Exercises to Avoid With Osteoporosis — And What to Do Instead

What exercises should I avoid after a spinal compression fracture?

If you have a recent spinal compression fracture, use the restrictions provided by your treating clinician. A general osteoporosis exercise list does not establish which movements are suitable during healing. Forward bending and deep or rapid spinal twisting may need to be avoided or modified. Ask your physical therapist to show you alternatives for daily tasks as well as exercise.

Physical therapy can begin after a physician determines that the fracture is stable. Your plan can address strength, balance and practical movement skills at a level suited to your recovery. If you have new back pain and suspect a fracture, arrange medical assessment before starting a new workout.

Sources: APTA spinal compression fracture guide and MedlinePlus compression fractures.

One of the most frustrating things I see as a physical therapist is patients with osteoporosis who’ve been told to “be careful” without anyone explaining what that actually means. They stop exercising entirely — and that’s the worst possible outcome.

I’m Dr. Emily Warren, a credentialed McKenzie therapist in Holladay, UT, and I work with patients with osteoporosis and osteopenia regularly. The truth is, exercises to avoid with osteoporosis is a much shorter list than most people think. The far more important conversation is about which exercises you should be doing.

Let me walk you through both.

Exercises You Should Avoid With Osteoporosis

These exercises increase fracture risk in people with reduced bone density. The common thread: they place excessive compressive, flexion, or rotational forces on vulnerable vertebrae.

1. Sit-Ups and Crunches

This is the big one. Loaded spinal flexion — curling your trunk forward against resistance — meaningfully increases compressive force on the anterior vertebral body. Research by Sinaki and Mikkelsen (Archives of Physical Medicine and Rehabilitation, 1984) showed that women with osteoporosis who performed spinal flexion exercises had significantly more vertebral compression fractures than those who performed extension exercises.

Your thoracic vertebral bodies are already at risk for wedge fractures from osteoporosis. Crunches concentrate force exactly where these fractures occur.

Safe alternative: Modified planks (on knees or against a wall), bird-dogs, and pallof presses all strengthen your core without loaded spinal flexion.

2. Toe Touches and Forward Bends Under Load

Standing toe touches, seated forward folds, and any exercise that involves bending forward while holding weight puts your spine in flexed position under load. This creates the same anterior vertebral compression as crunches, compounded by gravity and whatever weight you’re holding.

Safe alternative: Hip hinges (like deadlifts with light weight) keep your spine neutral while loading your hips. Hamstring stretches can be done lying on your back with a strap, avoiding spinal flexion entirely.

3. Heavy Rotational Exercises With Load

Exercises like Russian twists, cable woodchops with heavy weight, and rotational medicine ball throws combine flexion with rotation under load. This is the loading pattern most associated with disc injuries and vertebral fractures in osteoporotic bone.

Safe alternative: Anti-rotation exercises like pallof presses train your trunk to resist rotation, strengthening the same muscles without the fracture risk.

4. High-Impact Activities With Fall Risk

This is nuanced. Impact is actually good for bone density — it’s one of the primary stimuli for bone formation. The issue is activities where you’re likely to fall. For someone with osteoporosis, a fall from even standing height can cause a hip fracture or vertebral compression fracture.

Activities to be cautious with:

• Downhill skiing (consider your skill level and terrain)
• Ice skating
• Activities on unstable surfaces until your balance improves
• Contact sports

Important: Walking, hiking on maintained trails, and even jogging (if you’re accustomed to it) are generally fine and beneficial. Don’t avoid all impact — just minimize fall risk. See my guide on fall prevention for more on this.

5. Yoga Poses With Extreme Flexion or Extension

Certain yoga poses deserve caution:

• Full forward fold (Uttanasana) with rounding of the spine
• Plow pose (Halasana) — extreme cervical and thoracic flexion under body weight
• Full wheel (Urdhva Dhanurasana) — extreme extension
• Seated twists with leverage — forced rotation

Many yoga poses are wonderful for balance, flexibility, and strength. The key is modifying poses that involve extreme spinal positions. A good yoga teacher will offer modifications, but many don’t know the specifics of osteoporosis precautions. That’s where working with a physical therapist first helps — I can tell you exactly which modifications you need.

6. Rowing Machines With Poor Form

Rowing involves repeated spinal flexion under load. With proper form (maintaining a neutral spine and hinging from the hips), rowing can be acceptable. But most people round their low back at the catch position, which creates the same loading pattern as crunches — hundreds of times per session.

Safe alternative: If you enjoy cardio machines, the stationary bike (upright, not recumbent), elliptical, and treadmill walking/jogging are better options for bone health.

The Exercises You Should Be Doing (They Might Surprise You)

Here’s where the conversation gets exciting. Research in the last decade has completely changed our understanding of exercise and osteoporosis. The old advice — gentle walking, chair exercises, light stretching — doesn’t build bone.

What Actually Builds Bone Density

Bone responds to mechanical loading. Specifically, it responds to:

1. High-magnitude forces — heavier loads stimulate more bone formation
2. Novel loading patterns — your bones adapt to habitual loads; you need progressive challenge
3. Impact forces — ground reaction forces from jumping, hopping, and stomping

This means that the exercises many people with osteoporosis are told to do — gentle walking, light resistance bands, water aerobics — don’t provide enough stimulus to actually improve bone density. They’re not harmful, but they’re not therapeutic for bone.

The LIFTMOR Protocol

The landmark LIFTMOR trial (Watson et al., Journal of Bone and Mineral Research, 2018) changed the game. Researchers had postmenopausal women with low bone density perform high-intensity resistance training:

• Deadlifts (heavy, progressive)
• Squats (heavy, progressive)
• Overhead press (heavy, progressive)
• Impact loading (jumping chin-ups with a drop landing)

The results: significant improvements in bone density at the lumbar spine and femoral neck, improved functional performance, and — critically — no fractures or injuries during the study.

This challenged decades of conservative advice. It showed that when properly supervised, people with osteoporosis can safely perform heavy resistance training — and that this is exactly what their bones need.

I use principles from the LIFTMOR protocol with my bone health patients, adapting the program to each person’s starting fitness level, bone density results, and specific goals. You can learn more about this approach on my osteoporosis physical therapy page and best exercises for bone density guide.

Progressive Loading Is Key

You don’t start with heavy deadlifts on day one. The program progresses gradually:

1. Learn the movement patterns with bodyweight or light resistance
2. Build tissue tolerance over 2-4 weeks
3. Progressively increase load based on your response
4. Maintain training intensity long-term to retain bone gains

This is why working with a physical therapist who understands both osteoporosis and strength training is so important. I need to balance adequate loading (enough to stimulate bone) with safety (avoiding fracture risk during training).

A Patient Story: From Fear to Confidence

I worked with a 67-year-old retired teacher from Holladay who had been diagnosed with osteoporosis after a DEXA scan showed T-scores of -2.8 at her lumbar spine. Her doctor told her to exercise, but she was terrified of fracturing something.

When she came to me, she was doing 20-minute walks and chair exercises from a YouTube video. Her DEXA results had shown no improvement in two years.

We started with a thorough assessment of her movement quality, balance, and current strength levels. Then I built her a progressive program based on the LIFTMOR principles — starting with bodyweight squats, hip hinges with a dowel, and wall push-ups.

Over four months, we progressed to goblet squats with 25 pounds, trap bar deadlifts at 65 pounds, and she was doing step-ups onto an 8-inch box. Her confidence transformed. At her next DEXA scan, her T-score had improved to -2.5 — a meaningful improvement that her doctor was thrilled with.

She told me: “I went from being afraid to pick up my grandchild to deadlifting more than my grandchild weighs.”

What About Walking? Is It Enough?

Walking is excellent for cardiovascular health, mental health, and general well-being. It provides some bone-loading benefit at the hip (but not the spine), and it’s far better than inactivity.

But walking alone does not build significant bone density. A meta-analysis by Martyn-St James and Carroll (Journal of Bone and Mineral Metabolism, 2008) found that walking programs alone did not produce significant improvements in bone mineral density at the spine or hip.

If walking is all you can do right now, that’s a great starting point. But to actually build bone, you need progressive resistance training. I can help you get from “daily walks” to a program that genuinely improves your bone density. That transition is exactly what I do with my osteoporosis treatment programs.

Special Considerations for Utah’s Active Population

Living in Utah means many of my osteoporosis patients are hikers, skiers, and outdoor enthusiasts. The good news: these activities are generally great for bone health because they involve impact and weight-bearing. The key is managing fall risk.

For my patients who want to stay active on Utah’s trails:

• Work on balance training alongside strength training
• Use trekking poles on uneven terrain
• Choose trails appropriate for your balance and fitness level
• Build leg strength to reduce fatigue-related falls

Check out my hiking with back pain guide for more trail-specific advice.

Frequently Asked Questions

Can I do yoga if I have osteoporosis?

Yes, with modifications. Avoid extreme spinal flexion (full forward folds), extreme extension (full wheel), and forced twisting. Many yoga poses are excellent for balance and strength. I can help you identify which modifications you need.

Are resistance bands safe for osteoporosis?

Yes, but they may not provide enough load to actually build bone density. Research shows that high-intensity resistance training (like the LIFTMOR protocol) is more effective than light resistance band work. Bands are a good starting point, but you should progress to heavier loading over time.

Can I do Pilates with osteoporosis?

Pilates can be adapted for osteoporosis, but many traditional Pilates exercises involve loaded spinal flexion (the “hundred,” roll-ups, teasers). These should be modified or avoided. A Pilates instructor who understands osteoporosis precautions can make appropriate substitutions.

Should I stop all exercise if I’ve had a compression fracture?

Your medical clinician should determine when the fracture is stable and what activity restrictions apply. Once you are cleared for an exercise plan, a physical therapist can help you rebuild strength, balance, and daily movement skills at an appropriate starting level. The timing and progression depend on your fracture, symptoms, and overall health.

How heavy should I lift with osteoporosis?

The LIFTMOR trial used loads of approximately 80-85% of one-rep maximum, which is considered high-intensity. You work up to this gradually over weeks to months with proper supervision. The key insight from the research is that light weights don’t stimulate bone formation — you need meaningful mechanical load.

Is swimming good for osteoporosis?

Swimming is great cardiovascular exercise, but it provides minimal bone-loading stimulus because it’s non-weight-bearing. It should not be your primary exercise strategy for bone health. If you enjoy swimming, keep doing it — but add weight-bearing exercise as well.

Start Building Stronger Bones Today

You don’t have to figure out safe loading alone. Start with a one-on-one osteoporosis PT evaluation (90 minutes with Dr. Emily Warren, BoneFit-trained), or join our Bone Builder classes in Salt Lake City — small-group, PT-supervised strength training based on the LIFTMOR protocol. Call or text (385) 332-4939 with questions.