increase bone mass, slow bone loss, and/or reduce the risk of fractures.

Weight bearing aerobic exercise

depending on the severity of osteoporosis, patients may exercise in a weighted vest to stimulate osteoblastic activity

Resistance exercise

consistent effects are generally noted in spine bone density

flexion activities (sit ups, abdominal machines) can increase pressure on compromised vertebral bodies and increase risk for fracture

no combined flexion with rotation exercises in trunk

limit closed chain hip internal/external rotation activities to decrease torsion through femoral neck

avoid high velocity, high impact activities

begin weight training at low intensities with low repetitions (6-8) to minimize fracture risk; progress to 1-3 sets of 8-12 repetitions of resisted exercise

an alternative to a curl up for abdominal strengthening is a straight leg raise with a stable lumbar and pelvic spine

Woman lifting a straight leg for abdominal strength
Abdominal strengthening without flexing spine

Spine exercises

strong evidence that back extension exercise can markedly reduce compression fracture risk

Woman lifting elbows out to side raising trunk
Woman lifting rib cage up using arms

Woman lying on belly with pillow under front of pelvis, raising arms overhead and raising legs up off the follor
Prone spine extension exercises

Body Mechanics Training

  • posture awareness: emphasis on increasing control and activation of trunk extensors during postural activities, ADLs, and iADLs
    • hip hinging
    • hip and back extensor strengthening
  • log rolling for bed mobility
  • correct body mechanics for push/pull, lift, carry, etc.

Image of woman gardening when kneeling on pad compared to woman bending at the spine
Woman gardening with good and impaired body mechanics

Visit this recent New York Times Article about patient-centered interventions for fall prevention:


spinal orthoses can be customized or prefabricated for pain management and joint protection

alternative accessible content Kyphosis brace 2Dr. Weiß / CC BY-SA (

Fall prevention

exercises to target stiff and weak muscles should include some firm UE support to minimize risk for falls during unsupervised exercise

balance exercises: standing in a corner for safety or using a chair for support; narrow base of support and progressing to one leg

Woman standing on one leg with chair
Standing on one leg

home assessment: identify areas and objects within the home that may increase risk for falls or repeated trunk flexion motions

Health and Wellness Education


Exercise Self-Test

Select the images which are most appropriate for strengthening in a patient with osteoporosis

A. Medicine Balls.jpg

B. Hip Extension.jpg

C. Trunk flexion with resistance.JPG


 Show quiz question