Osteoporosis exercise physiotherapy, osteopenia programmes and Osteoporosis prevention plans: Reading London and web

Prevention and Early Bone Health

The reality is that most osteoporosis services begin after bone loss has already occurred, after osteopenia has been identified, and that is frequently after a fragility fracture has disrupted confidence, mobility and independence.

Yet we know that many of the foundations for lifelong skeletal health are established much earlier, throughout childhood and adolescence.

This is during the years when bone is developing most rapidly and remains highly responsive to physical loading, nutrition and environmental influence [1,2,3].

Healthy Bones Australia states clearly that calcium, vitamin D and weight-bearing exercise all play essential roles in bone health throughout life, although their relative importance changes across childhood, adulthood and later life [1].

This understanding and my desire to work upstream from the problems associated with Osteoporosis, sits behind the development of my Osteo-Pro: ProBone Activate programme.

This is a specialist health promotion and prevention programme designed to support parents of children and young people under the age of sixteen. With a particular focus on those aged approximately three to fourteen.

The programme recognises that community, parents and family environments strongly influence children’s behaviour, their movement habits, outdoor activity, exposure to nature, healthy nutrition, health beliefs and long-term behaviour patterns during critical years of skeletal development [2,4,5,6].

Research consistently shows that childhood and early adolescence represent important windows for building stronger bones and improving long-term skeletal resilience [1,2,3,7].

Weight-bearing and impact-based activities including running, jumping, climbing and active play stimulate bone adaptation during growth, while inactivity reduces these opportunities [1,7,8].

The Canadian Paediatric Society advises that supporting healthy bones in childhood involves regular physical activity, adequate calcium intake, sufficient vitamin D and reducing prolonged sedentary behaviour [2,9].

Bone health is also increasingly being understood within a wider environmental and public health context.

Research published in JAMA Network Open identified associations between exposure to residential green space and improved bone mineral density in young children, highlighting the importance of active outdoor environments during early development [10].

Other studies show that family members remain among the strongest influences on young people’s health knowledge and behaviours, reinforcing the importance of parent-focused education and early intervention [4,5,11].

At the same time, research suggests that many adolescents and young adults still possess poor knowledge of osteoporosis and bone health, despite the importance of these early years [12].

The Osteo-Pro: Better Bones Programme therefore has a programme designed to help families build stronger foundations earlier — long before osteoporosis and fragility fracture conventionally become part of the conversation.

Elevated Osteoporosis Risk

For many of the women I work with through Better Bones For Life, the most important moment isn’t the diagnosis of osteoporosis — it’s the period before it.

A family history of fragility fracture, the early signs of hormonal changes, irregular menstrual cycles, hot flashes, night sweats, vaginal dryness, sleep disruptions, mood changes, and “brain fog. 

In addition a recognition that there may be risk factors, long-term medication use, low body weight, years of inadequate nutrition, sedentary work, lack of exercise that  osteogenic and promotes bone formation, development, and the stimulation of new bone tissue.

These are all signals that bone health needs attention now, not after a diagnosis of Osteopenia, or something breaks.

Healthy Bones Australia describes exercise as playing a vital role across the entire lifespan: building bone in youth, maintaining it through adulthood, and preserving the mobility and balance that prevent falls in later life [6].

The Garvan Institute created the Know Your Bones tool specifically because awareness and early engagement are fundamental to prevention — understanding your own risk is the first step towards doing something about it [4].

And yet Osteoporosis Canada’s data confirm that fewer than half of people at elevated risk are meeting basic physical activity or nutritional recommendations.

This means the gap between what we know and what people are actually doing is large, and consequential [7].

Effect

Being told your bones are at risk lands differently for different people.

Some women feel energised by it — this is information they can act on, and they want to.

Others feel anxious, confused, or quietly frightened, particularly if the clinical conversation that delivered the information was brief and the pathway forward unclear.

Some avoid finding out at all.

The period of elevated risk that precedes a diagnosis or a first fracture is not a passive waiting room — it is the time when the choices being made every day are shaping the bone health of the next decade.

Research from the Garvan Institute’s Dubbo Study makes clear that fractures, and their consequences, occur across a wider age range and broader bone density profile than was previously understood. 

This reinforces why acting before a threshold is crossed matters so much [3].

For the women I work with in this space, what they need is not a leaflet.

They need real information, a programme that makes sense for their life, and support from someone who understands both the clinical picture and what it actually means to live in a body that feels less certain than it used to.

That is what I provide with my programme.

Management

Healthy Bones Australia is direct about what works: bones need specific types of exercise to respond — weight-bearing impact, progressive resistance training, and high-challenge balance work.

General activity, things most people do on an average day, helps overall health, but it isn’t enough to build or maintain bone on its own [6].

For women with osteopenia or identified risk factors, the foundations are bone-targeted movement, nutritional optimisation — adequate calcium, protein, and vitamin D — lifestyle awareness, and sustained, supported engagement with their own bone health.

Osteoporosis Canada’s 2023 guidelines lead with exercise as their primary recommendation, before everything else, naming balance and functional training alongside progressive resistance work as the first-line approach [7].

The Garvan Institute notes that healthy lifestyle behaviours across adulthood — diet and consistent progressive weight-bearing exercise — are the most important contributors to bone health in later life [4].

The Royal Osteoporosis Society’s Strong, Steady and Straight consensus statement confirms that exercise for bone health needs to be targeted, progressive, and individually tailored to be effective [19].

In my OsteoPro Bone Better Bones programme, that is exactly what I offer — evidence-based, individually tailored movement, education, and lifestyle support for women who are ready to take an active role in their bone health, and who deserve far more than a brief clinical encounter and a standard information sheet.

References: 3, 4, 6, 7, 19

Fragility Fractures

A fragility fracture is a fracture that happens from a force that wouldn’t break a healthy bone — a fall from standing height, a stumble, sometimes something as unremarkable as a sneeze or turning over in bed.

Fragility fractures are the most serious clinical consequence of osteoporosis, and what the research tells us is sobering.

The Garvan Institute of Medical Research’s Dubbo Osteoporosis Epidemiology Study — one of the longest-running osteoporosis studies in the world — established that every low-trauma fracture significantly increases the risk of another, with the highest risk window in the first five years after the initial fracture [1, 2].

It also showed that premature mortality rises following fractures across the skeleton, not just hips as was previously assumed [1].

And critically, half of all fragility fractures occur in people whose bone density doesn’t even reach the diagnostic threshold for osteoporosis — which is why looking at the whole fracture risk picture matters so much more than a single number from a DXA scan [3].

Effect

For many people, a fragility fracture is the moment they realise their bones have been quietly losing strength for years.

It is frightening, often painful, and frequently accompanied by a sudden, disorienting loss of what felt possible.

A hip fracture can be life-changing — many people who were independent before do not recover the same level of independence afterwards.

Vertebral (spine) fractures bring their own slower, cumulative burden: persistent back pain, height loss, changes in posture, and the altered mechanics that follow multiple collapsed vertebrae.

Wrist and shoulder fractures take away the daily tasks that feel most personal — getting dressed, cooking, driving, managing alone.

And across all of it, the fear of another fracture often does more damage than the fracture itself — because when we fear we reduce and can even stop movement, and it is movement that bones and muscles need most.

Management

A fragility fracture is a clinical event that demands a full response — not just treatment of the broken bone, but a genuine plan to prevent the next one.

The Garvan Institute has made clear that proper management following fracture could substantially reduce re-fracture risk — and yet the majority of people who sustain a fragility fracture still receive no bone health investigation or follow-up [4].

The evidence for what actually works is now strong.

The LIFTMOR randomised controlled trial at Griffith University, led by Watson, Weeks, Weis, Harding, Horan and Beck, showed that a short, twice-weekly programme of high-intensity resistance and impact training measurably improved bone density and physical function in postmenopausal women with low bone mass — safely, and with over 90% adherence [5].

Healthy Bones Australia identifies weight-bearing impact exercise, progressive resistance training, and challenging balance work as the evidence-based triad that bones respond to across the lifespan [6].

Osteoporosis Canada’s 2023 clinical practice guidelines lead with exercise — balance, functional training, and progressive resistance work — as the primary intervention for fracture prevention [7].

In my practice, recovery from a fragility fracture is always a whole-person process: rebuilding physical strength, movement confidence, and the sense that it is safe — and worthwhile — to move again.

References: 1, 2, 3, 4, 5, 6, 7

Falls and Increased Falls Risk

Falls and fractures go together in osteoporosis — you can’t address one without addressing the other.

Healthy Bones Australia reports that half of all falls in older adults happen at home, in familiar surroundings, doing everyday things [6].

The British Geriatrics Society describes falls in older people not as individual events with a single cause, but as a syndrome — the result of multiple things happening at once: reduced muscle strength, slower reactions, changes in balance and spatial awareness, altered gait, the effects of medication on blood pressure or alertness, and the accumulated impact of other health conditions [8].

In someone with osteoporosis, each of those factors carries more weight precisely because the consequence of falling is so much greater than it would be for someone with healthy bone.

Effect

Living with an elevated risk of falling does something quiet but significant to a person’s life. Behind all actions, movement behaviours and movement practices can lie a low level fear of more falls and more fractures.

Activities that were previously automatic start to require thought.

Social situations that involve uneven ground, unfamiliar spaces, or low lighting get quietly avoided.

The fear of falling — quite apart from whether a fall actually happens — is associated with reduced physical activity, social withdrawal, and a gradual narrowing of life.

And that narrowing matters, because it weakens the very muscles and balance systems that would have protected against a fall in the first place.

When osteoporosis and sarcopenia are both present — a combination now recognised as osteosarcopenia — the risk is substantially compounded.

A systematic review and meta-analysis published in Osteoporosis International confirmed that osteosarcopenia is associated with significantly higher rates of falls, fractures, disability, and mortality compared with either condition alone [9].

Management

The evidence for exercise in falls prevention is as strong as any evidence in musculoskeletal health — and the key is that balance training needs to be genuinely challenging to work.

Healthy Bones Australia is clear that the nervous system only adapts when it is pushed: that means balance tasks that change direction, require concentration, and are progressively made harder over time [6].

The British Journal of Sports Medicine supports progressive resistance and balance training as the primary approach to maintaining neuromuscular function and reducing falls in older adults [10].

Griffith University’s LIFTMOR research programme showed that high-intensity bone-targeted exercise — the foundation of the Onero programme — builds both bone and muscle strength safely across a wide age range, including people with established bone loss [5].

Osteoporosis Canada’s 2023 guidelines place balance and functional training at the top of their exercise recommendations, more than twice weekly [7].

In every programme I run, falls risk and the psychological impact of trauma, and movement confidence are addressed directly — they are not an afterthought.

References: 5, 6, 7, 8, 9, 10

Persistent Pain

Osteoporosis is often called a silent disease because it causes no pain or symptoms until something breaks.

But once a fracture has occurred — particularly in the spine — pain can become a persistent, complex, and deeply disruptive part of daily life.

Vertebral (spine) compression fractures are the most common source of ongoing back pain in osteoporosis, and their pain rarely behaves simply.

Acute fracture pain may ease over weeks, but for many people it gives way to something longer-lasting: pain driven by the altered mechanics of a changed spine, by the neurological sensitisation that develops when pain is present for a sustained period, and by the anxiety and muscle tension that chronic pain almost always brings with it.

The structural change and the pain experience do not map neatly onto one another.

Many people with significant vertebral changes have modest symptoms; others with limited imaging findings are in severe, function-limiting pain. Both are real, and both deserve to be taken seriously [11].

Effect

Persistent pain from osteoporotic fracture changes life quietly and incrementally.

Sleep is disrupted. Movement becomes something to manage rather than something that happens naturally.

Everyday things — carrying a bag, turning over in bed, sitting through a meal, reaching a shelf — become calculations.

The isolation that accompanies unrelenting pain is well documented: depression and anxiety are common in people living with chronic musculoskeletal pain, and in the context of osteoporosis they carry particular weight — because the pain comes alongside fear of further fracture, anxiety about movement, and often a profound sense of loss about what the body used to be able to do [12].

The gap between how someone looks from the outside and how they are actually managing is often enormous, and that invisibility is its own exhausting burden.

Management

Effective pain management in osteoporosis means addressing the whole picture — not just the structural source of the pain but the nervous system that is amplifying it, and the emotional experience that is shaping it.

Movement is central, not despite the pain but as part of managing it.

Back extensor strengthening is one of the most consistently evidenced physical interventions in osteoporotic vertebral fracture — it improves spinal support, gradually reduces kyphotic posture, and reduces pain over time [13].

The ESCEO and the IOF both support individually tailored exercise as a core part of management across all osteoporosis presentations, including those complicated by pain and fracture history [14].

Pain neuroscience education — helping people understand why pain persists, what the nervous system is doing, and why the scan result doesn’t explain everything — changes how people relate to their pain, and that shift makes a real difference to what they feel able to do.

Psychological support addressing trauma, anxiety, depression, sleep, and fear of movement is not a luxury or an add-on — in persistent pain, it is essential.

In my practice, pain is always understood as a whole-person real experience, not a purely structural problem with a structural solution.

References: 11, 12, 13, 14

Sarcopenia (Muscle Weakness)

Sarcopenia is the progressive loss of muscle mass, strength, and function that comes with ageing.

Sarcopenia and osteoporosis are not separate problems that happen to coincide. They are deeply connected.

Muscle contraction is one of the most important stimuli for bone formation.

When muscles pull on bone through movement and loading, bone responds by maintaining and building its structure.

When muscle mass and strength decline, that stimulus is reduced, and bone loss accelerates.

The relationship runs in the other direction too — pain, fracture, and restricted movement reduce the physical activity that muscle depends on, so the two conditions tend to spiral together rather than develop in isolation.

When both are present simultaneously — now recognised clinically as osteosarcopenia — the ESCEO and the IOF have both highlighted that the combined impact is greater than either condition alone.

Shared risk factors include ongoing and possibly reducing inactivity, low protein and vitamin D intake, hormonal changes, and chronic low-grade inflammation make this combination common, particularly in older women [9, 14].

Effect

The practical consequences of sarcopenia alongside osteoporosis are deeply felt in daily life.

As muscles get weaker through inactivity, getting up from a chair takes effort.

Stairs require thought. Carrying shopping, maintaining balance on uneven ground, moving quickly when something unexpected happens — all of these become harder.

Loss of physical strength changes what feels possible, and with it, what people choose to do.

Social life narrows. Activities get dropped. Independence, which most people only notice when it starts to slip, is incrementally affected.

A systematic review published in Osteoporosis International confirmed that osteosarcopenia is associated with a significantly elevated risk of falls, fractures, disability, and mortality compared to either condition in isolation [9].

Beyond the physical, there is the emotional dimension — the loss of a body that felt capable, the anxiety that comes with recognising increasing fragility, and the dependency that muscle weakness can begin to create in relationships.

These things deserve to be part of the clinical conversation, not left unaddressed alongside the physical prescription.

Management

The good news — and it is genuinely good news — is that muscle responds to the right exercise at any age.

Progressive resistance training is the most robustly evidenced intervention for sarcopenia, and its effects on bone and muscle are not two separate outcomes: they happen together.

The LIFTMOR trial at Griffith University demonstrated that twice-weekly high-intensity resistance and impact training produced significant improvements in bone density, muscle strength, and functional capacity in postmenopausal women with low bone mass — safely, with high adherence throughout [5].

The LIFTMOR-M trial extended those findings to older men [15].

Healthy Bones Australia places progressive resistance training — with progressive increases in load — alongside weight-bearing impact and challenging balance work as the essential framework for both bone and muscle health [6].

Osteoporosis Canada’s 2023 guidelines recommend progressive resistance training targeting back extensors and core muscles more than twice weekly as a primary clinical recommendation [7].

Nutrition matters equally: muscle protein synthesis requires adequate protein and vitamin D, and the ESCEO has identified nutritional optimisation alongside exercise as the foundation of managing osteosarcopenia — not one or the other, but both together [14].

References: 5, 6, 7, 9, 14, 15

Spinal Deformities (Kyphosis and Scoliosis)

When vertebrae fracture and partially collapse — as they commonly do in osteoporosis, often without a dramatic event and sometimes without the person even realising what has happened — the spine changes shape.

Progressive anterior wedging of the vertebral bodies produces the forward rounding of the upper back that is widely associated with osteoporosis: thoracic kyphosis.

Lateral displacement can produce or worsen scoliosis.

These changes are not cosmetic. They reflect real structural compromise of the spinal column, with consequences that ripple through the whole body — how it moves, how it breathes, how it carries itself through daily life.

Research documents that even vertebral fractures that produce no immediate symptoms are associated with measurable declines in pulmonary function as the thoracic space reduces [16].

Effect

As the kyphosis increases, the body’s centre of gravity shifts forwards.

Maintaining an upright position becomes effortful, placing sustained demand on the muscles of the back and lower limbs — muscles that are often already weakened by sarcopenia.

Gait changes and balance becomes less secure. The risk of further falls rises.

Height loss — which can amount to several centimetres over multiple fractures — is distressing in ways that go beyond the physical: it changes how people see themselves, how clothes fit, how they move through a world designed for a body they used to have [17].

Restricted breathing — because the rib cage has less room to expand — is rarely discussed in clinical consultations but is very much part of the lived experience, as is the early fullness and reduced appetite that comes from abdominal compression in pronounced kyphosis.

And the visible change in posture itself carries an emotional weight: for many women it becomes a marker of age and fragility that they did not choose, affecting confidence, self-presentation, and willingness to engage in social life.

Management

Back extensor strengthening is one of the most well-evidenced physical interventions in vertebral osteoporosis, improving the dynamic support of the spine, gradually reducing kyphotic posture, and reducing pain over time [13].

Healthy Bones Australia and Osteoporosis Canada’s 2023 guidelines both identify targeted exercise for back extensors and core as a specific clinical priority in this population [6, 7].

Balance and proprioceptive work addresses the gait and stability consequences of altered spinal alignment — directly relevant to falls risk.

The Onero programme, developed by Professor Belinda Beck at Griffith University through the LIFTMOR trial and developed further through the STOP FRACTURE! study, has demonstrated that high-intensity resistance and impact training builds bone and improves muscle strength safely even in those with existing vertebral fractures, under appropriate supervision [5, 18].

In my practice, the psychological impact of postural change — on confidence, identity, and social engagement — is never treated as peripheral. It is part of the whole-person picture that good bone health care must address.

References: 5, 6, 7, 13, 16, 17, 18