Osteoporosis is a disease in which your body loses bone faster than it can be replaced. This results in lower bone density, making your bones thinner and more fragile. As a result, bones are more likely to break, even from minor falls or bumps. While anyone can develop osteoporosis, it is more common in women than in men.

In the United States, about 10 million people have osteoporosis. Around 44 million people have a milder condition called osteopenia. Osteopenia means your bones are weaker but not as weak as in osteoporosis. Osteopenia can turn into osteoporosis without treatment. In 2024, around 2 million bone fractures occurred in the United States in people with osteoporosis and osteopenia. Researchers expect this number to reach about 3 million by 2025. The Bone Health & Osteoporosis Foundation says that half of all women and 1 in 4 men will experience a fracture due to weak bones at some point in their lives.

Osteoporosis is called a “silent” disease because most people do not know they have it until they break a bone or get a bone test from a medical doctor. The good news is that you can help prevent it. Eating healthy foods and staying active are great ways to keep your bones strong. Physical therapists help people with osteoporosis by creating safe exercise plans. These plans include weight-bearing activities such as walking or dancing, which help the body build bone.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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On this page

• What Is Osteoporosis?
• How Does It Feel?
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Osteoporosis?

Understanding bone density or bone strength is important when thinking about osteoporosis. By the time someone is 18 to 25 years old, they may have built up 85% to 90% of their peak bone strength. This means that preventing osteoporosis needs to begin early, ideally when you're young. Eating foods rich in calcium, vitamin D, and protein, and staying physically active, helps bones grow strong.

Bones go through an ongoing process known as remodeling (the body breaking down old bone and replacing it with new bone). By age 30, most people have reached their peak bone density. After that, bone remodeling slows, leading to some normal bone loss as we age. The way we live affects how much bone we lose. For example, not smoking, drinking less alcohol and caffeine, and regular exercise all help. Osteoporosis happens when we lose too much bone. It can lead to broken bones and negatively impact a person’s life.

Women who go through menopause and men over 60 are more likely to get osteoporosis. This is because of changes in estrogen and testosterone levels as we get older. These hormones play a vital role in bone remodeling. Some long-term health problems can also make bones weaken earlier in life. These include stomach problems, rheumatoid arthritis, spina bifida, cystic fibrosis, eating disorders, and kidney disease. These illnesses lower bone density in children and young adults. Some medicines, like steroids, can also increase the risk of osteoporosis.

How Does It Feel?

How Is It Diagnosed?

Physical therapists can screen for signs of osteoporosis, especially in those at greater risk due to age, medical history, or lifestyle factors. Your physical therapist may:

• Look at your posture, balance, and how you move.
• Ask you about any history of falls or fractures, which can indicate underlying bone weakness.
• Identify risk factors like family history, menopause, or decreased nutrition.
• Ask you about your medications, including steroids.

If your physical therapist thinks you might have osteoporosis, they will send you to a medical doctor for testing.

Physicians diagnose osteoporosis using a specialized X-ray called the DEXA (or DXA) scan. This scan measures bone density, a component of bone strength. Results are reported as a T-score in older adults and a Z-scores in children and young adults.Both scores help you and your health care team understand your bone strength, but they compare your results to different groups of people.

• A T-score tells how your bone density compares with that of the average healthy adult at peak bone density. The more negative the number, the lower your bone density. T-scores show the following results:
• Normal:-1.0 or greater (bones are in a healthy range)
• Osteopenia: Between -1 and -2.5 (bones are weaker than normal but not yet at osteoporosis)
• Osteoporosis: -2.5 or lower (bones are significantly weaker and more likely to break)
• A Z-score compares your bone density with that of other people your same age, sex, height, and weight. Z-scores mean the following:
  • Normal: Above -2.0 (bone density is typical for someone like you)
  • Low for age (osteoporosis):-2.0 or lower (bones are less dense than expected compared to peers). This may suggest an underlying medical cause.

Other ways to check bone health include regular X-rays, ultrasounds, and CT scans. A physical therapist may recommend discussing a bone density test with your primary care physician as part of your overall health management.

How Can a Physical Therapist Help?

If you are worried about your bone health or have osteopenia or osteoporosis, a physical therapist can help you avoid injuries. The goal of physical therapy is to help you start an exercise program that is right for you. Your physical therapist will:

• Assess how you move, your strength, and balance.
• Build a treatment plan that addresses your needs.
• Help you fit regular physical activity into your schedule.
• Improve your strength and how you move to prevent falls.

Exercise is very important for keeping your bones strong. Weight-bearing and resistance exercises put healthy, necessary stress on your bones, helping them maintain their strength and preventing further bone loss.

Examples of exercises that support bone health include:

• Weight-bearing exercises such as walking, hiking, tennis, pickleball, dancing, and jogging
• Resistance training such as using dumbbells, kettlebells, resistance bands, and Pilates

Physical therapy will help you:

• Build a safe strength training plan.
• Improve your balance.
• Address posture or movement problems.
• Help you improve the safety of your work or home space.

If you break a bone due to osteoporosis, your medical doctor will refer you to physical therapy to help you heal and get back to your normal activities.

Can This Injury or Condition Be Prevented?

Osteoporosis prevention starts by building strong bones during childhood, adolescence, and early adulthood. Some people are more likely to get osteoporosis because of their genes, but healthy habits help at any age. These include:

• Eating healthy foods
• Regular physical activity
• Avoiding excessive alcohol, caffeine, and salt intake
• Not smoking

The U.S. Department of Agriculture’s Dietary Guidelines for Americans provides nutritional guidance by life stage, including these essential nutrients for bone health:

• Calcium: found in dairy, fortified food, and leafy green vegetables.
• Vitamin D: found in fortified foods, sunlight, and dietary supplements (Vitamin D3 has been shown to be more beneficial than Vitamin D2).
• Protein: both plant and heart-healthy animal sources are beneficial.
• Other helpful nutrients are found in fruits, vegetables, nuts, seeds, and fish.

Starting and keeping an exercise routine that includes weight-bearing activity and resistance training to help bones stay strong is important at every age. Before starting a new routine, it’s smart to work with a physical therapist. They will assess your current strength and mobility, address any limits to movement, and create a safe exercise program with the right exercises for you.

To help prevent osteoporosis, aim for 30 minutes of weight-bearing activity on most days of the week (five to seven days) with resistance or strength training on two or three of those days. You can break daily exercise into shorter sessions that add up to 30 minutes per day if needed. Choose from among these examples:

Weight-Bearing Activities (5 to 7 days a week) to include:

• High impact exercises such as:
  • Aerobics
  • Sports
  • Hiking
  • Jogging
  • Running
  • Jumping rope
  • Dancing
  • Stair climbing
  • Weightlifting
• Low impact exercises such as:
  • Low impact aerobics
  • Cross-country skiing
  • Using elliptical and stair-stepping machines
  • Walking

Resistance or Strength Training (2 to 3 days a week) which involves using:

• Weights
• Resistance bands
• Bodyweight exercises or participating in Pilates, Yoga, or Tai Chi.

Know Your Risk

Knowing if you are at risk for osteoporosis helps you seek medical advice early and address any preventable factors. Things that raise your risk include:

• Older age (ages 65 and older for men and after menopause for women)
• Female sex
• Family history of osteoporosis
• Being Caucasian, Asian, or Latino
• Physically inactive lifestyle
• Diet low in calcium and vitamin D
• Medication history (corticosteroids, chemotherapy drugs, immunosuppressants)
• Having a small and thin body
• Medical history of chronic diseases or GI (gastrointestinal) disorders
• Hormone deficiencies
• Alcohol abuse
• History of breaking a bone in adulthood

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat those with osteoporosis. However, if you have an osteoporosis or a low bone density diagnosis, you may want to consider:

• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy or geriatric physical therapy. These physical therapists have advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist with a practice focus on treating older adults and people with osteoporosis.

You can search for physical therapists with specific experience or expertise using the American Physical Therapy Association’s Find a PT tool.

General tips when you are looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• Ask about the physical therapists' experience in helping people who have osteoporosis.
• Be prepared to describe your symptoms in as much detail as possible. Make a note of what makes your symptoms better or worse.

Further Reading

The following websites are important and reputable resources to obtain more information about improving your bone health:

Bone Health and Osteoporosis Foundation. Accessed August 15, 2021.  

American Bone Health. Accessed March 28, 2018.

American Bone Health. Fracture risk calculator. Accessed March 28, 2018.

Osteoporosis Canada. Accessed March 28, 2018.

Osteoporosis Canada. Too fit to fracture series. Accessed March 28, 2018.

Own the Bone. Accessed March 28, 2018.

National Osteoporosis Foundation and Pilates Anytime. Safe movement video series. Accessed March 28, 2018.

MedBridge. Osteoporosis education courses for physical therapists. Accessed March 28, 2018.

Office of the US Surgeon General. The 2004 Surgeon General’s report on bone health and osteoporosis. Accessed March 28, 2018. 

Physical Activity Guidelines Advisory Committee, US Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: US Department of Health and Human Services. Published 2018. Accessed May 24, 2021.