Most people learn they have osteoporosis from a bone density scan or a broken bone, not from pain. What comes next has two halves. Your physician handles the medical half: ordering the scan, interpreting it and deciding whether medication makes sense. Physical therapy handles the other half: osteoporosis exercise that is safe and progressive, better balance, a stronger upper back, and ways of bending, lifting and getting around that go easier on your spine. That second half is what we work on at Lake Erie Physical Therapy in Buffalo.
Osteoporosis and low bone density in plain words
The American Physical Therapy Association’s ChoosePT site describes osteoporosis as a disease in which your body loses bone faster than it can replace it. You usually don’t feel anything until a bone breaks, most often in the hip, the wrist or the middle to lower back. Some people first notice that they’re getting shorter or that their upper back is rounding.
Physicians diagnose it with a DXA (also written DEXA) scan, a quick, painless, specialized X-ray. Results come back as a T-score, which compares your bone density with that of a healthy adult at peak bone density:
- -1.0 or higher: normal
- Between -1 and -2.5: low bone density, also called osteopenia
- -2.5 or lower: osteoporosis
Being female and getting older both raise your risk, particularly after menopause for women and from age 65 for men. ChoosePT also lists a family history of osteoporosis, a small, thin frame, physical inactivity, a diet low in calcium and vitamin D, heavy drinking, a broken bone as an adult, and medicines such as corticosteroids.
What your physician does, and what we do
We don’t perform bone density testing, and we don’t prescribe medication. Your physician orders the DXA scan and, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), may prescribe medication to slow or stop bone loss and prevent fractures. If your history suggests osteoporosis that hasn’t been tested, we send you to your physician, as ChoosePT describes.
Our part starts with a one-on-one evaluation of your scan results, fracture history, medications, strength, balance and walking. NIAMS notes that a physical therapist can recommend exercises to strengthen and support your back, teach safe ways of moving through daily activities, and tailor an exercise program to your circumstances. You leave with a home program, and any hands-on care we use is gentle and chosen with your bone density in mind.
Osteoporosis exercise: what a good program includes
First, an honest expectation. NIAMS notes that for older adults, exercise no longer increases bone mass. What it does is build muscle, strength, coordination and balance, which lowers your chance of falling. The Too Fit To Fracture recommendations from an international panel say the strongest evidence concerns falls, and they strongly recommend combining strength and balance training. The same building blocks apply to low bone density exercise, adjusted to your results and fracture history.
Strength training
Progressive resistance work for the major muscle groups, at least twice a week, is the backbone: legs and hips for stairs and getting up from a chair, plus the muscles along your spine that help you stand tall (Too Fit To Fracture specifically mentions the spinal extensors). Movements are slow and controlled, and the load rises gradually.
Balance training
The same recommendations suggest balance training every day, roughly 15 to 20 minutes. It can start with simple stances and steps and progress to tai chi style movements as you get steadier.
Weight-bearing activity
Walking is a good base, and ChoosePT lists walking, hiking and dancing among weight-bearing options. NIAMS advises people with osteoporosis to avoid high-impact exercise, so clear jumping or running with your physician and therapist first. Walking alone isn’t a complete plan, though: the panel recommends against aerobic exercise to the exclusion of strength and balance work.
Bending, lifting and twisting with less strain
Too Fit To Fracture says everyone with osteoporosis should learn how to move safely or take precautions when twisting or bending. In practice, that means:
- Bending at the hips and knees to pick things up, keeping your back long rather than rounded
- Holding loads close and turning with your feet instead of twisting your trunk under a load
- Getting in and out of bed, the car and the tub in ways that protect your spine
- Rethinking the snow shovel: pushing snow is usually easier on your back than lifting it and twisting to throw it
If you also have back pain, we test how it responds to movement with your bones in mind. Many people also want help with a rounded upper back; our page on posture covers that side.
Making falls less likely
ChoosePT notes that with osteoporosis, even a fall from standing height or a step off a curb can break a bone. Alongside strength and balance work, we check how you walk, turn and get up from a chair or the floor, and whether a cane or walker would help. At home, NIAMS suggests clutter-free floors, well-lit stairs with rails on both sides, and grab bars near the tub, shower and toilet. Outside, it recommends supportive shoes with thin nonslip soles and, in winter, salt or kitty litter on icy sidewalks, advice that gets plenty of use in Buffalo.
After a spine fracture
For people who have had a spine fracture from osteoporosis, Too Fit To Fracture suggests consulting a physical therapist to make sure exercise is safe and appropriate. We start where your pain and your physician’s guidance allow, often with positions that ease pain, gentle work for the muscles that hold you upright and safer ways to move through the day.
Warning signs that need a physician
Physical therapy does not replace a medical diagnosis. See a physician before starting therapy, or get emergency care where noted, if:
- After a fall, you have hip or groin pain or can’t put weight on your leg. Go to an emergency department; this can be a hip fracture.
- A wrist is badly swollen, misshapen or very painful after a fall. Get it checked the same day.
- Back pain came on suddenly and severely, especially after a minor fall, a lift or no clear injury at all. It may be a spine fracture.
- You’re getting shorter or your upper back is rounding, and you haven’t discussed it with your physician.
- Back pain comes with fever, unexplained weight loss or a history of cancer, or no position eases it, including at night.
- You have new numbness or weakness in your legs, or changes in bladder or bowel control. Go to an emergency department.
Coverage, and keeping it going after discharge
Medicare doesn’t require a referral to start physical therapy. We write a plan of care, and your physician (or nurse practitioner or physician assistant) certifies it; Medicare Advantage plans may require prior authorization. Our Medicare page has the details. With most other plans, New York’s direct access law lets you start without a referral for up to 10 visits or 30 days, whichever comes first, though some insurers still require one to pay, so confirm with us first.
Bone health is a long game. After discharge, our Keep It Going program lets you keep exercising at the clinic for $10 a visit or $70 a month for unlimited visits. It’s usually not covered by insurance, and it requires a prescription for maintenance exercise from your original referring physician, medical clearance from your family physician and a signed waiver.
To build a plan around your scan results and your fracture history, call (716) 332-4838 or request an appointment. Bring your most recent DXA report if you have one.
Sources
- Osteoporosis: Diagnosis, Treatment, and Steps to Take, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- Physical Therapy Guide to Osteoporosis, ChoosePT (American Physical Therapy Association)
- Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture, Osteoporosis International, 2014 (full text, PubMed Central)