Is Pilates Good for Osteoporosis? What the Research Actually Shows

If you have osteoporosis or are worried about bone density, you have probably been told to do weight-bearing exercise. What you may not have been told is where Pilates fits in, and how to use it well.

The short answer: Pilates is good for bone health, but it works best as part of a wider programme rather than on its own. Here is what the research actually shows, and what that means in practice.

Here are 5 things to know about Pilates and osteoporosis:

1. Pilates does improve bone density, the finding is small but it has been replicated consistently across 11 independent studies

2. Bone loss in perimenopause starts earlier than most women realise, and that is exactly the window to act

3. Pilates works best for bone health when paired with resistance training, each one addresses a different part of the picture

4. Pilates' biggest contribution to fracture prevention is reducing falls, not just building bone — and that matters more than most people think

5. Supervised Pilates is safe with osteoporosis, but a generic class is a different matter; the difference is assessment and individual modification

What does the research show about Pilates and bone density?

The evidence is real, and it is mixed. In 2021, a systematic review and meta-analysis published in PLOS ONE analysed 11 studies involving 591 participants aged 45 to 78 and found that Pilates produced a small but statistically significant improvement in bone mineral density, with an effect size of 0.14 (PMC8104420, PLOS ONE, 2021). The I² statistic, which measures how consistently results hold across different studies, was 0.0%. In other words, zero heterogeneity: every study pointed in the same direction.

A separate meta-analysis of three randomised controlled trials found no statistically significant effect on areal bone mineral density at the lumbar spine, total hip, or femoral neck (PubMed 33967223, 2021). The authors flagged low methodological quality in the included trials and called for more rigorous research. Both meta-analyses exist. Neither cancels the other.

What is notable about the PLOS ONE meta-analysis is precisely its zero heterogeneity. A small effect that replicates with perfect consistency across 11 different studies, populations, and durations carries more clinical weight than a large effect from a single trial. It means the finding is stable. Pilates is doing something real to bone, even if that something is modest. For women beginning to build a bone health programme, modest and consistent is a reasonable starting point. The question is what to build around it.

Programmes of 24 weeks or shorter produced the clearest effects (ES = 0.13), while longer programmes did not maintain statistical significance. This suggests the initial stimulus of beginning Pilates matters, and that continuing it without adding other load may not sustain the effect long-term. That gap is where combining Pilates with resistance training becomes relevant.

Why does perimenopause put bone density at risk?

By the time most women receive a diagnosis of osteopenia or osteoporosis, bone loss has often been underway for years. In 2022, the PeKnO prospective study followed 49 perimenopausal women with a mean age of 48.1 for two years and found an average lumbar spine bone density loss of 4.26% over that period (Diagnostics, 2022). A quarter of participants (24.3%) were classified as "fast bone losers," losing more than 7% in just 24 months.

The mechanism is hormonal. Estrogen suppresses the activity of osteoclasts, the cells responsible for breaking down bone. As estrogen declines in perimenopause, that suppression reduces, and bone is broken down faster than it is replaced. The PeKnO data showed this directly: women maintaining around 80% ovulatory cycles lost no significant bone density over two years. Women with only 20% ovulatory cycles lost approximately 10% over the same period.

The perimenopause window is the window to intervene. A DEXA scan at 55 showing osteopenia is already reporting the consequence of losses that began in the mid-40s. A woman in her 40s who starts loading her skeleton now, through Pilates, resistance work, or a combination, is building before the withdrawals accelerate. Globally, 1 in 3 women over 50 are affected by osteoporosis (International Osteoporosis Foundation). In the UK, 500,000 fragility fractures occur each year, roughly one every minute, at a cost to the NHS of over £4.5 billion annually (Royal Osteoporosis Society). Most of those fractures happen to women who did not know the clock was running.

There is more on exercise and perimenopause health in a separate post if you want the fuller picture.

What type of exercise is most effective for osteoporosis?

In 2025, a network meta-analysis published in Scientific Reports analysed 49 randomised controlled trials involving 3,360 postmenopausal women and ranked exercise types by their effect on bone mineral density (Scientific Reports, 2025). Combined aerobic and resistance training ranked first at both the lumbar spine and the femoral neck. At the lumbar spine, aerobic training came second and resistance training third. At the femoral neck the order differed, with whole-body vibration second and resistance training third. Pilates was not one of the eight exercise types the review compared, so it makes no finding about Pilates either way.

This is worth stating plainly: the evidence does not support Pilates as the primary intervention for building bone density. What the evidence supports is using Pilates as part of a programme that also includes progressive resistance work.

Pilates and resistance training are not alternatives for women concerned about bone health. They address different parts of the fracture risk equation. Resistance training loads the skeleton and stimulates bone remodelling. Pilates builds balance, proprioception, posture, and movement quality. Fall prevention is a direct fracture intervention. In 2022, a UK consensus statement found that exercise groups had a 5.8% fracture rate compared to 9.6% in sedentary controls (British Journal of Sports Medicine, 2022). That is a relative reduction of about 40%. The consensus statement does not break down how much of it came from fewer falls rather than stronger bone, so treat the fall-prevention explanation as a reasonable inference rather than a finding.

For women who cannot safely do high-impact or high-load exercise, Pilates is often the right starting point. For women who can, the most effective programme pairs it with something that also loads the skeleton. The strength training evidence for women over 40 is in a separate post.

Is Pilates safe with osteoporosis? What to avoid.

Supervised Pilates is safe for most people with diagnosed osteoporosis or osteopenia. The risk is not in the method. It is in whether the person has been properly assessed and whether sessions are adapted to their specific situation.

Movements that carry the most risk for spinal osteoporosis are those involving deep forward spinal flexion: full roll-ups, crunches, and aggressive curl-down from standing, along with extreme rotation under load. These are not contraindications for Pilates as a whole. They are movements that require modification, careful sequencing, or replacement in a supervised context. In a generic group class, that adaptation may not happen.

There is a related question that comes up often: is Pilates on apparatus better than mat Pilates for bone health? The spring resistance on Pilates equipment (including the reformer) does add mechanical loading, which theoretically provides more bone stimulus than bodyweight mat work. No peer-reviewed trials have directly compared the two for bone density outcomes. This distinction is currently expert opinion, not RCT evidence. Whether the apparatus or the quality of supervision matters most is worth discussing with whoever is taking you through sessions.

When someone comes to me with a DEXA result showing osteopenia or osteoporosis, the first thing I want to understand is what they are currently doing, and what they have stopped doing because they are afraid. Most people become more cautious after a diagnosis, and that caution is understandable. But bone responds to load. Stopping movement is counterproductive. The first sessions are about rebuilding confidence: breath, posture, extension, balance. From there we add load progressively. That doesn't happen in one session. It does happen consistently.

For anyone with a history of vertebral fracture, neurological symptoms, or acute back pain alongside a bone density diagnosis, assessment by a physiotherapist or GP should come before beginning Pilates. For chronic osteopenia or osteoporosis that has been reviewed and does not involve acute spinal involvement, supervised Pilates is both safe and appropriate.

 What to expect from bone health sessions at Shaw Lifestyle

Shaw Lifestyle's Corrective Exercise sessions (£65 per session) are designed for people navigating injury, imbalance, or postural concerns, including anyone working with a diagnosis of osteopenia or osteoporosis. They are not a general Pilates class.

A first session begins with a conversation: DEXA results, fracture history, current movement, what has been modified or avoided. From there, the programme is built around extension, balance, axial loading, and movement quality. Progression is structured to the individual. Nothing is assumed.

For the combined approach the 2025 network meta-analysis supports, Corrective Exercise sessions can be paired with the Strength Foundations Block (£220). Pilates for movement quality and fall prevention. Progressive resistance work for bone stimulus. That combination addresses both sides of the fracture risk equation.

A 2024 scoping review confirmed that the optimal Pilates protocol for musculoskeletal conditions is two sessions per week, 60 minutes per session, for a minimum of eight weeks (PMC11556558, International Journal of Sports Physical Therapy, 2024). That is the structure both services work within.

To discuss your bone health history and find out which starting point is right for you, Book a Call with Liz directly.

Frequently asked questions

Is Pilates good for osteoporosis?

Yes, with important nuance. In 2021, a meta-analysis of 11 studies involving 591 participants found Pilates produced a small but statistically significant improvement in bone mineral density, with zero heterogeneity across all studies (PMC8104420, PLOS ONE, 2021). Its strongest contribution to fracture prevention is fall prevention rather than bone density alone. It works best paired with progressive resistance training.

What exercises should I avoid with osteoporosis?

Deep spinal flexion (full roll-ups, crunches, aggressive forward bending) and extreme rotation under load are the primary concerns for anyone with vertebral involvement or spinal osteoporosis. In a supervised session these are assessed and modified individually. In a generic class, they may not be. For anyone with a vertebral fracture history, a supervised assessment before starting is the right first step.

Is Pilates on equipment better than mat Pilates for osteoporosis?

No peer-reviewed trials have directly compared the two for bone density outcomes. Pilates apparatus (including the reformer) adds spring resistance that theoretically provides more bone stimulus than mat work, but this remains expert opinion rather than RCT evidence. The quality of supervision and the individual programme design matter more than the apparatus, particularly for anyone with a diagnosed bone density condition.

How long does it take for Pilates to affect bone density?

The clearest effects in research came from programmes of 24 weeks or shorter at two sessions per week. A 2024 scoping review found the optimal protocol for musculoskeletal conditions is 60-minute sessions, twice weekly, for at least eight weeks (Sports Health, 2025). Programmes of 24 weeks or shorter outperformed longer ones in the bone density meta-analysis, suggesting that consistent early sessions matter most.

Should I do Pilates or strength training for osteoporosis?

Both, for different reasons. A 2025 network meta-analysis of 49 RCTs involving 3,360 postmenopausal women ranked combined aerobic and resistance training as the most effective intervention for bone mineral density (PMC11972399, Scientific Reports, 2025). Pilates addresses fall prevention and movement quality. The two approaches target different parts of fracture risk and are not alternatives. Shaw Lifestyle's Strength Foundations Block is designed for exactly this combination.

The evidence, stated plainly

Pilates alone is not the gold standard for building bone density. It does produce a small and consistent effect on BMD across 11 studies, and its contribution to fall prevention carries its own significant fracture risk reduction. Combined with progressive resistance work, it is a well-evidenced approach to comprehensive bone health. For women in their 40s and 50s, the time to start is before a DEXA scan confirms the loss that began years earlier.

Sources

- [PMC8104420: Pilates and Yoga for Bone Mineral Density, Systematic Review and Meta-analysis, 11 studies, 591 participants (PLOS ONE, 2021)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8104420/)

- [PubMed 33967223: Pilates Exercise and Bone Mineral Density in Postmenopausal Women, Meta-analysis, 3 RCTs (2021)](https://pubmed.ncbi.nlm.nih.gov/33967223/)

Perimenopausal Bone Loss and Ovulatory Activity, PeKnO Prospective Study, 49 women, 24 months (Diagnostics, 2022)

- [PMC11972399: Effect of Different Exercise Types on Bone Mineral Density in Postmenopausal Women, Network Meta-analysis, 49 RCTs, 3,360 participants (Scientific Reports, 2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11972399/)

Strong, Steady and Straight, UK Consensus Statement on Physical Activity and Bone Health, exercise vs control fracture rates (British Journal of Sports Medicine, 2022)

- [PMC11556558: Pilates Dosage in Musculoskeletal Rehabilitation, Scoping Review (International Journal of Sports Physical Therapy, 2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11556558/)

- [International Osteoporosis Foundation, Osteoporosis Epidemiology](https://www.osteoporosis.foundation/health-professionals/about-osteoporosis/epidemiology)

- [Royal Osteoporosis Society, Media Toolkit, UK prevalence and fracture statistics](https://theros.org.uk/about-us/media-centre/media-toolkit/)