Osteoporosis is a condition that causes bones to become weaker and more fragile. 54 million Americans over the age of 50 are affected with osteoporosis and low bone mass, with fractures occurring most commonly in the wrist, hip and vertebra (spinal bones). Osteoporosis if often referred to as the silent disease because it often goes undiagnosed until a person experiences a fall that results in a fracture.  It can lead to a stooped posture resulting in increased pressure on already fragile vertebra, thus increasing the risk of another fracture even greater (the fracture cascade).

Reading or hearing some of these statistics can be a bit depressing, but let me encourage you – your body is an AMAZING machine, capable of growth and adaptation at any age.  We don’t often think of our bones as having the ability to change and remodel, but the skeleton completely renews itself in 7-10 years (2 years in children!) (Source: NOS UK, 2012).  This blog will inform you further on osteoporosis and the role APPI Pilates can play in effective management following diagnosis, but more importantly how to prevent the diagnosis, starting as early as 8 or 9 years old!

Bones are constantly changing throughout our lives. There are 2 main sets of cells that aid regeneration of bone (bone turnover): osteoclasts break down old bone, and osteoblasts replace the bone. Between our mid 20s and 30s our bone mass density (BMD) remains relatively stable, but after the age of 35, there is a natural gradual loss of bone. This loss becomes more rapid following menopause, hence why osteoporosis is more common in women over the age of 50. This is due to the falling levels of oestrogen that causes the osteoclasts to work harder than the osteoblasts.

In women over 45 years of age, osteoporosis accounts for more days spent in hospital than Diabetes, Heart Attack, or Breast Cancer!  It is estimated that only 1/3rd of vertebral fractures come to clinical attention and under-diagnosis is a worldwide problem.

Other factors that increase the risk of developing osteoporosis include:

  • early menopause or hysterectomy
  • long term use of high dose oral steroids or other medicines that affect bone strength or hormone levels
  • other medical conditions e.g. inflammatory/hormone-related/malabsorption conditions
  • a family history of osteoporosis
  • having a low body mass index (BMI)
  • a history of disordered eating and/or irregular menstruation
  • heavy alcohol intake and smoking
  • consuming excessive amounts of acidic foods (soda, salt, caffeine, alcohol)

If you suspect that you have osteoporosis then it is important to discuss this with your PCP. You can complete an online assessment to help determine your risk using an online program called FRAX. This calculates the 10 year probability of you suffering a fracture of your spine, hip, shoulder or forearm. Your doctor will also determine the need to refer you for a DEXA scan which measures your BMD (bone mineral density). There is also a condition called osteopenia which means that your BMD is not as low as what would be considered osteoporosis, but it is important for you to be aware of this diagnosis and to act to improve your BMD.

Your PCP may prescribe medication to improve your levels of calcium and vitamin D. Calcium is important in enabling bone to be rebuilt and vitamin D is imperative for the body to be able to absorb calcium. Other ways to improve these levels include a healthy diet including foods rich in calcium and vitamin D (e.g. dairy products, dark leafy greens, nuts and fish), using supplements, maintaining a healthy lifestyle and enjoying some safe sun (always using sun screen as appropriate).

Exercise, including Pilates, is very important when a diagnosis of osteoporosis or osteopenia is made. The benefits of exercise are innumerable, but include maintaining bone mass, increasing strength and flexibility, and improving balance which in turn reduces the risk of falls and therefore risk of fractures are among a few.

Current ACSM/AHA recommendations include weight bearing (3-5 times per week) and resistance/strength exercise (2-3 times per week) in order to increase BMD by stimulating bone growth. Resistance/strength training is particularly important in increasing BMD and therefore reducing the risk of fractures occurring (Senderovich et al, 2017). Exercises for osteoporosis focus on extension (bending backwards) and rotation, and minimize the use of flexion (bending forwards) to reduce the pressure on the vertebra (Meeks, 2004). Balance focused exercises have been shown to reduce a person’s risk of falls by 25% (NIH consensus development conference statement, 2000).

Pilates can offer all of the above benefits to people with osteopenia/osteoporosis. A 2015 study by Endera et al showed that people who participated in Pilates saw an increase in their BMD, as well as improvements in their physical performance and their quality of life.

This graph from the International Osteoporosis Foundation, Move it or Lose it article demonstrates why it is so important to remain active throughout our lives.  If you haven’t been, that’s okay, start today!

Essential Osteoporosis Exercises


Foot Series – for balance and leg strength

  • Standing with feet hip distance apart
  • Inhale to prepare
  • Exhale, bend the hips and knees
  • Inhale, lift the heels off the floor keeping the hips and knees bent
  • Exhale, straighten the hips and knees to stand tall, keeping the heels lifted
  • Inhale, lower the heels
  • Repeat 10 times
  • Reverse the direction

Standing Scooter Level 1 – for balance and hip strength

  • Standing with feet hip distance apart and weight into the right foot, and ball of left foot on the floor (heel lifted)
  • Try to keep the weight in the right heel to focus the effort through the gluteal (hip) muscles
  • Inhale to prepare
  • Exhale, slide the left foot behind you
  • Inhale, slide the left foot forward to the starting position
  • Repeat 10 times and then repeat on the other side

Breast Stroke Prep Level 1 – for upper spinal strength (extension)

  • Lying down on your front, rest your forehead on a small cushion/folded towel. Keep the back of the neck long and rest your arms by your sides with palms upwards. Lengthen your low back by thinking of drawing your tailbone away from the crown of your head and towards your heels.
  • Inhale to prepare
  • Exhale, widen your collarbones and draw your shoulders away from the floor as you slide the shoulder blades gently down towards you hips, then lift the arms to hover 1-2” from the floor
  • Inhale and hold the position
  • Exhale, relax the shoulders and arms to return to the starting position
  • Repeat 10 times

Swimming Level 4 Arms Only – shoulder and wrist strength

  • Begin in four point kneeling
  • Inhale to prepare
  • Exhale, reach the right arm forwards off the mat to eye level
  • Inhale, lower the arm back onto the mat
  • Exhale, reach the left arm forwards off the mat to eye level
  • Inhale, lower the arm back onto the mat
  • Repeat 10 times with each arm

Take our Online Osteoporosis Course now!

Reference List

Endera A, Erden Z, Can F 2015 The effects of clinical pilates exercises on bone mineral density, physical performance and quality of life of women with postmenopausal osteoporosis.Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 849-858

Chan KM, Anderson M, Lau EMC 2003 Exercise Interventions: Defusing the world’s osteoporosis time bomb.Bulletin of the World Health Organisation vol 81 no. 11

Meeks, S 2005 The role of the physical therapist in the recognition, assessment and exercise intervention in persons with, or at risk for, osteoporosis. Topics in Geriatric Rehabilitation January/February/March Vol 21 (1): pg 42-56

Senderovich H, Tang H, Belmont S 2017 The Role of Exercises in Osteoporotic Fracture Prevention and Current Care Gaps. Where Are We Now? Recent Updates.Rambam Maimonides Med J. 2017 Jul; 8(3)

Health Professional’s Guide to Rehabilitation of the Patient with Osteoporosis (PDF Download Available). Available from: https://www.researchgate.net/publication/

NIH consensus development conference statement: osteoporosis prevention, diagnosis and therapy. 27-29 March 2000 http://consensus.nih.gov.cons/111/111_intro.htm

International Osteoporosis Foundation, Move it or Lose it article https://www.iofbonehealth.org/sites/default/files/PDFs/WOD%20Reports/move_it_or_lose_it_en.pdf\