Osteoporosis is a condition that weakens the bones, making them brittle and susceptible to fractures.

It predominantly affects women over age 50 and increasingly more and more men as well as young women. The current trajectory predicts an epidemic by 2050 with staggering economic and personal costs (1, 2).

Focusing on bone health early on is ideal in terms of prevention. However, it’s never too late to start making positive changes.

One of those positive changes could be embarking on a Pilates practice.

Rebekah Rotstein, a Pilates instructor and ambassador for American Bone Health, created Buff Bones®, a medically endorsed system of movement that utilizes Pilates amongst other modalities. Rotstein emphasizes that “Pilates can be beneficial [for those with osteoporosis], but needs to be modified appropriately”.

A bone-friendly Pilates class has numerous benefits for overall bone health and is safe for those with low bone density, osteopenia, or osteoporosis.

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Pilates can improve your quality of life with osteoporosis, but it’s important to note that a traditional Pilates class is not suitable for some one with low bone density. Your best bet is to work one-on-one with a certified instructor who understands osteoporosis and can customize a program specifically for you.

Prevents bone deterioration

The research about Pilates and bone density is inconclusive. Some studies report an increase in bone density, while others found none at all.

While most studies about Pilates and osteoporosis find very little increase in bone density after practicing Pilates, they do, however, positively note that Pilates can prevent further bone deterioration, and that it’s a safe workout with many other benefits (3, 4, 5, 6, 7).

While bone density is an important component of bone health it isn’t the only factor that (literally) makes or breaks your bones.

Rotstein reminds us that bones need to be resilient as well as dense to handle all different kinds of forces. While Rotstein is an advocate for Pilates, she highly recommends adding weight training to your physical activity. To increase bone density, the bones must adapt to heavier loads put on the body.

Decreases pain and improves quality of life

Some of the foundational principles of Pilates include the breath, concentration, precision, and flow making it a true mind-body modality that enhances self-awareness (8).

Breathing can be a means of relaxation and calming the nervous system. Enhanced self-awareness makes the individual responsible and in charge and more likely to make adjustments necessary for their own well being.

Studies have shown that Pilates decreases pain, improves quality of life, boosts mood, decreases stress, and is a safe and beneficial form of exercise (5, 9, 10, 11, 12).

Improves balance and prevents falls

Falling is detrimental to anyone with osteoporosis and is the leading cause of fractures.

Pilates is excellent not only for the physiology of improving balance and gait but for the result of confidence it instills in maintaining one’s independence (12, 13, 14, 15).

Improves posture and alignment

Optimal posture and alignment allows the body to move and function with more ease.

Misalignment and poor posture contribute to compression of the joints and organs along with tight and imbalanced muscles.

Pilates’ combination of strength, mobility, and flexibility with a focus on optimal alignment can result in less pain (13, 16, 17, 18, 19).

Improves mobility

Mobility is achieved through a balance of strength and flexibility.

Mobility is essential for a controlled and optimal range of motion in the joint. It fits in with overall health as a vital part to alignment, strength, and balance for ease in everyday and extracurricular activities.

Pilates exercises are a slow, controlled combination of strengthening with stretching that improves mobility (13, 20, 21).

When it comes to Pilates matwork, there are plenty of signature Pilates exercises that not only are safe, but highly beneficial for anyone with osteoporosis.

Muscle-building exercise is widely prescribed to help those living with osteoporosis (22). Exercises that stabilize and strengthen the hip, spine, and wrist are invaluable when you consider these are the main joints susceptible to fractures (23).

All of the Side Leg Series and Bridge variations emphasize core strength, alignment, and balance while strengthening the muscles around the hip.

Back extension and strengthening exercises are especially important and should be emphasized (except in the case of stenosis or spondylosis). Exercises in quadruped position (on all fours) and plank variations are great for full-body conditioning as well as wrist strengthening.

Standing Pilates, foot strengthening, and balance-enhancing exercises are also excellent because they are weight bearing and help with prevention of falls. Adding resistance such as therabands or weights are even better since weight-bearing with additional load is what helps improve bone quality.

Along the same lines, if you’re able to use Pilates equipment such as the reformer, chair, or tower you’ll build more strength due to the resistance created from the springs.

Many of the more traditional Pilates exercises are not suitable for anyone with osteoporosis.

Excessive flexion (rounding your back) and twisting are inappropriate for compromised bone tissue.

Loaded flexion or exercises that involve rolling in a curved position on your back are also a concern. These include Pilates exercises such as Rolling Like a Ball, Open Leg Rocker, Control Balance, Jackknife, and Roll Over.

Exercises that combine lateral flexion (side bending), flexion, and rotation are best avoided.

It should be noted that even though excessive flexion, twisting, and lateral flexion are contraindicated for osteoporosis, we are not robots that walk, move, and perform in a linear fashion.

Rotstein says “People should be aware there are so many movement options with an osteoporosis diagnosis! Certainly avoiding loaded thoracic flexion is key, but you can still find ways to mobilize through rotation that is isolated and safe.”

A good Pilates instructor will prepare, strengthen, and still mobilize and stretch your body in a safe manner. If you are living with osteoporosis and want to try Pilates, start by finding a qualified instructor to guide you safely.

Many of the Pilates exercises can be bone-friendly and safe for osteoporosis with a few modifications.

Take for instance, all of those abdominal strengthening exercises that traditionally have you curved forward. Simply omit lifting the head and shoulders to modify the movement appropriately (which by the way, makes those ab exercises more challenging!).

Incorporating a hip hinge with a neutral spine instead of rounding the body forward keeps the spine straight and sets the body up for optimal load transmission through the joints.

Working with a qualified and knowledgeable instructor or a specialized bone-safe Pilates class is recommended.

Pilates for osteoporosis is an invaluable tool to be included in your lifestyle for optimal bone health.

It’s important to consult your healthcare provider before starting a new exercise regime and to work with a knowledgeable Pilates instructor or participate in a specialized bone health class.

The benefits of better coordination, core and hip strength, optimal posture, and balance are key for preventing falls as well as preparing the body for activities with higher loads (such as weight training).

Modified Pilates includes many movement options for anyone with osteoporosis to remain healthy, strong, and fracture-free.