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).

It is ideal to focus on bone health early on. It is never too late to make positive changes.

One of the positive changes is starting a practice of thePilates method.

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.

image of senior woman lying on a Pilates reformer with a ball between her knees
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A traditionalPilates class is not suitable for some people with low bone density. If you want to work with a certified instructor who understands osteoporosis, you should work one-on-one with him.

Prevents bone deterioration

The research on bone density is not conclusive. Some studies show an increase in bone density, while others show no increase 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.

The bones need to be dense and resilient to handle all different forces. She recommends weight training to add to your physical activity. The bones have to adapt to heavier loads.

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 used to relax the nervous system. Enhanced self-awareness makes the individual responsible and in charge and more likely to make adjustments 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 the leading cause of osteoporosis.

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.

Poor posture and alignment can cause compression of the joints and organs.

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 important for a controlled range of motion. It is a vital part of overall health and helps with ease in everyday and extracurricular activities.

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

There are many signature Pilates exercises that are safe and 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.

The benefits of standing Pilates, foot strengthening, and balance-enhancement exercises include weight bearing and help with prevention of falls. Adding resistance such as therabands or weights is even better since it helps improve bone quality.

If you can use the reformer, chair, or tower, you will build more strength because of the resistance created from the springs.

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

Flexion and twisting are not appropriate for bone tissue that is compromised.

Rolling in a curved position on your back is a concern. Rolling Like a Ball, Open Leg Rocker, Control Balance, Jackknife, and Roll Over are some of the exercises that are included in these.

The best exercises to avoid are those that combine the side bending, the rotation, and the flexion.

Even though excessive bending, twisting, andlateral bending are not good for osteoporosis, we are not robots that walk, move, and perform in a linear fashion.

There are many movement options with an osteoporosis diagnosis. You can still mobilize through rotation if you avoid loaded thoracic flexion.

A good instructor will prepare, strengthen, and stretch your body in a safe manner. If you want to try a sport that is safe for you, you should find a qualified instructor.

Many of the exercises in thePilates program can be used to strengthen the bones.

Take for instance, all of the abdominal strengthening exercises that have you curved forward. Lifting the head and shoulders is enough to modify the movement.

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.

It is recommended to work with a qualified instructor or a specialized class.

Osteoporosis is a disease that can be treated with the use of a fitness program.

Before starting an exercise regimen, it is important to consult with your healthcare provider, as well as 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.

Anyone with osteoporosis can benefit from the many movement options in modified Pilates.