Osteoporosis is a silent disease that leads to fractures, postural deformities, and impaired balance, especially in postmenopausal women. In Pakistan, prevalence is high, with 39% of women reported as severely osteoporotic. Postmenopausal women with osteoporosis and balance issues face increased fall risk due to poor bone density, weakened muscles especially in the lower limb band altered posture .Balance and strength training reduce fall risk, but access to in-person rehabilitation is limited. Telerehabilitation provides remote delivery of structured exercise programs and has shown positive outcomes in balance and bone health. Few studies, however, have compared telerehabilitation with conventional training across all balance domains. The goal of this randomized controlled trial is to compare the effect of Telerehabilitation and Traditional Balance Training in Post Menopausal Women with osteoporosis. Participants will be randomly assigned to one of the two groups, and both will receive an identical standardized balance training program . The results of this clinical trial will help evaluate how telerehabilitation can improve the balance of postmenopausal women with osteoporosis and improve health outcomes.

Osteoporosis often remains undetected until fractures occur, typically involving the hip, wrist, or spine, and may also cause back pain, height loss, and kyphosis. Postmenopausal women face increased fall risk due to reduced bone density, weakened lower limb muscles, and altered posture. Many also develop fear of falling, which restricts activity and accelerates muscle weakness.

Globally, osteoporosis affects about 23.1% of women and 11.7% of men, with fragility fractures being a major cause of disability. In Pakistan, hospital-based findings show a high proportion of postmenopausal women as severely osteoporotic, with a strong link to fall-related injuries.

Exercise interventions, including balance, resistance, and weight-bearing training, are known to improve bone strength, postural control, and confidence by stimulating bone remodelling and enhancing musculoskeletal performance. Telerehabilitation, delivered via video conferencing, provides remote access to such programs and has demonstrated improvements in stability, weight-shifting, and functional balance.

However, most studies assess limited outcomes using tools like TUG or BBS, without addressing static, dynamic, anticipatory, and reactive balance together. Evidence largely comes from high-income countries, while data from resource-limited settings like Pakistan remain scarce. This trial seeks to evaluate telerehabilitation compared to traditional training across comprehensive balance domains in postmenopausal women with osteoporosis.

Inclusion Criteria:

• • Women diagnosed with osteopenia and osteoporosis at hip and lumbar spine through DEXA

  • Age 50-70 years
  • Have mobile phones and can communicate in video call
  • Have Balance score (21-44) on berg balance scale
  • A caregiver must be available to assist the participant during Tele sessions.

Exclusion Criteria:

• • Women with severe mobility impairments.

  • Women with cognitive conditions affecting participation.
  • Women with lower limb joint injury or surgery