New Insight Regarding Exercise Recommendations for Osteoporosis Management

Osteoporosis and Low Bone Mass are highly prevalent conditions for American adults. In June of 2014, the National Osteoporosis Foundation published an excerpt from an article in the Journal of Bone and Mineral Research that estimates that over 54 million citizens are currently affected. The incidence of fracture in the US population aged 50 or greater is thought to be 1 in 2 women and 1 in 4 men. The costs of these injuries are significant – estimated to total over 2 million broken bones and over $19 billion in expenses. 1 Of the total number of American adults with Osteoporosis or Low Bone Mass, approximately 43 million persons fall into an ‘at-risk’ category, meaning that they have decreased bone density but are not yet meeting the diagnostic criteria for full-blown osteoporosis. There is a huge opportunity for the medical community – particularly including physical therapists – to intervene with preventative measures for this group.

There is currently fairly widespread public knowledge that various types of exercise can positively affect bone mass. Resistance training and weight bearing activities like recreational walking are commonly recommended for patients that are at risk for the development of osteoporosis. A recent publication in physical therapy literature has summarized the analysis of multiple studies looking at the effects of exercise-based therapy for adults with osteoporosis. The findings of this meta-analysis – published in the online journal PT in Motion in January, 2015 – suggest that there is utility in making some modification to traditional recommendations. Specifically, this analysis showed significant treatment effects (meaning increased bone mass) only when high impact weight bearing activity was combined with resistance training exercise. Examples of high impact activity included jumping, skipping, dancing, and hopping. 2 These findings suggest that lower impact activity such as walking may not be as optimal as more intense high impact activity for inducing increased bone mass.

A 2010 publication of the Journal of Bone and Mineral Metabolism also supports the use of high impact activity for the prevention of bone mass deficits. In this analysis of multiple studies, it was found that exercise programs that combine ‘high impact’ activity with resistance training appear effective in ‘augmenting’ bone mineral density at the hip and spine in PRE-menopausal women. High-impact activity without resistance training was found to have a positive effect only at the hip.3 The British Journal of Sports Medicine in 2009 published similar findings in an analysis of studies of POST-menopausal women – stating that ‘mixed’ impact protocols (in this case jogging mixed with stair climbing and walking) in combination with resistance training programs had a positive effect on bone mineral density at the lumbar spine and hip. Impact-only protocols were found to be ineffective in this analysis.4

Safely accomplishing exercise programs that include high impact activity requires good strength, adequate balance, and skeletal structures and joints that are tolerant of this type of exercise. Physical therapy can help to ensure that all of these conditions exist for adults at risk for osteoporosis. Physical therapy can optimize joint mobility and biomechanics via manual therapy intervention, and can specifically prescribe, supervise and progress targeted activities that increase muscle mass, motor control, and position sense. Treatment by a physical therapist can also include fall risk assessment and instruction in fall prevention strategies, as well as postural exercise training to diminish the potential effects of poor posture (specifically excessive kyphosis) on a fragile skeletal structure. Additionally, physical therapist designed exercise and education programs can help at-risk patients to manage controllable risk factors associated with the development of osteoporosis, such as increased body mass index, decreased overall activity level, or counterproductive nutritional habits.

To learn more about Osteoporosis, Low Bone Mass, and how exercise therapy can be of benefit to you, please contact the Symmetry Physical Therapy team. We would be happy to schedule a consultation to discuss your specific situation.


1 National Osteoporosis Foundation


3 J Bone Miner Metab. 2010 May;28(3):251-67. doi: 10.1007/s00774-009-0139-6. Epub 2009 Dec 15. Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis.

4 Br J Sports Med. 2009 Dec;43(12):898-908. doi: 10.1136/bjsm.2008.052704. Epub 2008 Nov 3. A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes.