Osteoporosis in Physiotherapy and Pilates

When you have had a diagnosis of osteoporosis, it can be difficult to work out how to exercise safely. You may be told that exercise is the best thing for you. But what if you have already had a fracture? It might be that you associate moving around with a risk of falling and therefore of fracturing again. Exercise is known to be a great treatment for osteoporosis and can maintain bone density, if not improve it. Hopefully this post will help give you some ideas of how to exercise safely and effectively.

It is important to note that everyone’s diagnosis is different. Some people may be picked up by routine screening, others may be after a fracture, and some people will be told they are already at risk of fracturing particularly fragile bones. It is best to get individual advice for your own personal circumstances.

Image from theosteoporosiscenter.com

Osteoporosis is where there is thinning of the matrix of the scaffold that makes up bones. This leads to the entire bone structure becoming more fragile and at increased risk of fractures. Women are more at risk because bone loss is greater with the hormonal changes throughout the menopause. A fracture is not inevitable, and unless you have had a  fracture, osteoporosis does not cause pain.

Some areas are at greater risk of fractures than others. This is because of the type of bone in particular areas is at greatest risk of loss of density. The areas particularly affected are the thoracic spine (the middle back where the ribs attach), wrist and top of the femur (thigh bone) where it joins the pelvis at the hip joint.

Image from thinkloud65.wordpress.com

If someone has had spinal fractures, this can lead to a typical osteoporotic posture. The front part of the vertebrae (the bones which make up the spine) is the area most at risk of fracture and this can cause the spine to bend forwards more than usual. Unfortunately, this kyphotic (bent forward) position puts pressure on the front of the vertebrae and can lead to further fractures, so it’s always a good idea to work on posture and build strength in the muscles which support the spine into a more upright posture.

Image from pilatesfnb.com

You have probably also been told that regular exercise is a good practice to adopt. But how much and what type of exercise is right for you? People who have not had a fracture and have a milder form of bone density loss (osteopenia) may be able to do higher impact exercise such as jogging, whereas this is not appropriate for those who are less fit and have poorer balance. Again, individual advice is best. It is also not about exercising to extremes – combined with poor nutrition this can increase risk of osteoporosis, especially in dancers, elite athletes and people with eating disorders.

There is great evidence that weight bearing exercise can improve or maintain bone density, especially when combined with the right supplements and medication. For the hip and spine weight bearing can be achieved in standing – walking, and standing hip exercises can be very beneficial. Exercises lying on your front and lifting the shoulders (and head if able) can provide great weight bearing through the spine, and can be made harder by placing additional weights onto the spine. For weight bearing through the wrists, hand weights can be used and if able, the 4-point kneeling (hands and knees) position can be a great position to perform exercises.


Balance exercise is fantastic for both weight bearing exercise as well as to prevent falls. A good Pilates class or Physiotherapy exercise programme will include a standing element where you are encouraged to challenge and improve your balance safely, adapting exercises to your individual needs if you need more or less of a challenge.


Not all Pilates exercises are beneficial for osteoporosis, some exercises need to be avoided. These include anything which bends the spine forwards, twisting and sit-up type exercises. Any new exercise programme should be built up gradually. It is therefore vital that you get clearance from your doctor to exercise or do Pilates and you then tell your Physiotherapist or Pilates Instructor that you have a diagnosis of osteoporosis.

Please ask us if you have any questions!