| What We Treat
Osteoporosis
Been diagnosed with osteoporosis or osteopenia and told to be careful? Careful is rarely the right advice. Bone responds to load — and the right exercise programme is one of the few things that genuinely improves it.
Overview
What Is Osteoporosis?
Osteoporosis is a reduction in bone density and quality that makes fractures more likely, particularly at the wrist, spine and hip. It develops silently over years and is often only identified after a fracture from a fall that wouldn’t normally break a bone. The important message is that it is not a reason to stop loading your skeleton. Bone is living tissue that adapts to the demands placed on it, and progressive resistance and impact exercise are among the most effective non-pharmacological interventions available.
Bone Density and Bone Quality
Bone is constantly remodelled — old bone removed, new bone laid down. From the mid-thirties, and particularly after the menopause, removal starts to outpace replacement. A DXA scan measures density and gives a T-score: above −1.0 is normal, −1.0 to −2.5 is osteopenia, and −2.5 or below is osteoporosis.
Symptoms
How It Tends to Feel
Osteoporosis itself is silent. These are the features that suggest it may be present or progressing:
No Symptoms at All
The most common presentation. Bone loss produces no pain until a fracture occurs.
Fracture From a Minor Fall
A break from a fall at standing height or less is the classic fragility fracture and should always prompt assessment.
Loss of Height
Losing more than around 4cm from your peak adult height can indicate vertebral fractures.
Increasing Upper Back Curvature
A developing stoop can result from wedge-shaped vertebral fractures.
Sudden Mid-Back Pain
A vertebral fracture can occur with a cough, a sneeze or lifting something modest, and produces sudden localised back pain.
Ongoing Back Ache
Persistent aching after a vertebral fracture, often related to the postural change rather than the healed bone itself.
Causes & Risk Factors
Risk Factors
Some risk factors are fixed, and plenty are not. The modifiable ones are where the opportunity lies.
Menopause
Falling oestrogen accelerates bone loss substantially in the years around and after the menopause. Early menopause increases risk further.
Age and Sex
Risk rises steadily with age in both sexes. Men are affected too and are frequently under-diagnosed and under-treated.
Long-Term Steroid Use
Oral corticosteroids taken for three months or more significantly increase fracture risk and warrant specific assessment.
Previous Fragility Fracture
The single strongest predictor of a future fracture. Anyone over 50 with a fracture from a low-impact fall should be assessed.
Lifestyle and Nutrition
Smoking, high alcohol intake, low body weight, inadequate calcium and vitamin D, and physical inactivity all contribute meaningfully.
The Programme
What Bone-Loading Exercise Looks Like
Bone responds to specific kinds of load. A programme that works looks quite different from general activity — and it needs to be matched to your fracture risk and current capacity.
Assessment
Establish a safe, individualised starting point
- Review of your DXA result, fracture history, medications and other conditions
- Objective baseline testing of strength, balance and functional capacity
- Screening for vertebral fracture history, which affects what is appropriate
- Agreement on realistic goals — and on what we are actually trying to change
Tap through the stages. What is appropriate for you depends on your fracture risk, your history and your current capacity — this is a framework, not a prescription.
How We Can Help You
Treatment & Management
Physiotherapy sits alongside medical management, not instead of it. My focus is the exercise side — which is genuinely effective, and consistently the part people are given least help with.
What the evidence says
High-intensity progressive resistance and impact training has been shown in randomised trials — including the LIFTMOR trial in post-menopausal women with low bone mass — to improve bone density at the spine and hip and to improve functional measures, without the adverse events that were long feared.
NICE guidance on osteoporosis covers fracture risk assessment using tools such as FRAX and QFracture and the use of DXA. Exercise and falls prevention are recognised components of management alongside pharmacological treatment, and the two work best together.
When to Seek Help
Red Flags — Don’t Ignore These
Osteoporosis is managed rather than urgent. These features need prompt medical assessment:
⚠ Seek prompt medical assessment if you notice:
- Sudden, severe mid-back pain, particularly after a minor strain, cough or fall (possible vertebral fracture)
- Inability to weight-bear after a fall, or hip or groin pain following one (possible hip fracture — attend A&E)
- Rapid loss of height, or a noticeably increasing stoop over months
- New back pain with fever, unexplained weight loss, or a history of cancer
- Any of the spinal cord or cauda equina symptoms listed on the lower back pain page
These symptoms need same-day medical assessment. Please contact your GP or NHS 111 today, or attend A&E if they are severe or worsening quickly.
Common Questions
Frequently Asked Questions
Is it safe for me to lift weights?
For most people with osteoporosis, yes — and it’s one of the most useful things you can do. The evidence for supervised, progressive, high-intensity resistance training in this population is good, including in people with low bone density. The key words are supervised and progressive: technique and sensible loading matter, and a proper assessment comes first.
Isn’t walking enough?
Walking is excellent for cardiovascular health and general wellbeing, but it’s a weak stimulus for bone because the loads involved are low and familiar. Bone adapts to loads it isn’t used to. That means resistance training and, where appropriate, impact work.
What about osteopenia — do I need to do anything?
Osteopenia means bone density is below average but not in the osteoporotic range. It’s an excellent point to act, because you have more to work with. Building strength, balance and bone loading habits now measurably influences your trajectory.
Should I avoid bending forwards?
The advice to never bend forwards is outdated and impractical. What matters is avoiding repeated, heavily loaded end-range flexion, particularly combined with twisting — and learning to hinge from the hips when lifting. Sensible technique, not avoidance.
Bone Responds to Load — Let’s Use That
A proper assessment of your strength, balance and fracture risk, and a progressive programme built to do what bone actually responds to.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.