Osteoporosis Rehabilitation: Strength, Balance and Fracture-Safe Exercise

Assessment and reasoning

• Review fracture history, falls, back pain, medications, vision, balance and mobility.
• Assess strength and function such as sit-to-stand, gait and balance tasks.
• People with vertebral fracture or very high fracture risk may need individualized supervision.

Differential considerations and precautions

• A new major change in spinal or weight-bearing function requires appropriate clinical assessment.
• Unexpected non-mechanical symptoms should prompt reconsideration of the rehabilitation plan.

Exercise prescription

Too Fit To Fracture recommends multicomponent exercise combining resistance and balance training; aerobic exercise should not replace those components.

• Resistance training: commonly 2–3 days per week with gradual load progression.
• Balance: frequent practice using appropriately challenging standing, stepping and transfer tasks.
• Aerobic activity can support general health but should complement strength and balance.
• Teach safer transitions and lifting strategies when fracture risk is high.

Progression and reassessment

• Progress resistance when technique and recovery are acceptable.
• Make balance harder gradually while maintaining appropriate safety support.
• Track falls, strength, confidence and function rather than bone density alone.

Common mistakes and clinical pearls

• Walking alone is not a complete osteoporosis exercise program.
• Avoid creating fear of all spinal movement; teach context-specific safer movement.
• Clinical pearl: fall prevention and functional strength are major treatment targets.

Summary

Osteoporosis rehabilitation should build strength and balance while supporting safe, confident activity.