Editing Osteoporosis (section)

==Prevention==

Lifestyle prevention of osteoporosis is in many aspects the inverse of the potentially modifiable risk factors.<ref name="pmid25370432">{{cite journal | vauthors = Ebeling PR, Daly RM, Kerr DA, Kimlin MG | title = Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia | journal = The Medical Journal of Australia | volume = 199 | issue = 7 Suppl | pages = 90–91 | date = October 2013 | pmid = 25370432 | doi =  10.5694/mja12.11363| hdl = 10536/DRO/DU:30060407 | s2cid = 29255357 | url = https://eprints.qut.edu.au/77058/1/Ebe11363_web.pdf }}</ref> As tobacco smoking and high alcohol intake have been linked with osteoporosis, smoking cessation and moderation of alcohol intake are commonly recommended as ways to help prevent it.<ref name=Review2011/>

In people with [[coeliac disease]] adherence to a [[gluten-free diet]] decreases the risk of developing osteoporosis<ref name=LudvigssonBai2014>{{cite journal|vauthors=Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, Green PH, Hadjivassiliou M, Holdoway A, van Heel DA, Kaukinen K, Leffler DA, Leonard JN, Lundin KE, McGough N, Davidson M, Murray JA, Swift GL, Walker MM, Zingone F, Sanders DS, ((BSG Coeliac Disease Guidelines Development Group)), ((British Society of Gastroenterology))|title=Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology|journal=Gut|volume=63|issue=8|pages=1210–1228|date=Aug 2014|pmid=24917550|pmc=4112432|doi=10.1136/gutjnl-2013-306578|type=Review}}</ref> and increases bone density.<ref name=MirzaCanalis2015 /> The diet must ensure optimal [[calcium]] intake (of at least one gram daily) and measuring [[vitamin D]] levels is recommended, and to take specific supplements if necessary.<ref name=LudvigssonBai2014 />

Osteoporosis can affect nearly 1 in 3 women and the bone loss is the most rapid within the first 2–3 years after menopause. This can be prevented by menopause hormone therapy or MHT, which is meant to prevent bone loss and the degradation of the bone microarchitecture and is noted to reduce the risk of fractures in bones by 20-30%. However, MHT has been linked to safety concerns, so it is not generally recommended.<ref>{{Cite journal |last1=Gosset |first1=Anna |last2=Pouillès |first2=Jean-Michel |last3=Trémollieres |first3=Florence |date=December 2021 |title=Menopausal hormone therapy for the management of osteoporosis |url=https://pubmed.ncbi.nlm.nih.gov/34119418/ |journal=Best Practice & Research. Clinical Endocrinology & Metabolism |volume=35 |issue=6 |pages=101551 |doi=10.1016/j.beem.2021.101551 |issn=1878-1594 |pmid=34119418}}</ref> As far as management goes with this potentially limiting disease, there are practices that can and should be implemented within the daily lifestyle. For example, it would be beneficial if the individual with osteoporosis refrained from consuming excess alcohol and to avoid smoking.<ref>{{Cite journal |date=2021-09-01 |title=Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society |url=https://pubmed.ncbi.nlm.nih.gov/34448749/ |journal=Menopause (New York, N.Y.) |volume=28 |issue=9 |pages=973–997 |doi=10.1097/GME.0000000000001831 |issn=1530-0374 |pmid=34448749}}</ref> These individuals should also be intentional about intaking an adequate amount of protein, calcium, and vitamin D. If the woman has an even higher risk of fracture, managing this may require therapy. Generally, the recommended treatment of prevention for a decrease in bone mineral density is physical activity. Exercise is sometimes the best medicine. Resistance training is the most recommended method of physical activity but that can come in multiple forms. High intensity and high impact training is shown to be extremely beneficial in improving bone health and the most effective in improving, maintaining, bone density in the lower spine and femur. Although these types of exercises are safe for postmenopausal women, there still may be a need for supervision and precautionary measures.<ref>{{Cite journal |last=Compston |first=Juliet |date=2005-12-01 |title=How to manage osteoporosis after the menopause |url=https://www.sciencedirect.com/science/article/abs/pii/S152169420500080X |journal=Best Practice & Research Clinical Rheumatology |volume=19 |issue=6 |pages=1007–1019 |doi=10.1016/j.berh.2005.06.010 |pmid=16301194 |issn=1521-6942}}</ref>

===Nutrition===

Studies of the benefits of supplementation with calcium and vitamin D are conflicting, possibly because most studies did not have people with low dietary intakes.<ref name="MedicalLetter">{{cite journal| title =Drugs for Postmenopausal Osteoporosis| journal =The Medical Letter on Drugs and Therapeutics | date =29 September 2014 | volume =56| issue =1452| pages =91–96| url =https://secure.medicalletter.org/TML-article-1452a| pmid =25247344}}</ref> A 2018 review by the USPSTF found low-quality evidence that the routine use of calcium and vitamin D supplements (or both supplements together) did not reduce the risk of having an osteoporotic fracture in male and female adults living in the community who had no known history of vitamin D deficiency, osteoporosis, or a fracture.<ref name=USPSTF2018>{{cite journal | vauthors = Kahwati LC, Weber RP, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, Viswanathan M | s2cid = 205090176 | title = Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force | journal = JAMA | volume = 319 | issue = 15 | pages = 1600–1612 | date = April 2018 | pmid = 29677308 | doi = 10.1001/jama.2017.21640 | type = Systematic Review & Meta-Analysis | doi-access = free }}</ref> The USPSTF does not recommend low dose supplementation (less than 1&nbsp;g of calcium and 400&nbsp;IU of vitamin D) in [[postmenopause|postmenopausal women]] as there does not appear to be a difference in fracture risk.<ref name="USPSTF2018Recs">{{cite web|title=Final Recommendation Statement Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication|url=https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/vitamin-d-calcium-or-combined-supplementation-for-the-primary-prevention-of-fractures-in-adults-preventive-medication|website=www.uspreventiveservicestaskforce.org|publisher=USPSTF Program Office}}</ref> A 2015 review found little data that supplementation of calcium decreases the risk of fractures.<ref>{{cite journal | vauthors = Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR | title = Calcium intake and risk of fracture: systematic review | journal = BMJ | volume = 351 | pages = h4580 | date = September 2015 | pmid = 26420387 | pmc = 4784799 | doi = 10.1136/bmj.h4580 }}</ref> While some meta-analyses have found a benefit of vitamin D supplements combined with calcium for prevention of fractures, they did not find a benefit of vitamin D supplements (800 IU/day or less) alone.<ref>{{cite journal | vauthors = ((DIPART Group)) | title = Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe | journal = BMJ | volume = 340 | pages = b5463 | date = January 2010 | pmid = 20068257 | pmc = 2806633 | doi = 10.1136/bmj.b5463 }}</ref><ref name="Ave2014">{{cite journal | vauthors = Avenell A, Mak JC, O'Connell D | title = Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD000227 | date = April 2014 | pmid = 24729336 | doi = 10.1002/14651858.CD000227.pub4 | pmc = 7032685 }}</ref> Regarding adverse effects, supplementation does not appear to affect overall risk of death,<ref name="USPSTF2018" /><ref name="Ave2014" /> although calcium supplementation could potentially be associated with some increased risk of [[myocardial infarction]]s, [[stroke]], [[kidney stones]],<ref name="USPSTF2018" /> and [[gastrointestinal]] symptoms.<ref name="Ave2014"/> There is no evidence that supplementation before menopause can enhance bone mineral density.<ref>{{cite journal |vauthors=Méndez-Sánchez L, Clark P, Winzenberg TM, Tugwell P, Correa-Burrows P, Costello R |title=Calcium and vitamin D for increasing bone mineral density in premenopausal women |journal=Cochrane Database Syst Rev |volume=1 |issue=1 |pages=CD012664 |date=January 2023 |pmid=36705288 |pmc=9881395 |doi=10.1002/14651858.CD012664.pub2 |url=}}</ref>

[[Vitamin K deficiency]] is also a risk factor for osteoporotic fractures.<ref>{{cite journal | vauthors = Rodríguez-Olleros Rodríguez C, Díaz Curiel M | title = Vitamin K and Bone Health: A Review on the Effects of Vitamin K Deficiency and Supplementation and the Effect of Non-Vitamin K Antagonist Oral Anticoagulants on Different Bone Parameters | journal = Journal of Osteoporosis | volume = 2019 | pages = 2069176 | date = 2019-12-31 | pmid = 31976057 | pmc = 6955144 | doi = 10.1155/2019/2069176 | doi-access = free }}</ref> The gene [[Gamma-glutamyl carboxylase|gamma-glutamyl carboxylase (GGCX)]] is dependent on vitamin K. Functional polymorphisms in the gene could attribute to variation in bone metabolism and BMD.<ref>{{cite journal | vauthors = De Vilder EY, Debacker J, Vanakker OM | title = GGCX-Associated Phenotypes: An Overview in Search of Genotype-Phenotype Correlations | journal = International Journal of Molecular Sciences | volume = 18 | issue = 2 | pages = 240 | date = January 2017 | pmid = 28125048 | pmc = 5343777 | doi = 10.3390/ijms18020240 | doi-access = free }}</ref> [[Vitamin K2]] is also used as a means of treatment for osteoporosis and the polymorphisms of GGCX could explain the individual variation in the response to treatment of vitamin K.<ref>{{cite journal | vauthors = Hosoi T | title = Genetic aspects of osteoporosis | journal = Journal of Bone and Mineral Metabolism | volume = 28 | issue = 6 | pages = 601–607 | date = November 2010 | pmid = 20697753 | doi = 10.1007/s00774-010-0217-9 | s2cid = 35412918 }}</ref>

Dietary sources of calcium include dairy products, leafy greens, legumes, and beans.<ref>{{Cite web|url=https://www.pcrm.org/good-nutrition/nutrition-information/health-concerns-about-dairy/preventing-and-reversing-osteoporosis|title=Preventing and Reversing Osteoporosis|website=Physicians Committee for Responsible Medicine|language=en|access-date=2019-08-05}}</ref> There has been conflicting evidence about whether or not dairy is an adequate source of calcium to prevent fractures. The National Academy of Sciences recommends 1,000&nbsp;mg of calcium for those aged 19–50, and 1,200&nbsp;mg for those aged 50 and above.<ref>{{cite web | url = https://www.ncbi.nlm.nih.gov/books/NBK56056/#:~:text=The%20EAR%20is%20therefore%20set,1%2C300%20mg%2Fday%20is%20established. | title = Dietary Reference Intakes for Adequacy: Calcium and Vitamin D – Dietary Reference Intakes for Calcium and Vitamin D – NCBI Bookshelf | access-date = 18 December 2020}}</ref>  A review of the evidence shows no adverse effect of higher protein intake on bone health.<ref name="pmid28404575">{{cite journal | vauthors = Shams-White MM, Chung M, Du M, Fu Z, Insogna KL, Karlsen MC, LeBoff MS, Shapses SA, Sackey J, Wallace TC, Weaver CM | title = Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation | journal = The American Journal of Clinical Nutrition | volume = 105 | issue = 6 | pages = 1528–1543 | date = June 2017 | pmid = 28404575 | doi = 10.3945/ajcn.116.145110 | doi-access = free }}</ref>

=== Physical exercise ===
Evidence suggests that exercise can help promote bone health in older people.<ref name=Pinheiro2020>{{cite journal |vauthors=Pinheiro MB, Oliveira J, Bauman A, Fairhall N, Kwok W, Sherrington C |title=Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour |journal=The International Journal of Behavioral Nutrition and Physical Activity |volume=17 |issue=1 |pages=150 |date=November 2020 |pmid=33239014 |pmc=7690138 |doi=10.1186/s12966-020-01040-4|doi-access=free }}</ref> In particular, physical exercise can be beneficial for bone density in postmenopausal women,<ref name=Mohebbi2023/> and lead to a slightly reduced risk of a bone fracture (absolute difference 4%).<ref name=":Howe2011">{{cite journal | vauthors = Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G | title = Exercise for preventing and treating osteoporosis in postmenopausal women | journal = The Cochrane Database of Systematic Reviews | volume = Art. No.: CD000333 | issue = 7 | pages = CD000333 | date = July 2011 | pmid = 21735380 | doi = 10.1002/14651858.CD000333.pub2 }}</ref> Weight bearing exercise has been found to cause an adaptive response in the skeleton,<ref>{{cite journal | vauthors = Giangregorio L, Blimkie CJ | title = Skeletal adaptations to alterations in weight-bearing activity: a comparison of models of disuse osteoporosis | journal = Sports Medicine | volume = 32 | issue = 7 | pages = 459–476 | date = 2002 | pmid = 12015807 | doi = 10.2165/00007256-200232070-00005 | s2cid = 25835205 }}</ref> promoting osteoblast activity and protecting bone density.<ref>{{cite journal | vauthors = Uda Y, Azab E, Sun N, Shi C, Pajevic PD | title = Osteocyte Mechanobiology | journal = Current Osteoporosis Reports | volume = 15 | issue = 4 | pages = 318–325 | date = August 2017 | pmid = 28612339 | pmc = 5656287 | doi = 10.1007/s11914-017-0373-0 }}</ref> A position statement concluded that increased bone activity and weight-bearing exercises at a young age prevent bone fragility in adults.<ref>{{cite journal | vauthors = Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O'Karma M, Wallace TC, Zemel BS | title = The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations | journal = Osteoporosis International | volume = 27 | issue = 4 | pages = 1281–1386 | date = April 2016 | pmid = 26856587 | pmc = 4791473 | doi = 10.1007/s00198-015-3440-3}}</ref> Limitations in the available evidence hinder the production of detailed evidence-based exercise recommendations.<ref name=Mohebbi2023>{{cite journal |vauthors=Mohebbi R, Shojaa M, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, Lange U, Peters S, Thomasius F, Uder M, Kemmler W |title=Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators |journal=Osteoporosis International |volume=34 |issue=7 |pages=1145–1178 |date=July 2023 |pmid=36749350 |pmc=10282053 |doi=10.1007/s00198-023-06682-1 |url=}}</ref> Some expert consensus guidance does exist.<ref>{{cite journal |vauthors=Brooke-Wavell K, Skelton DA, Barker KL, et al |title=Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis |journal=British Journal of Sports Medicine |volume=56 |issue=15 |pages=837–46 |date=May 2022 |pmid=35577538 |pmc=9304091 |doi=10.1136/bjsports-2021-104634}}</ref><ref>{{cite journal |vauthors=Bae S, Lee S, Park H, et al |title=Position statement: Exercise guidelines for osteoporosis management and fall prevention in osteoporosis patients |journal=Journal of Bone Metabolism |volume=30 |issue=2 |pages=149–165 |date=May 2023 |pmid=37449348 |pmc=10345999 |doi=10.11005/jbm.2023.30.2.149 |url=}}</ref> International guidelines recommend multicomponent exercise tailored to individual needs that includes "balance and mobility training, paired with weight bearing exercise, progressive resistance training, and posture exercises" (generally accompanied by optimal nutrition).<ref>{{cite journal |vauthors=Karlsson MK, Rosengren BE |title=Exercise and peak bone mass |journal=Current Osteoporosis Reports |volume=18 |issue=3 |pages=285–290 |date=June 2020 |pmid=32249382 |pmc=7250943 |doi=10.1007/s11914-020-00588-1}}</ref>  Cycling and swimming are not considered weight-bearing exercise, and neither helps slow age-related bone loss (professional bicycle racing has a negative effect on bone density).<ref>{{cite journal | vauthors = Abrahin O, Rodrigues RP, Marçal AC, Alves EA, Figueiredo RC, de Sousa EC | title = Swimming and cycling do not cause positive effects on bone mineral density: a systematic review | journal = Revista Brasileira de Reumatologia | volume = 56 | issue = 4 | pages = 345–351 | date = 2016 | pmid = 27476628 | doi = 10.1016/j.rbre.2016.02.013 | doi-access = free }}</ref> Risk of adverse events from the types of exercise usually considered appropriate for people with osteoporosis is generally low (though repeated forceful forward spinal bends are discouraged).<ref name="NOGG2019-5">{{cite web |title=Non-pharmacological management of osteoporosis |url=https://www.nogg.org.uk/full-guideline/section-5-non-pharmacological-management-osteoporosis |website=www.nogg.org.uk |publisher=National Osteoporosis Guideline Group UK |archive-url=https://web.archive.org/web/20240612230817/https://www.nogg.org.uk/full-guideline/section-5-non-pharmacological-management-osteoporosis |archive-date=12 June 2024 |language=en |date=September 2021 |url-status=live}}</ref>

For people who have had vertebral fractures, there is moderate-quality evidence that exercise is likely to improve physical performance, as well as some low-quality evidence suggesting that exercise may reduce pain and improve quality of life.<ref name = "Gibbs_2019">{{cite journal | vauthors = Gibbs JC, MacIntyre NJ, Ponzano M, Templeton JA, Thabane L, Papaioannou A, Giangregorio LM | title = Exercise for improving outcomes after osteoporotic vertebral fracture | journal = The Cochrane Database of Systematic Reviews | volume = 7 | pages = CD008618 | date = July 2019 | issue = 7 | pmid = 31273764 | pmc = 6609547 | doi = 10.1002/14651858.CD008618.pub3 | collaboration = Cochrane Musculoskeletal Group }}</ref>

=== Physical exercise prescription ===
Osteoporosis is a very prevalent disease in the elderly population but not much is known about the optimal prescription and dosage of physical exercise to help prevent bone mineral loss. A lot of the focus around osteoporosis is prevention oriented, rather than maintenance focused, which should be the front runner when considering what approach to take. When prescribing exercise, an aspect to take into consideration is the individual’s need this can be attained by conducting a pre-exercise evaluation or screening, exercise should also be tailored to the individual and what works for them. Important things often overlooked when treating osteoporosis are muscle strength and maintenance of BMD, which should be incorporated into the program to optimize the benefits of exercise. This entails including exercises that focus on and improve muscle strength and exercises that focus on and improve skeletal strength or BMD as these go hand in hand for reducing fall and fracture risk.<ref name="Daly-2019">{{Cite journal |last1=Daly |first1=Robin M. |last2=Dalla Via |first2=Jack |last3=Duckham |first3=Rachel L. |last4=Fraser |first4=Steve F. |last5=Helge |first5=Eva Wulff |date=March 2019 |title=Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription |journal=Brazilian Journal of Physical Therapy |language=en |volume=23 |issue=2 |pages=170–180 |doi=10.1016/j.bjpt.2018.11.011 |pmc=6429007 |pmid=30503353}}</ref> It’s also important to reference the ACSM general training principle to better design a program for the individual. Which mode of exercise and dosage has been a recurring question for treating osteoporosis, many articles have found that multimodal exercise programs have had findings of significant improvement in factors related to osteoporosis. Factors include lower limb strength, balance, flexibility, and risk of falls.<ref>{{Cite journal |last1=Linhares |first1=Diego Gama |last2=Borba-Pinheiro |first2=Claudio Joaquim |last3=Castro |first3=Juliana Brandão Pinto de |last4=Santos |first4=Andressa Oliveira Barros dos |last5=Santos |first5=Luciano Lima dos |last6=Cordeiro |first6=Lilliany de Souza |last7=Drigo |first7=Alexandre Janotta |last8=Nunes |first8=Rodolfo de Alkmim Moreira |last9=Vale |first9=Rodrigo Gomes de Souza |date=2022-10-30 |title=Effects of Multicomponent Exercise Training on the Health of Older Women with Osteoporosis: A Systematic Review and Meta-Analysis |journal=International Journal of Environmental Research and Public Health |language=en |volume=19 |issue=21 |pages=14195 |doi=10.3390/ijerph192114195 |doi-access=free |issn=1660-4601 |pmc=9655411 |pmid=36361073}}</ref> Other modes of exercise have also proven to improve individuals with osteoporosis, some of these modes include weight-bearing, resistance specifically progressive resistance, and aerobic exercise. The recommendations for these types of exercises are as follows, weight-bearing exercise should be done 4–7 days a week, moderate to high intensity, activities should be multidirectional, and load should be more than typical everyday load on bones.<ref name="Daly-2019" /> Some examples of exercises are jumping, skipping, hopping, depth jumps, etc.  Recommended dosage for progressive resistance training is 2 or more days a week, intensity (load) should start low and increase gradually.<ref name="Daly-2019" /> Resistance training should focus on major muscle groups used for functional movements as well as muscles that have direct stress on bones susceptible to fracture. Considerations for resistance training are to teach proper lifting techniques and be careful with lifting weights above the head.<ref name="Daly-2019" /> Lastly, aerobic exercise has minimal effect on preventing BMD loss unless done at a higher intensity or with a load like a weighted vest. Considerations with this mode are that this may cause a higher risk of fall or fracture.<ref name="Daly-2019" /> Improvements can also be observed in other ways, such as decreased Timed-Up-and-Go, increased Sit-To-Stand, and increased One-Leg-Stance-Test. A study with a 12-week exercise intervention on postmenopausal osteoporotic women observed a 2.27 decrease in TUG times in their experimental group.<ref>{{Cite journal |last1=Filipović |first1=Tamara N. |last2=Lazović |first2=Milica P. |last3=Backović |first3=Ana N. |last4=Filipović |first4=Aleksandar N. |last5=Ignjatović |first5=Aleksandra M. |last6=Dimitrijević |first6=Sanja S. |last7=GopčEvić |first7=Kristina R. |date=February 2021 |title=A 12-week exercise program improves functional status in postmenopausal osteoporotic women: randomized controlled study |url=https://www.minervamedica.it/index2.php?show=R33Y2021N01A0120 |journal=European Journal of Physical and Rehabilitation Medicine |volume=57 |issue=1 |pages=120–130 |doi=10.23736/S1973-9087.20.06149-3|pmid=32902207 }}</ref> The overall thing to note when prescribing exercise for individuals with osteoporosis is to evaluate the individual's needs and then individualize their program with multiple exercise modalities that work for them, emphasizing increasing muscle strength as well as maintaining bone mass.

=== Physical therapy ===
People with osteoporosis are at higher risk of falls due to poor postural control, muscle weakness, and overall deconditioning.<ref name="Effect of balance training on falls">{{cite journal | vauthors = Zhou X, Deng H, Shen X, Lei Q | title = Effect of balance training on falls in patients with osteoporosis: A systematic review and meta-analysis | journal = Journal of Rehabilitation Medicine | volume = 50 | issue = 7 | pages = 577–581 | date = July 2018 | pmid = 29767225 | doi = 10.2340/16501977-2334 | doi-access = free }}</ref> Postural control is important to maintaining functional movements such as walking and standing. Physical therapy may be an effective way to address postural weakness that may result from vertebral fractures, which are common in people with osteoporosis. Physical therapy treatment plans for people with vertebral fractures include balance training, postural correction, trunk and lower extremity muscle strengthening exercises, and moderate-intensity aerobic physical activity.<ref name = "Gibbs_2019" /> The goal of these interventions are to regain normal spine curvatures, increase spine stability, and improve functional performance.<ref name = "Gibbs_2019" /> Physical therapy interventions were also designed to slow the rate of bone loss through home exercise programs.<ref name="Effect of balance training on falls"/>

[[Whole body vibration]] therapy has also been suggested as a physical therapy intervention. Moderate to low-quality evidence indicates that whole body vibration therapy may reduce the risk of falls.<ref name=Jepsen2017>{{cite journal | vauthors = Jepsen DB, Thomsen K, Hansen S, Jørgensen NR, Masud T, Ryg J | title = Effect of whole-body vibration exercise in preventing falls and fractures: a systematic review and meta-analysis | journal = BMJ Open | volume = 7 | issue = 12 | pages = e018342 | date = December 2017 | pmid = 29289937 | pmc = 6027066 | doi = 10.1136/bmjopen-2017-018342 }}</ref> There are conflicting reviews as to whether vibration therapy improves bone mineral density.<ref name=Jepsen2017 /><ref name=MarinCascales2018>{{cite journal | vauthors = Marín-Cascales E, Alcaraz PE, Ramos-Campo DJ, Martinez-Rodriguez A, Chung LH, Rubio-Arias JÁ | title = Whole-body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis | journal = Medicine | volume = 97 | issue = 34 | pages = e11918 | date = August 2018 | pmid = 30142802 | pmc = 6112924 | doi = 10.1097/MD.0000000000011918 }}</ref>

Physical therapy can aid in overall prevention in the development of osteoporosis through therapeutic exercise. Prescribed amounts of mechanical loading or increased forces on the bones promote bone formation and vascularization in various ways, therefore offering a preventative measure that is not reliant on drugs. Specific exercise interacts with the body's hormones and signaling pathways which encourages the maintenance of a healthy skeleton.<ref>{{cite journal | vauthors = Tong X, Chen X, Zhang S, Huang M, Shen X, Xu J, Zou J | title = The Effect of Exercise on the Prevention of Osteoporosis and Bone Angiogenesis | journal = BioMed Research International | volume = 2019 | pages = 8171897 | date = 2019-04-18 | pmid = 31139653 | pmc = 6500645 | doi = 10.1155/2019/8171897 | doi-access = free }}</ref>

=== Hormone therapy ===
Reduced [[oestrogen|estrogen]] levels increase the risk of osteoporosis, so [[hormone replacement therapy]] when women reach the [[menopause]] may reduce the incidence of osteoporosis. A more natural way of restoring hormone levels in postmenopausal women include participating in specific forms of exercise. Weight-bearing exercises and resistance training exercises such as squats with weights, step-ups, lunges, stair climbing, and even jogging can elicit hormone responses that are advantageous for post-menopausal women living with osteoporosis. These exercises result in the release of growth hormone and Insulin-like growth factor-1 or IGF-1 that participate in bone remodeling.<ref>{{Cite journal |last1=Moreira |first1=Linda Denise Fernandes |last2=Oliveira |first2=Mônica Longo de |last3=Lirani-Galvão |first3=Ana Paula |last4=Marin-Mio |first4=Rosângela Villa |last5=Santos |first5=Rodrigo Nolasco dos |last6=Lazaretti-Castro |first6=Marise |date=July 2014 |title=Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women |url=https://www.scielo.br/j/abem/a/fHhb6PgkgYsN5cZ8fwYQdjC/?lang=en |journal=Arquivos Brasileiros de Endocrinologia & Metabologia |language=en |volume=58 |issue=5 |pages=514–522 |doi=10.1590/0004-2730000003374 |pmid=25166042 |issn=1677-9487}}</ref> Stress is applied to the bones, thus activating osteoblast, which are cells that form new bones and grow and heal existing bones<ref>{{Citation |last1=Henry |first1=James P. |title=Histology, Osteoblasts |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK557792/ |access-date=2024-11-15 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491724 |last2=Bordoni |first2=Bruno}}</ref> while restoring hormones that increase bone density. Resistance training exercises, like weight lifting, can lead to brief increased in anabolic hormones, like testosterone, which aid in muscle and bone strength.<ref>{{Cite journal |last1=Christenson |first1=E. S. |last2=Jiang |first2=X. |last3=Kagan |first3=R. |last4=Schnatz |first4=P. |date=June 2012 |title=Osteoporosis management in post-menopausal women |url=https://pubmed.ncbi.nlm.nih.gov/22635014/ |journal=Minerva Ginecologica |volume=64 |issue=3 |pages=181–194 |issn=0026-4784 |pmid=22635014}}</ref> The increase in mechanical tension during resistance exercise will likely help stimulate the production of Insulin-like growth factors in the bone, but at a greater extent. Post-menopausal women experience a reduction of estrogen, which is essential for density, so these exercise-induced hormonal enhancements can counteract the loss of bone mineral density in the most critical area, like the lumbar spine and the femoral neck.<ref>{{Cite journal |title=Exercise for preventing and treating osteoporosis in postmenopausal women |url=https://www.cochrane.org/CD000333/MUSKEL_exercise-for-preventing-and-treating-osteoporosis-in-postmenopausal-women |access-date=2024-11-15 |journal=Cochrane Database of Systematic Reviews |date=2011 |doi=10.1002/14651858.CD000333.pub2 |language=en |pmid=21735380 | vauthors = Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G |issue=7 |pages=CD000333 }}</ref> Research suggest that regular resistance training accompanied with weight-bearing activities help reduce the progression of osteoporosis and risk of fracture.