercises to be optimally beneficial they must be focused extremely site-specific as they are only able to increase muscle mass and bone density only in the stimulated body regions.[6]

What are the benefits of Physiotherapy for Osteoporosis?

Physiotherapy and Exercise Physiology for osteoporosis can be broken down into two categories – prevention of osteoporosis and management of osteoporosis.

  • Prevention

Your Lane Cove physio and Exercise Physiologist is qualified to advise you in a number of ways to optimise your bone health. Your physio can design a bespoke bone health plan to include appropriate physical activity for your circumstances, nutritional information and guidance about smoking and alcohol intake. Your physio or EP will also talk to you about any other risk factors you might have for poor bone health and refer you for further assessment and management.

  • Management

Physiotherapy and Exercise Physiology plays an important role in the management of osteoporosis by outlining and implementing strategies including:

The optimal physical activity or exercise program to safely load your bones and keep them strong, exercises to optimise your posture and address postural changes and minimising your risk of falls through balance training. At Lane Cove Physiotherapy we are also passionate about educating clients about bone health and self-management strategies to avoid further deterioration, and assisting in rehabilitation after a fracture is sustained.

Aquatic physiotherapy for osteoporosis

A number of studies looking into the effects of aquatic physiotherapy and hydrotherapy have shown that exercising in water can be useful in at least maintaining, or improving, various measures of bone mineral density for those not able to exercise on land effectively.[7]

Aquatic therapy is an excellent way for those suffering from osteoporosis or arthritis to build strength, ease stiff joints and relax sore muscles using the waters buoyancy to greatly reduce the pressure on your joints[8]. This makes it easier to perform a variety of range of motion exercises without the fear of falling over or causing further pain.

The water in a hydrotherapy pool is also specifically heated to 34 degrees Celsius in order to increase circulation and blood flow, helping to activate areas of the brain that help to dampen pain signals to the brain.

If you are suffering from osteoporosis or you would like to learn about preventing a number of painful conditions related to a lack of bone density, arthritis and getting older, Lane Cove Physiotherapists and Exercise Physiologist are experts in identifying, treating and educating on a range of issues.




[2] Wright NC, Looker AC, Saag KG et al. (2014) The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. J Bone Miner Research. 29(11)

[3] National Institutes of  Health Osteoporosis and  Related  Bone Diseases ~  National Resource Center

[4] Kerstin M. Palombaro, Jill D. Black, Rachelle Buchbinder, Diane U. Jette, Effectiveness of Exercise for Managing Osteoporosis in Women Postmenopause, Physical Therapy, Volume 93, Issue 8, 1 August 2013, Pages 1021–1025

[5] Gómez-Cabello A., Ara I., González-Agüero A., Casajús J. A., Vicente-Rodríguez G. Effects of training on bone mass in older adults: a systematic review. Sports Medicine. 2012;42(4):301–325

[6] Zehnacker CH, Bemis-Dougherty A. Effect of weighted exercises on bone mineral density in post-menopausal women. A systematic review. J Geriatr Phys Ther. 2007;30(2):79-88.

[7]McMahon M. What impact does aquatic therapy have on bone density in postmenopausal women? If it has a positive or maintenance effect, what are the programme parameters that facilitate these outcomes? Aqualines: The Journal of the Hydrotherapy Association of Chartered Physiotherapists. 2017;29(1):8–21

[8] A Study of Hydrotherapy and Its Health Benefits, Mozhdeh Bahadorfar, International Journal of Research (IJR) Vol-1, Issue-8, September 2014