Skeletal Demineralization
PTA 104 Orthopedic Dysfunctions

Skeletal Demineralization

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution for commercial purposes. It is not intended to serve as medical advice or treatment. Contact for permissions.

For Your Info Only

Additional links are included in the 'sidebar' of your interactive lecture. These resources are for your information only and may help in the future with patient education in clinical practice

Reading and Study Tips


  1. Describe risk factors for skeletal demineralization
  2. Identify clinical indicators for bone loss
  3. Describe the role of PT in bone loss prevention
  4. Select appropriate exercises for patients with osteoporosis
  5. Explore resources for patient education in fall-risk management associated with osteoporosis


What is bone demineralization?

Imbalance between bone formation and bone resorption

Homeostatic mechanisms such as mechanical forces, nutrition, hormonal function (e.g., parathyroid, gonads) work to progressively replace and restore bone tissue to an ideal density. Failure to maintain balance between osteoblastic (bone forming) and osteoclastic (bone resorbing) systems results in loss of bone tissue.

Peak bone mass is typically maintained between ages 25-40




Incidence of Involutional Bone Loss





APTA PodCast on Osteoporosis

Clinical Significance of Bone Loss

Hip fx and OP.jpg



Clinical Indicators of Bone Loss






increase bone mass, slow bone loss, and/or reduce the risk of fractures.

Weight bearing aerobic exercise

depending on the severity of osteoporosis, patients may exercise in a weighted vest to stimulate osteoblastic activity

Resistance exercise

consistent effects are generally noted in spine bone density

flexion activities (sit ups, abdominal machines) can increase pressure on compromised vertebral bodies and increase risk for fracture

no combined flexion with rotation exercises in trunk

limit closed chain hip internal/external rotation activities to decrease torsion through femoral neck

avoid high velocity, high impact activities

begin weight training at low intensities with low repetitions (6-8) to minimize fracture risk; progress to 1-3 sets of 8-12 repetitions of resisted exercise

an alternative to a curl up for abdominal strengthening is a straight leg raise with a stable lumbar and pelvic spine

Woman lifting a straight leg for abdominal strength

Spine exercises

strong evidence that back extension exercise can markedly reduce compression fracture risk

Woman lifting elbows out to side raising trunk Woman lying on belly with pillow under front of pelvis, raising arms overhead and raising legs up off the follor

Body Mechanics Training

Image of woman gardening when kneeling on pad compared to woman bending at the spine

Visit this recent New York Times Article about patient-centered interventions for fall prevention:


spinal orthoses can be customized or prefabricated for pain management and joint protection

Fall prevention

exercises to target stiff and weak muscles should include some firm UE support to minimize risk for falls during unsupervised exercise

balance exercises: standing in a corner for safety or using a chair for support; narrow base of support and progressing to one leg

Woman standing on one leg with chair

home assessment: identify areas and objects within the home that may increase risk for falls or repeated trunk flexion motions

Health and Wellness Education


Exercise Self-Test

Select the images which are most appropriate for strengthening in a patient with osteoporosis

A. Medicine Balls.jpg

B. Hip Extension.jpg

C. Trunk flexion with resistance.JPG





Exam Prep and End of Lesson

  1. Can you educate a patient on factors which influence bone density?
  2. Can you recognize clinical indicators for bone loss during a patient screen?
  3. Can you prioritize exercises based on predictable impairments and risks associated with osteoporosis?