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Osteoporosis vs. Osteopenia: A Clinician’s Guide


You may have patients asking, “What is Osteoporosis? What is Osteopenia? What are the differences between the two?”. With an ageing population, it is not uncommon to have an individual diagnosed with Osteoporosis or Osteopenia. In 2009, approximately 10% of Canadians over the age of 40 had Osteoporosis. In this blog, we will discuss the causes, risk factors and treatment options for Osteoporosis and Osteopenia to better equip you to answer these questions and manage your patient’s condition.

What is Osteoporosis? 

Osteoporosis, literally defined as porous bone, is a disease in which an individual has low bone mineral density, which causes them to be at an increased risk for fractures. Osteoporosis is thought of as a “silent disease” because we may not notice any changes happening in the body until a fracture occurs. 


What Causes Osteoporosis? 

Throughout life, to keep bone healthy, the body replaces old bone with new bone. From childhood until one’s late 20s, new bone is added faster than old bone is removed, resulting in a net increase in bone mass. However, after that, with increasing age, more bone is broken down than is replaced, leading to weakened bones. The strength of one’s bones, also known as bone mineral density, can be assessed through a non-invasive procedure called Dual-energy X-ray Absorptiometry, or DXA for short.


What are the Risk Factors for Osteoporosis? 

There are a number of factors that impact one’s risk of developing Osteoporosis. Some of these factors are not modifiable, e.g. age and some are modifiable, e.g. how much we exercise.

Non-modifiable risk factors for Osteoporosis:

  • Sex, females more than males
  • Early menopause, before age 45
  •  Age, risk increases with age
  • Small body frame
  • Ethnicity, White and Asian populations more than African American and Hispanic populations
  • Family history of Osteoporosis

Modifiable risk factors for Osteoporosis:

  • Low calcium and vitamin D intake
  • Certain medications
  • Inactive lifestyle/extended bed rest
  • Cigarette smoking
  • Excessive alcohol intake
  • Anorexia nervosa

What is Osteopenia? 

Osteopenia is the precursor to Osteoporosis. It is an amount of bone loss that is more than typical healthy bones, but not yet as severe as Osteoporosis. The same natural process of bone replacement that leads to Osteoporosis causes Osteopenia, and they share the same risk factors. 


How can Rehabilitation Practitioners Help Manage Osteoporosis? 


  • Bone is a living tissue that grows stronger from being loaded during exercise, similar to muscles.
  • A rehabilitation practitioner can guide patients in safely doing weight-bearing exercises that will increase bone strength, and strengthen surrounding muscles.
  • Moderate intensity exercises that do not exacerbate pain are ideal.
  • Both weight-bearing aerobic exercise (e.g. walking, stair climbing, dancing, elliptical training) and resistance exercise (e.g. squats, lunges, calf raises, modified push-ups, bicep curls) are important. Non-weight bearing exercises such as swimming and cycling are good for overall health but not specifically helpful for osteoporosis.
  • Proper form when exercising is important to prevent injury. 
  • There are many safe and beneficial exercises for Osteoporosis. However, it is important to avoid explosive movements (e.g. jumping), excessive loading (e.g. very heavyweights), and extreme ranges of movement (e.g. excessive bending or twisting of the spine).
  • Remember to keep it fun!

Balance Training:

  • A rehabilitation practitioner can guide patients through exercises to improve their balance in order to reduce the risk of fractures that may occur due to falls.
  • Some exercises may focus on strengthening specific muscles that are important for maintaining balance, such as the quadriceps, hamstrings, gluteals and trunk muscles. 
  • Other exercises may focus on directly challenging and improving balance, such as single-leg stance or clock single-leg balance. Make sure that the patients are standing next to a stable surface (e.g. counter or railing) when practicing balance exercises so that they may easily reach for support if needed.

If you would like to prescribe any of the above exercises to your patients, subscribe to Embodia to access 1200+ exercises from Embodia’s exercise library. You can easily share exercise videos with your patients to increase their adherence to an exercise program and ultimately improve their functional outcomes.

Fall-Proofing the Home:

  • A rehabilitation practitioner can advise patients on how to make small changes in their home setup that will greatly reduce the risk of falls in the home. 
  • For example, clear all walking spaces and stairs of clutter, ensure that rugs are securely fastened to the floor, cords should be tucked away or along the wall and good lighting will help to see any obstacles.
  • More suggestions and additional information can be found in this blog by Embodia on falls prevention.

How can Rehabilitation Practitioners Help Manage Osteopenia?

If your patients have Osteopenia, the goal of treatment will be to prevent it from progressing to Osteoporosis. All of the exercises described above to increase bone and muscle strength will be beneficial to your patients.

We hope that this blog has provided some insight into the topics of Osteoporosis and Osteopenia. You can share this information with your patients by subscribing to Embodia and sending your patients a patient education tool on this topic.





Blog writers: Bella Levi, MScPT student, and Debra Posluns, MScPT student

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