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Overview of Osteoporosis

Osteoporosis is the loss of bone tissue leading to decreased bone density. Poor acquisition of bone density in youth and accelerated bone density loss during aging are the primary reasons for developing osteoporosis. Bone density acquisition and loss are regulated by genetic and environmental factors. Primary osteoporosis is due to loss of estrogen and aging, whereas secondary osteoporosis is due to conditions or medications that accelerate bone loss. Risk factors for developing osteoporosis are genetic, behavioral, and nutritional.1 Bone mineral density (BMD) is assessed by passing low-level radiation through the bone to estimate the level of bone mineral content. Tests are typically taken of the vertebral spine, neck of the femur, and wrist bones. Individuals with a BMD T-score of -2.5 or less are diagnosed with osteoporosis. Individuals with primary osteoporosis do not have specific causes for endurance impairments, outside of their normal limitations based on age and activity level. Those with secondary osteoporosis may have endurance impairments associated with another chronic condition. Management of osteoporosis requires the combination of factors to control the loss of bone density.2

Recommended Treatments for Clients With Osteoporosis

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Adequate intake of calcium and vitamin D Regular weight-bearing exercise
Avoidance of tobacco Avoidance of excessive alcohol intake
Pharmacologic therapies Falls prevention

Comorbidities to Consider

  • Postural changes and vertebral compression fractures are common complications associated with osteoporosis.

Client Examination

Keys to the Examination of the Client

  • Assess the risk of fracture using the World Health Organization's Fracture Risk Assessment Tool (FRAX).3

  • Because of the increased risk of fracture due to falling, assessment of balance and ongoing prevention of falling will be needed during exercise sessions.

  • A BMD test after 6 months of exercise may help determine the benefit of a specific exercise program.

Recommended Baseline Testing of Fitness Levels

  • Determine an aerobic capacity and strength assessment based on the client's functional status and plans for starting an exercise program.

Exercise Prescription


Type: Weight-bearing activities and weight training

Intensity: Moderate intensities

Duration: Start at 20–30 minutes

Frequency: Three to five times per week

Getting Started

Aerobic activities of walking, jogging, or dancing combined with a strength training program are recommended for patients with osteoporosis. There are no absolute restrictions for clients with primary osteoporosis; however, individuals with secondary osteoporosis may have limited ability to exercise due to other chronic conditions Exercise prescriptions are directed at slowing the rate of loss of bone density as there is limited evidence for the effects of exercise to reverse the pathogenesis associated with osteoporosis.4


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