Osteoporosis: Symptoms, Causes, Treatment, Exercises

What is osteoporosis?

Osteoporosis is a condition characterized by weakened bones that are more prone to fracture. It develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes.

Osteoporosis is often called a “silent disease” because it usually doesn’t cause symptoms until a fracture occurs.

However, symptoms may include:

• Back pain, often caused by a fractured or collapsed vertebra
• Loss of height over time
• Stooped posture (kyphosis) and standing tall causes discomfort
• Fractures of the bones that occur more easily than expected, especially in the hip, wrist, or spine

Causes of Osteoporosis

Osteoporosis results from an imbalance between bone resorption (breakdown) and bone formation.

Contributing causes include:

Non-Modifiable Factors:

• Age: Bone mass peaks in your 20s and declines with age
• Sex: Women, especially postmenopausal, are at higher risk
• Family history of osteoporosis or fractures
• Ethnicity: Higher risk in Caucasian and Asian populations

Modifiable Factors:

• Low calcium and vitamin D intake
• Sedentary lifestyle too much sitting
• Smoking
• Excessive alcohol consumption either binging or chronic use
• Certain medications like corticosteroids and or anticonvulsants
• Hormonal imbalances, such as low estrogen or testosterone
• Animal protein such as fatty meats
• Sugars and sweeteners such as soft drinks

Treatment for Osteoporosis

Lifestyle Management:

• Diet: Ensure adequate intake of calcium and vitamin D
• Exercise: Weight-bearing and resistance exercises improve bone strength
• Avoid smoking and excessive alcohol

Medications:

1. Bisphosphonates (i.e. alendronate, risedronate) – first-line drugs to prevent bone loss
2. Denosumab – a monoclonal antibody that slows bone resorption
3. Teriparatide or abaloparatide – parathyroid hormone analogs that promote bone formation
4. Raloxifene – selective estrogen receptor modulator for postmenopausal women
5. Hormone Replacement Therapy (HRT) – may help postmenopausal women but has risks

Fall Prevention:

• Home safety improvements such as grab bars in the bathroom, better lighting in the bedroom, appropriate furniture i.e. sturdy chairs, walkers and canes, appropriate footwear, personal alarm system i.e. smart watch
• Vision and hearing checks
• Balance training

Exercises

The best exercises for osteoporosis focus on improving bone strength, balance, muscle strength, and posture, while minimizing the risk of fractures. Here’s a breakdown of the most effective and safe exercises:

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🏋️‍♀️ 1. Weight-Bearing Exercises

These exercises force your body to work against gravity, stimulating bone growth. Take things slow and steady. Avoid high impact and twisting moves unless health care provider is with you and suggests otherwise.

Caution … High-Impact (if safe and advised by a doctor):

• Brisk walking
• Hiking
• Dancing
• Low-impact aerobics
• Jumping rope (for those without spinal fractures)

Low-Impact (safer for those with more severe osteoporosis):

• Walking
• Elliptical training i.e. these machines need a thorough introduction and maybe even need a support person with you while using them
• Stair climbing i.e. start with one step first and progress to more. Always pay close attention to what is happening around you.

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💪 2. Resistance (Strength) Training

Helps build muscle and strengthen bones.

• Free weights or weight machines … start “light” or maybe begin with body weight and no extra equipment at first so you can perfect your posture and form
• Resistance bands … begin light – bands come with different resistance
• Bodyweight exercises like:
  • Wall push-ups
  • Squats (with proper form)
  • Step-ups

Target major muscle groups, especially the hips, spine, and wrists — common fracture sites.

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🧘 3. Balance and Stability Exercises

Reduce fall risk — critical in preventing fractures.

• Tai chi/ Yoga/ Qi Gong
• Standing on one foot
• Heel-to-toe walking
• Balance board activities … be super careful when using any equipment. Make sure someone qualified has done a thorough job introducing the equipment to you. If you don’t feel confident, don’t use it.

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🧍 4. Posture and Flexibility Exercises

Improve alignment and reduce spinal fracture risk.

• Yoga (osteoporosis-safe poses only — avoid forward bends/twists)
• Pilates (modified for bone health) – pilates is all about strengthening your core and overall body control
• Stretching routines focusing on back, chest, and shoulders

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❗Exercises to Avoid

To prevent fractures:

• Avoid high-impact activities if bones are fragile (e.g., running or jumping)
• Avoid bending and twisting at the waist (e.g., sit-ups, touching toes)
• Avoid heavy lifting with poor form

Take Away … according to the Mayo Clinic

To ensure safety in a fitness class, individuals with osteoporosis should prioritize slow, controlled movements and avoid high-impact exercises, bending at the waist, and twisting movements. Consulting with a healthcare provider or physical therapist is recommended to develop a safe and effective exercise program tailored to their needs. 

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