Low bone mass is a condition that develops when a person:

• Has naturally lower bone density due to factors such as body size, genetics, or gender.
• Has gradually lost bone mass over time due to lack of exercise and poor diet.
• Begins to transition into menopause, when a loss of 20% to 30% of bone density naturally occurs.
• Has rapidly lost bone mass due to an illness or use of medication.

Generally, no symptoms occur with low bone mass. However, there are some subtle signs, called red flags that can indicate bone loss. Among them:

• A loss of more than 1.5 inches of height. This loss may indicate that your spinal bones are collapsing.
• A rounded upper back (kyphosis), which pushes your head forward. This may indicate that the spinal bones (vertebrae) are changing shape due to bone loss.
• Breaking a bone with very little impact. If you break a bone easily, such as falling from a standing height, you may have bone loss.
• Deep thigh pain in the middle section of your thigh bone. If you experience this type of pain, notify your doctor immediately. You may be at risk for a spontaneous thigh fracture, especially if you have been taking a fracture prevention medication.

You may simply not know that you have osteopenia. It is important to recognize any risk factors you may have. Your health care provider and physical therapist can help identify them.

Low bone mass is diagnosed through a quick and painless specialized scan ordered by a physician. If you are seeing a physical therapist for rehabilitation, they may confer with your physician if they detect a possible need for bone testing.

The results of the scan are reported using T- and Z-scores.

The T-score compares your score with that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass or osteopenia. Those who have a T-score of -2.5 and lower have osteoporosis.

Other methods of screening bone density include X-ray, ultrasound, and CT scan. If you have risk factors that include certain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan also may be prescribed. Your physical therapist can help determine what tests are best for you.

A physical therapist can help you prevent and treat low bone mass at any age. They will prescribe the specific amount and type of exercise that best builds and maintains strong bones.

Your physical therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. They will also conduct a complete physical examination and identify your risk factors for low bone density.

It is important to exercise throughout life. It is especially important to exercise to maintain healthy bones if you have been diagnosed with low bone mass. Exercise can help to build bone or slow the loss of bone mass.

Your physical therapist is likely to prescribe exercise and physical activity to help prevent fractures and falls, and to reduce bone loss. Your treatment program may include:

Exercise focus

• Posture guidance (spinal alignment and awareness for fracture prevention).
• Balance training.
• Leg strengthening.
• Spine stretches.
• Hip stretches.

Weight-bearing exercises

• Dancing.
• Tai chi.
• Walking at a quick pace (122-160 steps per minute, or 2.6 steps per second).
• Jumping, stomping, heel drops.
• Running.
• Racket sports.

Resistance exercises

• Weightlifting.
• Use of resistance bands.
• Gravity-resistance exercises (such as pushups, stair climbing).

Caution: Yoga and Pilates contain movements that may increase fracture risk for people with osteopenia or osteoporosis. If you have low bone density, it is important to avoid any movements that round or twist the spine and put excessive force upon the vertebrae.

Your physical therapist will design a personalized exercise program for you based on your needs and goals. They will also consider other physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add other activities. This increased physical effort will encourage your bones to grow stronger.

Your treatment plan may include exercises for the hips, spine, shoulders, and wrists. Your physical therapist will design a specific program based on the intensity, frequency, and amount of exercise that is best for you.

Exercise is only one component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet. They may suggest that you see a dietitian, who can teach you about the many foods that contribute to bone health. Your doctor also may prescribe medication or hormone replacement therapy. Your health care team will help you find the best combination of exercise, diet, and medicine to treat your condition.

You can reduce your chances of developing low bone mass by avoiding these risk factors:

• Cigarette smoking.
• Excessive alcohol intake (greater than one drink per day for women, two per day for men).
• Poor diet.
• Low calcium and vitamin D levels.
• A low activity level – less than 5,000 steps per day.

All physical therapists are prepared through education and experience to treat low bone mass. However, you may want to consider:

• A physical therapist who is a board-certified clinical specialist in women’s health, geriatric, or orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist who is experienced in treating people with women’s health, geriatric, or orthopedic conditions. Some physical therapists have a practice with a focus on women’s health, geriatrics, orthopedics, and osteopenia/osteoporosis.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have osteopenia or osteoporosis.
• Be prepared to share your desired activities and goals and describe the activities that you have trouble doing.