If you are living in London and have been diagnosed with osteoporosis, do you know whether your current exercise routine is protecting your bones – or quietly increasing your risk of fracture?
In a fast-paced city like London, where staying active is part of daily life, how can you be sure that the exercises you are doing are safe for your specific T-score and not putting fragile bones at risk?
Here is the clinical reality of osteoporosis: exercise is not universally safe – its benefit or harm is determined entirely by your T-score, your assessment, the approach taken, and the correct exercises applied at the right time with laser-sharp customisation.
Keep reading.
If you have a T-score below -3.5, I want you to know that exercising the wrong way is not just ineffective, it is dangerous and might harm you instead of giving any benefit.
Do you know?
According to the World Health Organization (WHO), the number of hip fractures worldwide due to osteoporosis is expected to rise threefold from 1.7 million in 1990 to 6.3 million in 2050. (Osteoporosis, 2006)
Also, the current data from England and Wales suggest that each year osteoporosis results in 180,000 fractures in women alone (70,000 hip fractures, 41,000 wrist fractures, and 25,000 vertebral fractures). (Osteoporosis, 2006)
I know you want to exercise, but each exercise you do must be matched according to your bone strength, which is measured by T-score.
It has been confirmed in the UK consensus statement on physical activity and exercise for osteoporosis. (Brooke-Wavell et al., 2022) and also recommended by the National Osteoporosis Guideline Group (NOGG) guidelines. (Compston et al., 2017)
Just like no two persons are the same in terms of intelligence, no two bones are the same.
If you have a T-score of -1.5, it requires a very different exercise approach compared to cases of severe osteoporosis with a T-score lower than that.
The problem is that most online advice treats all patients the same, which increases injury risk and reduces the effectiveness of osteoporosis exercises.
We’ll dive deep into it, but at this time, I want you to remember that research shows that safe and effective osteoporosis exercises depend entirely on the severity of your osteoporosis, which can be mild, moderate, or severe. (Compston et al., 2017)
Now, let’s move forward to discuss the osteoporosis exercise programme and osteoporosis severity.
How Osteoporosis Severity Is Classified?
Do you know what osteoporosis actually is?
This term is made up of 2 words, i.e., Osteo, which means bones, and Porosis, which means pores (gaps). (Clynes et al., 2020)
So, if you have more pores/gaps in your bone structure, this means that your bones are weak.
The extent of osteoporosis severity is defined by a scoring system known as T-scores.
And this T-score is measured through a specialized scan called Dual-energy X-ray Absorptiometry (DEXA) scan. (Sangondimath et al., 2023)
Customisation of your osteoporosis exercise programme is very crucial as it makes all the difference.
Think of two people having osteoporosis, but one has mild osteoporosis, and one has severe osteoporosis of the spine.
Hopping or low-level jumping may be recommended for the first person with mild osteoporosis to stimulate bone growth.
But if the second person with severe spinal osteoporosis performs the same exercise, the landing force can place excessive compression on already weakened vertebrae (spine), and it can result in spine fracture.
See?
The same movement but a completely different outcome.
That’s why the right exercise is not just about what you do, but whether your bones can safely tolerate it or not, and also other musculoskeletal weaknesses you might have.
According to World Health Organization (WHO) criteria and reinforced by NOGG (2024), the osteoporosis T-score scale is: (Miller, 2006)
- Normal: Above -1.0
- Mild Osteoporosis (osteopenia): -1.0 to -2.5
- Moderate Osteoporosis: ≤ -2.5 sometimes without fractures
- Severe Osteoporosis: ≤ -2.5 with fragility fractures
This simply means that if you have a higher osteoporosis T-score, it means osteoporosis severity is less.
DO NOT GET CONFUSED with the numbers, focus on the negative (-) sign with them.
If you have a T-score of -1 and someone has a T-score of -2.5, you have a MORE T-score than them.
I hope you get my point.
DEXa Scan vs Bone Fracture Risks
This DEXA scan assesses bone mineral density (BMD) at key areas of your body, like the spine, hip, and wrist, and the results can differ across these areas.
However, if you have already been diagnosed with osteoporosis, likely, other bones in the body might also be osteoporotic; therefore, the risk of bone fracture is not always limited to the DEXA scan location, and I suggest it is always best to take precautions rather than risk a bone fracture.
There is a possibility that you have a good T-score in your arms but a decreased T-score in your spine.
So, the exercise plan will be different when it comes to the spine compared to exercise plan for your arms and wrists.
In short, the DEXA scan results exercise planning must prioritise the weakest skeletal region, particularly the spine, due to fracture risk.
Osteoarthritis vs osteoporosis exercise is also a critical point that we’ll be discussing in the coming sections.
Understanding your exact bone status changes everything.
Once you know your T-score and fracture risk, exercise stops being guesswork and starts becoming targeted, effective, and safe.
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Exercises for Mild Osteoporosis (Osteopenia) – T-Score -1.0 to -2.5
If you have mild osteoporosis, this is the best stage to reverse the decline through mild osteoporosis exercises focusing on targeted loading and strengthening.
According to the Royal Osteoporosis Society, early osteoporosis exercise programmes significantly improve bone outcomes in patients with mild osteoporosis. (Brooke-Wavell et al., 2022)
Impact Exercise
While some trainers are of the view that impact exercises or bone loading exercises should be avoided in osteoporosis, research says that moderate-to-high impact is both safe and recommended at this stage. (Zhang et al., 2022)
You’ll be surprised to know that the UK consensus advises around 50 impacts per session on most days of the week, including jogging, hopping, and stamping. (Brooke-Wavell et al., 2022)
Do you know why?
Because these weight-bearing exercise osteoporosis strategies stimulate bone formation (osteogenesis) through ground reaction forces.
Another important point to remember is that multidirectional movement is superior to simple straight-line walking or jogging.
Here’s what N. Michael has to say about the Osteoporosis Rehabilitation Programme by Jazz Alessi.
“When I started, I could only complete 8 – 10 rowing repetitions with poor form.
- By the end of the program, I was able to do 30 repetitions (twice) with excellent form, and a 25% increase in resistance.
- My strength improved by 200%, and I became more toned and physically capable.
- Not only did my endurance increase – I could train 30 minutes longer without feeling exhausted-but my training volume (sets and repetitions) doubled.
- I not only found relief from chronic pain but also regained control of my life.”
Osteoporosis Resistance Training
If you do some exercises against a resisting force, such as an elastic band or using a dumbell, it is called resistance exercise.
According to international guidelines, resistance training 2–3 times per week is essential for your bone health. (Alnasser et al., 2025)
According to research, resistance training improves bone density, and improvements occur when loads are sufficiently challenging. (Kitsuda et al., 2021)
Exercises that make you use multiple joints of your body, such as squats, rows, and presses, are effective bone-loading exercises.
Osteoporosis Balance and Posture
Just like you need strength and stamina for your body, balance is extremely necessary, as loss of balance can result in falls and fractures. (Hsu et al., 2014)
Some common balance exercises that you can safely perform in your home are single-leg stands, tandem walking, and spinal extension exercises.
Mild osteoporosis offers the greatest potential for improvement, but only with the right loading strategy.
Click here to find the right loading strategy for your bones by booking a FREE ONLINE CONSULTATION.
Exercises for Moderate Osteoporosis – T-Score -2.5 or Below (No Fractures)
No matter at which stage of osteoporosis you are, exercise remains an essential component of your routine in moderate cases.
The thing you need to take care of is that the precision and supervision are critical at this stage to avoid injury while performing moderate osteoporosis exercises. (Beck et al., 2017)
Osteoporosis Impact Exercise
You can still perform moderate impact osteoporosis exercises as recommended by UK guidelines, but activities like jogging, stamping, and low-level jumping should be added to your routine gradually.
Depending on other musculoskeletal risks, I recommend my clients start with 10 impacts per session and progress gradually toward 50.
After working with 100s of clients with osteoporosis, my advice is to avoid high-impact plyometrics or jumping from height due to excessive loading forces.
Resistance Training
As per my long-term experience, resistance training (some call it strength training) is the most effective tool for improving and maintaining bone density; however, take into account that there are assessment-based bone fracture risks which will be identified and must be eliminated first.
A research study, i.e., the LIFTMOR trial (Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation) by Watson et al in 2018 demonstrated that high-intensity resistance training improved bone density safely in postmenopausal women with osteoporosis. (Watson et al., 2018)
However, at this stage, the technique is very crucial.
You should make sure that the exercises maintain a neutral spine and avoid flexion under load.
Movements to Modify in Osteoporosis
Just like not all clothes fit your body, not all exercises are good for your body, and YOU MUST KNOW THEM.
Being an elite personal trainer, I spend most of my time educating my clients about exercises to avoid with osteoporosis and exercises to modify.
This is the main part of the training.
No?
You should avoid high-degree spinal flexion, such as sit-ups and toe touches, because they increase vertebral compression risk and should be modified.
Performing a twisting movement of your spine when it is already under load is also not recommended.
These are not just my long-term battlefield-tested personal recommendations; they are backed by research and align with guidance for vertebral fracture prevention.
Read what Dr. Christian H (one of my clients) has to say about his rehabilitation programme.
- “As a doctor, I must warn you that Alessi’s going to take you through some exercise choices and nutritional shortcuts that will completely blow your mind!
- My back pain disappeared, and I don’t feel stressed anymore.
- I am sleeping better, and I perform better in a very demanding job.”
Exercises for Severe Osteoporosis – T-Score -2.5 or Below With Fractures
What do you do when your stomach is upset?
Do you stop eating, or do you start eating with caution?
You choose what food to eat and what food to avoid. Right?
You need to follow the same strategy if you have severe osteoporosis with fractures.
YOU DON’T NEED TO AVOID EXERCISING, YOU JUST NEED TO BE A LOT MORE CAUTIOUS
Severe cases require the most caution, but exercise remains essential for function and fracture prevention.
According to the National Osteoporosis Guideline Group (NOGG) and the Royal Osteoporosis Society, inactivity further increases fracture risk in patients with severe osteoporosis. (Brooke-Wavell et al., 2022)
Impact Exercise in Osteoporosis
In severe osteoporosis, you should only perform low-impact severe osteoporosis exercises.
Walking, marching, and gentle stair climbing – and laser sharp 1-2-1 customised exercises are appropriate exercises at this stage.
You must know that high-impact activities and exercises are contraindicated unless medically cleared. Safety is the key here. (Benedetti et al., 2018)
Just like certain foods are going to upset your stomach further, high-impact exercises will damage your already weakened bones.
My message to all my clients is “Keep moving but with caution,” and work with a specialist trainer to ensure safety, correct guidance, and bone fracture risks.
Resistance Training Effects
Resistance training is beneficial in severe osteoporosis cases, too, but IT MUST BE MODIFIED.
You should avoid any exercises that cause heavy axial loading through the spine.
I recommend my clients perform supported or seated exercises that minimize axial loading of their spines.
Resistance bands and light weights can be used.
One of the main focuses of severe osteoporosis exercises is on glutes (hip muscles), quadriceps (thigh muscles), and spinal extensors (back muscles) – but not limited to as other bones in the body appear osteoporotic.
And altogether these and more specific customisations (everyone is different) form the successful foundation of safe severe osteoporosis exercises.
Spinal Care and Posture
Research has shown that most of the fractures in severe osteoporosis are in the spine.
That’s why you need to take utmost care of your spine by performing exercises for osteoporosis of the spine.
As per my experience of dealing with 100s of clients with osteoporosis, in certain situations, spinal extension exercises are critical in the osteoporosis exercise programme, particularly with vertebral fractures.
Exercises like prone extensions and wall-supported posture exercises help in preventing kyphosis (an exaggeration of your thoracic spine curve).
You should avoid spinal flexion exercises such as sit-ups.
Falls Prevention
Building your muscles and maintaining them and your body functions (not just muscles) is important, but what is far more important is the FALL PREVENTION.
This is one of my top priorities for my clients with severe osteoporosis.
And to prevent falls, you need to incorporate safe and effective balance exercises in your routine, such as tandem walking, sit-to-stand, and weight shifting in different positions.
Research shows that this helps in improving your neuromuscular control. (Bae et al., 2023)
Environmental assessment is equally important, as sometimes the fall is not due to weakness but due to hurdles in the environment. (Özbaş et al., 2012)
Even in advanced stages, the right approach restores balance, body functions, abilities, and confidence in movement, helping you stay independent while reducing the fear of fractures.
Click here to book your FREE ONLINE CONSULTATION now.
Exercises to Avoid at Every Severity Level
If you have come this far in this article, this certainly means that YOU CARE FOR YOUR BODY.
This is the reason I have written this brief bonus section for you, based on my long-term experience of dealing with my clients with severe osteoporosis.
Do you know that – at least at times – a person who knows what not to do is more intelligent than a person who only knows the things that he/she should do.
When it comes to osteoporosis, I would like you to be a person who knows both things, i.e., exercises to do and exercises to avoid.
Certain exercises can dramatically increase fracture risk regardless of your osteoporosis and should be modified or avoided based on individual assessment.(Bae et al., 2023)
- Exercises with high-degree spinal flexion under load [They increase vertebral compression]
- Exercises with explosive twisting movements [They introduce shear forces across vertebrae]
- Exercises with high-impact landings from height [They cause sudden axial loading through your spine]
- Exercises with aggressive end-range stretching [They stress the bones and ligaments]
- Exercises with prolonged slouched posture [They contribute to spinal deformity]
These exercises to avoid with osteoporosis are not absolutely contraindicated, but require professional and expert individualised assessment.
Risk increases significantly in severe cases of osteoporosis; staying on the safe side is always worth it.
Click here to book your FREE ONLINE CONSULTATION now.
Osteoporosis Exercises – Why CUSTOMISATION is Important?
The core of my osteoporosis exercise programmes is the correct comprehensive ASSESSMENT, LASER SHARP CUSTOMISATION, and correct IMPLEMENTATION, so you will never risk anything but progress predictably and linearly.
I’ll tell you WHY CUSTOMISATION is crucial.
Exercise for osteoporosis must be customised because bone strength, fracture risk, joint pain, musculoskeletal issues, and loading tolerance vary widely between individuals, even with the same age, activity levels, gender, and diagnosis.
UK guidance (Royal Osteoporosis Society, 2022; NOGG, 2024) clearly states that exercise should be tailored to bone density, fracture history, and movement capacity.
Consider an example.
Resistance training is one of the most effective ways to improve bone density, but only when applied correctly according to the stage and severity of osteoporosis.
A well-balanced deadlift with a neutral spine can safely load the hips and spine, promoting bone strength in a mild osteoporosis patient.
However, if the same movement is performed with even a slightly rounded back, especially in someone with severe osteoporosis, the load shifts to the front of the vertebrae.
This significantly increases compression forces and can increase the risk of vertebral fractures.
A second example is resistance training.
Some exercises, like squats or deadlifts, are highly effective for improving bone density in mild to moderate osteoporosis when performed with good technique.
BUT …
In severe osteoporosis, particularly with spinal involvement, the same level of loading (even with correct form) may exceed safe limits.
In these cases, modified or supported strength exercises are required to reduce spinal stress while still maintaining muscle strength.
The message is simple:
“The same exercise can either strengthen bone or increase injury risk depending on how, when, and for whom it is used.”
Customisation ensures that every movement is both effective and safe.
Why Severity-Specific Programming Matters?
You must be thinking, ” Why does this severity-specific programming matter at all?
As per my experience, GENERALISATION is one of the biggest risks when it comes to ANY aspect of your life.
You have pain in your spine, leg, foot, arm, etc., and you generalise it and manage it just ONE WAY, you are doing wrong with your body.
Each type of pain needs to be assessed and managed according to the underlying cause. Agree?
Similarly, when it comes to an osteoporosis exercise programme, the severity of your osteoporosis MATTERS.
All exercise must be tailored to individual bone status.
One size fits all is not the right or safe approach and risks a bone fracture.
As you read in the above sections, a patient with a T-score of -1.5 can safely perform some high-impact loading (only some), while someone with fractures and a T-score below -3.0 cannot tolerate the same stress.
The Royal Osteoporosis Society (2022) also recommends individualised programming. (Brooke-Wavell et al., 2022)
A properly designed osteoporosis exercise programme uses DEXA scan results, exercise planning, alongside movement assessment and progression strategies.
Always remember that:
The osteoporosis T-score is the starting point, not the full picture.
Click here to book your FREE ONLINE CONSULTATION now.
Who Is Jazz Alessi?
Jazz Alessi is a London-based clinical exercise specialist with over 20 years of experience designing safe exercises for osteoporosis and complex conditions.
As an LSE invited guest tutor, Elite Personal Trainer, 2nd Generation Pilates Instructor, Harley Street Nutritionist, and former Special Forces coach, he specialises in assessment-led osteoporosis rehab programming.
His work focuses on postural assessment, osteoporosis, and progressive loading through a structured three-phase approach.
Known as the best osteoporosis specialist in London based, Jazz works extensively with older clients, many with very complex and co-existing spinal conditions.
All Jazz’s programmes have a physiotherapist on board and are fully customised following an in-depth assessment.
Conclusion
Osteoporosis is not the same for everyone and varies in severity.
The exercise must match your severity, body weaknesses, and musculoskeletal issues, not just with an osteoporosis diagnosis.
Mild cases require selected high loading and impact.
Moderate cases demand laser-sharp precision and supervision.
Severe osteoporosis requires safety-first, spine-protective movement with fall prevention.
The right osteoporosis exercise programme is not generic; it is built around your DEXA data, fracture history, and movement capacity.
Bones respond to the correct stimulus.
Apply the right one, and adaptation follows.
FAQs on Osteoporosis Exercises by Severity
Can you exercise with severe osteoporosis?
Exercise remains essential in severe osteoporosis, but it must be assessment-based, customised, low-impact, supervised, and focused on balance, posture, and safe strength training.
What exercises should you avoid with osteoporosis?
Movements involving spinal flexion under load, heavy twisting, and high-impact landings increase fracture risk and should be modified based on clinical assessment. Follow your doctor’s advice.
Is walking enough for osteoporosis?
Walking helps maintain bone health, but lacks sufficient loading stimulus alone; resistance and impact training are needed for meaningful bone density improvement.
Can resistance training improve bone density?
Progressive and safe resistance training improves bone density when loads are sufficiently high, as supported by clinical trials like the LIFTMOR study.
What is a DEXA T-score?
A DEXA T-score compares bone density to that of a young healthy adult and determines whether bone is normal, osteopenic, or osteoporotic.
Is Pilates safe for osteoporosis?
Pilates can be safe if modified to avoid spinal flexion and excessive rotation, focusing instead on posture, alignment, and controlled strengthening.
How often should you exercise with osteoporosis?
Exercise should be performed most days, combining resistance training two to three times weekly with regular balance and weight-bearing activities.
What is the difference between osteopenia and osteoporosis?
Osteopenia indicates mild bone loss, while osteoporosis reflects more severe loss with significantly higher fracture risk and stricter exercise considerations.
Can osteoporosis be reversed with exercise?
Exercise can improve bone density and slow progression, but high levels of osteoporosis – full reversal is uncommon and usually requires combined medical and lifestyle interventions.
Do I need a specialist for osteoporosis exercise
Yes, a specialist ensures exercises match bone status, reducing fracture risk and improving outcomes through personalised assessment and structured progression.
References
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