Exercises to approach carefully when you have osteoporosis

The goal of this article is not to frighten you away from movement. The evidence, as covered in the previous articles, is clear that appropriate exercise reduces fracture risk for most women with osteoporosis. The goal here is precision, not prohibition. Some movements place specific types of stress on the vertebrae that are worth understanding, particularly if your bone density is low at the spine or if you have already had a vertebral fracture.

Why the spine needs particular consideration

The lumbar and thoracic spine are among the most common sites for osteoporotic fracture, and specifically for vertebral compression fractures. These fractures can occur without a fall, simply from the forces generated by certain movements. Understanding which movement patterns place the highest stress on vertebrae helps you make informed decisions about your exercise choices.

The two movement patterns that warrant the most caution are:

• Spinal flexion under load: bending the spine forward while carrying weight, or forceful forward bending against resistance

• High-impact loading of the spine: activities that create strong compressive forces through the vertebral column

Spinal flexion: what to be aware of

Exercises and movements that involve forceful, loaded, or repeated forward bending of the spine include:

• Sit-ups and crunches, which generate significant flexion force at the lumbar spine through the weight of the upper body

• Toe touches and standing forward bends with straight legs, particularly when performed quickly or with added resistance

• Rowing machines, which place the spine in repeated loaded flexion

• Certain yoga poses including deep forward folds, particularly when performed with momentum or held under load

• Pilates exercises involving spinal flexion, particularly those where the weight of the legs provides a lever against the spine

This does not mean these movements must be eliminated entirely. Many physiotherapists work with women with osteoporosis to modify rather than remove these movements, adjusting range of motion, load, and technique to maintain the benefit while reducing the spinal stress.

High-impact activities: when to exercise caution

As covered in the previous article, impact exercise is beneficial for bone density and is appropriate for many women with osteoporosis. However, very high impact activities may warrant modification or avoidance for women with severe bone loss or a history of vertebral fractures.

Activities that may carry higher risk in this context include:

• Running on hard surfaces, particularly at high speed or for long distances

• High-impact aerobics involving jumping, particularly repetitive jump-landing combinations

• Contact sports where falls or collisions are likely

• Activities involving a high risk of tripping or falling on uneven terrain without adequate balance preparation

The threshold for what constitutes appropriate impact varies significantly depending on the individual. A woman with a T-score of -2.5 at the hip and no previous fractures may be well suited to jogging. A woman with a T-score of -3.5 and a history of vertebral fracture requires a more conservative approach.

Twisting movements under load

Rotational movements of the spine, particularly under load or at speed, can place shear forces on vertebrae that are worth being aware of. This does not mean avoiding all rotational movement, which is both impractical and unnecessary. It means being thoughtful about high-speed or high-load rotational activities, particularly those that combine rotation with forward flexion.

Golf is a sport that comes up frequently in this context. The golf swing involves significant spinal rotation and flexion under load. Many women with osteoporosis play golf safely, but it is worth discussing with a physiotherapist, particularly if spinal bone density is significantly low.

Movements that carry a fall risk

Any activity with a significant risk of falling warrants consideration in the context of osteoporosis, not necessarily to avoid it, but to approach it with appropriate preparation and precautions:

• Cycling, particularly road cycling, carries a fall risk that increases with speed and traffic

• Skiing and snowboarding involve high-speed falls onto hard surfaces

• Horseback riding involves falls onto hard ground from height

• Activities on unstable surfaces such as paddleboarding or trampolining

The decision about whether to participate in these activities is personal and depends on the individual woman's bone density, confidence, experience, and risk tolerance. Many women with osteoporosis continue activities they love with appropriate precautions. The goal is informed choice, not prohibition.

The most important message

Movement is medicine. The exercises in this article warrant thoughtfulness, not avoidance. Modifications rather than prohibitions are almost always the answer, and working with a physiotherapist or exercise physiologist experienced in osteoporosis is the most effective way to find the approach that is right for you specifically.