white-paper
osteoporosis
Closing the Exercise Gap in Osteoporosis Care
Prescribable, Measurable, and Reimbursable Exercise for Better Bone Health
Katie Daily
Founding Clinician
Summary
Osteoporosis affects over 10 million Americans¹ and causes more than 2 million fractures² each year, driving healthcare costs that exceed $57 billion annually.³ Medications improve bone density⁴ but fail to address the muscle weakness, balance deficits, and mobility limitations that cause 95% of fractures through falls.² Exercise is the only intervention that strengthens both bone and the movement systems that prevent falls—yet physicians lack a practical way to prescribe and monitor it.
Groove Health closes this gap through digital Remote Therapeutic Monitoring, delivering therapist-designed exercise programs with validated outcome tracking. Participants achieved measurable improvements across three key domains: 73% improved lower-limb strength (30-Second Sit-to-Stand), 64% improved balance (Single-Leg Stance), and 77% reported meaningful functional gains (Patient Global Impression of Change). Groove transforms exercise from a recommendation into a prescribable, trackable, and reimbursable standard of care for osteoporosis.
Introduction: The Osteoporosis Problem
Osteoporosis affects more than 10 million Americans, with an additional 44 million at risk due to osteopenia.¹ Roughly one in two women and one in five men over age fifty will experience a fracture related to bone fragility—accounting for more than 2 million fractures annually in the United States.² These injuries drive loss of independence, long-term disability, and healthcare costs exceeding $57 billion annually in the United States alone.³ Among Medicare beneficiaries who sustain an osteoporotic hip fracture, 92% are hospitalized within a week and 30% die within a year,²⁻³ underscoring the clinical severity and economic burden of this disease.
Pharmacologic therapies improve bone density and remain the first-line approach for osteoporosis,⁴⁻⁶ yet they address only one aspect of the disease—the structural fragility of bone. The functional impairments that underlie nearly all osteoporotic fractures—muscle weakness, impaired proprioception, mobility loss, and slowed reaction time—remain unresolved.⁵˒⁶
Exercise is the only intervention that addresses both aspects of osteoporosis—skeletal fragility and functional decline. It strengthens bone through mechanical loading while retraining the neuromuscular and sensory systems that govern balance, coordination, and postural control.⁷⁻¹³ By improving both skeletal integrity and functional capacity, exercise directly reduces the likelihood of falling—an event that precipitates nearly all osteoporotic fractures.¹³
Exercise achieves these effects through well-characterized physiological mechanisms. High-load and impact-based resistance training stimulates bone remodeling, helping preserve or increase bone mineral density at clinically relevant sites such as the hip and spine.⁷⁻⁹˒¹¹⁻¹² Controlled trials in postmenopausal women demonstrate that structured, progressive loading can not only slow bone loss but, in many cases, reverse it—even among those with established osteopenia or osteoporosis.⁸⁻⁹˒ ¹²˒¹⁴⁻¹⁵
Equally critical are the neuromuscular adaptations that reduce fall risk. Targeted strength, balance, and coordination training retrain the sensory-motor systems that govern postural control, proprioception, and reaction time¹⁰˒¹¹˒¹³—domains that pharmacologic therapies cannot restore. These interventions rebuild lower-limb strength and dynamic stability, improve gait and movement efficiency, and enhance the body’s ability to recover from perturbations.¹⁰˒¹³ The result is greater functional mobility and a measurable reduction in fall risk—the proximate cause of most osteoporotic fractures.
The Solution: Groove Health
Despite clear guideline support, exercise remains one of the most underutilized interventions in osteoporosis care.⁴˒⁷˒¹⁶ The barrier is not evidence—it’s execution. While physicians recognize the value of movement-based interventions in osteoporotic care, they lack the tools to prescribe, monitor, and measure within routine practice.
Groove Health closes that gap by making exercise prescribable, measurable, and reimbursable by medical providers. Programs are condition-specific, evidence-based, and designed by licensed physical therapists. Each plan is individualized to accommodate fracture risk, comorbidities, and functional capacity, ensuring both safety and clinical relevance. Digital delivery removes geographic and logistical barriers, while integrated monitoring tracks reproducible outcomes in bone health, balance, fall prevention, and patient-reported quality of life.
Through Remote Therapeutic Monitoring (RTM), Groove enables physicians to prescribe exercise, oversee adherence and outcomes, and capture reimbursement for their clinical oversight. The result is a practical, scalable pathway to integrate exercise into medical care.
Proof of Impact: Functional and Patient-Reported Gains
Groove Health’s model produced measurable functional improvements under practical application. Participants (mean age 65 years) completed an average of 2.⁸ exercise sessions per week and demonstrated gains across three domains central to fracture prevention—strength, balance, and perceived function.
Lower-extremity strength was evaluated using the 30-Second Sit-to-Stand Test, a validated measure of lower-limb strength and functional mobility.¹⁷˒¹⁸ Nearly three-quarters of participants (73%) improved from baseline, with a mean gain of 2.7 repetitions (Table 1).
Postural stability was assessed via the single-leg stance test, a validated assessment and one of the strongest predictors of fall risk in older adults.¹⁹˒²⁰ Nearly two-thirds of participants (64%) improved from baseline, with a mean increase of 10.6 seconds (Table 2). Approximately half (49%) gained 10 seconds or more, demonstrating clinically relevant improvements in stability.
Patient-perceived improvement was captured using the Patient Global Impression of Change scale, a validated tool quantifying perceived improvement over time.²¹⁻²³ Among 44 respondents, 77% reported being "much improved" or "very much improved," 18% reported "minimally improved," and 5% reported no change, with no reports of worsening (Table 3).
Outcomes Summary
Table 1. Improvements in lower-limb strength and functional mobility (30-Second Sit-to-Stand test) | |||||
N | Mean Change (reps) | Median Change (reps) | % Improved | % No Change | % Worsened |
49 | +2.7 reps | +2.0 reps | 73% | 10% | 16% |
Table 2. Improvements in balance and postural stability (Single-Leg Stance test) | ||||||||
N | Mean Change (sec) | Median Change (sec) | % Improved | % ≥ 5 sec gain | % ≥ 10 sec gain | % ≥ 15 sec gain | % No Change | % Worsened |
53 | +10.6 sec | +9.0 sec | 64% | 57% | 49% | 34% | 21% | 15% |
Table 3. Patient-reported perception of overall improvement (PGIC scale) | |||||||
N | Very Much Improved | Much Improved | Minimally Improved | No Change | Minimally Worse | Much Worse | Very Much Worse |
44 | 18% | 59% | 18% | 5% | 0% | 0% | 0% |
Discussion
The outcomes observed in this cohort carry direct clinical relevance for osteoporosis management. Lower-limb strength and balance are the most modifiable determinants of falls—the leading cause of fragility fractures.²˒¹¹˒²⁴ While medications improve bone density, they do not address the neuromuscular deficits—muscle weakness, slowed reaction time, and impaired postural control—that drive falls. The measurable gains achieved through Groove’s digitally delivered program demonstrate that exercise-based interventions can meaningfully improve these capacities under real-world conditions.
Participants in this cohort demonstrated measurable improvements in lower-extremity performance, as captured by the 30-Second Sit-to-Stand (30-STS) test—a validated indicator of lower-limb strength, mobility, and independence in daily activities.¹⁷˒¹⁸ Nearly three-quarters of participants improved from baseline, with an average gain of 2.7 repetitions.
The 30-STS is a well-established functional assessment, with lower scores consistently linked to frailty, falls, and mobility limitation in older adults.²⁴˒²⁵ Recent evidence further demonstrates that reduced lower-extremity strength—including poor 30-STS performance—is independently associated with fracture risk, even after adjusting for bone mineral density.²⁶ By moving the needle on this measure, Groove’s program demonstrated that lower-extremity strength can be improved through structured, remotely delivered exercise—supporting a functional pathway to reduced fall risk.
Improvements were also observed in the Single-Leg Stance (SLS) test, a validated measure of balance and postural stability.¹⁹˒²⁰ Balance deficits are among the strongest predictors of fall risk and mortality in older adults.¹⁹˒²⁰˒²⁷ In this cohort, participants increased SLS times by an average of 10.6 seconds, with nearly half achieving gains of 10 seconds or more—indicating meaningful improvements in single-limb stability and neuromuscular control.
The inability to maintain a 10-second single-leg stance has been linked to increased mortality risk, while longer hold times are associated with lower fall rates in older adults.20 By improving this validated measure of balance, Groove’s program demonstrated the ability to enhance neuromuscular stability—addressing one of the most influential factors in fall risk among adults with low bone density.
Participants’ perceptions of progress aligned with these functional gains. On the Patient Global Impression of Change (PGIC), 95% reported some level of improvement, with 77% describing themselves as “much improved” or “very much improved,” and none reporting worsening. This alignment between subjective perception and objective improvement underscores that the observed gains were not only measurable, but clinically meaningful—reflecting changes that patients both experienced and valued in their daily lives.
These outcomes align with established mechanisms in osteoporosis care. Progressive resistance and appropriately dosed impact loading provide the mechanical stimulus for bone remodeling at clinically relevant sites. ⁷⁻⁹˒¹¹⁻¹²˒¹⁴⁻¹⁵ In parallel, strength, power, balance, and dynamic-stability training retrain neuromuscular control—improving reaction time, postural stability, gait, and functional mobility—key determinants of fall risk.¹⁰˒¹³ By addressing skeletal fragility and functional decline through a comprehensive, digitally delivered program that is prescribable and reimbursable via RTM, Groove offers clinicians a practical way to influence fracture-risk domains that medications alone do not.
Conclusion
Exercise remains a cornerstone of osteoporosis care, yet its adoption in clinical practice has been limited by the absence of a prescribable, trackable, and reimbursable model. Groove Health demonstrates that such a framework is both feasible and effective. By combining evidence-based program design with validated functional and patient-reported outcomes, Groove delivers measurable improvements in strength, balance, and perceived function—key domains linked to fall and fracture risk—and offers clinicians a scalable pathway to integrate exercise into care as a true medical intervention rather than a general recommendation.
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