Osteoporosis is a widely spread affliction of the bone system. According to the WHO, in the US, Europe and Japan alone this condition affects 75 million people. Estimates are that one-third of women and one-fifth of men over 50 suffer a fracture due to osteoporosis at one time in their life. Osteoporosis is also called the “silent disease”; the disease is progressive and symptom-free until the first fracture. Two-thirds of the fractures (mainly in the vertebrae) are found “accidentally”. Once diagnosed, there is no cure for the disease. Osteoporosis can be kept under control only by lifestyle changes (diet and exercise) and medication. Therefore, awareness and prevention cannot be overestimated. In some countries, osteoporosis screening is standard from the age of 50, but in Belgium it is not. Even if you practice or wish to start practicing Pilates (or any form of exercise) and are over 50 years old, it is important to take this factor into account. Pilates, as well as yoga and other forms of exercise, can be the cause of bone fractures if you fail to take the necessary precautions. On the other hand, following a correct diagnosis, the Pilates method can be a fantastic tool to strengthen the bones and muscles and improve posture and balance.

Osteoporosis literally means “porous bone”. The skeleton has two types of bone, i.e. cortical bone (the enveloping part of the bone) and trabecular bone (the inner part).

Cortical bone (80% of the skeleton) has a dense structure.  Trabecular bone has the structure of a sponge, with open spaces inside it. It is located among others in the vertebrae (65%), the femoral neck,… Precisely this trabecular bone is prone to osteoporosis. Therefore, most fractures occur in the wrist, vertebrae and femoral neck.

Up to about the age of 25, the density of bone tissue increases, reaching its maximum value around that age. Cells in the bone tissue ensure that bone formation and resorption are balanced, “renewing” the entire skeleton once every 10 years. When bone resorption exceeds bone formation, the bone structure becomes more brittle and prone to fractures. After the age of 25, bone density decreases but generally remains relatively stable until about 50 years of age. The primary population group in which bone density decreases are women after menopause. Due to the dramatic decrease in estrogen, the bone loses its density at a rapid pace. Nonetheless, men and young people may also face a decrease in bone density.


The best way to know the skeleton’s condition is by performing a bone mineral density (BMD), using a DEXA scan (Dual-energy X-ray absorptiometry). The result of the scan is expressed in a so-called “T-score”. The reference value is a T-score of 0, the optimal bone density of a 25-year-old. A T-score between -1 and -2.5 is an indication of “osteopenia”, the precursor to osteoporosis (mild to moderate bone density loss). Scores below -2.5 are an indication of osteoporosis.

Risk factors for osteoporosis:

  • Age: risk increases in over 50-year-olds and accelerates in 65 to 70-year-olds
  • Decreased estrogen level, menopause in women
  • Genetic factors
  • Sedentary lifestyle, little exercise
  • Certain medications (steroids)
  • A lack of calcium, vitamin D
  • Smoking
  • Excessive alcohol consumption
  • Low BMI

Signs that may be indications of osteoporosis:

  • Height loss
  • Kyphotic posture (pronounced forward curve in the upper part of the spine)


Pilates is more than a set of exercises, it is about working consciously and developing proprio- and interoceptive ability; the fundamental principles of the method are of great value in the prevention of and work with osteoporosis. We work on (understanding) a better posture, and on moving more consciously (and thus in a more biomechanically correct manner). The method strengthens the posture-supporting muscles and works on balance. We consider the body as a tensegrity, each exercise is integrated; working with energy in opposition has a direct positive effect on bone strength.

However, when you have been diagnosed with osteoporosis, you do not belong in just any Pilates group class. While private sessions are of course always the ideal solution, a limited group lesson, factoring in osteoporosis, can be a valid alternative.

Traditional matwork, as developed by Joseph Pilates, includes many flexion exercises (i.e. exercises that make the spine round forward, as in a large part of the abdominal exercises that make up a significant part of the repertoire) and rotations. These cause compression on the front of the vertebrae and are not only not suitable for osteoporosis patients but may be a direct cause of fracture. For people with osteoporosis only a matwork lesson adapted to the prevention measures concerning osteoporosis is an option.

Keeping in mind these limitations, Pilates can help in building up the bone mass by straining the bones in an axial direction (while respecting biomechanical alignment, one of the foundations of the method) and by strengthening the muscles. The emphasis in a Pilates class with a focus on osteoporosis is on strengthening the muscles, in such a way that the muscle strain on the bones activates the bone cells to produce more bone. We work mainly with a neutral back, with very limited flexion or rotation. Exercises for the back muscles are important; in extension, the vertebrae are strained in a manner that makes the bone become stronger. We practice conscious, deep breathing to relax the chest joints. Balance is also an important factor in the lesson, of paramount importance towards fall prevention. We work on strengthening the legs, so lifting and bending can be done without additional strain on the back. Also -and especially- the work with Pilates equipment, which significantly increases bone resistance, is interesting for patients with osteoporosis.

It is of the utmost importance to have a clear diagnosis when you want to start taking Pilates. This way the Pilates lesson can become an enrichment for the person suffering from osteoporosis.