Osteoporosis: Causes, Symptoms and How Physiotherapy Can Help

Osteoporosis is often called the "silent disease" because it progresses without symptoms until a fracture occurs. In Malaysia, an estimated 1 in 3 women and 1 in 5 men over 50 will experience an osteoporotic fracture in their lifetime.

These fractures – particularly of the hip, spine, and wrist – can have devastating consequences for independence and quality of life. The good news is that targeted exercise prescribed by a physiotherapist is one of the most powerful tools for building and maintaining bone strength at any age.

What Happens in Osteoporosis

Bone is living tissue that constantly remodels itself – old bone is broken down (resorption) and new bone is formed (formation). In healthy adults, this process is balanced.

Osteoporosis develops when bone resorption outpaces formation, resulting in bones that become porous, brittle, and prone to fracture. The internal structure of the bone, which normally resembles a honeycomb, develops larger and more numerous holes, weakening its structural integrity.

Osteoporosis is diagnosed through a DEXA (dual-energy X-ray absorptiometry) scan that measures bone mineral density. A T-score of -2.5 or below indicates osteoporosis, while scores between -1.0 and -2.5 indicate osteopenia (reduced bone density that may progress to osteoporosis).

Why Bones Weaken

Several factors contribute to osteoporosis development, many of which are relevant to the Malaysian population:

• Hormonal changes – Oestrogen plays a critical protective role in bone health. After menopause, women experience rapid bone loss (up to 2-3% per year in the first 5-10 years), making postmenopausal women the highest-risk group
• Insufficient calcium and vitamin D – Despite abundant sunshine, many Malaysians have low vitamin D levels due to indoor lifestyles, heavy clothing, and use of sunscreen. Low dairy consumption in many Asian diets also reduces calcium intake
• Sedentary lifestyle – Bones require mechanical loading to stay strong. The increasingly sedentary lifestyle in Malaysian cities, with long hours of desk work and car travel, deprives bones of the stimulus they need
• Low body weight – Being underweight provides less mechanical loading on bones and is associated with lower bone density
• Smoking and excessive alcohol – Both directly impair bone formation and accelerate bone loss
• Certain medications – Long-term corticosteroid use, some cancer treatments, and certain other medications can reduce bone density
• Family history – A parent who had a hip fracture or osteoporosis doubles your risk

The Silent Nature of Osteoporosis

Osteoporosis itself rarely causes symptoms until a fracture occurs. However, there are subtle signs to watch for:

• Gradual loss of height – losing more than 2cm over time may indicate vertebral compression fractures
• Developing a stooped or rounded upper back (kyphosis) – caused by wedge fractures in the thoracic vertebrae
• Back pain – sudden onset of mid-back pain may signal a vertebral compression fracture, which can occur from something as simple as coughing or bending
• Fractures from minimal trauma – breaking a bone from a fall from standing height or less is a hallmark of osteoporotic bone

If you notice any of these signs, particularly if you have risk factors for osteoporosis, it is important to seek professional assessment and request bone density testing.

Struggling with Osteoporosis? A physiotherapist can assess your condition and create a personalised recovery plan. Chat with a physiotherapist near you

How Physiotherapy Builds Stronger Bones

Exercise is one of the few interventions proven to actually build bone density, not just slow its loss. A physiotherapist specialising in osteoporosis can design a safe, effective programme specific to your bone density level and fracture risk.

Weight-Bearing Impact Exercise

Bones respond to impact and ground reaction forces by becoming stronger:

• Walking and brisk walking – The foundation of bone-loading exercise, accessible to most people. Walking in Malaysia's air-conditioned shopping malls provides a comfortable environment
• Stair climbing – Produces greater bone-loading forces than level walking and is freely available in most Malaysian buildings
• Dancing and aerobics – Multi-directional impact loading that is effective and enjoyable. Group exercise classes are widely available at Malaysian community centres and gyms
• Heel drops – Rising onto tiptoes and dropping down onto the heels, creating a controlled impact through the skeleton. Simple yet effective and can be done anywhere

Progressive Resistance Training

Muscle contractions pull on bones at their attachment sites, stimulating bone formation:

• Squats and lunges – Loading the hip and spine, the two most critical areas for osteoporotic fractures
• Deadlifts and hip hinges – Strengthening the posterior chain while loading the spine and hips (taught with appropriate technique for your level)
• Upper body exercises – Push-ups (modified as needed), rows, and overhead presses to maintain wrist, shoulder, and spinal bone density
• Progressive overload – Gradually increasing resistance over time to continue stimulating bone adaptation

Balance and Fall Prevention

Since most osteoporotic fractures result from falls, improving balance is essential:

• Single-leg standing – Progressing from holding support to unsupported, with eyes open then closed
• Tandem walking – Walking heel-to-toe in a straight line
• Tai chi – Excellent for balance, shown to reduce fall risk by up to 50%. Tai chi groups are widely available in Malaysian parks and community centres
• Functional balance challenges – Practising movements that challenge balance in ways relevant to daily life, such as turning to look behind you or stepping over obstacles

Exercises to Approach with Caution

For people with established osteoporosis (T-score below -2.5 or previous fracture), certain movements should be modified or avoided:

• Avoid forceful spinal flexion (forward bending under load) – this increases vertebral fracture risk
• Avoid high-impact activities if you have severe osteoporosis – build up gradually
• Avoid combined spinal flexion and rotation under load
• Your physiotherapist will ensure all exercises are appropriate for your specific bone density and fracture risk

Building Bone Health for Life

• It is never too late to start – exercise improves bone density at any age, though starting earlier provides the greatest lifelong benefit
• Ensure adequate calcium intake – aim for 1000-1300mg daily through diet (dairy products, ikan bilis, tofu, and dark leafy vegetables) or supplements if needed
• Get enough vitamin D – 15-20 minutes of morning sun exposure on arms and face several times per week, and consider supplementation if levels are low
• Exercise consistently – bone responds to regular loading, so aim for weight-bearing exercise on most days and resistance training 2-3 times per week
• Fall-proof your home – remove loose rugs, ensure good lighting, install grab bars in bathrooms, and keep pathways clear

Strengthen Your Bones with Expert Guidance

Osteoporosis is a serious but manageable condition. With the right exercise programme, dietary support, and medical management when needed, you can significantly reduce your fracture risk and maintain an active, independent life.

A qualified physiotherapist can assess your specific situation and create a treatment plan designed for your needs. Find a physiotherapist near you and take the first step toward getting back to the activities you love.