Strong, steady and straight consensus: A multidimensional exercise intervention for postmenopausal osteoporosis

Background: Osteoporosis is a systemic skeletal disorder characterized by low bone mineral density and deterioration of bone microarchitecture, leading to increased bone fragility and fracture risk in postmenopausal women. Patients with osteoporosis frequently experience pain, spinal deformities, reduced hip and trunk strength, impaired balance, and fear of falling. Exercise-based interventions provide a vital role in improving musculoskeletal function and reducing fall risk. The Strong, Steady and Straight framework, developed by the Royal Osteoporosis Society, offers an evidence-based approach to exercise prescription for osteoporosis. This study aims to evaluate the clinical applicability of multidimensional exercise programme based on the Strong, Steady and Straight framework in improving musculoskeletal and functional outcomes in a postmenopausal woman with osteoporosis.
Case: A 58-year-old postmenopausal woman with osteoporosis and thoracic kyphosis underwent an 18-week supervised physiotherapy programme, delivered twice weekly and supported by a home-based routine. The programme combined balance and gait training (“Steady”), postural and spinal strengthening (“Straight”), and safe resistance and weight-bearing exercises (“Strong”). Outcome measures were assessed at baseline, week 9, and week 18.At 18 weeks, marked improvements were observed: pain decreased (Numerical Pain Scale: pre- 7/10, post- 3/10), mobility improved, fall risk reduced (Timed Up and Go: pre-17 seconds, post-10 seconds; Five Times Sit-to-Stand: pre-20 seconds, post- 11 seconds), and walking endurance increased (6-Minute Walk Test: pre-320 m, post-410 m). Balance and gait improved significantly (Berg Balance Scale: pre-39/56, post- 49/56; Functional Gait Assessment: pre-16/30, post-24/30). Fear of falling reduced substantially (Falls Efficacy Scale: pre-44, post-28). Postural alignment improved modestly (thoracic kyphosis angle: pre-58°, post-56°), however the hip range of motion limitations persisted.
Conclusions: This case demonstrates that an individualized programme structured around the Strong, Steady and Straight framework is safe, feasible, and clinically meaningful changes in improving pain, balance, functional mobility, endurance, and fall-related confidence in osteoporosis.