When was the last time you talked to your primary care provider about osteoporosis, or bone loss? If you’re over the age of 50, it’s possible that this has already come up. Whether it’s a conversation you’ve already had with your doctor, or one that’s been on your mind, it’s a worthwhile chat. Osteoporosis is pretty common, affecting about 10 million Americans along with the 44 million that have osteopenia, or low bone density, according to the Bone Health & Osteoporosis Foundation. 

Although it may not be fun to think about, keeping tabs on your bone density can help prevent issues down the road that may make it harder to stay active and do all the things you love. Thankfully, there is a lot you can do to reduce your risk and prevent complications of bone loss.

“It’s natural to be concerned when you read about osteoporosis and bone fractures,” says Gina Clark, PT, DPT, a physical therapist at Hinge Health. “But doing the hobbies and physical exercises you love as well as some targeted exercise therapy to maintain strength and flexibility can go a long way in helping you stay healthy.”

Here’s what Hinge Health physical therapists want you to know about exercise and preventing osteoporosis.

Risk Factors for Osteoporosis

Osteoporosis affects both men and women, of every race and ethnicity. However, women are generally at a higher risk than men, and people who are white or Asian generally have a higher risk than other races. People with smaller body frames may also be at a greater risk because they might have less bone mass to draw from as they age. Other factors that can affect osteoporosis risk include:

Hormonal changes. A decrease in estrogen levels during menopause may lead to a loss of bone density, which makes menopause a perfect time to start following good habits for healthy bones. But premenopausal women who have irregular menstrual periods may be more vulnerable too. Men are also more likely to develop osteoporosis if they have a condition that causes low levels of testosterone.

Nutritional deficiencies. A diet low in calcium and vitamin D may increase your risk for osteoporosis. So can excessive dieting and low protein intake. To help protect against this, it’s recommended that premenopausal women and men consume at least 1,000 mg of calcium per day, preferably through food. Postmenopausal women need even more — around 1,200 mg. Men over 70 and postmenopausal women should also consume 800 IU of vitamin D every day, and premenopausal women and younger men should get 600 IU. Talk to your doctor about whether calcium and vitamin D supplements are recommended for you.

Being sedentary. The more exercise you get, the lower your risk of developing osteoporosis.  Weight-bearing activities, such as walking, jogging, or strength training, all help to build bone mass. This is good news, because it means keeping up with — or ramping up —  your exercise routine can make a big difference. Being active also helps to build balance. “When you sit more and move less, you can start to struggle with balance, which increases risk of a fall,” explains Dr. Clark. 

Certain medical conditions or drugs. Certain diseases raise the risk of developing osteoporosis, such as celiac disease, rheumatoid arthritis, inflammatory bowel disease, and certain cancers such as multiple myeloma. Long-term use of certain medications can contribute, too. They include:

• Glucocorticoid medications (such as prednisone) to treat asthma or rheumatoid arthritis

• Antiseizure medications to treat conditions like epilepsy 

• Aromatase inhibitors to treat breast cancer

• Proton pump inhibitors to lower stomach acid levels

Family history. Having parents or siblings with osteoporosis or who are prone to bone fractures can increase your risk too. That’s not to say you will get osteoporosis. But if you have any of the risk factors above in addition to a family history, talk to your doctor. They can advise whether or or how often you should get bone density scans. You may benefit from working with a dietitian (to tweak your diet so you get plenty of bone-building foods) or a physical therapist (to add bone-strengthening exercises to your workout routine). 

Osteoporosis Symptoms

It’s important to talk to your doctor about osteoporosis, even if your bones feel perfectly fine. Osteoporosis is typically known as a “silent” disease, but if your bones have weakened, you may notice the following:

• Back pain 

• Loss of height

• Stooped posture (kyphosis)

• Bones that break more easily than expected (you may experience a fracture if you fall from standing height, for example, or bend or lift something)

The best way to avoid all of this? Early diagnosis and treatment, says Dr. Clark.

Physical Exercises for Osteoporosis

Whether you’ve recently been diagnosed with osteoporosis or are at risk for it, you might be tempted to avoid exercise because you worry about being “fragile” when you exercise. This is a huge misconception, stresses Dr. Clark. “Staying active is exactly what you need to do to keep your bones strong.” A 2022 review published in the British Journal of Sports Medicine found that regular weight-bearing and resistance exercise not only helped improve bone strength in people with osteoporosis, it also reduced the risk of falls by 26%.

While all types of movement are helpful, Hinge Health physical therapists say the following types of exercise can be especially good for osteoporosis: 

Weight-bearing exercises. Weight-bearing and higher-impact activities challenge your bones more. Impact may sound scary but it's just a way to describe how your body is making contact with the ground. Examples include anything where you’re putting weight on your feet, such as walking, jogging, stair climbing, and tennis. “Dancing is also a terrific exercise, because it’s not just weight bearing, but it’s multi-directional resistance training, which gets your muscles to contract in various ways,” she says

“Cycling and swimming are great for your cardiovascular health, but since they are non-weight bearing, they won’t help to directly strengthen bones,” explains Dr. Clark. The more impact a movement or exercise puts into your bones, the more those bones will work to get thicker, denser, and stronger. If you really enjoy doing these activities, keep doing them! It may just help to incorporate some weight-bearing work into your routine, as well. 

Aim for 30 minutes most days of the week. Whether it’s a 30-minute session or multiple sessions spread out throughout the day, the benefits to your bones are the same.

Resistance exercises. These use either weights or your body’s own resistance to work against gravity. While you can use free weights, a weight machine, resistance bands, or your own body weight, "I particularly like resistance band exercises because they challenge your muscles as the bands stretch, whatever direction that might mean,” says Dr. Clark. While when you lift weights, you always have to lift against gravity to challenge your muscles. This makes resistance bands more dynamic and accommodating to how you want to challenge yourself.

These exercises recommended by Hinge Health physical therapists are great for building strong bones, helping to prevent and manage osteoporosis and bone loss. “I recommend doing these resistance exercises two to three days per week,” says Dr. Clark. “If you don’t have much time, squeeze in small amounts, or just do one body part each day.” 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Tips for Exercising and Osteoporosis

Weight-bearing movement is one of the best things you can do to prevent osteoporosis. If you already have osteoporosis or osteopenia (lower bone density), you should still be as active as possible. But you may want to avoid or minimize high-impact activities that involve forceful bending and twisting of your back and hips until you feel strong enough to handle these types of activities to reduce the risk of stress fractures. If you have questions about what’s appropriate for you, ask your provider.  

Tips to Prevent Osteoporosis

In addition to exercising regularly, other healthy lifestyle habits can help keep your bones strong and healthy. This includes:

• Eat a healthy diet. A 2018 study published in the American Journal of Clinical Nutrition found that a diet rich in produce, nuts, whole-grain cereals, olive oil, and fish increased hip bone density among people with osteoporosis over a 12-month period. A diet rich in these types of foods helps control inflammation, which may help protect bones. These foods are also rich in magnesium and potassium, which are needed for strong bones, too.

• Get help to quit smoking. Smoking cigarettes speeds up bone loss. Research suggests that women who smoke a pack of cigarettes a day throughout adulthood have up to a 10% reduction in bone density by menopause.

• Avoid falls. No matter what your bone density is like, it’s wise to safeguard your home environment to minimize issues that could make you trip and fall. Remove loose rugs and electrical cords. Make sure stairs and entrance ways in your home are well-lit. Don’t walk on slippery surfaces, such as ice or wet floors. Talk to your doctor about any medication you take that can affect your balance and get regular check-ups for vision and hearing.

• Cut back on alcohol. More than two drinks a day can raise the risk of fractures.

Physical Therapy for Osteoporosis 

If you are diagnosed with either osteoporosis or osteopenia, a physical therapist can help, says Dr. Clark. They can show you specific exercises to help build bone, as well as ways to improve your balance to reduce your risk of falling. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. What Women Need to Know. (n.d.). Bone Health & Osteoporosis Foundation. Retrieved from https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/

2. Osteoporosis Fast Facts. (n.d.). Bone Health & Osteoporosis Foundation. Retrieved from https://www.bonehealthandosteoporosis.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf

3. Rosen, H. N. (2023, February). Patient education: Osteoporosis prevention and treatment (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/osteoporosis-prevention-and-treatment-beyond-the-basics

4. Brooke-Wavell, K., Skelton, D. A., Barker, K. L., Clark, E. M., Biase, S. D., Arnold, S., Paskins, Z., Robinson, K. R., Lewis, R. M., Tobias, J. H., Ward, K. A., Whitney, J., & Leyland, S. (2022). Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine, 56(15). doi:10.1136/bjsports-2021-104634

5. Jennings, A., Cashman, K. D., Gillings, R., Cassidy, A., Tang, J., Fraser, W., Dowling, K. G., Hull, G. L. J., Berendsen, A. A. M., de Groot, L. C. P. G. M., Pietruszka, B., Wierzbicka, E., Ostan, R., Bazzocchi, A., Battista, G., Caumon, E., Meunier, N., Malpuech-Brugère, C., Franceschi, C., & Santoro, A. (2018). A Mediterranean-like dietary pattern with vitamin D3 (10 µg/d) supplements reduced the rate of bone loss in older Europeans with osteoporosis at baseline: results of a 1-y randomized controlled trial. The American Journal of Clinical Nutrition, 108(3), 633–640. doi:10.1093/ajcn/nqy122

6. Osteoporosis. (2022, November 15). National Institute on Aging. https://www.nia.nih.gov/health/osteoporosis 

7. Osteoporosis. (2021, August 21). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-203519688