Osteoporosis and Exercise

Osteoporosis and Exercise

Osteoporosis  means “porous bones.” Osteoporosis is a systemic skeletal disease characterized by the loss of the normal density of bone and micro architectural deterioration of bone tissue leading to weak and brittle bones and increased risk of fracture.

Osteoporosis is one of the most common disease conditions affecting older people especially women. Any bone can be affected by osteoporosis, but the most common sites are bones in the hip, spine, wrist, ribs and pelvis. Osteoporosis is a chronic condition of multifactorial etiology and is usually clinically silent until a fracture occurs.

Primary causes

  • Decrease estrogen levels, during menopause.
  • Changes associated with ageing.

Risk Factors

  • Age : > 45 years in Female and 60 years in Male.
  • An inactive and sedentary Lifestyle — lack of exercise.
  • Low vitamin D intake.
  • Insufficient calcium intake.
  • Low estrogen levels which accelerates the process of bone loss to a rapid level. 
  • White women and Asian women face the greatest risk of osteoporosis.
  • Certain medications such as diuretics, steroids, and anticonvulsants.
  • Thin and small body frames.
  • Family history of osteoporosis.
  • Excessive alcohol consumption.


The osteoporosis condition can be present without any symptoms for decades, because osteoporosis doesn’t cause symptoms unless bone fractures.

  • Fractures of the Hip, Spine, Wrist are common. Fractures of the spine can cause severe “band-like” pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain. Hip fractures typically occur as a result of a fall.
  • Aches and pains.
  • Loss of height or curving of the spine, which gives the individual a hunched-back appearance of the upper back, often called a “dowager hump”

Management of osteoporosis

  1. Lifestyle changes -quit smoking, curtail alcohol intake, exercise regularly, and consume a balanced diet with adequate calcium and vitamin D.
  2. Take calcium and vitamin D supplements -Calcium > 1200 mg/day + vitamin D 400-800-I.U./day as prescribed your doctor. Vitamin D helps in the absorption of calcium from the intestines. An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. 
  3. Regular physical activity on a long-term basis has a particularly important role in maintaining healthy bones. Exercise can maintain and increase bone strength by increasing bone mass or by slowing age-related bone loss. Muscle strength is also increased, which is important for supporting the joints and preventing falls. Exercise has also been shown to improve co-ordination and balance, which helps to prevent falls and to improve general physical health and well-being. Exercise at least 3 hours per week.  

Factors to be considered for exercising

  • Age is a major factor in determining the right exercise program for you. Also, the aim of exercise is different, like preventing falls in elderly to strengthening bones in young adults.
  • Severity of your osteoporosis helps in determining the fracture risk (low, moderate or high) and accordingly plan the exercise program under the guidance of your physiotherapist.
  • Underlying medical conditions.
  • Current medications.
  • Current fitness levels.

Strength training 

Strength training includes use of free weights, weight machines, resistance bands or water exercises to strengthen the muscles and bones in your arms and upper spine. Strength training works directly on your bones to slow mineral loss. Resistance exercises can be done using weight machines, free weights and resistance bands to do calf raises, knee flexion, hip flexion and hip extension. Leg press, Squats, lunges, planks, push-ups are also beneficial.

Weight-bearing aerobic activities

Include walking, dancing, low-impact step aerobics, elliptical training machines, stair climbing. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss. They also provide cardiovascular benefits.

Flexibility exercises. 

Stretches are best performed after your muscles are warmed up — at the end of your exercise session, for example. They should be done gently and slowly, without bouncing. 

Balance exercises

Balance training is an important part of looking after your bones. Working on your balance can improve your stability and help prevent falls, which can cause fractures. For example-standing on one leg, sitting on an exercise ball, and balancing with a rocker board under your feet. Yoga, double leg press, exercise ball, tai chi.

Postural correction exercises

Emphasize on back extension exercises. In addition, abdominal exercises, arm/shoulder exercises and core muscles exercises, all help in maintaining good posture.

Movements to avoid

If you have osteoporosis, don’t do the following types of exercises:

  • High-impact exercises, such as jumping.
  • Exercises in which you bend forward and twist your waist, such as touching your toes, doing sit-ups or using a rowing machine.
  • Sudden and forceful movements.
  • Any exercise that is likely to cause you to fall.

Exercise Tips

  1. Exercise at least thrice a week.
  2. Progress slowly over time. Too quick progression increases the injury risk.
  3. Include a variety of exercises like weight-bearing activities, balance exercises, strength training and flexibility exercises.
  4. Choose exercise that matches your ability and is enjoyable.

Some Examples of exercises for Target areas

  • Spine — Back extensions. A simple back extension exercise: Lie on stomach with forehead resting on floor or rolled up towel. Extend arms straight in front of head. Raise head off the floor a few inches. Hold for several seconds. Do three sets of 10 repetitions.
  • Hip — Squats, hip adduction/abduction exercises with elastic bands or weights
  • Forearm — Bicep curls, wrist curls, reverse wrist curls

Include a variety of exercises for all major groups to promote well-balanced muscle development. Improved muscle strength also enhances coordination and balance to protect against falls.


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