Osteoporosis physiotherapy: what exercise can still do

The bone-density printout is still in your handbag. Osteoporosis physiotherapy was not part of the advice that came with it. Your sister read the T-score and told you to give up the morning walk. The tablet has been started. The walk has already shrunk to the car park, and your upper back rounds a little more when you stand at the stove.

A DXA report labels osteoporosis at a T-score of -2.5 or lower. Between -1 and -2.5 is osteopenia. Malaysia's 2022 guideline also treats a spine or hip fracture from a standing-height fall as osteoporosis, even when the density is higher than that cut-off. That result is not a reason to stop moving.

The same guideline says osteoporosis here is still underdiagnosed and undertreated. The Ministry of Health guideline recommends screening every postmenopausal woman from 50, and anyone with a previous low-trauma fracture, height loss, or a risk of falling.

Back pain that should be checked before harder training

Many vertebral fractures are quiet on the day they happen. See a doctor before harder exercise if mid-back pain starts after an ordinary bend, cough, or lift, if the upper back has newly rounded, or if you have lost more than 4 cm in height. Severe pain needs a look now. If you wait, a new fracture can be mistaken for an old backache.

Seek urgent care if that pain comes with new leg weakness or numbness, or a change in bladder or bowel control.

The medicine has a job that exercise cannot do

If a bone medicine has been prescribed, keep taking it unless the prescriber changes it. Exercise trials have not matched those medicines for preventing fractures. Calcium and vitamin D matter when food falls short. Take them alongside the medicine, not instead of it.

The Royal Osteoporosis Society makes the same point for patients. Exercise and a sensible diet help, and they do not replace osteoporosis medicine when the chance of a broken bone is high. Their guide to exercise for bones is worth reading before you cancel the walk.

Training can still change muscle, balance, and how you load your bones on an ordinary day. Many people fear that bending will break a bone. If you avoid moving, the leg muscles that catch a stumble get weaker.

Why giving up the walk raises your falls risk

A large review cited in Malaysia's guideline found that exercise cut the rate of falls by 23% in older adults, compared with no programme. The programmes that did this mixed balance, everyday movement, and strength, often above three hours a week. Programmes that were mostly walking were much less certain.

If you are steady on your feet, keep a comfortable walk and add strength and balance in the same week. If you are already falling, build that strength and balance with someone watching before you speed the walk up. If you sit more and replace the walk with nothing, your balance gets worse.

Bone and muscle often thin together. If a parent is also getting weaker through the arms and legs, our guide to sarcopenia in Malaysian families covers what strength work can still change.

What osteoporosis physiotherapy changes

We start by watching you move: how you stand up, how you lift, whether your back curls to reach the floor. We then teach safer ways to do those jobs, following the Royal Osteoporosis Society's Strong, Steady and Straight advice, and adjusted for whether a vertebra has already broken.

For many people the useful mix is:

• Strength that can progress a little. Sit-to-stand from a stable chair is a fair home version, if your back stays comfortable.
• Balance beside a support. A kitchen counter is enough for a slightly narrower stance. If you are already falling, practise with supervision rather than inventing a harder drill alone.
• Time on your feet. Apartment stairs count. Jogging, hops, and some dancing are higher impact. After a vertebral fracture, or several fractures from minor force, keep impact around brisk walking until a physiotherapist has seen your technique.

A crushed vertebra does not grow back to its old height, and posture drills will not straighten the curve it leaves. Upper-back strength can still make standing more comfortable.

Until you have been assessed, ease off these, especially with a very rounded upper back:

• Repeated sit-ups, curl-ups, and toe-touches that load a curled spine.
• A fast twist while holding something heavy, feet planted.
• A sudden bend to lift a rice cooker, or a grandchild, off the floor. Hinge at the hips and knees, and keep the load close. These fractures tend to crush the front of a weakened vertebra.

You can keep smooth turning within a range that feels easy, and you can keep doing housework.

If a parent is already walking more slowly, our guide to a slower walk in older age sets out what to check.

That osteoporosis physiotherapy visit covers fractures, medicines, height, and how you stand and lift. You should go home with a way to move that suits your spine. Exercise will not change the diagnosis on your scan.

If you have a report and you are unsure what you can still do, message us on WhatsApp. Pinpoint Physiotherapy is in Ara Damansara. Tell us whether you have had a fracture, and which household job you have started handing over.