Bone Strengthening for Osteoporosis and Osteopenia

At Posture Plus Hong Kong, we are the first clinic in Asia that is licensed to carry out the Onero™ programme, which is an evidence-based exercise program that has been developed specifically to prevent osteoporotic fracture, maximize bone density and prevent falls and fractures. We are trained to deliver this program and provide the expertise and support to ensure you manage your bone health safely.

What is Osteoporosis and Osteopenia?

Osteoporosis is defined by the World Health Organisation (WHO) as a disease characterized by low bone density and a deterioration of the bone tissue leading to bone fragility and as a consequence, increased risk of fracture. It is typically known as a “silent” disease because it is often not diagnosed until after a broken bone (fracture) has occurred following a minor incident.

  • In Hong Kong, 50% of postmenopausal women have osteoporosis.
  • Osteoporosis affects 45% of women who are 50 years of age or older.
  • This is not a disease which only affects women – a study done by the Chinese University of Hong Kong in 2001 showed that over 22% of men in Hong Kong aged 65 and over suffered from osteoporosis.

Osteopenia is a lower than normal bone density. It is considered a “warning” zone for action to halt the loss or even to improve bone density.

A visual comparison of bone density in normal people versus bone density in those with osteoporosis

What is the Importance of Bone Health?

Healthy bones are an indication of and affect your general health. The personal cost of osteoporosis in terms of risk of injury, pain, quality of life and rehabilitation time as well as the financial cost to the community as a whole is significant.

Research by the Osteoporosis Society of Hong Kong predicts that the number of hip fractures caused by osteoporosis alone will triple over the next 30 years. As Hong Kong has a rapidly aging population with a relatively high life expectancy, they urge people to be tested and to start appropriate “healthy bones” interventions early. DON’T WAIT!

What happens to our bone health over our life span?

Bone growth is rapid during childhood and adolescence and we reach a peak bone mass around the age of 30.

After that there is a steady rate of age-related loss of bone for both men and women. For women, there is a significant increase in the rate of bone loss following menopause for a period of 5-7 years after which the rate levels off. By the time women reach 80 years of age they have lost up to 40% of their peak bone mass. For men the lifetime loss of peak bone mass is around 25% and is a relatively steady decline, however, the rate of loss accelerates after 70 years of age.

The key factor is to build bone mass in childhood prior to reaching skeletal maturity (25 years of age). We should aim to have the best peak bone mass possible at 30 years of age in order to offset the natural decline in bone density over our lifetime. Not only will healthy bones withstand more force and loading without suffering injury, they will heal faster than osteoporotic bones.

Where are the common fracture sites of osteoporosis and how do they happen?

The most common fracture sites caused by Osteoporosis are the hip, spine and the wrist. “Fragility” fractures occur from seemingly minor incidents such as:

  • Falling from a standing height
  • Coughing
  • Sneezing 

Who is at risk of osteoporosis?

There are many risk factors which can increase your chances of suffering from osteoporosis – some we can’t change – for example genetics – if either of your parents have been diagnosed with osteoporosis, gender, race or previous use of steroids. Then there are some risks we can change – inactivity, smoking, drinking more than 2 units of alcohol daily and a diet low in calcium.

To determine your risk of breaking a bone, please visit the Healthy Bones Australia website and fill out this questionnaire

What is the Onero Programme?

Logo of the Onero Program, designed by the Bone Clinic and Professor Belinda Beck in Australia

Onero™ is the award winning evidence-based exercise treatment programme for osteoporosis, developed from the LIFTMOR study conducted at Griffith University under the supervision of Professor Belinda Beck. The programme consists of supervised, bone-targeted resisistance and impact training designed specifically to improve bone health, prevent osteoporotic fracture, and preventing falls in at-risk individuals. The programme was developed by Professor Belinda Beck

Ongoing data collection indicates that Onero™ increases bone mass, improves posture and decreases falls in clinic patients. Results show that 86% of patients increased bone mass at the lumbar spine and 69% of patients increased bone mass at the hip (graphs below). Those results were recently presented at the annual scientific meeting of the American Society of Bone and Mineral Research in Montreal (2018).

To be safe and effective the programme is supervised by our registered physiotherapists who are trained and licensed to deliver the programme. In collaboration with our clinic Bone Health Asia at Prohealth Sports And Spinal, we are the first providers of this programme in Asia. Onero™ has successfully helped improve the bone health of osteoporosis and osteopenia patients in Australia since 2015.

View our own Case Study on the effects of Onero™ on Bone Mineral Density and Functional Measurements in Men and Women with Osteoporosis or Osteopenia in Hong Kong.

Why is supervised exercise recommended?

Bone loading exercises need to be done in a specific way and to be done safely, you need close supervision from health providers who have specific training.

The most important aspects of Onero are the following:

  • How you lift: The way you move ensures that the load is transferred to the areas which need it the most.
  • How much you lift: The weight has to be of a sufficient amount so as to stimulate the bone and strengthen muscles.
  • Progression of load: The speed of progression is important to ensure safety.

What to expect in an Onero Bone Density Programme Session?

The initial session involves a detailed assessment of your general health as well as understanding your specific bone health risk factors. We also conduct tests for balance, strength and flexibility. These measurements along with your bone scan results will dictate the starting point and speed of your progression on the programme.

In each 40 minute treatment session you will perform different types of “lifts” with varying loads, impact training, balance work and other specific exercises that are prescribed for you.

How does the Onero Bone Density Programme help with bone health?

Bone growth is slow. It takes at least 6 months for new bone to be laid down and the imaging results lag even further behind. Research results have shown that Onero helps both men and women with low to very low bone mineral density. The results have shown significant increases in bone mineral density, muscle strength, and balance as well as a decreased number of falls after a period of 8 months of training.

How often do I need to attend sessions?

The original study which Onero is based upon, took a group of individuals with low to very low bone density and put them through training for 30 minutes 2 times a week over an 8 month period. Bone production and resorption never stops so you must continue to load your bones. After our peak bone mass is achieved, our bone density tends to decline with age. So, the old saying is true – if you don’t use it – you will lose it!

Bone absorption and resorption never stops so you must continue to load your bones. After our peak bone mass is achieved at 30 years of age, our bone density naturally decreases with age. If you don’t use it – you will lose it!

Want to know more about osteoporosis, osteopenia and bone health?

To find out more, book an appointment with our Onero Certified Physiotherapists.

Judith has spent the last 25 of her 35 year physiotherapy career focussing on the assessment and treatment of dysfunctional posture and movement patterns through rehabilitation exercise and ergonomic intervention.

Having observed a high rate of osteoporosis and osteopenia prevalent in her client base, Judith started to explore what current treatment options were available both in Hong Kong and around the world. During that search, she came across LIFTMOR, a study which showed dramatic improvement in the bone density of subjects (with osteopenia and osteoporosis) through a specific targeted exercise programme. It seemed a natural progression of her current practice to open Bone Health Asia, and to become one of the first physiotherapists to complete the Onero Academy Programme outside of Australia.

She passionately believes in the importance of patient education in order to empower her patients to take charge of their own health. With OneroTM she hopes to show people that they can improve their bone health safely and effectively through exercise based treatment.

Contact Us Today

If you would like treatment or advice on osteoporosis or osteopenia, book an appointment with our Onero Certified Physiotherapists.

Useful Resources & Downloads

Case Study on the Effects of ONERO in Men and Women with Osteoporosis or Osteopenia in Hong Kong

Posture Plus Founder Judith Anne Gould has produced a case study report the potential benefits of a high-intensity exercise programme Onero™. During the study, she tested 4 clients (3 women and 1 man) all under the age of 60. View the case studies here.


  1. Watson SL, Weeks BK, Weis L, Horan SA, and Beck BR (2015) Heavy resistance training is safe and improves bone, function and stature in postmenopausal woman with low to very low bone mass: Novel early findings from the LIFTMOR trial. Osteoporosis International, 2015, DOI 10.1007/s00198-015-3263-2.
  2. Beck BR, Weeks BK, Weis LJ, Harding A, Horan S, Watson SL: Restoring Standing Height: Yet Another Benefit of Exercise for the Osteoporosis. ASBMR 2015 Annual Meeting, Seattle, Washington, USA, Oct 9-12, 2015.
  3. Resource: The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control.
  4. Resource: International Osteoporosis Foundation (IOF).
  5. Resource: Healthy Bones Australia.
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