Just in the past several weeks I’ve had many clients come to me with a new diagnosis of either osteoporosis or osteopenia. It’s understandable: my typical clientele is female-bodied folks over 60 and with that group we’ve got a collision of two important factors. One is that female-bodied folks are more at risk for osteoporosis, especially post menopause, and the other is that diagnostic testing usually begins at age 65. Put those two things together and my ideal clientele is also ideal for getting that diagnosis.

Getting that diagnosis can be really scary and really frustrating. Scary because who wants their bones to crumble? Plus we all have family and friends (or have at least heard many stories of people) who’ve broken a hip and never made it back from the injury.

Frustrating because there’s not a ton of good information out there about what you should do to maintain healthy bones and stay strong after the diagnosis.

I just spent a little time with Google reading through a variety of well-respected sites and came up with the following information:

Tennis is a great choice of a high impact sport to help build bone health.


You should absolutely avoid tennis because of the extreme bending and twisting it requires which can create fractures.

An elliptical machine is a good choice to get low impact bone building and cardio.


An elliptical machine is a bad choice because it doesn’t give you any ground force to help build your bones.

High impact exercise is one of the best things you can do to build bone health and strength.


High impact exercise like running and jumping is a bad idea because it can lead to fracture.

You get the picture. Super frustrating if you’re working to stay active, build strength, and avoid injury.

Part of the problem is that people are different and where people are with this situation is going to manifest differently. Are you 45 and have gone through chemo and radiation for cancer treatment and have an osteoporosis diagnosis resulting from that? Are you 85 and in good health but your bone cells are doing that natural progression toward loss of strength and resilience? Are you very petite with a bird-like frame and have spent a good amount of time on a bike? Or are you fairly sturdy and solid with some weight lifting in your past? Do you have any history of disordered eating? Are you a bookworm who hates the outdoors? Do you have any spinal curvature?

All of those things (and more!) are going to have an affect on how you experience osteoporosis.

I’m not a doctor and there are many aspects to osteoporosis that are way outside my scope of practice. I’m also not miraculously going to be able to give you the one nugget of information that’s going to let you make a 10 bullet point exercise plan that’s perfect for exactly your situation.

I CAN help you wade through and find what is consistent in the information out there.

Things that we know are good:

Movement! Don’t stop moving if you have a movement habit and do start moving if you don’t right now. Walking (if it’s in your wheelhouse of options) is one of your best choices.

Impact! How much depends on your situation. If your bones are quite fragile (and a doctor can help you figure out what kind of range you’re in) then simple walking and stomping might be your limit. (When you’re stomping, don’t forget to “stomp” your wrists if they’ll let you because they tend to be one of the vulnerable points.) If you are stronger and healthier, then something with a higher impact like jumping might be in order. You can also get this impact from hanging from a bar with your hands and letting yourself fall onto your feet.

Varying your input and your options! I liked one article I read that suggested “surprising your bones” by varying the speed of your walk, how much impact you’re giving your feet, and the way that you’re walking. Your body thrives on variety of input so using your joints in their full range in a variety of ways and under a variety of conditions is going to be mostly helpful. (See below for where it’s not helpful.) And varying your options means giving your body more than one “go to” stance or posture. Teach your body to hold itself in a variety of ways under a variety of conditions. One example is bending over to pick something up. Maybe you usually round your spine and reach down that way. Can you hinge? Can you squat? Can you squat with one foot forward and one back? What about with the other foot forward?

Developing strength in places where the bone is vulnerable or in areas that help with balance! Strengthening your hips in all directions does double duty because it’s a vulnerable area AND it helps with balance. Other vulnerable areas are the spine (strengthen with extension exercises like Dart or Birddog/also known as arm and leg reaches, or shoulder strengthening exercises like rowing but see note below for possible problems with rowing), wrists (strengthen with wrist curls or hands and knees exercises), and ribs (strengthen with full breathing exercises.) For balance, you need strong and mobile feet and ankles plus strong legs generally and a strong core. Doing balance exercises will help build all those things. If your balance isn’t good, hold onto something so you don’t risk a fracture while you’re building strength.

Weight! How to add weight is a complex topic in its own right. For some tips, read this blog post and remember that you need to think about your unique abilities at the moment while remembering that the more weight you can work with safely, the better, when it comes to bone health. See notes below for some things to watch out for. Also, think about your own body weight. If you’re really tiny, gaining weight might be helpful if you’re able to do that. If you have a few extra pounds and you’re post-menopausal, don’t lose that weight! For extra credit: Muscle is HEAVY!! If you build muscle, you are building strength AND giving yourself a more stable structure around your joints AND giving yourself some extra weight to carry around.

Things we know are bad:

Weighted spinal flexion (and what makes it worse is weighted spinal flexion with rotation!) Anything where you’re rounding your spine and adding weight is going to be a problem. Here’s a not complete list to help you get started thinking about what this might mean: Pilates short spine on reformer, Yoga plough pose or Pilates rollover, Pilates rolling like a ball, rowing exercises against resistance as on a rowing machine where you round your spine, rounding your spine to pick something up off the floor, rounding your spine while you try to pull a really stubborn weed, working with weights with a rounded spine…and so on. Remember earlier when I said adding weight is good? It is! But make sure you’re holding your spine in neutral and hinge if you’re going to bend forward with it. Using video can help you see yourself to make sure you’re not rounding without realizing it.

Falling and risking fracture! This may seem like a no-brainer but the more you can do to help yourself not fall or to learn how to fall well if you do fall, the better. This would include things like looking around your house for trip and fall hazards, teaching yourself to automatically use the grab bar in the shower and the handrail on stairs, working on balance exercises, building strong muscles, knowing under what circumstances your body is prone to loss of balance.

Things that can be problematic depending on your situation: 

Spinal flexion, rotation, side bending: Here’s where things get really tricky. How much is too much? We don’t know and the answer (probably) is “it depends.” We are still fairly new in having diagnostic tools to measure osteoporosis and our tools only measure bone density; they don’t tell you how good your bone cells are at repairing damage.

And when it comes to the spine we’re in tricky territory. You’ll probably know it if you break your hip or your wrist and mostly that only happens if you fall; you may not know it if you fracture your spine. With osteoporosis in the spine we can have micro-fractures like crumbling that might create some pain but also might not, and then we can suddenly end up with a more catastrophic fracture building from those micro-fractures. If you have any spinal curvature, you are going to be even more prone to this issue. You can think of spinal curvature plus osteoporosis like a waterfall hitting a boulder below: If the boulder is centered (no spinal curvature) and the water (osteoporosis) hits the whole thing at once, the wear and tear will be spread over the whole rock, but if the boulder is off center in some way or twisted (spinal curvature), the water will concentrate its effect in one place leading to more wear and tear there.

I said earlier that moving your joints in all directions is good and that is true, but if you’re dealing with osteoporosis you may need to consider your risk factors and also your personal willingness to take on risk.

Some side bending and a little cat/cow is probably fine for almost everyone. You’re not going to get through your life without ever doing any spinal flexion. Chances are you’re flexing your spine right now as you read this if you’re like most people.

Extension is excellent for osteoporosis. Adding spinal rotation to extension (as opposed to adding it to flexion) is excellent because it helps build the shoulder and spinal muscles that help support the spine. (Not sure how to tell if you’re rotating in flexion or extension? Ask yourself if you’re rotating towards the front of your spine and curling in, or rotating towards the back of your spine and opening away. The first is a no-no, the second is a yes please!)

Teaching your body how to correctly perform a hinge is good for everyone regardless of diagnosis! Even without osteoporosis, a lot of folks spend too much time rounding their spines and not enough time hinging at the hip.

But regarding flexion/rotation/side bending, here are some movements you might want to consider and ask yourself if it’s risky for your specific situation and if you want to take on that risk (and by the way, all of these movements create wear and tear on the bones for everyone regardless of diagnosis): Pilates stomach series from a curled up position, roll ups, the saw, Yoga triangle pose or any revolved or twisted pose, bending and twisting to pick up something heavy (generally speaking, this is not a great idea for anyone, regardless of bone health because of the risk of injury), tennis or other racket sport, golf, working out on weight machines that require you to bend and twist to get on or off, bicycling if you cycle with a rounded spine, playing a sport like soccer with a high risk of falling.

You may or may not decide to cut those things out, depending on your personal situation. You may also decide to do modified versions of those things with less extreme movements, so maybe in a Pilates class you don’t go into the full range of Saw, but you do a smaller rotation, or maybe you take up pickleball instead of tennis because there’s less force involved with that game. The point is, it may be a good idea to think it through and make a decision before you end up in a class or a game where you’re just following along and doing what everyone else is doing.

Things that can be great on their own but either won’t help you with bone health or might create problems:

Bicycling, swimming (although great for strengthening upper back which is one of the vulnerable areas), static stretching, weight equipment or gym machines if used with a rounded spine, lots of sports, curling up on the couch to watch Netflix, spending hours hunched over a computer writing your memoir, gardening, skiing (another high risk of falling), modern dance, reading a book in the bathtub (uh oh, spinal flexion)…

You can see from this list that you’re not going to want to get rid of all those things from your life nor should you. Doing things that are fun and satisfying and creative and community/friendship-building and nurturing and relaxing…those are all important and we always have to weigh what matters to us. Driving is crazy dangerous and yet we’re all out there driving cars because we have places to go and people to see that are important to us. Use the information you’re given and know that we don’t have all the information. Accept that it’s frustrating and scary. Know that you may have to give up certain things and that it’s okay to grieve the loss of them. Then make the best decision you can and live your life.

Copyright © 2021 Autumn Needles Pilates and Fitness, LLC All rights reserved.