Dr. Shiva Jain Sangoi (PT)
BPTh, MPTh (Ortho), FIFA Diploma in Football Medicine
The report that makes people stop moving
A DEXA scan comes back with the word osteoporosis on it, and almost overnight a whole family changes how it treats someone. The mother who used to walk to the market is told to take a rickshaw. The father who climbed four floors every day is told to wait for the lift. Nobody wants a fracture, so the instinct is to protect the bones by doing less.
That instinct is understandable, and it is mostly wrong. Exercise for osteoporosis is one of the few things research consistently supports for keeping bones and muscles stronger and, just as importantly, for reducing falls — which is what actually causes most fractures. The real question is not whether to move but how, and that is where many patients get stuck between internet advice that is too timid and gym advice that is too aggressive.
What osteoporosis actually is
Bone is living tissue. It is constantly broken down and rebuilt, and it responds to the loads placed on it. Osteoporosis is a condition in which bone density and quality have dropped enough that bones break more easily — a wrist from a fall onto an outstretched hand, a hip from a fall sideways, or a vertebra in the spine that compresses, sometimes with surprisingly little force. Osteopenia is the in-between stage: lower than ideal density, but not yet in the osteoporosis range. The general overview of osteoporosis is a reasonable starting point if you want the background.
It is often called a silent condition, because it usually causes no pain at all until something breaks. Women after menopause are at the highest risk, because the drop in oestrogen speeds up bone loss, but men are affected too, especially later in life. Long-term steroid use, low body weight, smoking, heavy alcohol use, a family history of hip fracture, and long periods of inactivity all add to the risk.
Myth: "Weak bones need rest"
This is the core misunderstanding. Bones get stronger in response to load, and they lose strength without it. Astronauts lose bone in space; patients on prolonged bed rest lose bone in a matter of weeks. Resting weak bones does not protect them — it tends to weaken them further, along with the muscles and balance that stop a person from falling in the first place.
What research commonly suggests instead is a combination of three things, adjusted to the individual:
Weight-bearing activity. Anything done on your feet, where the skeleton carries your body weight — walking, climbing stairs, dancing. Swimming and cycling are excellent for the heart and joints but put little load through bone, so on their own they are not enough for bone health.
Progressive strength training. Muscles pull on bones when they work, and that pull is a stimulus for bone. Studies suggest that supervised, gradually progressed resistance training can be safe and useful even in people with low bone density — a shift from older advice that told them to avoid anything heavier than a water bottle. The key words are supervised and progressive.
Balance training. This is the part families most often overlook. A fracture needs a fall, in most cases. Improving balance, reaction and leg strength reduces the chance of that fall, and that protects the hip and wrist more directly than any bone density number.
Movements that need care
Exercise is protective, but not every movement is equal. Commonly given guidance for people with osteoporosis — especially if they have already had a spinal fracture — is to be careful with:
- Repeated, loaded forward bending of the spine. Deep toe-touches, full sit-ups and crunches, and lifting heavy objects with a rounded back put the front of the vertebrae under compression, which is where spinal fractures tend to happen.
- Forceful twisting of the trunk, particularly combined with bending — some yoga poses, golf swings pushed to the end of range, or twisting to lift a heavy bucket.
- High-impact or jarring activity if density is very low or there has been a recent fracture.
- Movements with a high fall risk — standing on stools to reach the top shelf, or rushing to the bathroom at night in a dark flat.
What this looks like in a Mumbai home
Much of the day-to-day risk is practical rather than medical. Wet bathroom floors, especially in the monsoon. A loose rug in the passage. Slippers without backs. Getting up quickly from floor sitting or a low sofa. The *jharu-pocha* done bent double. Reaching for the pressure cooker on the top shelf. None of these are dramatic, but a physiotherapist looking at how someone actually moves through their day often finds more to change there than in any exercise sheet.
For older patients who find it hard to reach a clinic, a home assessment can be useful precisely because it happens in the real environment — the actual stairs, bathroom and bed. Our guide on physiotherapy for seniors and home visits after 60 covers when that makes more sense than clinic visits, and our elderly home physiotherapy page explains how those visits work.
Where physiotherapy fits alongside your doctor
Osteoporosis is diagnosed and medically managed by a doctor — usually through a bone density scan, blood tests, and sometimes medication, calcium and vitamin D. Physiotherapy does not replace any of that. Its role is the movement side: assessing strength, balance, posture and fall risk, building a programme that loads bone safely and progresses it over time, teaching safer ways to bend, lift and get up from the floor, and helping someone regain confidence after a fracture. Many patients find the confidence part matters as much as the strength — fear of falling on its own makes people move less, which feeds the cycle.
If you are recovering from a wrist, hip or spinal fracture, rehabilitation is usually more structured and closely tied to the surgeon or physician's instructions. Our osteoporosis management page describes how we approach both prevention and post-fracture care. We do not offer needling or cupping; treatment is assessment-led exercise, education and hands-on work where it helps.
When to book an assessment
It is worth seeing a physiotherapist if you have been told you have osteoporosis or osteopenia and do not know what exercise is safe for you, if you have had a fall or a near-fall in the past year, if you feel unsteady on stairs or when turning, or if you are recovering from a fracture and want to get back to normal activity.
See a doctor promptly if you have sudden, severe back pain after a minor strain, cough or lift — this can be a spinal fracture — or if you notice a loss of height, a new stoop, or pain after any fall. These need medical review before exercise.
The first consultation at our Borivali West clinic is free — a full assessment with Dr. Shiva Jain Sangoi (PT), MPTh (Ortho), FIFA Diploma in Football Medicine, with over 10 years of practice and 8,000+ cases treated. You can contact PhysioSthanak or walk in at Shop No. 14, Hari-Smruti Premises, SVP Road, opposite HDFC Bank, Borivali West. (Home visits are charged separately as they involve travel time, and online consultations are a paid service.)
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*This article is for general information only and is not a substitute for professional assessment. Consult a qualified physiotherapist for advice specific to you.*