Clinically reviewed by What is osteoporosis
Osteoporosis means the inside of the bone has become thin and porous, so it breaks under a force that would not normally break a bone. In Urdu it is hadiyon ki kamzori.
It is not the same as arthritis, and this confusion is very common. Arthritis is a painful joint. Osteoporosis is a weak bone, and a weak bone does not hurt. It is silent until something breaks.
It is diagnosed with a DEXA bone density scan, ordered by a doctor. It is very common in women after menopause, and it happens to men too, usually a decade later.
Symptoms you might have
- Nothing at all, in most people, until a bone breaks. There is no ache that warns you
- A fracture from something minor: a trip at home, a hand put out to break a fall
- Losing height over the years, more than two or three centimetres
- The upper back becoming rounded and the head carried forward
- Sudden mid or lower back pain starting while bending or lifting, which can be a spinal compression fracture
- Clothes fitting differently around the middle as the spine shortens
Why it happens
- Menopause. Bone is lost fastest in the first five to ten years after periods stop
- Age, in both men and women, and long periods of inactivity or bed rest
- Low vitamin D, which is widespread in Pakistan because of limited sun exposure on the skin
- Years of low calcium in the diet, including through repeated pregnancies and long breastfeeding
- Long term steroid tablets, smoking, being very thin, and an early or surgical menopause
- Thyroid and parathyroid problems, and some kidney and bowel conditions
When you should see a physiotherapist
Come in if a DEXA scan has shown osteoporosis, if you have broken a bone from a small fall, or if you are losing height. The aim is to build strength and balance so you do not fall, because a fall is what turns weak bone into broken bone.
Go to a hospital the same day after a fall if the hip or leg cannot take weight, or the leg looks shorter or turned out. See a doctor the same day for sudden severe back pain that started with a bend or a lift. Go immediately if that pain comes with numbness around the groin or back passage, loss of bladder or bowel control, or leg weakness.
Medication, calcium and vitamin D are the doctor's decision after blood tests. Physiotherapy does not replace them.
Al-Shama Physiotherapy Clinic
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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یہ فارم پُر کریں؛ واٹس ایپ پر آپ کی تفصیلات کے ساتھ پیغام تیار ہو جائے گا۔Yeh form bharein, WhatsApp aap ki tafseel ke saath khul jaye ga.
How it is treated
Exercise is the part of osteoporosis care that belongs to physiotherapy, and it has two jobs: loading the bone, and keeping you on your feet. The second prevents more fractures than the first.
- Weight bearing exercise: walking, stair climbing and standing work. Bone only responds to loads it actually feels
- Progressive resistance training for the hips, thighs and back muscles, with weight added over weeks. This is the part with the best evidence for bone and for strength
- Back extensor strengthening, which improves posture, reduces back pain and is linked to fewer spinal fractures
- Balance training, graded and supervised, because falls prevention is fracture prevention
- Spine sparing movement training: how to bend from the hips, lift, and get out of bed by rolling instead of folding the spine forward
- Gentle manual therapy for stiff muscles nearby. Forceful spinal manipulation is not used on osteoporotic bone
- TENS for pain control after a spinal compression fracture, alongside whatever the doctor has prescribed
There is no operation for osteoporosis itself. Some fractures need surgical fixing, and that is an orthopaedic surgeon's decision.
Exercises, and what to avoid
What helps
- Brisk walking most days, thirty minutes, on even ground where possible
- Sit to stand from a chair and step-ups on a low step, progressing to holding weight
- Standing heel raises at a counter, and gentle rows and back lifts for the upper back
- Balance practice at a counter: feet together, then one foot slightly ahead, holding thirty seconds
What to avoid
- Bending the spine forward: toe touching, sit-ups, crunches and deep forward folds. This is the movement that cracks a thin vertebra
- Twisting the spine while holding weight, including lifting a bucket and turning with it
- Lifting anything heavy with a rounded back. Hinge at the hips and keep the load close
- Jumping, jarring impact, and anyone pulling or wrenching your limbs during a stretch
What you can do at home
Get calcium from food every day: milk, dahi, cheese, leafy saag, til and small fish eaten with the bones.
Sunlight on the skin helps vitamin D. Whether you need a supplement, and at what dose, is your doctor's decision after a blood test.
Get out of bed by rolling onto your side, dropping the legs over the edge and pushing up with your arms, rather than sitting straight up.
Use a low stool to put your shoes on and a long handled brush, so you are not folding forward.
Make the house safe: non-slip mat in the bathing area, light on the stairs, no loose rugs. See the fall prevention page on this site. Heat eases muscle spasm around a sore back, and ice does nothing for bone.
How long it takes
Strength and balance improve within eight to twelve weeks of a proper programme, and that is what reduces your fracture risk soonest.
Bone itself changes slowly. A repeat DEXA scan is usually not worth doing before twelve to twenty four months, and exercise alone changes density only a little. It builds muscle, balance and posture strongly, which is what prevents the fracture.
A spinal compression fracture usually settles over six to twelve weeks, with the sharpest pain in the first two to three weeks. Treatment then is positioning, pain control and gentle movement, not strengthening.
Bone is lost again if the loading stops, so this is lifelong work. Two or three strength sessions a week, continued, is the whole prescription.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
ہڈیوں کی کمزوری میں ہڈی اندر سے کھوکھلی ہو جاتی ہے۔ اس میں درد نہیں ہوتا، اسی لیے پتا نہیں چلتا جب تک کوئی ہڈی ٹوٹ نہ جائے۔ آرتھرائٹس میں جوڑ دکھتا ہے، اس میں ہڈی کمزور ہوتی ہے۔
دوا، کیلشیم اور وٹامن ڈی ڈاکٹر دیتے ہیں، بلڈ ٹیسٹ کے بعد۔ فزیوتھراپی ان کی جگہ نہیں لے سکتی۔ ہمارا کام طاقت اور توازن بڑھانا ہے، تاکہ آپ گریں ہی نہ، کیونکہ گرنا ہی ہڈی توڑتا ہے۔
دو چیزیں سختی سے منع ہیں: آگے جھک کر پیروں کو ہاتھ لگانا، اور وزن اٹھا کر کمر گھمانا۔ جھکنا ہے تو گھٹنے اور کولہے سے جھکیں۔ روزانہ چلیں اور ہفتے میں دو تین بار طاقت کی ورزش کریں۔
Roman Urdu
Hadiyon ki kamzori mein haddi andar se khokhli ho jati hai. Is mein dard nahi hota, isi liye pata nahi chalta jab tak koi haddi toot na jaye. Arthritis mein jor dukhta hai, is mein haddi kamzor hoti hai.
Dawa, calcium aur vitamin D doctor dete hain, blood test ke baad. Physiotherapy in ki jagah nahi le sakti. Hamara kaam taqat aur tawazun barhana hai, taake aap giren hi na, kyunke girna hi haddi torta hai.
Do cheezen sakhti se mana hain: aage jhuk kar pairon ko haath lagana, aur wazan utha kar kamar ghumana. Jhukna hai to ghutne aur kolhe se jhuken. Rozana chalen aur hafte mein do teen bar taqat ki warzish karen.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Can exercise reverse osteoporosis?
Which exercises are dangerous with osteoporosis?
Is osteoporosis the same as arthritis?
Do I need calcium and vitamin D tablets?
My back has become rounded. Can it be straightened?
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