Osteoporosis and osteopaenia

As physiotherapists, we hold regular CPD sessions. At the last one, we learnt about the current guidelines and thoughts about exercise for people who have or suspect they have osteoporosis or osteopaenia.
Have you been diagnosed with osteoporosis or osteopaenia?
Below are our guidelines:
Osteoporosis and osteopaenia
Taken from Modifying Pilates for Clients with Osteoporosis by Sherri R Betz april 2005
One in two women over fifty have reduced bone density sufficient to put them at risk of fracture of the thoracic spine and 1 in 2 women and 1 in 4 men over fifty will have an osteoporosis related fracture in their lifetime.(NOF 2005)
Many people are unaware that their bone density has reduced until an event ends up with investigations.
Bone density decreases from the neck to the lower or lumbar spine but the ability to absorb force and size of vertebrae is greater in the lumbar spine decreasing towards the neck. The thoracic spine is naturally slightly flexed which has a tendency to compress the vertebral bodies which is the softest part of the vertebrae.
These facts combined, place the thoracic spine at greatest risk of fracture.
Bone scans are taken of the lumbar spine and hip. If these show loss of bone density, you can assume this will be greater and have more impact in the thoracic spine
There are many things that can be done to decrease the risk of fracture. See the full article for more.
Weight bearing exercise has been shown to halt the progression of bone density loss and maybe to actually improve it.
There is some evidence that strong back extensors (the muscles that bend you backwards) reduce the risk of fractures and improve bone mineral density.
There is also some evidence to suggest that flexion and side flexion exercises of the thoracic spine increases the risk of fractures. Normal day to day activities involving curving of the thoracic spine with the addition of a force like a sneeze or a light load can be enough to cause a fracture in a vulnerable person.
Modified Pilates can be a great form of exercise for osteoporosis sufferers provided that certain precautions are taken. Principally, this involves not flexing the thoracic spine and limiting the side bending and certainly not combining them. Extension of the thoracic spine or bending backwards is recommended (swan dive, dart, cobra are good exercises therefore)
How to alter typical exercises that we use in Pilates(the names of the exercises in the full article are not the same as we use and many are not exercises that we do anyway)
In a class situation, it can be difficult to always give the precautions for each exercise. If in doubt, modify the exercise yourself by maintaining a neutral or optimal spine position throughout, avoiding curling your thoracic spine.
Please ask the instructor for advice if necessary.
Roll down - Instead of rolling down with a curled thoracic spine, hip hingeing should be adopted, keeping the spine straight, with some bend of the knees.
Side bend in standing/ sitting - Reach the arm up to the ceiling to open the waist without reaching over to the side.
Sit ups or anything involving lifting your head from the floor - Don't! Avoid raising your head and shoulders from the floor as this flexes your thoracic spine. To strengthen your abdominals, work on one leg stretch-stretching a leg out maintaining a good spinal position. Your instructor can advise which level is best for you.
Shoulder bridge - Don't lift your hips too high and keep pillows under head to a minimum or remove.
Rolling exercises - Contraindicated for anyone with impaired bone density. Do something on your stomach or repeat leg stretch exercises on your back.
Sitting on the floor - You may need to use blocks or a stool to sit on to limit thoracic curve if your legs are tight.
When curling backwards eg roll ups, concentrate on moving from your lower spine and hips, keeping your thoracic spine fairly straight and limit the distance you move.When stretching forwards, move forwards at your hips for a leg stretch rather than curling forwards
Cat curl - Limit the upward movements of your spine and concentrate on smooth controlled movement downwards and back to neutral.
If you want more information, please visit the National Osteoporosis Society www.nos.org.uk
I have an article which was published in 2005 which explains things very well.
I will email it to you on request. I am trying to add a link here and will do so when I have figured out how!!

In summary, our advice is to avoid exercises that encourage you to flex or curl your thoracic spine eg roll downs and 'sit ups'. These can be modified into a hip hinge or another exercise substituted. 
Exericses that encourage thoracic extension eg swan dive are excellent exercises though.

Please let the instructor know if you think this affects you.