Clinical Practice Guideline for the Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis

This clinical practice guideline (CPG) provides evidence-based recommendations for physical therapists managing patients with suspected or confirmed osteoporosis. Developed by the Academy of Geriatric Physical Therapy, the document adapts existing high-quality international guidelines to the United States healthcare context, focusing specifically on exercise interventions designed to mitigate the loss of bone mineral density (BMD).

The guideline development group utilized the ADAPTE process to systematically review and adapt existing international guidelines. After evaluating several candidates using the AGREE II instrument, the group selected the 2021 Scottish Intercollegiate Guideline Network (SIGN) document as the primary source. The team extracted and contextualized exercise recommendations based on mode, frequency, and intensity, while considering the practical realities of physical therapy practice in the U.S.

The CPG emphasizes that exercise must be long-duration (6-48 months) to effectively impact bone health. For postmenopausal women, the guideline suggests static weight-bearing exercises (like single-leg standing) for hip BMD, and progressive resistance strength training—often combined with impact exercises—for the femoral neck and lumbar spine. For premenopausal women, the focus is on high-force, high-impact activities combined with resistance training to build and maintain bone strength. The guideline notes that while evidence for men is currently limited, general lifelong fitness and bone health strategies are encouraged due to the lack of adverse effects.

The authors highlight that effective bone health management requires long-term commitment, which may necessitate a shift in how physical therapy episodes are structured. Clinicians are encouraged to consider social determinants of health—such as economic stability, access to safe environments, and social support—when designing these long-term programs. The guideline explicitly notes that it does not cover fall prevention or fracture risk reduction, recommending that therapists consult separate, dedicated guidance for those critical aspects of patient care.