BONE HEALTH
Osteoporosis is a significant health concern for postmenopausal women, increasing the risk of fractures, disability, and loss of independence. Although medications can help improve bone mineral density (BMD) and reduce fracture risk, they do not address other important factors such as muscle weakness, decreased power, impaired balance, and reduced functional mobility. These factors contribute significantly to falls and fractures. According to Daly et al. (2019), exercise is one of the most effective strategies for addressing multiple fracture risk factors simultaneously. However, not all exercise is equally beneficial for bone health. The type, intensity, frequency, and progression of an exercise program are essential to achieving meaningful improvements in bone strength and overall physical function.
The research highlights three major components of an effective osteoporosis prevention program: progressive resistance training, weight-bearing impact activities, and challenging balance exercises. Resistance training should be performed at least twice weekly, targeting major muscle groups, particularly those surrounding the hips and spine. Exercises such as squats, lunges, hip strengthening, and spinal extensor strengthening are recommended, with gradual progression toward moderate-to-high resistance. Weight-bearing impact activities, including jumping, hopping, step-ups, and multidirectional movements, provide mechanical loading that stimulates bone adaptation. Additionally, balance and mobility training should accumulate at least 2–3 hours per week to improve postural control, coordination, and functional stability. Importantly, walking, swimming, and cycling alone are generally insufficient to produce significant improvements in bone density. Combining different exercise modalities provides greater benefits by addressing both skeletal and non-skeletal factors associated with fracture risk.
From a physical therapy perspective, the most important takeaway is that osteoporosis prevention requires an individualized and progressive exercise approach. Exercise selection and intensity should be based on each individual's bone health, muscle strength, balance, functional abilities, and fracture risk. Patients who are sedentary, have significant weakness, or demonstrate impaired balance should first develop adequate strength and stability before progressing to higher-impact activities. Individuals with severe osteoporosis, a recent fracture, or significant functional limitations should undergo a comprehensive evaluation by a physical therapist before beginning an exercise program. Ultimately, the evidence supports a multimodal approach combining progressive resistance training, appropriately prescribed weight-bearing impact activities, and challenging balance exercises. Consistency and progressive loading are key to maintaining bone health, improving physical function, reducing fall risk, and promoting long-term independence in postmenopausal women.
Based on: Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW. Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Brazilian Journal of Physical Therapy (2019).
