Osteoporosis & Osteopenia: Why Movement Is Medicine
Physical therapy for bone health, strength, and longevity — with a special focus on women navigating perimenopause, menopause, and beyond.
What Is Osteoporosis — And Why Does It Matter?
Osteoporosis is a condition in which bones lose density and become more fragile, increasing the risk of fractures — even from minor falls or everyday movements. Osteopenia is the stage before osteoporosis, where bone density is lower than normal but hasn't yet reached the threshold for a full osteoporosis diagnosis.
Both conditions are common, underdiagnosed, and frequently undertreated. According to the National Osteoporosis Foundation, approximately 10 million Americans have osteoporosis and another 44 million have low bone density. Women account for the vast majority of those affected — and the window of greatest risk begins earlier than most people realize.
The good news: bone loss is not inevitable, and it is never too late to take action. Physical therapy plays a powerful role in both preventing and managing osteoporosis — and strength training is at the center of that approach.
The Hormonal Connection: Perimenopause, Menopause & Bone Loss
Estrogen plays a critical role in maintaining bone density. It helps regulate the cells responsible for building and breaking down bone tissue, keeping that process in balance. When estrogen levels decline — as they do during perimenopause and menopause — that balance shifts. Bone breakdown begins to outpace bone formation, and density can decrease rapidly.
In the first five to ten years following menopause, women can lose up to 20% of their bone density. This is one of the most significant and least-discussed health transitions women experience — and it is one that physical therapy is uniquely positioned to address.
The perimenopausal and early menopausal years represent a critical window. Beginning a structured strength training program during this time does not just slow bone loss — it can actively stimulate new bone formation, improve balance, reduce fall risk, and build the muscular foundation that protects your skeleton for decades to come.
Strength training is one of the most evidence-based interventions available for bone health. It is not optional for women in midlife — it is essential.
Why Strength Training Is the Cornerstone of Bone Health
Bone is living tissue. It responds to mechanical load — meaning that when muscles pull on bones during resistance exercise, the bone responds by becoming denser and stronger. This process, called bone remodeling, is driven by the stress placed on the skeleton during weight-bearing and resistance activities.
Aerobic exercise like walking is beneficial for overall health, but it does not provide the mechanical stimulus needed to build or maintain bone density. Strength training does. Specifically, exercises that load the spine, hips, and wrists — the most common fracture sites in osteoporosis — are most effective.
What the research tells us:
Progressive resistance training has been shown to increase bone mineral density at the spine and hip in postmenopausal women
High-intensity resistance training (when done safely and progressively) produces greater bone density benefits than low-intensity exercise
Strength training also improves muscle mass, balance, and coordination — all of which significantly reduce fall risk
The benefits are dose-dependent: consistency over time matters more than any single workout
Starting strength training during perimenopause — before significant bone loss has occurred — is ideal. But beginning at any stage, including after an osteoporosis diagnosis, is beneficial and appropriate with proper guidance.
How Physical Therapy Can Help
Many women with osteopenia or osteoporosis are told to "be careful" or "avoid high-impact activity" — advice that, while well-intentioned, can lead to reduced activity, further deconditioning, and greater fracture risk over time. Fear of movement is one of the biggest barriers to the very interventions that would help most.
A physical therapist specializing in bone health can help you move confidently and safely — building strength progressively, with full attention to your individual history, current bone density, fracture risk, and goals.
At Hampton Physiotherapy, I can help you with:
A comprehensive assessment of your strength, balance, posture, and movement patterns
A personalized, progressive strength training program designed around your bone density and fracture risk level
Education on which exercises are most beneficial — and which to modify — based on your DEXA scan results
Balance and fall prevention training to reduce your risk of fracture-causing falls
Posture and body mechanics education, particularly for spinal health
Guidance on how to safely progress your exercise program over time
Collaboration with your physician or endocrinologist to ensure your care is coordinated
A Note on Fear and Exercise with Osteoporosis
One of the most common things I hear from patients with osteoporosis is that they are afraid to exercise — afraid of falling, afraid of fracturing, afraid of doing something wrong. That fear is completely understandable. And it is also one of the most important things to address.
Inactivity accelerates bone loss, weakens the muscles that protect your skeleton, and increases fall risk. Movement — done thoughtfully and progressively — is protective. The goal of physical therapy is not to push through risk carelessly, but to help you build strength and confidence in a way that is appropriate for your body right now.
You do not need to be an athlete. You do not need to lift heavy weights from day one. You need a program that meets you where you are and builds from there — and that is exactly what I am here to help you create.
Ready to take the first step toward stronger bones?
Whether you have received a recent osteopenia or osteoporosis diagnosis, are navigating perimenopause or menopause, or simply want to be proactive about your bone health, I would love to work with you. At Hampton Physiotherapy, you will receive one-on-one care tailored specifically to your needs, your goals, and your life.
