Introduction #2352

Osteoporosis Guidelines

5 min - Introduction


Mary Oates from the National Osteoporosis Foundation gives an overview for guidelines to help you find the tools you need to stay happy, healthy, and independent with osteoporosis.
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Mar 13, 2016
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Hi, my name is Dr Mary Oates. I specialize in physical medicine and rehabilitation. I've been focusing on osteoporosis evaluation, prevention and treatment for the last 24 years in the osteoporosis field. I work with the international society of clinical densitometry. I'm a certified interpreter for the Dexa scans that are used to give you a bone score to tell you how strong your bones are and for the National Osteoporosis Foundation, I am a clinical advisor and I'm also a chairman and the founder for the fracture liaison service.

That program is a very important international movement that is helping us target patients that experience for agility fractures. We want to devote resources to identifying and educating these patients and getting them treated so they don't suffer the next devastating fracture. The exercise and Rehabilitation Advisory Council is an important part of the National Osteoporosis Foundation. It brings together nutritionists, clinicians, physical therapists, and community outreach educators to come up with guidelines and best practices on how we can all strengthen our bones and prevent falls, which lead to devastating fractures. National Osteoporosis Foundation is committed to partnering with public and private organizations to prevent osteoporosis. Educate clients, educate patients and physicians and other healthcare providers to avoid the devastating for agility fractures that can occur with osteoporosis.

So we also see patients in our practice that have osteoporosis. They have weakened skeletal structure. And so what we want to do is keep these patients active because the most common request I get from patients is how can they stay healthy? How can they stay active and therefore be independent? So what we want to do is give you tools on how to do your favorite activities to do your activities in your home, but to do them safely.

For people that have normal bone density or normal bone strength and want to maintain it, we want to emphasize weight bearing activity. Weight bearing activity is when you're standing and your body weight is being transferred down through the bones to your feet. So that's weight bearing activity. Higher impact activity such as jogging, um, or running is better than low impact activity like walking. But please don't forget about how important walking is for cardiovascular and muscle strength.

We also want to emphasize muscle strengthening exercises because muscle strengthening and bone strengthening is site-specific. If you lift a hand weight, you strengthen your arm, which puts tension on your bone, which strengthens the bone in your arm. So walking and strengthening activities for the legs will strengthen the bones and the muscles in the legs and upper extremity exercises. We'll do that for your arms for the spine. The research has shown that back extensor strengthening exercises will actually increase bone strength in your back and reduce fractures later in life.

So the four main goals that we have for maintaining your bone strength is a walking program, a balance program, a muscle strengthening program, and a specific back extensor strengthening program. Walking is a very important part of any program. It maintains bone, mineral density and muscle strength. It won't actually build bone, but if you don't walk, you'll lose bone and you'll lose muscle mass. So it's very important and we recommend three to five times a week for about 40 minutes for patients who have osteoporosis. Then we want to avoid certain activities that can cause fragility fractures. So there's four main points that we need to discuss.

One is we don't want you to do jarring activities such as running or jumping that can cause compression of the spinal bones in the back. The second is we don't want you to do anything with forceful forward flection. The curvature at the spine with forces applied can collapse the front part of the vertebrae. We also don't want you to do high risk sports such as skydiving or going on a zip line that can make accidents more common. And lastly, we would prefer that you don't lift anything heavier than 20 pounds and for all lifting you safe lifting techniques and keep, um, objects as close to your midline as possible. I practiced Yoga and plotters myself and so I don't wanna, I don't want anybody to be discouraged from doing their favorite activities.

I want them to learn the modifications that they can use so they can continue to practice their plots. In Yoga in particular, uh, pilates, reformer activities are much more suited to a stable spine, um, for activities for people that are new to Palazzos with osteoporosis. Here at the National Osteoporosis Foundation, we want you to stay active. So we've compiled a short video series on ways that you can be safe in your activities at home and be safe in your activities and recreation. We hope you enjoy them and look forward to you visiting or


Please clarify whether with "osteopenia" level of bone density, that loading such as jogging would be advised. ACSM research has recommended such back in 2004. Have guidelines changed? Would Reformer Jump Platform work be less of an impact and safe for osteoporosis due to the supine posture? Thank you for keeping the Pilates community informed. I appreciate your knowledge.
Sherri Betz
1 person likes this.
Hi Kathleen,
Great question! The current expert opinon recommendation for safe jogging is greater than a -3.0 Tscore. This is highly dependent upon previous history of fracture, height loss, kyphotic posture, rib to pelvis distance, core control, body awareness and proper running technique. I take many things into consideration before I recommend running in someone with either osteoporosis or osteopenia.
Sherri Betz
As for Reformer Jumping, there is no research on this regarding fractures or effect on bone density. There would be less impact on the spine with the supine position and I think that Reformer jumping is a great preparation for dynamic activities in standing/vertical position. Guidelines are changing rapidly. The APTA Bone Health Special Interest Group is working on a Clinical Practice Guideline document that will summarize all known research and provide a new set of guidelines for osteoporosis. You can also find a good bit of information on questions such as these at and at
While this is informative and helpful, the whole notion of the dexa scan was not even discussed, specifically that these bone scans are a group of women in their mid 20's and is not a control group. There is no background on the gene pool of this group, etc. anyone beyond their 40's is not going to fare well taking these scans. tnis is information that people need to delve more into before being "diagnosed" with a "condition".
Jamie H
1 person likes this.
This is an interesting and informative video. Its so crucial that a walking program, balance program, muscle strengthening program, and back strengthening program be implemented on a regular basis.
Joyce Dev
1 person likes this.
Thank you as always for providing educational videos such as this. Most of my clients are 40 plus and want to keep doing flexion exercises despite having a diagnosis of osteopenia and osteoporosis. This demographic of our clientele need education and reminding of the latest bone health research. Please keep bringing this vital information to the Pilates community.
1 person likes this.
I have osteopenia. Is plank and fore-arm plank safe?
Sherri Betz
1 person likes this.
Hi Theresa,
Yes, plank and forearm plank are safe.
2 people like this.
Can you give an example of "forceful forward flexion"? And more specifically I want to know if any exercise where your head lifts off the ground is unsafe for someone with osteoporosis? I believe so, but just checking. Thanks for great info!
thanks great video
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