Margaret Martin, Physical Therapist

Is The Side Bend Safe for Your Spine ?

Margaret Martin — Sun, 07 Sep 2025 14:44:38 +0000

September 7, 2025

If you’ve been diagnosed with osteoporosis or osteoarthritis of the spine, there’s one popular move you’ll want to consider modifying: the side bend. Whether it is performed as a standing side bend or a seated side bend, this stretch can be unhealthy for your spine and put it at risk of a vertebral compression fracture.

Side bend exercises, performed with or without weights are popular in gym classes, fitness videos and senior exercise classes. This popular exercise could put your spine at risk of a compression fracture or an osteoarthritic flare up. (1, 2, 3)

After I explain how side bends can harm your spine, I will share two great alternatives that will make your spine feel great and allow you to put your mind at ease.

Standing Side Bend and Seated Side Bends

The standing side bend and seated side bend exercises create what’s called “an asymmetrical loaded compression” on your vertebrae and the facet joints.

Here’s what happens to your spine during this movement:

Uneven weight distribution: Instead of your spine bearing weight evenly and leveraging all of the trabeculae, all the force concentrates into the side you are bending towards. This means fewer trabeculae support the vertebral body.
Excessive compression: The weight of your head (about 11-12 pounds), shoulders, upper body, and any additional weights you’re holding gets channeled through a smaller surface area in your spine.
Increased fracture risk: For people with osteoporosis, this concentrated pressure significantly raises the risk of compression fractures.
Arthritis aggravation: If you have arthritic spinal joints, you have a disproportionately higher load being taken through the facet joints on the side you are bending towards. This loading pattern can trigger painful flare-ups.

The bottom line? If you have osteopenia, osteoporosis, or osteoarthritis of your spine, you are not helping your spine with loaded side bends, rather you may be hurting yourself. (1,2,3)

This is why I want to show you two wonderful alternatives.

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Two Safe Alternative Side Bends

Don’t worry! You don’t have to give up that satisfying side stretch entirely.

Here are two spine-safe alternative side bends that provide the same range of motion without the dangerous loading.

Option 1: Hands and Knees Side Bend

Setup:

Get on your hands and knees with hands directly under your shoulders
Keep your elbows slightly bent (bonus: this gives your triceps a gentle workout!)
Use knee pads if kneeling is uncomfortable

The Movement:

Bring your right shoulder forward while moving your right pelvis back
Focus on opening up the entire side body
Take a breath in, then exhale as you return to center
Repeat on the other side
For a deeper stretch: Place your right hand over your left hand for additional side opening

Why it’s safer:

This side bend does not load the weight of your head, shoulders, or upper body onto a small portion of your spine. This allows you to get that satisfying stretch without risk of a vertebral compression fracture.

Option 2: Lying Down or Supine Side Bend

Setup:

Lie on your back with legs straight
Raise both arms overhead
Place a pillow under your head/neck for comfort if needed
If shoulder compression feels uncomfortable, place a pillow under your arms

The Movement:

Walk your feet away from your body’s midline
Simultaneously walk your shoulders in the same direction
Continue until you feel a “delicious stretch” through your entire side body
Hold and breathe, then slowly return to center

Side Bend smart exit strategy:

If you feel pulling in your lower body: Come out with your upper body first
If you feel more stretch/pulling in your upper body: Lead with your lower body when returning to center.

Why These Side Bend Modifications Matter

These alternatives give you the satisfying range of motion and side body opening that you crave, but with a crucial difference: minimal to zero spinal loading.

You do not have to worry about the uneven loading created by your upper body weight being placed through your vertebrae.

Instead, you can enjoy the feeling of stretching your muscles and fascia knowing your keeping your spine free from harm.

Conclusion

Too many people contact me after injuring themselves while “just trying to help themselves” by following along with exercise classes or workout videos. If you have osteoporosis, osteopenia, or severe osteoarthritis, generic fitness routines aren’t designed with your specific needs in mind.

These simple modifications are not limitations—they empower you by learning intelligent alternatives so you can stay active for years to come.

The goal is to avoid vertebral compression fractures and arthritis flare-ups that could sideline you from the activities you love.

These spine-friendly side bend alternatives will keep you moving while protecting your most important structural support system — your spine.

Margaret Martin

Margaret Martin is a Physical Therapist with 40 years of clinical experience. Her expertise is in the treatment and prevention of osteoporosis through exercise, safe movement and fall prevention. For the last 20 years, she has concentrated on bone health and has treated thousands of patients for their osteoporosis, osteopenia and low bone density.

References

Marras WS, Granata KP. Spine loading during trunk lateral bending motions. J Biomech. 1997 Jul;30(7):697-703. doi: 10.1016/s0021-9290(97)00010-9. PMID: 9239549.
Wiatt E, Flanagan SP. Lateral Trunk Flexors and Low Back Pain: Endurance and Bilateral Asymmetry. Athletic Therapy Today. 2009 May
Sungwook Kang, Chan‑Hee Park, Hyunwoo Jung, Subum Lee, Yu‑Sun Min, Chul‑Hyun Kim, Mingoo Choi, Gu‑Hee Jung, Dong‑Hee Kim, Kyoung‑Tae Kim, Jong‑Moon Hwang.

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Is The Spine Twist Safe If You Have Osteoporosis?

Margaret Martin — Fri, 05 Sep 2025 14:37:46 +0000

September 5, 2025

Many of my clients tell me about a “really great morning stretch routine” they’ve discovered that “increases thoracic mobility and range of motion”. However, when they demonstrate these routines, I often notice they include the spine twist. These are unsafe for them due to their either their osteoporosis, osteopenia or low bone density. In this post, I’ll show you two alternative ways to safely perform the spine twist (sometimes called the “t spine twist”, “torso twist”, or “thoracic twist”).

Spine Twist

The spine twist can help improve the mobility of our rib cage. However, when you have osteopenia or osteoporosis, doing a spine twist in sitting or standing can increase your risk of a vertebral compression fracture.

It’s important to note that while most of the rotation during the spine twist occurs in the thoracic region of your spine, there is also rotational movement happening in the cervical (neck) and lumbar (low back) regions of the spine.

Avoid the Standing Spine Twist and Sit Twist Exercise

It’s impossible to completely avoid twisting your spine during daily activities — turns and rotations are natural parts of everyday movement. However, if you have low bone mass, osteopenia, or osteoporosis, you should avoid doing full twisting motions while sitting or standing.

This is particularly important when you twist only from your spine without moving your pelvis or feet. These isolated spinal twists can put extra stress on weakened bones and potentially cause a vertebral compression fracture.

Later in the post, I have a video where I demonstrate how to do common activities of daily living without incorporating a spine twist.

Standing Spine Twist

When you stand straight, your spine supports the full weight of your head, shoulders, and arms. Adding a twisting motion creates what’s called a “loaded twist motion” — you’re twisting your spine while it’s under pressure. For people at risk of a vertebral compression fracture, this combination of uneven load and twisting, significantly increases the stress on your spine and can cause a compression fracture or worsen an existing injury.

You might think this doesn’t apply to you if you don’t have a compression fracture. But here’s an important fact: studies show that about 70% of people with osteoporosis actually have compression fractures they don’t know about.

Many of these fractures happen with little to no pain, so you may not realize you have one. The problem is that the spine twist and other risky movements can make existing compression fractures worse or cause new ones in nearby vertebrae.

Sit and Twist Exercise

Most people do not realize that when you do the spine twist you potentially create 40% more load on your spine than standing! My advice: Avoid the sit and twist exercise if you have osteoporosis, osteopenia or low bone density.

Spine Twist and Vertebral Compression Fracture Risk

Vertebral compression fractures most commonly occur in the middle portion of the thoracic spine, (T6, T7, T8) though they also commonly occur closer to the low back, most commonly at T12 and L1. Compression fractures rarely occur in the cervical spine (neck area).
The problem for people with osteoporosis or osteopenia is significant. The movement involved in the traditional spine twist performed while standing or sitting (often found in Pilates, yoga and aerobic exercise classes) puts them at much greater risk of vertebral compression fractures compared to the general population.

Unfortunately, most fitness, Pilates, and yoga instructors aren’t aware of this risk. Even more concerning, many people don’t realize they’re at risk for compression fractures until they’re actually diagnosed with one.

Let’s explore two much safer alternatives for performing the spine twist. In both cases, we do a supine spine twist lying on the floor.

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Supine Spine Twist and Mobility: Option #1

Before trying any new stretch, I highly encourage you to get a recommendation from your physical therapist about whether the supine spine twist is safe for you.

This safer approach uses two key modifications: first, we’ll use a towel at the waist to support your lumbar curve and the space between your pelvis and ribs. Second, we’ll place a pillow behind your back. The thickness of this pillow depends on your flexibility level.

This supine spine twist is actually a modified Feldenkrais movement called the shoulder spine integrator.

Supine Spine Twist Setup and Execution

Start by lying on your side with the towel positioned in the hollow of your waist. Position your arms out at 90 degrees from your body, creating a straight line with your shoulders and pelvis. Your knees and hips should also be at 90 degrees.

From this position, sweep your top hand across the forearm of your bottom hand and bring it to rest at your breastbone. Then reach back toward the pillow. The pillow should provide enough support that you can feel it and rest into it comfortably. If it doesn’t offer adequate support, adjust accordingly.

Take a deep breath in, then exhale as you rotate back into the pillow.

Supine Spine Twist Hand Placement Options

There are two reasons I recommend bringing your hand to your breastbone rather than extending your arm fully. First, depending on the health of your neck, you have an alternative: you can bring your hand to rest on your bottom ear, transitioning it to your top ear as you rotate.

The second reason is crucial for safety. If I allowed you to bring your arm all the way back, the movement would shift from active rotation (using your own muscles) to passive rotation (where the weight of your arm pulls you down). This means your body would go beyond its active limits, which isn’t safe.

By keeping your hand either on your bottom ear or at your breastbone, you maintain control while still achieving excellent rotation. Most of this rotation occurs through the thoracic spine — the part of your spine with ribs attached.

Lying Twist Stretch and Mobility: Option #2

If you want to focus slightly more on the lower lumbar spine area (though most rotation still happens in the Thorcic spine), here’s another safe alternative. You can use a pillow for this variation.

Lying Twist Stretch Setup and Execution

Lie flat on your back and continue using the towel support at your waist. This time, place the pillow down beside your knees. You can open up your chest, which creates a nice variation of the stretch.

Shift your hips about an inch away from the side you’re going to rotate toward. Take a breath in, then exhale while dropping your knees to that side, creating a gentle rotational stretch.

Without the pillow, you would be “hanging” in the stretch, which creates a greater twist.
However, since I don’t know each person’s individual situation—and many people might have compression fractures without realizing it—I’m not comfortable suggesting that everyone can safely do the more intense version.

This is why it’s always best to check with your individual therapist.

Lying Twist Stretch Proper Positioning

Breathe in and exhale as you lower your knees to the side
Position the pillow close enough to support your thighs so you can relax into the stretch
Focus on breathing deeply into the stretch
Remember to always roll over onto your shoulder when transitioning back up to a sitting position.

How to Safely Twist Doing Activities

I demonstrate how to modify your activities of daily living so that your twist and rotation movements are safer.

Conclusion

One of my main motivations for creating these educational posts is to help you avoid compression fractures or arthritis flare-ups in your back. I receive too many emails from people saying, “But I was just trying to help myself”—people who were simply doing exercises or following along in fitness classes.

If you know you have osteoporosis or severe osteoarthritis, please make these modifications to keep your spine safe. Your long-term spinal health is worth the extra precautions.

Margaret Martin

References

Takano, H. , Yonezawa, I. , Todo, M. , Hazli Mazlan, M. , Sato, T. and Kaneko, K. (2017) Biomechanical Study of Vertebral Compression Fracture Using Finite Element Analysis. Journal of Applied Mathematics and Physics, 5, 953-965. doi: 10.4236/jamp.2017.54084.
Wiklund P, Buchebner D, Geijer M. Vertebral compression fractures at abdominal CT: underdiagnosis, undertreatment, and evaluation of an AI algorithm. J Bone Miner Res. 2024 Aug 21;39(8):1113-1119. doi: 10.1093/jbmr/zjae096. PMID: 38900913.
Li, Y., Yan, L., Cai, S. et al. The prevalence and under-diagnosis of vertebral fractures on chest radiograph. BMC Musculoskelet Disord 19, 235 (2018). https://doi.org/10.1186/s12891-018-2171-y

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Gut Health and Osteoporosis

Margaret Martin — Fri, 22 Aug 2025 15:33:13 +0000

August 22, 2025

Today we’re going to explore the fascinating connection between your gut health and osteoporosis. We are going to do a deep dive into the relationship between gut microbiome and bone health, and I’ll give you practical, science-backed strategies you can start using today.

Gut Health and Osteoporosis

Recent research has discovered what scientists call the ‘gut-bone axis’ — a direct communication pathway between the bacteria in your digestive system and your bones.

Here’s how it works: Your gut microbiome — that’s the trillions of beneficial bacteria living in your intestines — plays three crucial roles in bone health.

First, it helps you absorb essential minerals like calcium and magnesium.
Second, it produces compounds called short-chain fatty acids that actually signal your bones to rebuild themselves.
And third, it regulates inflammation throughout your body, including in your bones.

When your gut health is compromised, this entire system breaks down, sadly leading to accelerated bone loss.

Link Between Gut Health and Osteoporosis

A groundbreaking study published in Food Science and Human Wellness (1) followed postmenopausal women with osteoporosis and found something remarkable. Women with healthier, more diverse gut microbiomes had significantly better bone density. Specifically, they had higher levels of beneficial bacteria families called:

But here’s the really exciting part: you’ve all heard me talk about the importance of prunes — another study showed that when postmenopausal women consumed prunes daily for 12 months, those who responded best to the treatment had distinct gut microbiome patterns. The ‘responders’ — women who actually improved their bone density — had more diverse gut bacteria and lower levels of inflammatory markers like IL-1β and TNF-α.

This tells us that having the right gut bacteria might actually determine whether bone-building interventions work for you.

Diet, Gut Microbiota and Bone Health

So what does this mean for you personally? Well, if you’ve been told you have osteoporosis or osteopenia, you’ve probably been focusing on calcium supplements and weight bearing exercise — and those are still important. But we now know that without a healthy gut microbiome, you might not be absorbing that calcium effectively, and your bones might not be responding optimally to your efforts.

Think of your gut bacteria as the construction crew for your bones. You can deliver all the building materials you want – calcium, vitamin D, magnesium – but if your construction crew isn’t functioning well, the building project suffers.

The research shows that women with diverse, healthy gut microbiomes produce more short-chain fatty acids, which literally tell your bone-building cells, the osteoblasts, to get to work. They also have better gut barrier function, which reduces systemic inflammation that can break down bone tissue.

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Gut Health and Osteoporosis: A Guide to Bone Health

Now, let’s get to the practical part — what can you actually do to optimize your gut health for stronger bones?

Strategy 1: Focus on Fiber Diversity

The research consistently shows that bacterial diversity is key. This means eating a wide variety of plant foods. I recommend aiming for 30 different plant foods per week — that includes fruits, vegetables, whole grains, legumes, nuts, seeds, and herbs. Each different plant food feeds different beneficial bacteria.

Strategy 2: Include Specific Bone-Supporting Foods

The prune study I mentioned earlier showed remarkable results. Women who ate 50-100 grams of prunes daily — that’s about 5-10 prunes — saw significant bone density improvements. Prunes are rich in phenolic compounds that feed beneficial bacteria and have anti-inflammatory effects.

Other gut-friendly, bone-supporting foods include:

Fermented dairy like kefir and yogurt
Fermented vegetables like sauerkraut and kimchi
Prebiotic-rich foods like garlic, onions, and Jerusalem artichokes
Polyphenol-rich foods like berries, green tea, and dark leafy greens

Strategy 3: Support Your Gut Barrier

A ‘leaky gut’ allows inflammatory compounds to enter your bloodstream and promote bone breakdown. To strengthen your gut barrier:

Include omega-3 rich foods like fatty fish, walnuts, and flax seeds
Eat collagen-supporting foods like bone broth
Consider zinc-rich foods like pumpkin seeds and oysters
Include glutamine-rich foods like bone broth and cabbage

Strategy 4: Minimize Gut Disruptors

Things can harm your beneficial bacteria:

Limit processed foods and added sugars
Be cautious with unnecessary antibiotics
Manage stress through meditation, gentle exercise, or other relaxation techniques
Ensure adequate sleep, as poor sleep disrupts gut bacteria

Strategy 5: Consider Targeted Supplementation

While food should be your first approach, some supplements show promise:

A high-quality, multi-strain probiotic with Lactobacillus and Bifidobacterium strains
Prebiotic fibers like inulin or galacto-oligosaccharides
Vitamin D3, which works synergistically with gut bacteria for calcium absorption

Gut Health and Osteoporosis: A Word of Caution

Now, I want to set realistic expectations. The research shows that meaningful changes in gut microbiome diversity can happen within 2 to 4 weeks of dietary changes, but bone density improvement, as you know, takes longer — typically 6 to 12 months. This is because bone remodeling is a slow process.

However, you might notice other benefits much sooner — better digestion, improved energy, and reduced inflammation markers that can occur within weeks.

Conclusion

Before I wrap up, I want to emphasize that this approach should complement, not replace, your current bone health strategy. Continue working with your healthcare provider, maintain your calcium and vitamin D intake, and keep up with strength training and weight bearing exercise.

Think of gut health optimization as a powerful addition to your bone health toolkit.

The connection between gut health and bone density represents an exciting frontier in bone health research. By nurturing your gut microbiome with diverse, nutrient-dense foods and healthy lifestyle practices, you’re not just supporting your digestive health — you’re potentially giving your bones the support they need to stay strong and resilient.

Remember, small, consistent changes can lead to significant improvements over time. Start with one or two strategies that feel manageable, and gradually build from there.

You have more control over your bone health than you might think — and it starts in your gut.

Margaret Martin

References

Pauline Duffuler, Khushwant S. Bhullar, Jianping Wu,, Targeting gut microbiota in osteoporosis: impact of the microbial-based functional food ingredients,
Food Science and Human Wellness, Volume 13, Issue 1, 2024, Pages 1-15, ISSN 2213-4530

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High Velocity Resistance Training Increases Bone Density

Margaret Martin — Thu, 21 Aug 2025 16:07:10 +0000

August 21, 2025

I want to share some exciting research that could change how you think about exercise for bone health. We’re going to talk about something called high velocity resistance training (HVRT), and I’ll explain exactly what that means and how it can help protect your bones.

A comprehensive study just published in the journal Bone (1) looked at 25 different studies involving over 1,200 people. The researchers wanted to answer one key question: Can high-velocity resistance training help build stronger bones in older adults?

The answer? A resounding yes.

What is High Velocity Resistance Training?

High velocity resistance training (also referred to as high velocity strength training) is actually simpler than it sounds. It means doing resistance exercises where you lift the weight as quickly as you can on the “up” phase, then lower it slowly and controlled on the “down” phase.

Think of it this way: instead of doing a slow, methodical bicep curl that takes 3 seconds up and 3 seconds down, you’d explode up in 1 second, then take 3 seconds to lower the weight. You’re training your muscles to generate power — not just strength.

Why Does High Velocity Resistance Training Matter for Your Bones?

Your bones respond to the forces placed on them. It’s called Wolff’s Law — bones adapt to the loads they’re regularly subjected to. When you move explosively, you create higher forces that stimulate bone-building cells called osteoblasts during the bone remodeling process.

The research showed that high velocity resistance training exercises increased bone mineral density between 0.9% to 5.4% at the most important sites — your lumbar spine, hip, and femoral neck. These are exactly the areas where fractures can be most devastating.

High Velocity Strength Training: Frequency

The research gives us clear guidelines as to how often you need to do high velocity strength training to benefit your bone density. The studies consistently showed that you need at least 2 sessions per week to see bone benefits. Less than that, and you won’t get the bone-building response you’re looking for.

Most effective programs in the research lasted at least 6 months, with many showing continued benefits when extended to 12 to 18 months.

As a physical therapist, I need to address safety. High velocity strength training might sound intimidating, but it can be very safe when done properly. We discuss this in the next section.

High Velocity Resistance Training Exercises: Safety

Here’s my 4 recommendations to get started:

Get Medical Clearance If you have osteoporosis or osteopenia, talk to your doctor first. Some people with severe osteoporosis might need to start with traditional strength training before progressing to explosive movements.
Start with Bodyweight Before adding any weights, master explosive bodyweight movements like:
- Sit-to-stand from a chair — go down slowly with control but come back up as quickly as possible
- Push-ups with explosive up phase
Consider Using Machines First When you’re ready for weights, machines can feel safer than free weights because they guide your movement path but use them as a stepping stone to doing free weights — which prepares your body for real life.
Focus on Major Muscle Groups The research showed the best results came from exercises targeting muscles attached to the spine and hips — think squats, step ups, rows, and push ups.

High Velocity Resistance Training Exercises Examples

Below are three high velocity resistance training exercises:

Bicep curl
Squat
Push up

Note in each example how I vary the speed.

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High Velocity Strength Training: Results

One of the most impressive studies followed women for 16 years. Here’s what they found: the bone benefits peaked around year 4, then remained stable for the entire 16-year period. But — and this is crucial — when people stopped exercising for more than 6 months, they lost those benefits.

This tells us that consistency is absolutely key. The good news? Even when people reduced their training frequency after the initial intensive phase, they maintained many of their bone gains as long as they didn’t stop completely.

My exercise schedules that accompany my book, Exercise for Better Bones, allows you to follow the research guidelines at a pace that best suits your schedule!

Remember, “explosive” means fast and controlled — never jerky or out of control.

HVRT Cautions

The research also revealed some important caveats:

Combination Programs Work Best: The most successful studies combined high velocity resistance training with weight bearing exercises, balance training, and cardiovascular activities.
Progressive Overload Matters: You need to gradually increase the challenge over time — whether that’s more weight, more sets, or more speed.
Individual Variation: Some people in the studies responded better than others. Factors like nutrition, Vitamin D status, and overall health all play a role. Get the help you need to ensure your nutritional and Vitamin D status is optimized.

Please consult with a healthcare provider or physical therapist if you experience:

Any pain during or after exercise, that goes beyond regular post exercise muscle soreness.
Dizziness or balance problems
Shortness of breath beyond normal exertion
Any new symptoms

High Velocity Resistance Training: Sarcopenia and Dynapenia

High velocity resistance training may help prevent both sarcopenia (age-related muscle loss) and dynapenia (decline in muscle power with aging). These conditions can lead to reduced mobility, increased fall risk, and diminished quality of life. High velocity resistance training can preserve muscle mass.

Conclusions

This research gives us strong evidence that high velocity resistance training can be a powerful tool in fighting osteoporosis.

For optimum results aim for:

At least 2 sessions per week
Combine explosive movements with traditional strength training
Focus on major muscle groups attached to spine and hips
Consistency…over years, not months
Always prioritize safety and proper form

I’m excited about this research because it gives us another evidence-based tool to help you maintain your independence and quality of life as you age. Strong bones mean fewer fractures, which means staying active and healthy for years to come.

Remember, every person is different, and what works best for you might need some customization. This is why my book and videos have not two or three different levels but four levels to allow you to optimize where you start and where you build to.

If your body needs further customization, consider working with a physical therapist who understands osteoporosis — so they can help you design a safe, effective program that fits your specific needs and limitations.

Margaret Martin

References

Haque I, Schlacht TZ, Skelton DA. The effects of high velocity resistance training on bone mineral density in older adults: A systematic review. Bone. 2024 Feb;179:116986. doi: 10.1016/j.bone.2023.116986. Epub 2023 Dec 7. PMID: 38070720.

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Hormone Therapy and Exercise Can Increase Bone Density

Margaret Martin — Tue, 19 Aug 2025 16:22:01 +0000

August 19, 2025

A recent comprehensive research review published in May 2025 (1) examined how combining exercise and hormone therapy improves bone health. In today’s post we will review that study and also cover what was said regarding hormone replacement therapy at the April 2025 World Congress on Osteoporosis.

If you’re concerned about osteoporosis or have been wondering whether hormone therapy might benefit your bones, this post is for you.

Hormones, Estrogen and Bone Remodeling

Let me start by explaining what happens to your bones during menopause. Throughout your life, your bones are constantly going through a process called bone remodeling — breaking down old bone tissue and building new bone. This process is carefully balanced by two types of cells: osteoblasts that build bone, and osteoclasts that break it down.

Estrogen plays a crucial role in this process. It enhances the activity of bone-building osteoblasts while suppressing the bone-breaking osteoclasts. When estrogen levels decline during menopause, this delicate balance shifts dramatically. The result? More bone is being broken down than built up, leading to decreased bone mineral density and increased fracture risk.

The research shows that postmenopausal women can lose bone at an alarming rate — with bone resorption significantly outpacing bone formation. This is why osteoporosis affects one in three women over 50 worldwide.

Now, let’s talk about menopause hormone replacement therapy, or HRT. This treatment involves supplementing the hormones your body is no longer producing in adequate amounts.

Two Types of Hormone Replacement Therapy

There are two main types of hormone replacement therapy for menopause:

Combined HRT includes both estrogen and a progestogen (like progesterone). This is recommended for women who still have their uterus, as the progestogen protects the lining of the uterus from the effects of estrogen alone.
Estrogen-only HRT is suitable for women who have had a hysterectomy, since there’s no uterus to protect.

The research shows that HRT works by reducing excessive bone resorption – essentially putting the brakes on the bone-breaking osteoclasts that go into overdrive after menopause.

Exercise and Bone Health

Exercise is another powerful tool for bone health. When you exercise, especially with weight-bearing and strength training activities, you create mechanical stress on your bones.

This stress triggers your bone cells — specifically the osteocytes — to respond by stimulating new bone formation.

The research review analyzed multiple studies and found that specific types of exercise are most effective for menopausal women:

Strength training at 70-85% of your one-repetition maximum, performed 2-3 times per week
Weight bearing exercise activities like jumping, running, or hopping, done at least 3 times per week
Combined programs that include both strength and weight bearing exercises such as Exercise for Better Bones

The key finding? Exercise alone can significantly improve bone mineral density in the lumbar spine, femoral neck, and total hip.

Hormone Therapy and Exercise

Here’s where it gets really interesting. The research found something remarkable: when hormone therapy and exercise are combined, they work better together than either intervention alone.

Specifically, the studies showed that hormone therapy and exercise generated significantly greater effects on both femoral neck bone density and lumbar spine bone density compared to exercise-only interventions. This suggests what researchers call “a positive estrogenic response to mechanical loading during exercise.”

In simpler terms, estrogen appears to amplify your bones’ response to the mechanical stress of exercise. Think of it as estrogen making your bones more receptive to the bone-building signals that exercise provides.

The research noted that mixed loading exercise programs — those combining different types of activities — were particularly sensitive to this hormone therapy enhancement, especially for spine bone density.

Hormone Therapy: Are There Risks?

While these findings are encouraging, I want to be completely transparent about the risks associated with hormone therapy. The research acknowledges several important safety considerations:

The most commonly studied form of hormone therapy in these studies was conjugated equine estrogens (CEE) with medroxyprogesterone acetate (MPA), taken orally. However, studies have linked this combination to increased risks of:

Breast cancer
Blood clots (thromboembolism)
Stroke
Cardiovascular disease

It’s important to note that current prescribing practices have evolved significantly. Many healthcare providers now prefer:

Transdermal estrogen (patches, gels, or sprays) which may have lower risks of blood clots and stroke
Bioidentical progesterone rather than synthetic progestins

The research emphasizes that most current guidelines recommend hormone therapy primarily for women under 60 or within 10 years of menopause, and only when other treatments aren’t suitable.

When the brakes were put on the use of hormone therapy for women in North America, following the Women’s Health Initiative Study in 2000 the same was not the case in Europe and South America.

At the world congress this past April, gynecologist from Brazil and Italy spoke of the youthfulness that went beyond bones in their 80 and 90 year old patients who had been using hormone replacement therapy for decades.

HRT and Exercise Recommendations

Based on this research, here are my five evidence-based recommendations:

Prioritize Exercise as Your Foundation Regardless of whether you choose hormone therapy, exercise should be central to your bone health strategy. The research consistently shows that structured exercise programs can significantly improve bone density.
Consider the Timing If you’re considering hormone therapy for bone health, the research suggests it may be most effective during perimenopause and early postmenopause — ideally within the first 10 years after menopause.
Focus on Combined Exercise Programs Aim for a program that includes:
- Strength training 2 to 3 times per week at moderate to high intensity
- Weight bearing exercise activities at least 3 times per week
- Duration of at least 6 months, with longer programs showing better results
Discuss Modern Hormone Replacement Therapy Options with Your Doctor If you’re considering hormone therapy, talk with your healthcare provider about:
- Transdermal estrogen delivery methods
- Bioidentical hormone options
- Your individual risk profile
- The timing of initiation
Take a Personalized Approach The research emphasizes that osteoporosis management requires a personalized, multifaceted approach. Your treatment plan should consider your individual risk factors, medical history, and preferences.

Conclusion

Remember, while exercise is universally beneficial and recommended for bone health, hormone therapy isn’t appropriate for everyone. The research noted that many guidelines prioritize other medications like bisphosphonates as first-line treatments for osteoporosis, with hormone therapy considered when these aren’t suitable.

The key takeaway from this research is that if you are a candidate for both interventions, combining exercise with appropriate hormone therapy may provide synergistic benefits for your bone health that neither approach can achieve alone.

This research gives us valuable insights into how we can optimize bone health during and after menopause. The combination of exercise and hormone therapy shows promise, but it’s crucial to work with knowledgeable healthcare providers who can help you weigh the benefits and risks based on your individual situation.

Remember, building and maintaining bone health is a marathon, not a sprint.

Consistency with exercise, whether combined with hormone therapy or not, remains your most powerful tool for strong bones and reduced fracture risk.

Margaret Martin

Reference

Platt Olivia , Bateman James , Bakour Shagaf, Impact of menopause hormone therapy, exercise, and their combination on bone mineral density and mental wellbeing in menopausal women: a scoping review, Frontiers in Reproductive Health, Volume 7 – 2025, DOI=10.3389/frph.2025.1542746

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Can Osteoporosis Cause Back Pain?

Margaret Martin — Tue, 19 Aug 2025 12:25:29 +0000

August 19, 2025

Can osteoporosis cause back pain? Unfortunately, it can be. Understanding why osteoporosis can cause back pain —and what you can do about it — is critical to reclaiming your comfort, quality of life, and mobility.

The starting point is to determine if your osteoporosis is, in fact, the cause of all your back pain. There could be other sources for your discomfort or a combination of sources. We discuss this topic in the next section.

Is Your Back Pain Caused By Osteoporosis?

During my 40 years of clinical practice as a Physical Therapist, I have treated many patients with acute and chronic back pain. I learned that there are many things that can cause back pain.

Before placing the blame on your osteoporosis or osteoarthritis, you should rule out whether the pain is coming from muscles. Without determining that your muscles are the pain source, you shut off all further inquiry and this potentially leaves you with pharmaceutical intervention as your only solution.

Muscles and Back Pain

Back pain from poor posture or compression fractures can occur because of the changes in your spine’s shape—called kyphotic deformity or the “dowager’s hump”. The kyphosis shifts your center of gravity forward. This forces your back muscles to work overtime, contracting constantly to keep you upright. The result? Persistent muscle fatigue and pain that continues even after any initial fracture has healed.

In my practice, I use myofascial release and trigger point massage therapy to both diagnose and treat pain caused by muscle. The best resource, I have found, on trigger point therapy is The Trigger Point Therapy Workbook by Davies and Davies.

They discuss back pain extensively in their book. Davies and Davies state that extreme tension in the deep spinal muscles can entrap the nerve root as it exits the spine and cause pain. (1)

How do you know if the problem is coming from the muscle tension at the spine?

The answer: If a deep spinal muscle is causing the pinched nerve, the muscle will be tight and tender to the touch. A few treatments will improve all the symptoms. However, if the problem is coming from the spine itself, there will be little relief with detailed trigger point massage. The latter indicates that the pain source is not the muscle and likely something else. (1)

To help you evaluate the possible sources of your back pain, I strongly encourage you to work with a clinician with well-trained hands and a good understanding of muscle anatomy.

There are numerous muscles that can be constant sources for back pain. These include deep and superficial spinal muscle, including the longissimus and iliocostalis.

Once you eliminate muscle as the potential source of the back pain, you should consider other sources with your osteoporosis potentially being a culprit. The next section examines how osteoarthritis can be a source of back pain.

Osteoarthritis Back Pain

Osteoarthritis is a normal part of aging, it is the most common type of arthritis of the spine. It is a sign that you have been active and there has been wear and tear (on mostly the facet joints) of your spine. Genetics, diet and lifestyle play a big role in arthritic changes of your spine.

It is more common than not to develop osteoarthritic changes in the spine as we age. Just like osteoporosis, not all individuals with osteoarthritis suffer from back pain.

Here are a few easy ways to determine if your back pain is coming from osteoarthritis:

Pain is usually associated with stiffness
Worse with damp rainy weather
Your spine can predict biometric pressure changes
You feel more pain and stiffness in the morning or after resting for too long
Pain and stiffness improves with heat and gentle range of motion exercises

How Osteoporosis Causes Back Pain

Recent research suggests that the same bone cell imbalances that drive osteoporosis may also contribute to spinal pain through increased osteoclast activity in the vertebral cartilagenous end plates. (2)

Age-related changes in the vertebral cartilagenous end plates (the interfaces between your spinal discs and vertebrae illustrated below) are particularly important. These areas can become porous and develop increased nerve growth, potentially contributing to chronic low back pain.

Osteoporosis Back Pain

Your bones are living, breathing tissues that are constantly rebuilding themselves. In healthy bones, this process, called bone remodeling, is beautifully balanced. But in osteoporosis, this delicate equilibrium gets disrupted in ways that directly generate pain.

The trouble starts with overactive bone-destroying cells called osteoclasts. These cells go into overdrive, breaking down bone tissue faster than your body can rebuild it. The overactive osteoclast don’t just affect the endplates, ask we mentioned above, but can also affect the bone within the vertebra. This process has been shown to create pain generating chemicals.

These chemicals increase the density of pain-sensing nerve fibers within your bones themselves. This means that even minor mechanical stress—like reaching into the back seat of the car or carrying groceries—can trigger significant pain signals. Your bones literally become more sensitive to pain as osteoporosis progresses.

Back Pain After a Compression Fracture

The most devastating consequence of this bone weakening process is vertebral compression fractures. These fractures are incredibly common, affecting an estimated 550,000 to 700,000 Americans every year. Sadly, only about one-quarter to one-third of these fractures are actually diagnosed clinically. (2) Not knowing that you have a compression makes it harder for you to know how to best protect and strengthen your spine.

Roughly half of all vertebral compression fractures can occur with little to no pain. Thus many people are walking around with compressed fractured vertebrae without even knowing it.

Each vertebral fracture sets off a domino effect. Once you’ve had one vertebral fracture, your risk of having another spine fracture increases by five times, and your risk of a hip fracture doubles.

Research shows that vertebral wedging (the most common type of vertebrae compression) averages 21% in people with osteoporosis compared to just 7.7% in healthy individuals. This progressive spinal deformity significantly correlates with back pain severity and can create a devastating impact on quality of life.

Can Osteoporosis Cause Bone Pain?

Recently I spoke to Dr. Keith McCormick and asked him can osteoporosis cause bone pain? Keith explained how bone pain can be caused by the loss of bone density due to inflammation as well as vertebral compression fractures.

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Osteoporosis Pain Management

There are several different types of treatment for osteoporosis pain. We now understand that early, aggressive intervention can significantly improve both pain outcomes and your ability to get through the day. The key is addressing osteoporosis back pain through multiple pathways simultaneously.

Exercise: Your Most Powerful Tool

Exercise interventions have evolved far beyond simple “weight-bearing activities” to sophisticated, multicomponent programs, such as Exercise for Better Bones, that target multiple aspects of bone health. The most effective approach combines moderate-intensity resistance training (at 65-80% of your maximum effort) performed three days weekly with balance work and appropriate weight-bearing activities.

Combined exercise programs consistently outperform single-type exercise approaches. The integration of strength training, balance work, and weight-bearing activities addresses not only bone density but also fall prevention, postural stability, and functional capacity—all crucial for managing osteoporotic back pain.

Balance training deserves special mention. Twelve-month balance programs show significant improvements in balance confidence and meaningful reductions in fall frequency. This is crucial because addressing the psychological fear of falling often helps break the cycle of inactivity that perpetuates bone loss.

Safety is paramount: Certain exercises are absolutely contraindicated if you have osteoporosis, and should be avoided. These include traditional sit-ups, loaded forward flexion (bending forward with weight), and forceful twisting motions. If you’ve had vertebral fractures, you’ll need modified protocols emphasizing extension-based movements with supervised progression. (2)

Nutrition: Beyond Calcium and Vitamin D

While calcium and vitamin D remain foundational—with research confirming that combined supplementation (around 833 mg calcium daily plus vitamin D) produces significant bone density improvements—the nutritional landscape has expanded considerably.

Whole-food approaches consistently outperform isolated supplements. Dairy products fortified with calcium and vitamin D demonstrate superior effectiveness compared to pills alone, while fermented dairy products show additional benefits with 24% hip fracture reduction in observational studies.

Protein adequacy represents a critical but often overlooked component. Optimal intake ranges from 1.0-1.2 grams per kilogram of body weight daily for postmenopausal women and older adults—higher than standard recommendations. High-quality animal proteins show superior outcomes for hip fracture prevention, though combining plant and animal proteins optimizes overall bone health.

The micronutrient profile now includes magnesium (320-420 mg daily) and vitamin K2 (90-120 mcg daily). Nearly 45% of Americans show magnesium deficiency, which impairs calcium utilization and bone formation. Vitamin K2, particularly the MK-7 form, activates osteocalcin for optimal calcium binding to bone matrix. (2)

Modern Pharmaceutical Approaches

While many people, understandably, have reservations about using osteoporosis medications, recent advances have revolutionized how we approach osteoporosis back pain treatment.

Bone-building medications (called anabolic therapies) now outperform traditional bone-preservation (bisphosphonate) drugs for immediate pain relief. (2)

Romosozumab (Evenity) leads the field for rapid back pain relief, with its unique dual action of increasing bone formation while decreasing bone breakdown. Clinical improvement typically begins within 2-3 months, making it particularly effective for people with acute vertebral fractures. (2)
Teriparatide remains highly effective, especially when given daily rather than weekly. This pure bone-building medication improves the internal scaffolding of bones (trabecular connectivity) and reduces tiny fracture risk, typically providing pain relief within 3-6 months. (2)
Denosumab (Prolia) has emerged as the preferred option for people who’ve already experienced fractures, effectively preventing new fracture-related pain episodes through its potent bone-preservation action. (2)

Conclusion

The management of osteoporotic back pain has evolved from reactive treatment to proactive, multimodal strategies. The evidence clearly demonstrates that early intervention with bone-building therapies, combined with appropriate exercise and nutritional strategies, can significantly improve both pain outcomes and functional capacity.

For acute vertebral fractures, bone-building medications provide superior pain relief compared to traditional bone-preservation drugs, with clinical improvement typically beginning within 2-3 months. This should be followed by transition to bone-preservation therapy to maintain gains.

Your exercise prescription should emphasize multicomponent programs with professional supervision, especially during initial phases. Nutritional interventions require comprehensive approaches that go well beyond basic calcium and vitamin D supplementation.

The prognosis for osteoporotic back pain has improved significantly with these evidence-based approaches, particularly when implemented early in the disease process. Coordinated care that addresses the biological, mechanical, and psychological aspects of osteoporotic fracture management can substantially improve quality of life outcomes and reduce the devastating impact of progressive spinal deformity.

Remember: osteoporotic back pain is complex, but it’s not hopeless. With the right combination of treatments, many people experience significant improvement in both pain and function. The key is working with healthcare pro

Margaret Martin

References

Davies C., Davies A. The Trigger Point Therapy Workbook. 3rd ed. New Harbinger Publications Inc. 2013.
Zhen, G., Fu, Y., Zhang, C. et al. Mechanisms of bone pain: Progress in research from bench to bedside. Bone Res 10, 44 (2022). https://doi.org/10.1038/s41413-022-00217-w

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How to Treat a Compression Fracture

Margaret Martin — Sun, 17 Aug 2025 02:28:46 +0000

What is it like to live with a compression fracture? Are there effective ways to treat a compression fracture with Physical Therapy? Do I recommend specific exercises for my clients with compression fractures? Is there a best way to sleep with a compression fracture? I answer each of these questions in this blog post.

In the video, you will meet Brenda — one of my clients with compression fractures — and hear her story of how her compression fractures happened, how they affected her quality of life, and what she has done to return to living an active life.

The first video, is 25 minutes long. There are two more videos later in the blog. One is 5 minutes in duration and the other is 10 minutes. If you are at risk of a compression fracture, already have one or know someone suffering from a compression fracture, you should read this blog post and view the videos — the time you invest will be well worth your while. I promise.

Introduction

My patient, Brenda, is here to share with you how her life has been impacted by compression fractures.

Of all the individuals that I’ve worked with who have compression fractures, Brenda is the most positive and persistent client. She does every single compression fracture exercise I ask her to do. Each time we meet she arrives with her completed checklist and asks me questions specific to compression fractures.

When Brenda prepared for today’s talk, she realized how frustrated she was with her situation. She felt despair and anger because of her compression fractures. I asked her not to emphasize her frustration but, instead, share the tactics that have helped her deal with her compression fractures. Brenda’s story is meant to help all of those individuals, men and women, with compression fractures who are suffering in silence.

Brenda’s Thoracic Compression Fracture

Brenda is a retired teacher. She has always enjoyed gardening, bi-weekly exercise classes, and daily walks.

In her thirties Brenda realized that she needed to look after her bones. Her mom had fractured both of her hips as well as her pelvis. Brenda’s genetics and family history of osteoporosis were red flags indicating that she might have some issues with her bones sometime in the future.

A routine DEXA (Dual-Energy X-ray Absorptiometry) test and FRAX score, in 2011, showed that Brenda had some bone loss. She was diagnosed with osteopenia. She became more careful, watched the calcium in her diet, her vitamin D levels, and continued her exercise classes.

Her General Practitioner recommended bisphosphonates, but she couldn’t tolerate them. He switched her to Prolia. She was on Prolia for four years. A repeat DEXA showed that she had improved, so she discontinued her Prolia injections in the spring of 2015. She was excited because she felt she had turned the corner. Brenda concluded that her bones were healthy because of her exercises, diet and Prolia injections. It turned out that Brenda came to this conclusion prematurely.

T9 Compression Fracture

Once she got the clean bill of health, Brenda planned a dream holiday for her and her husband — a five week trip to Africa.

Unfortunately, that dream holiday became a nightmare. On the first day of the trip she experienced severe back pain (read this post to answer the question: can osteoporosis cause back pain?) when she moved some heavy bags. She was able to manage the pain because she had some over-the-counter pain medication with her. However, by the time the trip ended, she was in severe pain. Too severe for her pain medications to suppress. The more potholes she hit as they drove across Africa, the worse her pain got.

As soon as she returned to Canada, she went to see her doctor. He diagnosed her with a strained back. Unfortunately, a series of x-rays showed that Brenda had a 70% T9 compression fracture. It was a thoracic compression fracture and four other vertebrae had some level of compression.

Physical Therapy Treatment for a Thoracic Compression Fracture

I asked Brenda to discuss the treatment she received after the diagnosis of her compression fractures.

After the diagnosis of compression fractures, Brenda was given strong painkillers that helped manage the pain and allowed her to sleep. The physiotherapist (the one she saw before she came to see me) helped with the pain. The physiotherapist used hot pads, electrical pulses that stimulate the muscles, acupuncture, and a minimal amount of ultrasound. That initially helped with the general pain.

Can You Make a Compression Fracture Worse?

I wish more people asked me this question because so many people don’t realize that yes, your vertebral fracture can get worse.

It is so very important to remind yourself that this can happen.

How you get up in the morning, how you choose to move a certain way, how you dress, how you tie your shoes, how you garden – all of those things allow you to be in control and avoid your compression fracture to become more compressed.

If you currently have a 30% compression of your vertebral body, it can become 40% or even 50% compressed.

Some people can compress their vertebral body so much that they can’t see it on an x-ray anymore. It is not something I wish on any of you.

However, since you’re watching this, this is likely not to occur because you’re taking things in hand and you’re empowering yourself to be able to move well.

I asked Brenda if either the physician that gave her the diagnosis or the initial physiotherapist who treated her told her that the compression fractures could get worse by how she moved.

Brenda said she was not informed about this. In fact, she did not even know that one of her compression fractures, a T9 compression fracture, was compressed 70% and could not be fixed.

I find that many people do not understand the importance of good posture, good movement and the potential repercussions on the health of their spine. I encourage readers to read my blog post on Osteoporosis Posture Explained where I discuss, in detail, key concepts related to postural alignment and how good posture practices can fend off compression fractures.

How to Move When You Have a Compression Fracture

Compression fractures are not static. How you move throughout the day, the exercises you do, how you lift, how you bend, how you get in and out of bed — all of these things can either keep the vertebra from becoming more compressed or cause further collapse. This is not meant to scare you. Rather, it is meant to inform you that it is in your control to help yourself reduce the further risk of a compression fracture.

Vertebral Kyphoplasty and Compression Fracture

A surgical technique called vertebral kyphoplasty would be the only way to fix her T9 compression fracture. This intervention would have to happen within the first six to eight weeks after a T9 compression fracture. During a a vertebral kyphopasty surgery, the surgeon re-inflates the vertebra with kyphoplasty and then injects a form of cement into the vertebral body.

Although a vertebral kyphoplasty can give you pain relief, it doesn’t actually stop the progression of further compression fractures. The importance of good body mechanics and diligence during your exercises is really important — despite having that type of intervention.

Further, the vertebral kyphoplasty could be detrimental because it could make one strong section with weaker bones around it.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

Brenda’s Life Before Her Vertebral Compression Fractures

Brenda’s vertebral compression fractures changed her lifestyle. She states that her life went from “white to black” — a 100% change in her life. Here she details each of the parts of her life that have been affected by her compression fracture and how she has had to accommodate the pain from the compression fracture.

Community and Family Activities

Before the compression fracture, Brenda was the “Energizer bunny”. She was involved in the community association, university women’s group; did things at home like refinishing furniture for her daughter; and was engaged in lots of activities.

But all that changed 100% because of the pain.

Gardening

Brenda has had to hire young women to help her with the garden because gardening involves hauling, lifting, heaving, and shovelling. These activities can be bad for your back when done incorrectly. All she can do now is deadhead plants. Gardening was a stress reliever before, now it’s a source of stress.

Cleaning

Brenda considers herself to be one of those “odd people” that likes to clean. Again, it’s sort of a feel good thing, but she has had to hire a cleaning lady to help her with the heavy stuff, the vacuuming, the washing of floors, the toilets — all those things that put extra strain on her back.

Laundry

Brenda can do a little laundry, but ironing is very difficult, so she has embraced the “rumpled linen look”.

Driving

When she first had her T9 compression fracture, Brenda could not drive. She could hardly get into the car when she had to go to various appointments. It has only been of late that she feels comfortable enough to drive, but she is much lower now in the seat of the car — three inches lower. It took nine months from the time of the initial severe pain to get to the point where she can drive again.

Food Preparation

Brenda’s husband has health issues of his own and he is very limited in what he can do. In the beginning, shortly after the compression fracture food preparation was limited to semi-prepared or prepared foods.

Brenda is limited in what she can do in the kitchen. For example, in order to peel a potato or a carrot, she had to put both my forearms on the counter. She could not lift a dish in or out of the oven.

Grocery Shopping

Brenda is unable to do the grocery shopping and has left that task to her husband.

General Mobility Around the House

Brenda had to use a walker for the first time ever in her life after the compression fracture. She used it to get out of bed and to the bathroom in the morning. She has not had to use a walker for about the last three weeks.

Clothing

Brenda has had to “embrace the crumpled look” because everything hurts around her middle. She finds that she cannot wear tight clothing that might press on the bone that is protruding in her back.

Physical Therapy Treatment for Vertebral Compression Fractures

The following are the compression fracture Physical Therapy treatment modalities that helped her with her compression fracture.

Myofascial Release Therapy for Compression Fracture

Brenda indicated that the best compression fracture Physical Therapy treatment option for her has been myofascial release. It has helped with the initial spasms. She experienced really bad vice-like grips around her right hip after an episode with the spasms. These have been taken that away completely.

Also, because the tightness in her chest has been reduced, she feels a little bit more erect. She does not have that same pulling forward sensation that she experienced before.

Targeted Compression Fracture Stretching Exercises

Brenda never lets a day go by without doing her targeted stretches. She finds them to be really helpful. They relieve her pain or her aches. They help her with fighting this gravitational pull that she experiences from morning till night.

Brenda does stretches from the Exercise for Better Bones program but I have advised her to hold them a lot longer (as long as 10 minutes) than I have recommended in the book. They are more like a fascial stretch.

Brenda finds that it takes the 10 minutes for her body to release and relax into the stretch. She finds that the prolonged fascial stretches make her feel good.

Dynamic Taping for Compression Fracture

Brenda finds the dynamic tape to be another kind of little miracle worker. She could not believe that it actually works. When it’s not there, she can really feel the difference. It has really helped with that long muscle in her back that is strained.

Strengthening Exercises for Compression Fracture

Brenda finds the strengthening exercises to be very beneficial. Because she was physically fit before the compression fracture, her muscle memory is coming back. Every time she improves in her exercises, her muscles are activated; and every time those muscles are activated, she is stronger in whatever she does, whether it’s getting off the toilet, getting out of a chair, getting out of bed in one smooth motion. This is a big, big step and improvement for Brenda.

Be Fit Before Your Compression Fracture

There are considerable benefits to being fit before the compression fracture. Unfortunately, a lot of women and men do not exercise until something happens and their body does not have a positive association with exercise. Brenda did.

As a result, Brenda was used to muscle soreness from vigorous exercise. Women and men who have not exercised before think that something has gone wrong. Brenda has always had a positive association with exercise. I think that is very important. I encourage listeners to exercise in a regular basis.

Strengthening Exercises

Brenda found the strengthening exercises that I have given her to be initially were very hard to do even though she was fit. She could hardly lift my head up off the floor. But, to her credit she did one rep, and then she did three reps, and then she did 5 reps, and then, eventually, she did 10 reps.

Brenda considers it “baby steps” progress. She is fastidious about her chart and can see her progress. She finds this motivating. If you understand intellectually what the exercise will do, then she really motivated in terms of her everyday life. So that really, really has helped.

Nordic Walking with Weighted Kypho Orthosis Vest

Brenda uses activator poles (Nordic walking poles) with a weighted kypho-orthosis vest. She used to walk five kilometres plus a day. After the compression fracture the most she could walk was five houses and back — and that exhausted her.

Today she is up to three kilometres walk at a snail’s pace. She can do it with the poles and the vest because it keeps her in the proper position.

The weighted kypho-orthosis vest helps her walk more upright because it counterbalances the weight of her head and allows her to control where her posture is taking her. She is also wearing the weighted kypho-orthosis vest when she prepares her meals.

Brenda says the vest helps her stay more upright because her body naturally wants to go forward. That’s the go-to position and she has to fight that all the time.

Advice for Your Younger Self

I asked Brenda knowing what you know now, what would you tell your younger self? Here are Brenda’s thoughts on that question.

Choose the Right Health Professional

The first thing she would tell her younger self (in fact, what she has told her daughters) is that you have to be really fastidious, as much as you can be, about choosing your general practitioner, or your family doctor.

He or she should be your strongest advocate in the medical system. They should listen carefully, they should be able to communicate well to you, so that if you don’t understand the medical jargon that they break it down for you. They should be able to answer the questions you have and anticipate the questions that you don’t have — the things that you should know.

Be Assertive and Own Your Health

You may have to be assertive to get your needs met. For Brenda that’s not such an easy thing to do. But one has to stand up for one’s rights and it’s their professional duty to find out if they don’t know. And they won’t know everything. Often your physician is a generalist. But they do have a professional obligation to find out and to send you on to a specialist who does know.

Keep a Copy of All Tests

You should keep a hard copy of all tests that you have even in this day and age of electronic copies. Have a file so that you can trace back your health history. It will save a lot of time.

Take Someone With Your When You Are in Severe Pain

When you are in really severe pain, you need to take somebody with you to the doctor because the brain is fuzzy under pain and you just are not fully aware of what is happening.

Get a Second Opinion

Brenda says you should not be afraid to get a second opinion. It doesn’t hurt. The world is not going to fall apart. If it doesn’t feel right, it probably isn’t right. You know your own body, and that is important to follow through.

Pay Attention to Your Diet

Be bone health aware in terms of not just milk, but other sources of calcium as well. Especially after you have left home. You have to be your own calcium conscience.

Exercise

Get fit and exercise. But, Brenda was not aware of the kinds of exercises that were detrimental to her spine. Many fitness professionals are not trained to deal with a person with osteoporosis. Brenda did the wrong exercises with gusto. She is now paying the price.

Back Brace for Compression Fracture

In this section we cover how to choose a back brace for compression fracture and discuss Brenda’s experience.

Understanding Back Brace for Compression Fractures

A back brace for compression fracture is a supportive device designed for individuals who have sustained one or more vertebral compression fractures.

These braces provide targeted support for either the lumbar spine (the five vertebrae in the lower back) or the thoracic spine (the 12 vertebrae in the middle back where the ribs attach). The specific type of brace depends on the location and severity of your compression fracture.

Types of Back Braces for Compression Fractures

Selecting the appropriate back brace for compression fractures requires careful consideration of two critical factors.

First, you must identify the exact location of your vertebral compression fracture to ensure the brace supports the affected area of your spine.
Second, you need to determine the level of support or rigidity required based on your fracture’s severity.

For minimal compression fractures, very little support may be needed, and some individuals may not require any brace at all. Many people with compression fractures experience no pain and can heal naturally without additional support.

However, if you’re experiencing significant pain or your orthopedic physician has determined that your compression fracture is unstable, a more rigid back brace for compression fractures will be necessary. In these cases, your physician will recommend the appropriate level of stability needed to keep your spine safe during the healing process.

Choosing the Right Back Brace for Your Compression Fracture

The selection process begins with identifying the precise location of your compression fracture. Your back brace must provide stabilization and support specifically around the fractured area.

The choice largely depends on how fragile and vulnerable your compression fracture is—if the fracture is severely compressed and causing nerve irritation, you’ll likely need a brace with greater stability and rigidity.

Professional guidance is invaluable in this selection process. Ideally, you should work with a physical therapist trained in back brace fitting for a compression fracture or an orthotist who specializes in spinal support devices.

It’s worth noting that very few orthopedic surgeons routinely recommend back braces for compression fractures—my observation is that only about 10% of individuals with compression fractures receive brace recommendations. This makes professional guidance even more crucial for selecting the most appropriate device for your specific condition.

Spinomed Back Brace

I recommend the Spinomed Back Brace for my clients with compression fractures. It is the only back brace that has been studied for this population.

Professional Fitting and Customization

Professional fitting is essential, especially if you’ll be wearing the brace for extended periods or relying on it for daily activities. A properly fitted back brace serves four critical functions:

Providing enhanced stability.
Managing pain.
Optimizing posture and alignment for proper healing.
Minimizing irritation to surrounding tissues.

When you’re depending on a back brace for several hours daily over an extended period, customization becomes particularly important. A professional fitting ensures the brace performs optimally while maximizing your comfort and mobility.

Duration and Proper Usage Guidelines

The duration of back brace wear depends significantly on whether your brace has been professionally fitted and customized. If you’re using a non-fitted, off-the-shelf brace strictly for support, limit wear time to activities where you specifically need additional stability—such as transferring in and out of bed, gardening, or caring for grandchildren. Avoid wearing an uncustomized brace during other activities, as prolonged use can weaken your core stabilizing muscles rather than strengthen them.

For long-term healing, the goal is to gradually transition from brace dependence to natural muscle support. Once your physician gives permission to begin core strengthening exercises and you feel your deep core muscles becoming stronger, start weaning yourself from the brace during specific activities. Your abdominal and core muscles are designed to function as your body’s internal back brace, providing natural stabilization.

If you find that your core musculature never fully develops the necessary strength, continue using the back brace minimally—only for specific high-demand activities that require additional spinal stabilization, similar to how bodybuilders use back braces for heavy lifting.

Support for L1 and T12 Compression Fractures

Compression fractures in the L1 or T12 vertebrae require special consideration due to their location at the junction between the lumbar and thoracic spine. A standard short lumbar brace will not provide adequate support for fractures in these areas. You’ll need a longer brace that extends from the lower lumbar region through the upper thoracic area.

The Spinomed brace is one example of a device that provides comprehensive support through the entire spine, making it suitable for fractures at this critical transition zone.

Why Amazon Isn’t the Best Option for Compression Fracture Braces

Purchasing a back brace from online retailers like Amazon is not recommended for compression fractures due to several significant limitations.

First, these braces are not fitted to your specific body dimensions and spinal anatomy.
Second, without professional guidance, you cannot determine whether a particular brace is appropriate for your specific type and location of compression fracture.
Third, there’s no way to verify that an online purchase provides the exact level of stability and support your condition requires.

Instead, seek care from a local orthotist who can offer a variety of braces for you to try and provide personalized recommendations. You can also obtain referrals through your physician or an orthopedic specialist who can recommend the most appropriate brace for your specific compression fracture pattern and ensure proper fitting when necessary.

Real-World Experience: Brenda’s Back Brace Journey

Understanding how back braces work in practice can be helpful when making your own decision. Brenda, who has experience with compression fractures, has tried three different types of braces throughout her recovery journey, each serving different purposes and offering varying levels of support.

The Weighted Kypho Orthosis Vest

Brenda’s first brace was a Weighted Kypho Orthosis vest, specifically designed to counterbalance the weight of heavier breasts or forward head posture—common issues that can exacerbate compression fracture symptoms. She found this vest particularly helpful during walking, food preparation, and any activities requiring prolonged standing. The weighted design helped improve her posture and reduce strain on her fractured vertebrae.

Unfortunately, this specific brace has been discontinued and is no longer available through official channels. While there are products on Amazon using similar names, they do not follow the same research-based protocols regarding weight distribution and placement that made the original effective. For this reason, these alternatives cannot be recommended as suitable substitutes.

The ObusForme Back Brace

When Brenda’s back pain was at its worst during the early stages of her compression fractures, she purchased an ObusForme Back Brace from a medical supply store in Ottawa. This belt brace provided her with a sense of stability and support, making her feel like it “held things together” during her most challenging days. She would wear it specifically on days when she felt weaker or needed extra support, finding it particularly helpful during her acute pain phase.

I usually do not recommend this type of belt for most compression fractures as it might not be sized properly and, as a result, provide enough stability around the compression fracture for many people.

The Basic Lumbar Support

Brenda’s third brace was a standard lumbar support device, which unfortunately did not meet her needs. She found it lacked adequate firmness and didn’t provide the specific support her compression fractures required. The brace was not particularly supportive for her condition, and she eventually gave it to a friend, indicating that it didn’t offer sufficient benefit to warrant continued use.

Lessons from Brenda’s Experience With Back Braces for Compression Fracture

Brenda’s journey illustrates several important points about back brace selection.

First, different braces serve different purposes—what works during acute pain phases may not be suitable for long-term support.
Second, the specific design and construction quality matter significantly; generic lumbar supports may not provide adequate support for compression fractures.
Finally, professional guidance and medical supply stores often offer better options than generic online purchases.

Making an Informed Decision About Back Brace for Compression Fracture

When dealing with a compression fracture, remember that not everyone requires a back brace. The decision should be based on your specific symptoms, fracture severity, and overall treatment plan. If you’re experiencing significant pain, have been told your fracture is unstable, or need additional support during daily activities, a properly fitted back brace for compression fracture can be an invaluable tool in your recovery journey.

The key to successful brace use lies in professional guidance, proper fitting, and understanding that the brace is typically a temporary support system. Your ultimate goal should be to strengthen your natural core muscles to provide long-term spinal stability.

Work closely with your healthcare team to determine if a back brace is right for you, and if so, ensure you receive proper guidance on selection, fitting, and usage duration to maximize your healing potential while maintaining your overall spinal health.

Spinomed Back Brace

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Lumbar Support Brace for Lighter Work

Brenda has a smaller lumbar brace that she wears for household things like dusting or doing the laundry.

It is not so much as a support, as a reminder: “Don’t do bad moves.” (Brenda uses the Obusforme Brace in the illustration.)

Lumbar Support Brace for Lighter Work

Brenda has a smaller lumbar brace that she wears for household things like dusting or doing the laundry.

It is not so much as a support, as a reminder: “Don’t do bad moves.” (Brenda uses the Obusforme Brace in the illustration.)

Weighted Kypho Orthosis Vest

Brenda uses a Weighted Kypho Orthosis Vest for walking, while preparing her food and any activity anything where she is standing around a long time.

The other day, while her house cleaner does all the challenging stuff, Brenda wore the vest to dust. It’s a reminder to keep upright.

Nutrition and Compression Fractures

In this section we will cover the nutrition advice Brenda follows to reduce the pain associated with her compression fracture.

Nutrition and Protein

Earlier Brenda recommended that people make sure calcium be part of their diet. While calcium is important, you should make sure you have adequate amounts of nutrients including vitamin D, magnesium and vitamin K.

Prunes have been shown to play an important role in bone health.

I find that many of my clients do not have enough protein in their diet. Protein is one of the main building blocks. If you have the protein, which is acidic, make sure you increase you intake of fresh fruits and vegetables which are alkaline and help balance the acidity in protein.

Support Devices for Compression Fractures

Heat Pad

Brenda uses a heating pad a lot. When she starts to feel achy, she sits down for 15 minutes and puts it on. It helps take the ache away. When she does her stretching exercises, she has it underneath her as well.

Reacher

The reacher is a terrific little device. It was very handy in the initial stages because everything seems to drop when you don’t want it to drop. You can use one for the garden for picking up things like sticks.

Shopping Cart

When Brenda goes to the large shopping stores, she will lean on the cart handle to take some of the pressure off her back. Sometimes she will put her purse in her back and adjust it so it is in the small of her back. It operates like the weighted kypho orthosis vest mentioned earlier in this blog post.

Lumbar Compression Fracture Exercises

Before we begin, I have a video that addresses many people’s concerns about starting an exercise program after a compression fracture.

The following are 15 the lumbar compression fracture exercises I recommend for my Physical Therapy clients with osteoporosis:

Chest stretch
Chin tuck
Arm lengthening or reach back
Arm pull back
Shoulder Stabilization
Abdominal activation
Wall push-ups
Bridging
Prone leg lift
Squats
Step ups
Bicep curls
Horse Stance
Floor M
Reverse Fly

These exercise choices are based on a study published in BMC Musculoskeletal Disorders by Bennell. These can be broken into two major groups: one set of exercises for posture and flexibility and the other for strengthening. I explain these in more detail below.

I do not recommend that every one with a compression fracture do all of these exercises. Everyone is different and the exercises will need to be broken into groups and delivered at apace that works for you.

The best thing you could do is to work closely with a Physical Therapist who is knowledgeable in the treatment of compression fractures.

If that person is not accessible, then I recommend you start with the Posture Exercises outlined in my book, Exercise for Better Bones.

The Bennell study (2) looked at the effects of compression fracture exercises and manual therapy on physical impairments, function and quality-of-life in persons with osteoporotic compression fractures. The study concluded that there are positive benefits of physical therapy prescribed compression fracture exercises for patients with compression fractures.

Spine Fracture Treatment Exercises and Thoracic Compression Fracture Exercises

The exercises I have listed are appropriate as spine fracture treatment exercises and thoracic compression fracture exercises.

Physical Therapy Compression Fracture Treatment Guidelines

The following is the treatment protocol I use (based on the Bennell study) for clients with compression fractures.

Once your muscles have started adapting to the change in height caused by the spinal compression fracture and the compression fracture has had time to heal (usually 8 to 12 weeks after the episode of increased pain) you should start a compression fracture exercise program.

The goals of compression fracture exercise program are to:

Decrease your pain at rest and with movement.
Increase your standing tolerance and overall strength.
Reduce your risk of falling.

I recommend that you invest time and understand how compression fractures occur and learn how to avoid all activities and postures that can make your compression fracture worse. Both of these items are covered in this blog post and in the Exercise for Better Bones program.

Physical Therapy Compression Fracture Treatment Guidelines

The following is the treatment protocol I use (based on the Bennell study) for clients with compression fractures.

The goals of compression fracture exercise program are to:

Decrease your pain at rest and with movement.
Increase your standing tolerance and overall strength.
Reduce your risk of falling.

Physical Therapy Exercises for Compression Fracture

I recommend a compression fracture exercise program that includes a combination of postural, flexibility, strength and trunk control exercises. The specific exercise mix is dependent on the individual needs of my clients and I choose what is appropriate after an assessment.

Daily Postural and Flexibility Lumbar Compression Fracture Exercises

Each of these compression fracture exercises can be found in Exercise for Better Bones. I decide the appropriate mix of postural and flexibility exercises based on my assessment of the individual.

Chest stretch
Chin tuck
Arm lengthening or reach back
Arm pull back
Shoulder Stabilization

With time I encourage you to progress the chest stretch by lying on your back over a rolled-up blanket. Place the blanket lengthways.

Straighten your arms out at the height of your shoulders (shown in Stronger Bones Stronger Body workout video) to open up your chest wall and reduce the constant forward pull into gravity.

Strength and Trunk Control Lumbar Compression Fracture Exercises

A selection of these compression fracture exercises can be done up to three times per week. I decide the appropriate mix of strength and trunk control exercises based on my assessment of the individual.

Abdominal activation
Wall push-ups
Bridging
Prone leg lift
Squats
Step ups
Bicep curls
Horse Stance
Floor M
Reverse Fly

Finally, I encourage you to work with a health care professional who can provide soft tissue massage, postural taping, or taping and gentle spinal mobilization.

Physical Therapy Exercises for Compression Fracture

Daily Postural and Flexibility Lumbar Compression Fracture Exercises

Each of these compression fracture exercises can be found in Exercise for Better Bones. I decide the appropriate mix of postural and flexibility exercises based on my assessment of the individual.

Chest stretch
Chin tuck
Arm lengthening or reach back
Arm pull back
Shoulder Stabilization

With time I encourage you to progress the chest stretch by lying on your back over a rolled-up blanket. Place the blanket lengthways.

Straighten your arms out at the height of your shoulders (shown in Stronger Bones Stronger Body workout video) to open up your chest wall and reduce the constant forward pull into gravity.

Strength and Trunk Control Lumbar Compression Fracture Exercises

Abdominal activation
Wall push-ups
Bridging
Prone leg lift
Squats
Step ups
Bicep curls
Horse Stance
Floor M
Reverse Fly

Finally, I encourage you to work with a health care professional who can provide soft tissue massage, postural taping, or taping and gentle spinal mobilization.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Sex With Compression Fractures

My first piece of advice regarding sex with compression fractures is to consult with your physician before engaging I a physical activity such as sex with your partner.

Second, I cover this topic in more detail in my online course, Guide to Living with Compression Fractures.

When Can You Have Sex After a Lumbar Compression Fracture?

There is no need to give up an enjoyable sex life because of a compression fracture. Vertebral compression fractures (VCF) may alter your sex life, but they should certainly not eliminate it.

A compression fracture may make you feel fragile and vulnerable. That is natural.

Have open and honest conversations about these feelings with your partner. It can help you both feel more comfortable with the situation.

Let your partner know how you feel and discuss the support you need. These conversations provide you both with the opportunity to demonstrate love and care for each other.

A vertebral compression fracture can create stress in your relationship. It is important that you keep this in mind and I recommend that many people consider couples therapy during times of stress. You can find a good therapist in your area. For example this is a good source of couples therapy in Toronto.

During the First 8 to 12 weeks of Recovery (May be Longer for Some People)

When you’re in the recovery stage, physical intimacy is best expressed in alternative ways than intercourse. Consider exploring each other through gentle, sensual touch.

After the Healing Phase

Once you have been given the green light by your physician or surgeon to exercise, you can also start exploring intercourse again.

For some with minimal compression(s) in the mid thoracic spine, little may change for you. Lumbar compression fractures will certainly create a bigger impact on the positions you choose and how aggressive you are comfortable being.

Discuss positions you both enjoy as long as you both keep in mind that the partner with a compression fracture has a heightened awareness of their safety.

Symptoms of Compression Fracture

The following are six symptoms of a compression fracture:

Over the age of 60.
History of a previous fracture, whether that is a wrist fracture, a toe fracture.
Have a shorter duration of back pain. Don’t disregard back pain that only lasts a couple of weeks.
Find that your back pain might not be sharp but a lot of people with vertebral fractures will describe their back pain as crushing in nature.
Your back pain actually gets better when you lie down.
Unlike people with sciatica, your back pain most likely will not be, if it’s from a vertebral fracture, will not be going into the leg.

If you have any of these symptoms, especially a combination of these symptoms, you should ask your doctor to assess you for a vertebral fracture.

Many people are not aware that they have a compression fracture. In fact, a recent study (3) states that about 12% of post-menopausal women will have a vertebral fracture but only one third of those will get the attention of a medical professional.

In the video below I identify the symptoms of compression fracture and what you should do if you have a fracture.

Post Menopausal Women and Symptoms of Compression Fracture

A recent study looked at how 12% of people that are post menopausal are going to have a vertebral fracture in their lifetime.

But only one-third — less than 4% of those fractures — are brought to the attention of the doctor and therefore are brought to the attention of the individual.

This is striking, not only am I seeing people with one vertebral fracture or two vertebral fractures, but by the time they come to see me, by the time they’re first diagnosed, they actually have five vertebral fractures.

This is really terrible because it affects their quality of life. Then they become fearful of moving and it’s a vicious circle.

Compression Fractures Can Get Worse

My clients come to see me after they have been diagnosed and no one has told them that their vertebral fractures can get worse (until they meet me). Just because your spine has compressed 70%, it doesn’t mean that it can’t keep compressing.

If you have a compression fracture, it is so important for you to be really meticulous about your alignment because those fractures will get worse. Not only will the actual fractures themselves get worse but you are at a higher risk of fracturing more and more levels. But all is not lost.

Impact of Exercise on Compression Fractures

A recent study (4) shows that a 12 month duration of exercise had a very positive effect for people who had experienced vertebral fractures. The outcome was that after 12 months they had a significant improvement in quality of life. They had an easier outcome of doing their tasks of daily living, their functional mobility was improved and their balance was improved.

If you have been diagnosed with a vertebral fracture do intelligent exercises, avoid all forward flexion, follow the guidelines that I have on my blogs and in Exercise for Better Bones and play it safe and know that you can still improve your quality of life and you can still be stronger.

If you are not sure whether you have a compression fracture but have any of the six symptoms listed above have it investigated.

What is Compression Fracture

I want to talk about a topic that is especially close to my heart: movements that increase your risk for spinal fractures or compression fractures. During this discussion of the movements that cause a fracture we will get into detail on what is a compression fracture.

Compression Fracture Movements

Many new clients come to me for Physical Therapy compression fracture treatment because they receive advice from fitness trainers or books that does not take into account the fact that they have osteoporosis, osteopenia or low bone density. The clients think that they are doing things that are sound and right for them given the fragility of their bones. They are trying their very best.

Unfortunately, there are a lot of movements that they are doing (under the guidance of a fitness instructor or book that is not familiar with osteoporosis) that might be good for the general public but not for individuals with low bone density, osteopenia or osteoporosis. These movements are putting them at risk of a compression fracture.

By the end of this tutorial, you’ll have a good understanding of what movements, be it in yoga, pilates, in an exercise class or movements around the house, that you should modify.

Spine Anatomy: Compression Fracture in Back

In this tutorial, we’re going to look at why the lumbar and thoracic spine is more at risk than other bones in the body of a compression fracture. This would be a good time to review, if you haven’t yet done, the tutorial on understanding bone.

(To follow this tutorial you will have to play the embedded video because I will refer to images and diagrams as I speak through the talk.)

The illustration shows the normal curves in our spine. We have a normal inward curve in our lumbar spine, or our low back, which is referred to as a lordosis. A normal inward curve in our upper spine, which is the cervical lordosis, is at our neck. We have a normal small outer curve in our upper back, referred to as the thoracic spine.

These curves look really pronounced in our illustration. But if you look at somebody with good alignment, you’ll usually see a nice shape to the spine.

We know from previous tutorials that the vertebral body is composed of a hard outer coating. This hard coating is referred to as cortical bone.

The cortical bone surrounds the trabecular bone in the inside — the softer bone. The trabecular bone is commonly referred to as cancellous or spongy bone.

The illustration to the right shows the cross section of a vertebra of the spine. The cortical bone is the thick non-porous bone at the rim on the cross section of the spine. The trabecular bone is the porous bone in the center of the cross section.

Thoracic Compression Fracture Versus Lumbar Compression Fracture

A compression fracture can happen anywhere along the spine. The incidence of thoracic compression fracture is the highest among all parts of the spine because this area is the one where the postural stoop (or kyphosis) will occur. You could experience a lumbar compression fracture when you have an impact. I had a client who went tobogganing with her grandchildren. As they were going down the snow run they hit a few bumps — enough to cause a lumbar compression fracture and considerable pain.

Flexion Exercise Versus Extension Exercise

In the 1980’s, we weren’t sure whether flexion or extension exercises were a safe thing to give to a woman with osteoporosis or people with back pain. Fortunately there were physicians who studied this issue.

If you who are not familiar with flexion and extension exercises, I have two photos showing each type of exercise.

The first photograph on shows a flexion exercise. Note how our model Pat is rounding her back in order to complete the sit up or crunch exercise. Unfortunately, this exercise is still very popular in exercise classes and used by many personal trainers.

The second photo shows an extension exercise.

Note how our model Aline, in the photo, is performing the Prone M (also referred to as Floor M) exercise by elevating her torso upwards and creating an extension of her back.

I also prepared a video explaining flexion and extension.

In 1984, Dr. Mehrsheed Sinaki at the Mayo Clinic did a study (5) on postmenopausal osteoporotic women that looked at the effects of flexion exercises versus extension exercises.

The mean age or the average age for the women in this study were 49 to 60 years of age.

She broke the study set into four exercise groups:

First group did extension exercises.
Second group did flexion exercises.
Third group did a combination of flexion and extension exercises.
Fourth group did no exercise at all.

Within a year and a half, if they had back pain or if they were due for a follow-up, members of the study set would report back in. Dr. Sinaki did spinal x-rays and would see whether or not they had sustained fractures of the spine. These were the findings.

Flexion Compression Fracture

Compression fractures occurred at the following rates by group:

Group	Exercise Class	Fracture Rate
1	Extension Exercises	16%
2	Flexion Exercises	89%
3	Extension & Flexion	59%
4	No Exercise	67%

The study found that fractures occurred at a very high rate, 89%, in the group that had done flexion exercises (group #2), such as sit ups and toe touch exercises.

The group that did no exercise at all (group #4) still had a very high rate of fracturing. The thought behind that is that for a lot of things that we do in life such as picking out the laundry, reaching forward, coughing, sneezing, involves a lot of flexion.

Further, unless we counteract that with some extension exercise, as you see in group #3 where they did some extension and some flexion, you will not reduce your rate of compression fracture.

The group that did just extension exercises (group #1) had a very low rate of fracturing. Sixteen percent in comparison to 90%. This is a substantial difference.

Why Flexion Causes Compression Fractures

Let’s take a closer look at what happens to your spine when you do flexion exercises or perform activities that cause a flexion motion. The image provides a closer look at the actual trabeculae or the cross-bridges within the vertebral body. When we do a lot of flexion motions of the spine, as well as side flexion and extremes of rotation, those motions have been implicated with high forces and can cause excessive stress on the vertebral body.

The weakened trabeculae in osteoporotic bone can’t withstand those excessive forces. As a result, they start to fracture. You can see in this vertebral body that there are large pits. The weakened areas are unable to bear the stress caused by the flexion (wether through exercise, activities of daily living or other sources) with the result being a compression fracture.

The x-ray image of the spine below shows a compression fracture. The white vertebra is compressed. This can cause a loss of height of the vertebrae.

What has happened is that there’s been so many forces that the disc is actually starting to push through the vertebrae. The vertebrae itself is actually quite a bit shorter in stature than the vertebrae above and below it. It has just compressed in on itself.

How to Reduce Kyphosis

If we want to stop the progression of forward flexing of the spine (kyphosis) that occurs because of the repeated wedge fracturing like we see in the image to the right, we need to do this at a stage ideally where the individual has not yet fractured. This is also known as a Dowager’s Hump, buffalo hump, or neck hump.

We prefer to work with them when they are still able to hold their ear over their shoulder and their shoulder over their hip in nice alignment.

Exercise and movements during the day that put our spine in flexion are implicated. We need to make sure that when you are moving, that you have the best alignment possible.

In the video, you will see Pat, one of my clients, demonstrating how to garden safely.

In the photo, Pat is bending forward in an unsafe manner. She is putting a lot of force on her spine, especially in her mid back, through this position. She is lifting a heavy bag in a flexed position. This movement could cause a compression fracture.

If she took the time to get down and kneel, as she is demonstrating in the second photo, she will maintain a nice postural alignment.

The bending is happening in the knee and hip as opposed to the spine. That’s much safer on the spine. The loading through trabeculae and the whole vertebral body is much more even and safe.

Exercises and Movements That Increase Risk of Compression Fracture

Studies have shown that exercises that involve flexion increase your chance of spinal fracture. They have also demonstrated that exercises that involve the combination of flexion and rotation increase fracture risk even more than flexion exercises only.

Daily activities can be problematic. I will often see women carry heavy purses and they go to sit down and they’ll rotate and drop their purse to the side. Movements like create a very compressive load and put your spine at risk of a compression fracture.

Movement Strategies to Avoid a Compression Fracture

Here are several movement strategies that will reduce your risk of a compression fracture.

Follow an exercise program designed for people with osteoporosis. Exercise for Better Bones is an osteoporosis exercise program that provides exercise programs for people at different fracture risk and activity levels.

Make sure you follow good movement patterns during your activities of daily living (ADL). There is a comprehensive guide on safe movement included with Exercise for Better Bones.

Yoga and pilate moves need to be practiced with caution and should be practiced under the supervision of instructors who are well trained in the precautions that need to be carried out for individuals with osteoporosis and low-bone density. If you want more information or have an instructor who wants more information, consider Yoga for Better Bones. It provides details on Yoga poses you should modify or avoid.

Avoid exercises that put you in flexion. Stay clear of exercises that involve flexion and rotation. I wrote a detailed post on osteoporosis exercises to avoid.

Types of Vertebral Compression Fractures

Not every vertebral compression fracture is alike. Just as we are all unique in our makeup, the same applies to compressions that can occur in the spine. The most significant risk factor for obtaining a vertebral compression fracture is having osteoporosis.

Compression fractures may be classified based on the portion of the vertebral body that is affected. (1) They are generally classified when at least 20% of the height of the affected portion is lost.

Wedge Vertebral Compression Fracture

The wedge vertebral compression fracture takes its name from the shape that is created as the front or anterior of the vertebral body is affected.

Wedge compressions are most commonly seen in the mid back, around the level of the lower angle of the shoulder blades.

Biconcave Vertebral Compression Fracture

The biconcave vertebral compression fracture, like the wedge fracture can have different levels of compression. With a biconcave vertebral compression fracture the middle of the vertebra collapses.

With biconcave fractures the top of the vertebral body takes on what looks like a smile while the bottom of the vertebral body takes on a grin.

In the next lessons I cover in more detail what types of movements have been shown to increase the risk of both wedge and biconcave vertebral compression fractures.

Crush Vertebral Compression Fracture

A crush vertebral compression fracture is the least common type of vertebral compression fracture. In crush fracture the posterior portion of the vertebral body collapses.

The last type of compression fracture is classified as complex.

How Do I Strengthen my Back After a Compression Fracture?

In order to strengthen your back (and improve your posture) after a vertebral compression fracture, I highly recommend that you start with the postural exercises in Exercise for Better Bones and then build from there to the Beginner strength exercises. After that, continue through to the Active strength exercises.

All of those exercises are incredibly safe and progressive.

Take it one day at a time, one exercise at a time, and progress at a pace that works for you.

Weight Lifting After Compression Fracture?

Yes, absolutely.

How much weight can you safely lift?

I don’t know.

It depends on your body, how strong you were, the quality of your bone, and your form when you exercise.

It is always best to start slowly and gradually with baby steps. Start at the beginner level, gradually work your way up, see what your body allows you to do, and maximize the weight that you can lift safely.

Can I Wear or Use a Weighted Vest After a Compression Fracture?

Weighted vesta are a popular exercise device for many people with osteoporosis but should you wear one if you have a compression fracture? I answer that question in this video:

Can You Drive with a Compression Fracture?

If you find that you have no pain sitting or doing shoulder checks, then there’s no reason that you can’t drive.

However, I have a number of clients who took several months, even some as long as nine months, to be comfortable driving. This was due to the fact that they would place their hands down by their side to brace themselves when the car went over a little pothole or bumpy spaces in the road.

If they were driving, they didn’t feel they had the control of both their body and the car at the same time.

So it’s a personal decision that you’re going to have to make to keep you safe and feeling well.

Is a Heating Pad Good for a Compression Fracture?

Yes, it is.

In the early phases of your vertebral fracture, there will be some inflammation around the vertebral body itself, but the heat pad can be applied away from the vertebral bodies and to all the back muscles on either side of the vertebrae. The heat helps the muscles to relax.

As time goes on, your spine has to work a little harder if you have compressions because the forces in the spine have changed.

The heating pad is nice when you’re taking your break before bed or taking siesta in the afternoon, for example, to bring some blood flow to the muscles and give them a little break throughout the day.

As mentioned earlier in this post, Brenda uses a heating pad a lot. When she starts to feel achy, she sits down for 15 minutes and puts it on. It helps take the ache away. When she does her stretching exercises, she has it underneath her as well.

Best way to Sleep with Compression Fractures

Here is my recommended osteoporosis sleeping position for people with compression fractures. This is likely the best sleeping position for osteoporosis of the spine:

If you wear pyjamas to bed, choose silky material to help reduce friction and make moving in your bed easier.
‘Log roll’ when turning in bed. Keep your knees bent, roll your shoulders and knees simultaneously.
Use extra pillows to ensure a supportive sleeping position.
Use a heating pad to help your muscles relax.
Consider wearing a waist belt to support the space between your lower ribs and pelvis.
Use a pillow under your knees/legs when sleeping on your back.
Keep your head pillow as low as you comfortably can when on your back.
Use a pillow between your knees and ankles when sleeping on your side.
If you are a side sleeper, make your head pillow wide enough that it supports your head in a neutral position (i.e. that your chin is in at the level of the middle of your breastbone).
Consider sleeping in your own bed so that you do not have the worry of your partner’s movements jarring your back.
Avoid sleeping in a recliner. Get as flat as you comfortably can so as to take weight off your compressed vertebra.
Avoid a water bed.
Avoid a memory foam mattress if you keep your room cooler than 65 degrees Fahrenheit at night (because they get too stiff).
Medium-firm mattress is often recommended but you have to find the one that is right for you. Make sure you spend at least 10 minutes lying on one at the shop. Wear the same thickness of clothes you would at night.

To learn more about how to get a good night’s sleep if you have a compression fracture, visit my page dedicated to better sleep.

How to Get Out of Bed With a Compression Fracture

Here are my recommendations for patients with compression fractures who want to know how to get out of bed with a compression fracture:

Use your pelvic floor and deep abdominal muscles to brace your back when getting in and out of bed.
To get out of bed, ‘log roll’ onto your shoulder and then push yourself up with your hands until you are in a sitting position.
To get in bed, get in a sitting position. Carefully tilt down, lower yourself with your hands and roll onto your shoulder until you are lying flat on your side.

Compression Fracture and Back Pain

A comprehensive study published in the Journal of Bone and Mineral Density in September 2017 (7) identified a relationship between the incidence of compression fracture and back pain.

The research team examined data from 4,396 men over the age of 65. The men had enrolled in the Osteoporotic Fractures in Men study between 2000 and 2002. The key findings and conclusions were:

Only 25% of new vertebral fractures are diagnosed by their physician.
Approximately 60% of older men with small osteoporosis-related compression fractures reported new or worsening back pain.
The percentage of men in the study reporting back pain with undiagnosed compression fractures (70%) exceeded those without compression fractures by 11 percentage points (59%).
93% of the men who had their fractures diagnosed during the study reported back pain.
Prevention the compression fractures could have reduced the onset of back pain and further disability in the study group.

The study’s main author, Dr. Howard Fink, concluded: “Back pain is the most common symptom (of compression fractures).” The study results are similar to findings in elderly women.

Recall that Brenda experienced severe back pain during her trip to Africa — likely brought on by a compression fracture. If you experience back pain, consult your physician and specifically ask if she can determine if the cause is a compression fracture.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Conclusion: How to Treat a Compression Fracture

We have covered a wide range of issues related to compression fractures. We learned why your spine is at risk of a compression fracture and about physical therapy compression fracture treatment. Brenda’s story shows that every person’s experience with compression fracture is going to be different.

We identified six symptoms that you might have a compression fracture. I have quite a few clients that have compression fractures and do not even know they ever had them. I’ll ask them to get x-rays because I’m trying to convince them to move safer. Some clients might have had a bit of back pain that goes away after six to eight weeks. They’re the lucky ones. Their compressions fracture may not always stay like that.

Brenda’s experience shows that you should find a health practitioner that you trust and has knowledge in treatment of osteoporosis and compression fractures.

There are many things that you can do to make your life with a compression fracture. We covered these in this blog post.

Safe compression fracture exercises and safe movement are critical to reducing your risk of another compression fracture.

I hope that this blog does help make the life of listeners a little bit easier out there, and if anybody wants to add their comments at the end the blog, feel free to do so.

Margaret Martin

References

Mokhtarzadeh H, Anderson DE. The Role of Trunk Musculature in Osteoporotic Vertebral Fractures: Implications for Prediction, Prevention, and Management. Curr Osteoporos Rep. 2016 Apr 4. [Epub ahead of print]
Kim L Bennell, Bernadette Matthews, Alison Greig, Andrew Briggs, Anne Keppy, Margaret Sherburn, Judy Larsen, John Wark. Effects of an Exercise and Manual Therapy Program on Physical Impairments, Function and Quality-of-life in People with Osteoporotic Vertebral Fracture: A Randomized, Single-blind Controlled Pilot Trial. BMC Musculoskeletal Disorders. Posted 03/19/2010
Clark E.M., Gooberman-Hill R, Peters TJ. Using self-reports of pain and other variables to distinguish between older women with back pain due to vertebral fractures and those with back pain due to degenerative changes. Osteoporosis International. April 2016, Volume 27, Issue 4, pp 1459-1467
EvstigneevaL et al. Effect of twelve-month physical exercise program on patients with osteoporotic vertebral fractures: a randomized, controlled trial. Osteoporos Int. 2016 Mar 16. [Epub ahead of print]
Sinaki M, Mikkelsen BA, Postmenopausal spinal osteoporosis: flexion versus extension exercises, Arch Phys Med Rehabil. 1984 Oct; 65(1): 593-6
Association of Incident, Clinically Undiagnosed Radiographic Vertebral Fractures With Follow‐Up Back Pain Symptoms in Older Men: the Osteoporotic Fractures in Men (MrOS) Study, Howard A Fink et al, Journal of Bone and Mineral Density, September 7, 2017

The post How to Treat a Compression Fracture appeared first on MelioGuide.

What To Do After Being Diagnosed With Osteoporosis

Margaret Martin — Fri, 01 Aug 2025 14:59:40 +0000

August 1, 2025

If you’ve just been diagnosed with osteoporosis or osteopenia, you’re probably feeling overwhelmed and maybe a little scared. I get it. Like many people I know, you are trying to figure out what to do after being diagnosed with osteoporosis.

But here’s what I want you to know: this diagnosis doesn’t define your future. What you do next absolutely matters, and today I’m going to share the five critical steps that can make all the difference in your bone health journey.

What To Do After Being Diagnosed With Osteoporosis

As a Physical Therapist who’s worked with hundreds of women navigating osteoporosis, I’ve seen firsthand how the right approach can transform not just your bone density, but your entire quality of life.

The five steps aren’t just suggestions – they’re your roadmap to taking control of your bone health. Use this five point checklist to keep track of what to do after being diagnosed with osteoporosis.

Get Your DEXA Report With Images

The first thing you need to do – and I mean within the next week – is obtain your complete DEXA report. Not just the T-scores that your doctor might have mentioned, but the entire report including the actual images.

Here’s why this matters: those images tell a story that numbers alone can’t. They show the quality of the DEXA test, areas of particular concern, and can reveal patterns that will guide your entire treatment approach. They can also reveal, to the trained eye, whether your bone density test was properly done and measured. At the 2025 World Conference on Osteoporosis, held in Rome, data was shared that errors occur not just once in a while but in the range of 40 to 90% globally.

Call your doctor’s office or the imaging center and specifically ask for both the complete test. This includes not only a written report but also the images of your hips and spine. You have every right to these – they’re your medical records. Paper reports are fine but many facilities can provide them digitally, which makes it easier to share with other healthcare providers later.

Don’t let anyone tell you that you “don’t need” the images or that they’re “too technical.” You’re building your healthcare team, and every qualified professional you work with will want to see these complete results. If they do not, you should consider working with someone else.

Record Three Months of Your Activity Level

Now on to the second step, I need you to be completely honest with yourself about your activity level over the past three months. And I mean brutally honest – no one else needs to see this but you.

Get a notebook or open a document on your phone and write down:

How many days per week you exercised
What types of activities you did
How long each session lasted
How intense these activities were

Include everything: your morning walks, that yoga class you attended twice, the gardening you did last weekend, even taking the stairs instead of the elevator.

Why three months? Because this gives us a realistic picture of your baseline. Not your best week, not your worst week, but your actual lifestyle pattern.

This isn’t about judgment – it’s about creating a starting point.

If you haven’t fractured doing what you’ve been doing you likely won’t fracture in the coming months, but taking stock of what you’ve been doing provides you with a foundation you can build on. If you’ve been walking 2 miles a day, you can consider gradually increasing the pace you do those steps. Don’t stop moving.

If your exercise program involves exercises to avoid such as twist and forward bends it’s time to find a program that offers more intelligent exercises. Gradually increase the weight you lift, don’t stop lifting.

If you’ve not been committed to exercising, it’s time to prioritize the health of your bones and your body.

Exercise and Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Record Five Days of Your Nutrition Activity

Your third assignment is to become a food detective for five consecutive days. This means tracking everything you eat and drink, including all supplements.

I need you to calculate your daily intake of:

Protein
Calcium
Vitamin D
Magnesium
Vitamin K2
The number of fruits and vegetables

Use a nutrition tracking app like Cronometer or MyFitnessPal – they’ll do the calculations for you. If you prefer pen and paper, that works too, but you’ll need to look up the nutritional content of your foods.

Why these specific nutrients? They’re the building blocks of bone health.

Protein provides the framework for bone formation.
Calcium is the primary mineral in bones.
Vitamin D helps your body absorb calcium.
Magnesium is essential for bone structure.
And vitamin K2 directs calcium to your bones instead of your arteries.

Don’t change your eating habits during these five days – we want to see your real patterns, not your “perfect” eating week.

Record Factors That Affect Bone Density and Bone Quality

Quality matters as much as quantity when it comes to bone health. Your fourth step is to record all the other factors that might be negatively affecting your bone quality as well as your bone density.

Make a list that includes:

Your sleep quality and duration
Stress levels and what you do to manage your stress
Any medications you’re taking, a quick search will tell you how they affect your bones
Smoking
Alcohol consumption
Your hormone status, especially if you’re pre or post-menopausal
Any chronic health conditions
Symptoms of digestive issues such as decreased appetite, fatigue, abdominal pain and cramping.
Your balance. This doesn’t impact your bones but poor balance increases your risk of falling which in turn increases your risk of breaking a bone.

The things on this list can help you identify hidden factors that might be working against your bone health, even if you’re doing everything else right.

Start with the things you can most easily change and once you have succeeded you’ll know when you’re ready to take on the next one.

Find Qualified Health Care Professionals

Your final step is perhaps the most challenging: finding qualified healthcare professionals who truly understand osteoporosis in three key areas.

Nutrition

Look for a registered dietitian who specializes in bone health, not just general nutrition. They should understand the complex interactions between nutrients and be able to create a personalized plan based on your food tracking results.

Exercise and Movement

You need someone who understands that not all exercise is created equal for osteoporosis. Weight-bearing and resistance exercises are crucial, but they need to be appropriate for your current bone strength and your fitness level. My website, MelioGuide.com is actually a great place to start!

Hormones and Pharmaceuticals

Whether you’re considering hormone therapy or exploring pharmaceutical options, you need a healthcare provider who stays current with the latest research and can discuss all your options, including timing and combinations.

Don’t settle for providers who brush off your questions or seem rushed. You deserve professionals who will take the time to explain your options and work with you as a partner in your care.

Conclusion: Five Things To Do After Being Diagnosed With Osteoporosis

Here’s what I want you to remember: you are not a passive recipient of this diagnosis. You are about to become your own strongest advocate, and knowledge truly is power.

These five steps aren’t just busy work – they’re the foundation of a comprehensive approach to bone health that can absolutely change your trajectory. I’ve seen women transform their bone density, reduce their fracture risk, and regain confidence in their bodies by following exactly these steps.

Your osteoporosis diagnosis isn’t the end of your story – it’s the beginning of you taking control of your health in ways you never have before.

Take it one step at a time, Remember: you’ve got this, and you’re not alone in this journey.

Margaret Martin

OsteoStrong Review: What’s Wrong With OsteoStrong?

Margaret Martin — Thu, 31 Jul 2025 01:28:49 +0000

July 31, 2025

As a Physical Therapist and licensed health professional, I frequently receive questions about OsteoStrong from my patients. Many women in their 40s, 50s, 60s, and 70s are understandably concerned about maintaining or improving their bone density, especially as the risk of osteoporosis increases with age. They specifically ask: Is OsteoStrong safe? Is it effective? Is there credible research supporting their claims?

As a clinician, I will only recommend a modality when it can demonstrate that it is an effective and safe way to improve bone health. Recently, Osteostrong identified a study out of Greece that it claimed supports that their devices improve bone health.

In the past, I’ve been hesitant to speak openly about the company. There was an unpleasant OsteoStrong lawsuit with a client who experienced a compression fracture (1) (2). However, a recent development has encouraged me to share my professional insights with you.

What is OsteoStrong?

Before diving further into the topic, let’s clarify what OsteoStrong actually is. OsteoStrong is a private company offering membership-based gym services specifically targeting individuals with osteoporosis. They operate through a franchise model, with “OsteoStrong Centers” located throughout the US, Canada, Europe, and other parts of the world.

The company claims their protocol involves “bone strengthening” through brief (12-minute), weekly, low-impact, high-intensity osteogenic loading sessions. This certainly sounds appealing, especially for those seeking efficient ways to improve bone health.

Review and Evaluation of The Recent OsteoStrong Study

In February 2025, a team of researchers in Greece published a study on OsteoStrong in the Journal of Clinical Endocrinology and Metabolism (3). This study, which was funded by OsteoStrong, claimed that the OsteoStrong protocol effectively increases bone mineral density, improves bone quality, and delivers other health benefits.

However, Dr. Lora Giangregorio, a leading researcher in osteoporosis and exercise from the University of Waterloo in Canada, has published a thorough review of this study (4). Dr. Giangregorio has published numerous studies on osteoporosis and exercise and is highly respected in her field. Her analysis reveals several concerning issues that anyone considering OsteoStrong should be aware of.

Major Shortcomings of the OsteoStrong Study

Dr. Giangregario identified seven significant shortcomings in the OsteoStrong study.

1. Failure to Meet Basic Scientific Standards

According to Dr. Giangregorio, the OsteoStrong study fails to meet even the most fundamental standards expected in scientific research:

No clear objectives or hypotheses
Inadequate information about ethical approval
No clear statistical analysis plan describing how results were analyzed
Incomplete description of how data was collected and analyzed for many outcomes
No clear information about what the control group actually did

Scientific research follows internationally accepted standards and checklists for reporting. Alarmingly, this study is missing most of these essential elements.

2. Lack of Trial Registration

The scientific community agrees that all clinical trial protocols should be registered in a widely available online registry to ensure transparency. This registration number should be included in the published study.

Without a registered protocol, no one can confirm whether the researchers followed their original plan or if they changed their analysis or reporting methods to align with desired outcomes.

Interestingly, there is no information confirming that the OsteoStrong trial was registered. Dr. Giangregorio contacted both the authors and the university’s ethics board to determine if it was registered but received no response.

3. “Low Quality Study” with High Risk of Bias

From what Dr. Giangregorio could determine, this appears to be a very low-quality study with no efforts made to reduce the risk of bias.

Rather than using a randomized controlled trial (the gold standard in research), participants were allowed to choose whether they wanted to be in the control group or the OsteoStrong group. This self-selection creates an immediate bias, as people eager to participate in OsteoStrong may have had different health status or habits than those who opted out.

Additionally, there’s no indication that the study blinded the assessors – meaning the people evaluating outcomes knew which participants were in which group. This knowledge can significantly influence results, whether consciously or unconsciously.

4. Confounding Factors: Osteoporosis Medications

Dr. Giangregorio noted it was unusual that the study enrolled participants who were taking osteoporosis medications. These medications increase bone mineral density on their own, which confounds the results – especially if:

The types of medications varied among participants
Duration of medication use differed
The number of participants was too small to separate medication effects from OsteoStrong effects

The study provides very little information about the types of osteoporosis medications participants were taking, how long they had been on them, or whether they took them consistently. This means the study wasn’t designed to accurately test the effects of OsteoStrong independent of medication effects.

5. The Crucial Question: Does OsteoStrong Improve Bone Density Scores?

For many women considering OsteoStrong, the most important question is whether the study demonstrated that OsteoStrong increases bone mineral density compared to the control group.

Surprisingly, we don’t know the answer because the authors didn’t report any analyses of between-group differences in bone mineral density at the hip or spine. Instead, they reported other statistics that aren’t typically used or accepted in clinical trials, such as:

Changes in bone mineral density within each group (but not compared between groups)
T-scores
The percentage of people who experienced an increase in bone mineral density

The scientific standard is to focus on whether the bone mineral density change in one group is statistically different from the other group. Without this comparison, we cannot draw conclusions about effectiveness.

6. Lack of Proper Statistical Analysis

The study reported changes within each group but did not report statistical analyses comparing between the groups. Without this critical between-group analysis, it’s inappropriate to make conclusions about the effectiveness of OsteoStrong compared to the control.

Dr. Giangregorio points out that the average bone mineral density was already different between groups at the start of the study – something that shouldn’t happen if the groups are properly balanced. There’s also no information about how the researchers handled:

Baseline differences between groups
Missing data
Outliers (unusually large individual changes that can skew averages)

Some participants showed changes that seem implausibly large. Including these outliers can falsely increase the average change reported. Dr. Giangregorio noted several errors and outliers in the paper, suggesting that a closer examination of the data and statistical analysis is warranted.

7. Follow the Money: Who Funded the Study?

Just as we might be skeptical of research funded by pharmaceutical companies, it’s important to note that this study was funded by a private company that owns OsteoStrong franchises.

Although the authors disclosed this funding, there remains significant potential for conflict of interest that could influence how the study was designed, conducted, analyzed, and reported.

8. Scientific Community Response

Dr. Giangregorio believes that the peer reviewers who evaluated this paper before publication may have missed several critical issues. She notes that the paper doesn’t even meet all of the journal’s own authorship guidelines.

The Bone Health and Exercise Science Lab at the University of Waterloo and other scientists globally have made the journal editors aware of their concerns about this paper and have called for its retraction. Several researchers from multiple countries, including researchers at Harvard, have written letters calling for its retraction.

Importantly, the senior author of the study is an editor for the journal where it was published, raising additional questions about the review process.

Exercise and Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

OsteoStrong Review: July 2025

Previously, we examined the “research” OsteoStrong promotes as evidence for its claims on increasing bone density and improving health. We highlighted how Dr. Lora Giangregorio from the University of Waterloo identified significant shortcomings in that research, concluding that its cornerstone—the “Greek study”—is not credible evidence.

Now, I want to guide you through a far more definitive OsteoStrong review and analysis. The research team, including Dr. Giangregorio, published a comprehensive paper in the July 2025 issue of the prestigious journal Osteoporosis International (5). Titled “OsteoStrong and bone health: a scoping review,” this paper examines the available scientific literature to answer the critical questions that patients and their healthcare providers have about the program’s efficacy and safety, such as:

Does OsteoStrong work?
Are there any OsteoStrong side effects?

Let’s start with a discussion of how the research team approached these questions.

OsteoStrong Review Methodology

The research team cast a wide net to find all available evidence. They systematically searched five scientific databases for any study involving OsteoStrong machines. Their goal was to find any data related to the outcomes that matter most to bone health: changes in bone strength, risk of falls, and fracture rates.

OsteoStrong Review: General Concerns

The OsteoStrong review identified several significant methodological issues with the research:

Conflicts of Interest: Of the four studies for which full texts were available, three have evidence of conflicts of interest. The first author of one study was also the sole participant in the study, and the third author of the same study was the inventor and medical science advisor of OsteoStrong.
Publication Issues: One study was identified from a journal whose publisher appears on Beall’s list of predatory publishers, which are not typically indexed in major bibliographic databases.
Small Sample Sizes: Most studies included 26 or fewer participants, limiting the ability to draw meaningful conclusions about effectiveness or safety.

Does OsteoStrong Work?

The research team examined the research to see if OsteoStrong does work as promised by the company. The evaluated OsteoStrong on several dimensions. Let’s discuss each one.

Fractures

The fracture data from OsteoStrong studies is extremely limited and concerning. None of the studies had sufficient sample size to properly test fracture outcomes, yet some troubling findings emerged.

In one of the studies, researchers identified multiple vertebral compression fractures in the OsteoStrong group:

One T8 wedge fracture progressed from grade 1 (mild) to grade 2 (moderate)
Five new incident wedge fractures at 8 months: T5 grade 1, T6 grade 1, T8 grade 1, and T9 grade 1

In contrast, no incident fractures were reported in the high-intensity resistance training (HiRIT) or control groups.

Another study reported three vertebral fractures in the OsteoStrong group compared to one in the exercise group.

Falls

Only one study reported comprehensive fall data. While the authors found no significant between-group differences in the number of falls or people who fell, the sample sizes were too small to draw meaningful conclusions.

Bone Mineral Density (BMD)

The research team evaluated OsteoStrong as it relates to effect on bone mineral density (BMD). They examined the results by area of anatomy.

Lumbar Spine BMD

Studies examined lumbar spine BMD with highly inconsistent results.

Femoral Neck BMD

Several studies reported femoral neck BMD outcomes but found no statistically significant between-group differences.

Total Hip BMD

Several studies examined total hip BMD but found no statistically significant between-group differences.

Femoral Neck and Total Hip Volumetric BMD (vBMD)

Femoral Neck vBMD: No significant between-group or within-group differences were found for total, trabecular, or cortical vBMD at the femoral neck.
Total Hip vBMD: Similarly, no significant differences were observed between groups for total hip vBMD measurements.

Bone Material Strength Index

The researchers used bone material strength index (BMSi) but found no significant difference was found between exercise and OsteoStrong groups.

OsteoStrong Side Effects and Adverse Events

The OsteoStrong side effects and adverse event reporting across studies was inadequate, but several concerning patterns emerged.

In one study, the OsteoStrong group experienced:

Right knee discomfort during leg press
Left shoulder muscle discomfort during chest press (caused 3 weeks of missed sessions)
Low back discomfort after vertical lift (participant refused to perform vertical lift for four subsequent sessions)

Study Limitations in Safety Assessment

The researchers emphasized that none of the studies had sufficient sample sizes to properly assess safety, particularly for low-frequency but serious events like fractures. The small sample sizes make it difficult to determine the true safety profile of OsteoStrong interventions.

The Verdict: Is OsteoStrong a Hoax? Is OsteoStrong Legitimate?

While the authors do not question the legitimacy of the business venture, they do share their concerns with the potential for conflict between client care and profit maximization.

OsteoStrong is a for-profit company that sells franchises where members pay to access OsteoStrong proprietary equipment. The company and franchisees stand to benefit from being able to point to research that their intervention is effective while keeping research questioning the efficacy of the modality.

The company’s social media channels and website highlight published research that aligns with claims on their website but does not include the independent trials that reports incident fractures and no between-group differences in favour of OsteoStrong.

This does not suggest that OsteoStrong is hoax or is not legitimate. OsteoStrong is not a hoax, by any measure.

However, the review is more of warning for you, the reader, and that you should tread cautiously with OsteoStrong and their claims.

Individuals considering OsteoStrong as a treatment should be cautioned that claims that it has been shown to be safe or that it increases bone mineral density have not been substantiated by well-designed, published randomized controlled trials.

Discussion

The research on OsteoStrong is mainly limited to small observational studies that are at risk of bias because of conflict of interest, imprecision, publication in a predatory journal, participants on anti-resorptive medications, or poor-quality research reporting. The effects of OsteoStrong on bone strength outcomes are inconsistent, and currently there is little data on safety of this intervention.

The researchers emphasize that individuals considering OsteoStrong as a treatment should be cautioned that claims that it has been shown to be safe or that it increases bone mineral density have not been substantiated by well-designed, published randomized controlled trials.

OsteoStrong Efficacy and Effectiveness

If you’re a woman concerned about your bone health and considering OsteoStrong, what does all this mean?

In Dr. Giangregorio’s professional opinion – which I share – it is not possible to draw any meaningful conclusions from this study regarding the efficacy and effectiveness of OsteoStrong or from any of the published research on OsteoStrong to date.

The Bone Health and Exercise Science Lab and their international colleagues do not recommend making decisions to participate in OsteoStrong based on this new study. The serious methodological flaws, potential conflicts of interest, and lack of proper statistical analysis mean that the reported benefits cannot be trusted.

Conclusion: Looking Forward

There are reportedly two other studies about OsteoStrong that have not been published yet. These may provide more insight into whether OsteoStrong is truly effective. Until then, I recommend approaching claims about OsteoStrong with healthy skepticism.

Bone health is too important to entrust to interventions without solid scientific backing. As we learn more about OsteoStrong through future research, I’ll continue to share updates and insights with you.

Remember, improving and maintaining bone health is a long-term commitment that typically involves multiple approaches working together.

There are no quick fixes or miracle solutions, but there are evidence-based strategies, such as my Exercise for Better Bones program, that can help you maintain your bone density and reduce fracture risk as you age.

Margaret Martin

References

Oliveri v. Osteostrong, 2021 Ohio 1694, 171 N.E.3d 386 (Ohio Ct. App. 2021), Casetext. https://casetext.com/case/oliveri-v-osteostrong
“Anguish” Failed to be an Effective Substitute for “Negligence” in Ohio Case, Doric Cotten, Sport Waiver July 21, 2021 https://www.sportwaiver.com/anguish-failed-to-be-an-effective-substitute-for-negligence-in-ohio-case/
Nektaria Papadopoulou–Marketou, Anna Papageorgiou, Nikolaos Marketos, Panagiotis Tsiamyrtzis, Georgios Vavetsis, George P Chrousos, Effective Brief, Low-impact, High-intensity Osteogenic Loading in Postmenopausal Osteoporosis, The Journal of Clinical Endocrinology & Metabolism, 2025;, dgaf077, https://doi.org/10.1210/clinem/dgaf077
Osteostrong and Osteoporosis: BonES lab review of new study. https://youtu.be/fI3s_bbqrKQ?si=cNS4CwmGYZr4iXj5
Kabra A, Katzman WB, Lane NE, Giangregorio LM. OsteoStrong and bone health: a scoping review. Osteoporos Int. 2025 Jul 21. doi: 10.1007/s00198-025-07614-x. Epub ahead of print. PMID: 40691713.

The post OsteoStrong Review: What’s Wrong With OsteoStrong? appeared first on MelioGuide.

Aromatase Inhibitors and Bone Loss During Breast Cancer Treatment

Margaret Martin — Wed, 30 Jul 2025 15:25:03 +0000

Breast cancer patients now experience significantly higher survival rates thanks to early diagnosis and more effective treatments. Aromatase inhibitors, a class of hormone therapy medications, stand out as one of the most effective protocols for preventing hormone receptor-positive breast cancer recurrence. While highly effective, these medications can cause bone loss as a side effect. This article explores the connection between aromatase inhibitors and bone loss, their potential to cause osteoporosis or osteopenia, and strategies to protect your bone density while using these medications.

Dr. Theresa Guise, a world-renowned expert on cancer and bone health, shares her insights throughout this article. As a professor, clinician, and chief of the Bone and Mineral Disorder section at the University of Texas MD Anderson Cancer Center, Dr. Guise has dedicated her career to understanding how cancer and its treatments affect the musculoskeletal system.

How Cancer Treatment Impacts Bone Remodeling

Cancer treatments often affect bone health more significantly than cancer itself. While we typically associate cancer’s impact on bones with metastasis (cancer spreading to bone), many cancer treatments can affect bone health even when cancer hasn’t spread to the bones.

Common cancer treatments that can affect bone mineral density include:

Chemotherapy radiation used across many cancer types
Anti-estrogen therapy for breast cancer
Anti-androgen therapy for prostate cancer
Glucocorticoids (steroid hormones like prednisone or dexamethasone)

These treatments disrupt the bone remodeling process and can lead to bone loss, fractures, muscle weakness, and potentially osteoporosis.

Breast Cancer Treatment and Osteoclasts

Cancer treatments can stimulate osteoclastic bone resorption, accelerating the bone remodeling process. In this situation, osteoclasts destroy bone faster than osteoblasts can rebuild it, resulting in net bone loss.

Breast Cancer Treatment and Osteoblasts

Some treatments, particularly glucocorticoids, directly inhibit osteoblast activity. The effects can be dramatic — radiation therapy, for example, can cause significant bone loss within a short timeframe. This makes it crucial to identify these potential effects before treatment begins and implement preventive measures, such as medications or low intensity vibration therapy.

Aromatase Inhibitors and Bone Loss During Breast Cancer Treatment

As both a researcher and patient, Dr. Guise brings unique insight into aromatase inhibitors, which have become the standard first-line treatment for estrogen receptor-positive breast cancers. These drugs have proven more effective than their predecessor, Tamoxifen, by blocking the aromatase enzyme that converts androgens to estrogens.

While effective at treating breast cancer, aromatase inhibitors reduce estrogen levels below those typically seen in menopausal women, leading to various musculoskeletal problems.

Exercise and Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

I cover important topics related to osteoporosis exercise including:

Can exercise reverse osteoporosis?
Stop the stoop — how to avoid kyphosis and rounded shoulders.
Key components of an osteoporosis exercise program.
Key principles of bone building.
Exercises you should avoid if you have osteoporosis.
Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Do Aromatase Inhibitors Cause Osteoporosis?

Bone loss affects most women taking aromatase inhibitors. Those starting treatment with osteopenia may develop osteoporosis without preventive measures. This occurs because estrogen naturally inhibits bone-resorbing osteoclasts. When aromatase inhibitors deplete estrogen, bone loss accelerates as osteoblasts struggle to keep pace with increased resorption.

Beyond bone loss from aromatase inhibitors, many postmenopausal women with breast cancer experience muscle weakness and generalized aches in their muscles, bones, and joints. These side effects are associated with aromatase inhibitors and sometimes lead to treatment discontinuation.

Aromatase Inhibitors and Bone Loss: How to Counter Bone Loss

Several strategies can help counter bone loss during aromatase inhibitor therapy:

Medications like Prolia (denosumab) or bisphosphonates like zoledronate
Low intensity vibration therapy, particularly helpful for patients experiencing muscle weakness
Mechanical loading exercises, when tolerated

Research in Dr. Guise’s laboratory shows that low intensity vibration can prevent bone loss, improve muscle strength, and reduce fat in mouse models. A clinical trial at Indiana University is currently evaluating these effects in women taking aromatase inhibitors.

Aromatase Inhibitors and Osteoporosis: Dr. Guise's Personal Journey

Dr. Guise shares her personal experience as a breast cancer patient taking aromatase inhibitors. By combining a low intensity vibration platform (used twice daily) with zoledronate treatment, she achieved a 3% increase in bone density — a marked improvement over the bone loss typically seen with aromatase inhibitors alone.

Aromatase Inhibitor Therapy and Bone Loss: Updated Guidelines for 2025

A group of clinicians and researchers (including Dr. Guise) recently published a joint position statement for a number of leading osteoporosis organizations in the August 2025 edition of the Journal of Bone Oncology. (1) The statement provides updated guidelines for the management of aromatase inhibitor associated bone loss in women with hormone sensitive breast cancer.

The key message for you is that women taking aromatase inhibitors for breast cancer face a 2 to 4 times higher risk of bone loss and fractures compared to normal menopause, making early bone-protective treatment essential rather than optional. The good news is that effective treatments like denosumab (Prolia) and bisphosphonates not only prevent fractures but may also improve breast cancer survival outcomes.

We review this joint statement in this section.

Elevated Risk of Vertebral and Hip Fractures

Women with hormone-responsive breast cancer who receive adjuvant endocrine treatment with aromatase inhibitors are known to be at higher fracture risk due to a marked increase in bone resorption.

Studies have shown that aromatase inhibitor associated bone loss in postmenopausal women with hormone-sensitive breast cancer, where estrogen is already naturally depleted, can lead to a 2 to 4 fold increase in bone loss compared to the usual postmenopausal decrease in BMD, leaving them at high risk of fragility fractures.

The relative risk (RR) for hip fractures and non-vertebral fractures was 1.18 versus controls, while the RR for vertebral fractures was much higher, at 1.84. This means women on aromatase inhibitor therapy face nearly double the risk of spine fractures compared to those not on this treatment.

Extended Aromatase Inhibitor Treatment Increases Bone Loss Risk

A systematic review and meta-analysis of seven trials of 16,349 breast cancer patients treated with either extended-duration aromatase inhibitors, placebo or no treatment found that longer treatmen

Aromatase Inhibitors and Bone Loss Risk Factors

The updated guidelines identify several key risk factors that increase your fracture risk beyond Aromatase inhibitors therapy itself. These include:

Age over 65 years
T-score below -1.5 on bone density testing
Current or history of smoking
Body mass index (BMI) less than 24
Family history of hip fracture
Personal history of fragility fracture after age 50
Previous vertebral fracture
Use of oral corticosteroids for more than 6 months

Advanced Assessment Techniques

Modern fracture risk assessment goes beyond traditional bone density (DXA) scans. The FRAX® tool was developed for use in the general population and was not specifically designed for use in patients with breast cancer undergoing aromatase inhibitor treatment.

However, newer techniques are showing promise. Trabecular bone score (TBS) utilizes grey-level texture measurements on lumbar spine DXA images to capture information relating to trabecular microarchitecture and has been shown to be an independent indicator of increased fracture risk.

A study of 100 patients with early-stage ER-positive breast cancer treated with aromatase inhibitors assessed elevated fracture risk using BMD alone, BMD plus FRAX® and a combination of BMD, FRAX® and TBS. The use of multiple assessment techniques incrementally improved the identification of patients at increased fracture risk with the combination of all three procedures maximizing the number detected.

Treatment Options: What Works Best

The good news is that effective treatments are available. The updated guidelines provide clear evidence-based recommendations:

Denosumab (Prolia) emerges as a first-line therapy. Denosumab is recommended as a first-line therapy for aromatase inhibitor associated bone loss prevention by the European Society for Medical Oncology (ESMO) and in the 2021 updated guidance on management of cancer treatment-induced bone loss (CTIBL).
Intravenous bisphosphonates have been upgraded to Level I evidence. Adjuvant zoledronate was found to significantly reduce the incidence of fractures in this patient cohort, with a 5-year fracture rate of 3.8 % compared to 5.9 % in the control arm.
Oral bisphosphonates have also shown efficacy, though with some limitations regarding absorption and compliance.

Treatment Guidelines and Monitoring

The updated algorithm is straightforward: All women receiving aromatase inhibitor treatment should be informed of this significantly increased risk and its consequences and have their individual fracture risk evaluated to determine an appropriate management strategy.

For women with T-scores below -2.0 or those with T-scores between -1.5 and -2.0 plus additional risk factors, bone-protective therapy should be initiated alongside aromatase inhibitor treatment. BMD should then be monitored every two years.

Discussion

If you’re receiving aromatase inhibitor therapy, don’t wait to address bone health. The evidence overwhelmingly supports early intervention. Work with your healthcare team to assess your individual risk, consider the most appropriate bone-protective therapy, and establish a monitoring plan. Remember, protecting your bones isn’t just about preventing fractures—it may also improve your overall cancer outcomes.

Aromatase Inhibitors and Bone Loss: Conclusion and Summary

Aromatase inhibitors are an effective treatment for breast cancer. However, they have side effects that patients and clinicians need to address.

There is a relationship between aromatase inhibitors and bone loss, osteoporosis and bone density. Aromatase inhibitors disrupt the bone remodeling process and can lead to a reduction in bone density and cause osteoporosis. In summary:

Aromatase inhibitors effectively treat estrogen receptor-positive breast cancer but can cause significant bone loss
Cancer treatments often affect bone health more than cancer itself through various mechanisms
Without preventive measures, aromatase inhibitors may lead to osteoporosis, especially in patients who already have osteopenia
Multiple treatment options exist to counter bone loss, including medications and low intensity vibration therapy
A combined approach using both medication and mechanical stimulation, specifically low intensity vibration, appears most effective at maintaining bone density during treatment

Margaret Martin

Reference

Peyman Hadji, Matty Aapro, Nasser Al-Dagri, Majed Alokail, Emmanuel Biver, Jean-Jacques Body, Maria Luisa Brandi, Janet Brown, Cyrille Confavreux, Bernard Cortet, Matthew Drake, Peter Ebeling, Erik Fink Eriksen, Ghada El-Hajj Fuleihan, Theresa A. Guise, Nick C. Harvey, Andreas Kurth, Bente Langdahl, Willem Lems, Radmila Matijevic, Eugene McCloskey, Rossella Nappi, Santiago Palacios, Georg Pfeiler, Jean-Yves Reginster, René Rizzoli, Daniele Santini, Sansin Tuzun, Catherine Van Poznak, Tobias De Villiers, M. Carola Zillikens, Robert Coleman, Management of aromatase inhibitor-associated bone loss (AIBL) in women with hormone-sensitive breast cancer: An updated joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG, Journal of Bone Oncology, Volume 53, 2025, 100694, ISSN 2212-1374, https://doi.org/10.1016/j.jbo.2025.100694.

The post Aromatase Inhibitors and Bone Loss During Breast Cancer Treatment appeared first on MelioGuide.

Margaret Martin, Physical Therapist

Is The Side Bend Safe for Your Spine ?

Table of Contents

Standing Side Bend and Seated Side Bends

Free Osteoporosis Exercise Course

Two Safe Alternative Side Bends

Option 1: Hands and Knees Side Bend

Setup:

The Movement:

Why it’s safer:

Option 2: Lying Down or Supine Side Bend

Setup:

The Movement:

Side Bend smart exit strategy:

Why These Side Bend Modifications Matter

Conclusion

Margaret Martin

Further Reading

References

Is The Spine Twist Safe If You Have Osteoporosis?

Table of Contents

Spine Twist

Avoid the Standing Spine Twist and Sit Twist Exercise

Standing Spine Twist

Sit and Twist Exercise

Spine Twist and Vertebral Compression Fracture Risk

Free Osteoporosis Exercise Course

Supine Spine Twist and Mobility: Option #1

Supine Spine Twist Setup and Execution

Supine Spine Twist Hand Placement Options

Lying Twist Stretch and Mobility: Option #2

Lying Twist Stretch Setup and Execution

Lying Twist Stretch Proper Positioning

How to Safely Twist Doing Activities

Conclusion

Margaret Martin

Further Readings

References

Gut Health and Osteoporosis

Table of Contents

Gut Health and Osteoporosis

Link Between Gut Health and Osteoporosis

Diet, Gut Microbiota and Bone Health

Take My Free Osteoporosis and Exercise Course

Gut Health and Osteoporosis: A Guide to Bone Health

Strategy 1: Focus on Fiber Diversity

Strategy 2: Include Specific Bone-Supporting Foods

Strategy 3: Support Your Gut Barrier

Strategy 4: Minimize Gut Disruptors

Strategy 5: Consider Targeted Supplementation

Gut Health and Osteoporosis: A Word of Caution

Conclusion

Margaret Martin

Further Readings

References

High Velocity Resistance Training Increases Bone Density

Table of Contents

What is High Velocity Resistance Training?

Why Does High Velocity Resistance Training Matter for Your Bones?

High Velocity Strength Training: Frequency

High Velocity Resistance Training Exercises: Safety

High Velocity Resistance Training Exercises Examples

Free Osteoporosis Exercise Course

High Velocity Strength Training: Results

HVRT Cautions

High Velocity Resistance Training: Sarcopenia and Dynapenia

Conclusions

Margaret Martin

Further Readings

References

Hormone Therapy and Exercise Can Increase Bone Density

Table of Contents

Hormones, Estrogen and Bone Remodeling

Two Types of Hormone Replacement Therapy

Exercise and Bone Health

Hormone Therapy and Exercise

Hormone Therapy: Are There Risks?

HRT and Exercise Recommendations

Conclusion

Margaret Martin