Osteoporosis & Osteopenia: What to do?


 I was talking to my mom the other day and she mentioned she was told she has osteopenia. She seemed alarmed. The physician offered medical treatment to help improve her bone density, but she is hoping to try some conservative treatment as a supplement.  As your Physical Therapy Guide, and a Doctor of Physical Therapy with an advanced board specialty,  and offering non-pharmaceutical (and supplemental to rx) options for healthy physiologic change to keep living and moving is my job.


I explained to my mom, as we get older, things like bone mass and muscle mass change. Bone mass tends to peak by 30 years old and is maintained until around age 50. Along with menopause and the change in hormone levels, loss of muscle mass also begins at the age of 50. Osteopenia can progress with further losses of bone mass (osteoporosis), especially after the first five years of menopause, with as much as a 20 percent decrease. Musculoskeletal decline is heavily linked to protein, calcium, and vitamin D availability, with a decrease in physical activity levels surrounding this decade and beyond.



But while all this can seem alarming, it certainly does NOT mean that it is the end. Navigating these feelings and understanding the body is key in taking the first steps in helping treat this.  Being diagnosed with these "O" terms is a reason to continue to build muscle and strong bones! 


Here are some tips I shared with her:


1) Increase her resistance training. Lifting weights and working out on land specifically helps to build strong bones. Specifically working on exercises to increase bone density in the SPINE and HIPS. 


2) Check in with a dietitian to help supplement healthier nutrition choices for necessary minerals like calcium and Vitamin D. 


3) Education about bone health! We talked about what exactly happens with this, so it's less scary for her. 


In the end she felt more in control of her health, empowered, and a lot less worried about her future and joy for movement. 


Do you have osteopenia/osteoporosis? How are you navigating this? Do you have questions about it?


With love,

Dr. Leada 



Thanks for your guidance, Leada.  My recent bone density test within the last 6 months showed I have osteopenia.  I am now going to the gym 3 times a week (sometimes 4)....and am taking strength and conditioning classes or doing the weights myself  Hoping this will help my T score.   Question is this:  my husband's cousin, who is in her 50's, has been diagnosed with severe osteoporosis - not osteopenia, with possibility she may have to get daily injections.  Problem is she also has heart issues, congestive heart failure, and has been advised by the heart doctor not to ever lift anything beyond 5 pounds.  How can she incorporate resistance training, if at all?  

@DebbieJ I am so proud to hear how you've come along with your fitness journey! I remember talking to you about about options several months ago. GOOD WORK! As far as your friend's cousin, that is certainly a more tricky scenario. With those heart conditions we often are carefully monitoring a patient's vitals as they exercise and have a program set for them after they've been evaluated. If they have precautions, light resistance bands and bodyweight exercises are generally still viable options to help add some stress to the bones without over-stressing the cardiovascular system. We actually have physical therapists that are specialists in cardiopulmonary rehab (find them in this directory here) and that would be an excellent option for them! Especially since regularly exercising in a way that is fit for their body and their heart condition is important now, maybe more than ever. Please pass this message on to them 🙂 

Thank you, Leada!  I will share this information with the cousin.  Appreciate your guidance!

Anytime, @DebbieJ! That's why I'm here😊


I'm glad you brought up this important subject. I have osteopenia that is worsening.  I had to stop walking and doing yoga two years ago--and don't do any resistance training--because I have a relatively new pain in my knee (PT exercises are making it worse) and chronic bilateral tennis elbow (doing OT for this now to strengthen my forearms and upper back, but pain remains for ADLs, let alone other things).  Are there bone-strengthening exercises I could still do?  Thank you kindly for your work here, and for any insights you can provide for me. 🙂

Hi Wisconsin! If you haven't been evaluated by a PT recently, it's probably time to get checked out again. A good PT will take any bone density into consideration and be able to lead you through a routine that doesn't bother your knees so you can get back to walking and yoga. Resistance training is great for osteopenia and osteoporosis, but you want to be sure you are in a good place to start with. I'd be happy to chat with you more: kari@streamlinephysicaltherapy01.com

So glad you found this post @Wisconsin! I 100% agree with @DrKariDPT. Ground-based exercises with weights are the way to go and easy to start without pain, but if you do have pain then it would be the best first step to get assessed so that your PT can create the right plan for you. After an assessment, your PT can create a program to 1) help you overcome whatever is bothering you and 2) start to build muscle and build up bone strength :). Without an assessment, it's a shot in the dark to tell you which exercises might be best for you. For now, if walking is good, then I would keep that in your routine and call in for an appointment ASAP so you can get started!


I’d check out a different PT and/or chiropractor who doesn’t just do ‘adjustments’ which I think is somewhat old school these days. I see a chiropractor who is more like a PT but of course has higher end training so I personally like the combo or it could be this particular person as also had an excellent PT in the past. There are also bone health specialists, I am wondering with one and also taking a new medication after having a bad side effect from Prolia injections. It’s not a bisphosphate as they have same side effects nor hormone therapy. Additionally, I’m doing the Osteostrong program that was recommended by two of my physicians so we’ll see how things look after a year of both. Osteostrong is once a week for approx 15 min. (Check if a location near you), bone health specialist said they’ve seen good results so that was all I needed !