Bone health: osteopenia and osteoporosis

Both are measured by DEXA scan. Osteopenia means your bone density is below average for a healthy young adult but not far enough below to be classed as osteoporosis. Osteoporosis means it's past that threshold and your fracture risk is higher. Neither is a sentence. Both respond to strength training, balance work and the right kind of loading. The number on your scan tells you where you are right now. It doesn't tell you where you're going to be in five years, because that depends on what you do next.

Your T-score compares your bone density to a healthy 30-year-old. Above -1 is normal. Between -1 and -2.5 is osteopenia. -2.5 or lower is osteoporosis. Numbers without context aren't very useful though. Two women with the same T-score can have very different fracture risk depending on age, history, family history, body type and current activity. A T-score is a starting point for a conversation, not a diagnosis on its own. If yours has come back surprising, get a clinician to talk you through what it means alongside everything else about you. That's where the real picture is.

Massage doesn't change bone density. What it does change is everything that builds up around an osteoporosis diagnosis: the muscles that are working to protect a joint or an area, the compensations from being scared to move, the way a body stops moving freely once someone has given up the things they used to do. I treat the body so it's freer to do the strength work that does build bone, and I manage pain or stiffness that's getting in the way of training. Massage is the supporting cast in bone health, not the lead.

Yes, and the research is clear: progressive resistance and impact loading are two of the most effective things you can do for your bones. The only 'no' is high-twist, high-bend movements done badly. So crunches, yoga twists into spinal flexion, and any new sport you've never done before are worth checking with someone who understands your scan results before you start. Everything else, like lifting heavier than you think you should or jumping if your joints allow, is on the table. Doing nothing is more dangerous to your bones than training is.

The list is shorter than most people are led to believe. Loaded forward bending is the real one: sit-ups, crunches, toe touches, and anything that repeatedly rounds the spine under weight. Forceful twisting comes next, so heavy rotational work and some yoga twists are worth modifying. That's largely it. Everything else is a question of how you build up to it, not whether you're allowed. The mistake I see most often isn't someone doing a dangerous exercise. It's someone who's stopped doing almost everything after a diagnosis and lost strength and balance as a result, which is what actually makes a fracture more likely.

Get a second opinion before you accept it as the rule for life. 'No high impact' is sometimes a sensible short-term restriction (just after a fracture, for example) and sometimes outdated advice based on a fear of doing harm rather than what the research actually says. The current evidence supports progressive impact loading for most people with osteoporosis, introduced carefully. If your doctor said no impact full stop, I'd want to know why specifically, and I'd want a physio or specialist who works in bone health involved in the conversation. Total avoidance of impact is rarely the right long-term answer.

Yes. Heavy deep tissue work and aggressive joint mobilisations on someone with significant bone loss aren't appropriate, particularly around the spine and ribs. I adjust pressure and technique based on what I know about your bone density and where you are clinically. If you don't know your T-score, that's fine, we'll work conservatively and you can always get a scan later. If you do know it, tell me before the first session so I can plan accordingly.

Yes, once your medical team has cleared you for movement. The order matters: medical clearance first, then me. After a vertebral fracture, a hip fracture or a wrist fracture, the worry about it happening again can shrink your world faster than the original injury did. Rebuilding strength and balance is what gets you back to walking the dog, lifting a grandchild, getting out of a chair without thinking. We start where you are, not where you were. Progress is slower than you'd like and faster than you'd think.

Yes, with a clearer plan than for someone without that history. We'd avoid spinal flexion and twisting work in your training, use modified positioning on the treatment table, and prioritise the kind of strength and posture work that protects what's already happened from getting worse. Bring your scan results and any letters from the consultant if you have them. The more I know upfront, the safer the work.

No. If your GP or a specialist has prescribed medication for your bones, stay on it. The strength, impact and balance work we do runs alongside your treatment, it doesn't replace it. Exercise gives you things a prescription can't: stronger muscles, better balance, fewer falls. Medication decisions belong with the person who prescribed it, so talk to them before changing anything.

No. HRT is a separate decision between you and your GP or menopause specialist. The training and treatment work either way. HRT does have evidence behind it for bone health in the perimenopausal and postmenopausal years and is worth a conversation with your doctor if you haven't already had one, but it isn't a prerequisite for working with me. Plenty of my clients are on it. Plenty aren't.

It depends on what we're working on. If you've come because of pain or restriction holding you back from training, weekly for the first two or three sessions, then dropping back to fortnightly, then monthly maintenance once you're moving freely. If you've come because you want help building a strength programme alongside what you're already doing, every four to six weeks for treatment plus a strength check-in is plenty. In Edinburgh you can also work through a block of ten sessions, usually weekly, with the baseline testing at the first appointment and a retest at the last so you can see what's changed. We space them to suit you rather than to a fixed schedule. That block isn't on the online booking system, so email me if it's what you're after. Bone density itself takes six to twelve months to shift on a scan. Symptoms and confidence shift much faster than that.

You sit down, we talk, I take a history. Nothing happens to you that you haven't agreed to. We'll also do some simple baseline testing: grip strength, balance, and standing up out of a chair, timed. They take a couple of minutes each, there's no way to fail them, and they give us a starting point to measure against later. By the end you'll have a clear sense of what's going on, what's a priority, what we'll work on together and what (if anything) needs another professional in the loop, plus two or three easy things to fit into your ordinary day. In Peebles you can book a single appointment and decide from there. In Edinburgh this work usually runs as a block of ten, with the consultation and testing at the first appointment and the option to retest at the last so you can see what's changed. That block isn't bookable online, so email me and we'll work out what suits you. Most people leave the first session less frightened than they came in. That's the point.