Osteoporosis and Back Pain: Spinal Fractures and Safe Exercise
Quick summary
- Osteoporosis itself has no symptoms. Spinal (vertebral) fractures are the most common osteoporotic fracture, and only about one in three comes to clinical attention (International Osteoporosis Foundation).
- An Australian position statement recommends progressive resistance training and suitable impact exercise for bone health, plus balance training to reduce falls, while avoiding loaded spinal flexion (Beck et al., 2017).
- In the LIFTMOR trial, supervised high-intensity resistance and impact training improved spine bone density and physical function in postmenopausal women with low bone mass (Watson et al., 2018).
- Forceful spinal manipulation is not appropriate where bones are significantly weakened. Gentle, low-force techniques are used instead (WHO, 2005).
Osteoporosis is often called a silent condition. Bones gradually lose strength without any pain, until one breaks. For many people the first sign isn't a dramatic fall but a sudden or nagging pain in the middle or lower back, or noticing they've lost height. If you have osteoporosis or osteopenia (lower-than-ideal bone density), here's what's worth knowing about your back, and how to stay strong and active safely.
Spinal Fractures Often Go Unnoticed
Vertebral fractures, where a bone in the spine partly collapses, are the most common fracture linked to osteoporosis. According to the International Osteoporosis Foundation, only about a third come to clinical attention. Some cause sudden, sharp back pain after a minor strain, cough or lift. Others cause little pain at all. Having one vertebral fracture substantially raises the risk of further fractures, which is why recognising them matters.
Signs worth raising with your GP
- sudden back pain after a minor strain, bend, lift, cough or sneeze, particularly in the middle back
- height loss of a few centimetres or more
- an increasing forward curve of the upper back
- back pain in someone with known osteoporosis, long-term steroid use, or a previous low-trauma fracture
If a fracture is suspected, your GP can arrange imaging and review your bone-health treatment.
Exercise for Bone Health and Falls Risk
The old advice for osteoporosis was gentle walking and not much else. The evidence has moved on. Exercise and Sports Science Australia's position statement explains that bone responds best to progressive resistance training and suitable impact activities, and that strength and balance training reduces falls, which is just as important for preventing fractures (Beck et al., 2017). It also stresses that programs should be individualised, accompanied by adequate calcium and vitamin D, and should avoid loaded spinal flexion, such as sit-ups or bending forward to lift heavy weights.
The Australian LIFTMOR trial tested this directly in 101 postmenopausal women with low to very low bone mass. Over eight months, twice-weekly supervised sessions of high-intensity resistance and impact training improved lumbar spine bone density, femoral neck measures and physical function compared with a low-intensity home program, with minimal adverse events (Watson et al., 2018). The key word is supervised. The program was carefully taught and progressed.
Principles for exercising with osteoporosis
- Build strength progressively through the legs, hips and back, with good technique, ideally with qualified supervision at first.
- Include balance work most days, such as standing on one leg near a bench or heel-to-toe walking.
- Keep the spine upright when lifting. Hinge at the hips rather than rounding the back.
- Avoid sit-ups, toe touches and twisting under load.
- If you have had a vertebral fracture, get individual advice before starting impact or heavy loading.
See also our article on balance and fall prevention.
How Hands-On Care Should Be Adapted
The World Health Organization's guidelines on chiropractic safety list osteoporosis among conditions where forceful manipulation carries extra risk and lower-force techniques are preferred (WHO, 2005). A review of chiropractic care in older adults likewise notes that high-force manipulation is contraindicated in severe osteoporosis (Dougherty et al., 2012).
Our Approach in Kogarah
At Spirit Chiropractic, our focus is helping you manage back pain and stay active, working alongside your GP:
- we ask about any bone density (DEXA) results, fracture history and medications at your first visit
- we adapt our techniques to your bone health, using gentle mobilisation and soft-tissue work rather than high-velocity thrusts
- we support a strength, balance and posture routine suited to you
- we refer you to your GP if your bone health hasn't been checked, or if your symptoms suggest a possible fracture
Back pain and worried about your bones?
We'll take a careful history, adapt our techniques to your bone health, and support a strength and balance routine suited to you, working alongside your GP.
Spirit Chiropractic is at Shop 23/6 Belgrave Street, Kogarah. If your GP has put you on a chronic condition management plan, here's how Medicare works for chiropractic.
Request an appointment Call 0410 420 856Frequently Asked Questions
Can osteoporosis cause back pain?
Osteoporosis itself doesn't cause pain, but it makes fractures more likely. Spinal (vertebral) fractures can cause sudden or persistent back pain, height loss or a more rounded upper back. Many go unrecognised, so new back pain in someone with osteoporosis is worth checking with a GP.
What exercises should I avoid with osteoporosis?
Exercise and Sports Science Australia advises against loaded spinal flexion, such as sit-ups, toe touches or rounding the back to lift. Twisting under load is also best avoided. Progressive strength, impact and balance exercise is generally encouraged with appropriate guidance.
Is weight training safe with osteoporosis?
With proper supervision and progression, research such as the LIFTMOR trial suggests high-intensity resistance and impact training can be safe and beneficial for many postmenopausal women with low bone mass. Programs should be individualised, especially after a fracture.
Is chiropractic safe if I have osteoporosis?
Forceful spinal manipulation is not appropriate where bones are significantly weakened. A chiropractor should ask about your bone health and use gentle, low-force techniques, alongside exercise and fall-prevention advice.
How do I know if I've had a spinal fracture?
Possible signs include sudden back pain after a minor strain or cough, height loss, or an increasing curve in the upper back. Some fractures cause few symptoms. Your GP can arrange imaging if a fracture is suspected.
References
- Beck, B.R., Daly, R.M., Singh, M.A.F., & Taaffe, D.R. (2017). Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), 438–445. https://doi.org/10.1016/j.jsams.2016.10.001
- Watson, S.L., Weeks, B.K., Weis, L.J., Harding, A.T., Horan, S.A., & Beck, B.R. (2018). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284
- International Osteoporosis Foundation. Vertebral fractures due to osteoporosis (fact sheet).
- World Health Organization. (2005). WHO guidelines on basic training and safety in chiropractic. Geneva: WHO.
- Dougherty, P.E., Hawk, C., Weiner, D.K., Gleberzon, B., Andrew, K., & Killinger, L. (2012). The role of chiropractic care in older adults. Chiropractic & Manual Therapies, 20, 3. https://doi.org/10.1186/2045-709X-20-3
This article is general information, not a diagnosis or a substitute for an individual assessment. If you have new or worsening symptoms, see a registered health practitioner.
