Physiotherapy for Osteoporosis in Older Adults (2026 Guide)

What Is Osteoporosis?

Osteoporosis is a condition where bones become less dense and more fragile, increasing the risk of fractures. The word literally means "porous bones." In healthy bone, the internal structure is dense and well-connected. In osteoporotic bone, this structure becomes thinner and more widely spaced, reducing the bone's ability to withstand force.

Osteoporosis is common in older Australians, particularly in women after menopause. According to Healthy Bones Australia, osteoporosis affects an estimated 1.2 million Australians, with a further 6.3 million having low bone density (osteopenia). The condition is often called a "silent disease" because bone loss occurs without symptoms until a fracture happens.

The most common osteoporotic fractures occur in the hip, spine (vertebral compression fractures), and wrist. Hip fractures in particular can have serious consequences for older adults, often leading to significant loss of independence, prolonged hospitalisation, and increased mortality risk.

While osteoporosis cannot be cured, it can be managed. Treatment typically includes medication (prescribed by your doctor), adequate calcium and vitamin D intake, and importantly, targeted exercise. Physiotherapy plays a role in prescribing safe and effective exercise programs for people with osteoporosis.

Why Exercise Matters for Osteoporosis

Bone is living tissue that responds to the forces placed on it. When you perform weight-bearing and resistance exercises, the mechanical loading on the bones stimulates the cells responsible for building new bone (osteoblasts). This can help maintain bone density and, in some cases, may help slow the rate of bone loss.

Exercise for osteoporosis works on two fronts:

Bone Loading

Weight-bearing and resistance exercises place force through the bones, providing the mechanical stimulus that bone needs to maintain or build density. Not all exercise loads bone effectively - the exercise needs to be of sufficient intensity and involve the right type of loading for the bones at risk.

Fall Prevention

The majority of osteoporotic fractures result from a fall. Improving balance, coordination, and reaction time through targeted exercise can reduce the likelihood of falling in the first place. Even if bone density is low, not falling means not fracturing. This is why balance training is considered equally important as bone-loading exercise for people with osteoporosis.

Important distinction: Exercise for osteoporosis is not the same as general exercise for fitness. The program needs to specifically include bone-loading activities and balance challenges. Walking alone, while beneficial for general health, may not provide sufficient stimulus to meaningfully affect bone density in someone with established osteoporosis.

Types of Exercise Recommended for Osteoporosis

Clinical guidelines recommend a combination of exercise types for people with osteoporosis. Your physiotherapist will select and dose these based on your bone density results, fracture history, current fitness, and other health conditions.

Weight-Bearing Impact Exercise

Activities performed on your feet where your body works against gravity. For older adults with osteoporosis, this may include brisk walking, stair climbing, dancing, or gentle stamping exercises. The impact of your feet hitting the ground sends loading forces through the leg bones and spine. The intensity and type of impact exercise is adjusted based on your fracture risk and physical capacity.

Progressive Resistance Training

Muscle strengthening exercises using body weight, resistance bands, or light weights. When muscles contract and pull on the bones they are attached to, this creates a loading force that stimulates bone. Key areas to target include the legs (squats, leg press, heel raises), the spine (back extension exercises), and the hips (hip abduction, hip extension). The resistance needs to be progressively increased over time to continue providing an effective stimulus.

Balance and Coordination Training

Exercises that challenge your balance reduce the risk of falling. For people with osteoporosis, not falling is the most direct way to prevent a fracture. Balance exercises may include standing on one leg (with support nearby), tandem standing and walking, weight shifting, stepping over obstacles, and exercises that challenge your reaction time. These are progressed from simple to more challenging as your balance improves.

Posture and Spinal Extension

Osteoporosis commonly affects the spine, and vertebral compression fractures can lead to a rounded (kyphotic) posture. Exercises that strengthen the back extensor muscles and promote an upright posture are important for spinal health. These may include gentle thoracic extension exercises, shoulder blade squeezes, and prone lying positions.

What to Avoid with Osteoporosis

While exercise is strongly recommended for osteoporosis, certain types of movement may increase fracture risk and are generally avoided, particularly for people with moderate to severe osteoporosis or a history of vertebral fractures.

Sustained or loaded forward bending (spinal flexion) - exercises that involve bending forward through the spine under load, such as sit-ups, toe touches, or heavy lifting from the floor, can increase the compressive force on the front of the vertebrae and may increase fracture risk in osteoporotic spines.
Rapid twisting movements under load - forceful rotational movements through the spine, especially when combined with bending, place uneven stress on the vertebrae.
High-impact activities beyond your capacity - while impact loading is beneficial, activities that are beyond your current fitness and balance level increase fall risk. The level of impact needs to match your capacity.

Key point: The specific movements to avoid depend on the severity of your osteoporosis, which bones are affected, and whether you have had previous fractures. This is why having a physiotherapist assess your individual situation and prescribe a tailored program is important. A generic exercise program may include movements that are inappropriate for your level of bone density.

The Evidence for Exercise and Osteoporosis

The evidence supporting exercise for osteoporosis management is substantial. Research has demonstrated several consistent findings:

Progressive resistance training and weight-bearing impact exercise can help maintain bone mineral density in postmenopausal women and older adults
Balance and functional training can reduce falls risk, which directly reduces fracture risk
Exercise programs that include back extensor strengthening may help improve posture and reduce the risk of vertebral fractures
Exercise needs to be ongoing - the benefits diminish if you stop exercising

It is important to be realistic about what exercise can achieve. In someone with established osteoporosis, exercise alone is unlikely to restore bone density to normal levels. However, it may help slow the rate of bone loss, reduce fracture risk through improved balance, and maintain the strength and function needed for daily life. Exercise works best as part of a comprehensive management plan that includes medication, nutrition, and falls prevention.

How a Physiotherapist Can Help

A physiotherapist experienced in working with older adults and osteoporosis can provide a tailored, safe exercise program based on your individual bone density, fracture history, and physical capacity. Specifically, a physiotherapist can:

Assess your current strength, balance, posture, and functional capacity
Prescribe weight-bearing and resistance exercises at the appropriate intensity for your bone density level
Include balance training to reduce your falls risk
Advise on movements to avoid based on your specific fracture risk
Teach safe movement strategies for daily tasks (lifting, bending, reaching)
Progressively increase the challenge of your program as you get stronger
Assess your home environment for fall hazards

For more about our approach to balance and falls prevention, visit the falls prevention service page. For information about funding options, see our funding and payment options page.

Frequently Asked Questions

Can exercise reverse osteoporosis?

Exercise alone is unlikely to reverse established osteoporosis or restore bone density to normal levels. However, appropriate weight-bearing and resistance exercise may help slow the rate of bone loss and maintain bone density. Combined with medication, nutrition, and falls prevention strategies, exercise is an important part of comprehensive osteoporosis management.

Is walking enough exercise for osteoporosis?

Walking is beneficial for general health and provides some weight-bearing stimulus, but it is generally not sufficient on its own for meaningful osteoporosis management. Clinical guidelines recommend adding progressive resistance training and balance exercises to a walking program. A physiotherapist can design a program that includes the right combination and intensity of exercise for your situation.

Are there exercises I should avoid with osteoporosis?

Certain movements may increase fracture risk for people with moderate to severe osteoporosis, particularly sustained or loaded forward bending through the spine (such as sit-ups and toe touches) and forceful twisting movements. The specific restrictions depend on which bones are affected and your fracture history. A physiotherapist can advise on what to avoid and provide safe alternatives.

Diagnosed with Osteoporosis?

We provide in-home physiotherapy with tailored exercise programs for osteoporosis management. Safe, effective exercise to support your bones and reduce fracture risk.

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