Bone health after menopause: exercise for osteoporosis

Oestrogen helps protect bone. In the years after menopause, bone is lost faster than it is rebuilt. Low vitamin D, low calcium and protein intake, low body weight, smoking, some medicines such as long-term steroids, and a family history of hip fracture all add to the risk.

Osteoporosis has no symptoms until a bone breaks. The most common fractures are in the wrist, the spine and the hip. A spinal fracture may show up only as sudden back pain after a minor strain, or a gradual loss of height and a more rounded upper back.

Strength training: bones respond to muscles pulling on them. Exercises with bands, weights or body weight, done two or three times a week and gradually made harder, are among the most useful things you can do. Research has shown that supervised, progressive strength and impact training can be done safely by many women with low bone density.

Weight-bearing and impact exercise: walking helps, but on its own it is a fairly gentle signal to bone. Brisk walking, stair climbing, and small jumps or heel drops, if your bones and joints allow, give a stronger signal. Your physiotherapist will judge what is safe for you.

Balance training: most hip fractures happen in a fall. Balance exercises, such as standing on one leg near a counter or walking heel to toe, reduce the chance of falling.

Back strengthening and posture: exercises for the muscles along the spine help posture and may reduce the risk of spinal fractures.

Repeated or forceful bending forward of the spine, especially with a load, such as sit-ups, toe touches or lifting heavy objects with a rounded back, puts the front of the vertebrae under strain. So does twisting the spine forcefully under load.

This does not mean you must avoid all bending. It means learning to bend from the hips with a straight back when lifting, and adapting exercises and some yoga poses that involve deep forward bends. A physiotherapist can show you how.

Bones need calcium, protein and vitamin D. Vitamin D deficiency is very common in India, even in sunny regions. Your doctor may check your level and advise supplements.

A DEXA scan measures bone density. Ask your doctor whether you need one, especially after a fracture from a minor fall, with a family history of hip fracture, or if you take long-term steroids. If you are prescribed medicines for osteoporosis, exercise works alongside them, not instead of them.

Many women in their 60s and 70s have never had a bone density scan. If your mother has lost height, has a rounded upper back, or has broken a bone in a minor fall, ask her doctor about osteoporosis.

A physiotherapist can set up a safe strength and balance programme at home by video, with a female physiotherapist if she prefers.