Insights from the Art of Pilates Podcast

Osteoporosis is often called the "silent disease." Many people don't realise they have it until they experience a fracture. Yet the consequences can be life-changing, affecting mobility, independence, confidence, and overall quality of life.

In a recent episode of the Art of Pilates Podcast, I had the privilege of speaking with Professor Belinda Beck, one of Australia's leading researchers in osteoporosis and bone health. As the founder of the Bone Clinic and creator of the internationally recognised Onero™ exercise program, Belinda has transformed the way we think about building bone and preventing fractures.

Our conversation covered everything from exercise and bone density to medications, posture, falls prevention, and the role Pilates can play in healthy ageing.

Why Osteoporosis Matters

When most people think about osteoporosis, they think about broken bones. But osteoporosis is much more than that.

The three most common fractures associated with osteoporosis are:

• Wrist fractures

• Vertebral (spinal) fractures

• Hip fractures

Hip fractures are particularly concerning. Belinda explained that after a hip fracture, many older adults lose their independence and may require long-term care. Mortality rates increase significantly following a hip fracture, especially in advanced age.

Spinal fractures can be equally devastating. These fractures often occur at the front of the vertebrae, creating a wedge-shaped deformity that contributes to the rounded posture commonly seen in older adults.

The Hidden Effects of Spinal Fractures

Many people assume that losing height is simply a normal part of ageing.

However, significant height loss can be a warning sign of vertebral fractures.

As spinal fractures accumulate, they can create an exaggerated thoracic curve known as kyphosis. This forward-stooped posture affects far more than appearance.

Belinda explained that kyphosis can:

• Shift the body's centre of gravity forward

• Increase the risk of falls

• Reduce peripheral vision

• Compress the abdominal contents

• Affect balance and mobility

Even everyday activities can become more challenging. Something as simple as a dressing gown becoming too long after losing several centimetres of height can create an unexpected trip hazard.

Osteopenia Is Not "Nothing"

Many people feel relieved when they are told they have osteopenia rather than osteoporosis.

However, Belinda cautioned against becoming complacent.

Osteopenia is often viewed as a warning sign that bone density is declining. While osteoporosis is diagnosed when bone density reaches a specific threshold on a DEXA scan, osteopenia still represents an increased fracture risk.

Interestingly, because there are more people living with osteopenia than osteoporosis, a large number of fractures actually occur in people who have "only" osteopenia.

The message is clear: early action matters.

Exercise: One of the Most Powerful Tools We Have

One of my favourite moments in our conversation was when Belinda said:

"There is no circumstance where exercise is not going to help."

Exercise supports bone health, muscle strength, balance, coordination, confidence, and overall wellbeing.

While exercise alone may not always eliminate the need for medication, it remains one of the most effective strategies for maintaining independence and reducing fracture risk.

Belinda shared countless stories from participants in the Onero program who reported feeling stronger, moving better, experiencing less pain, and regaining confidence in activities they had avoided for years.

As Joseph Pilates wrote in Return to Life Through Contrology, movement has the power to transform how we live. Listening to these stories, it truly felt as though many people were returning to life.

Can Pilates Build Bone?

This is a question I am frequently asked.

Belinda was clear that current research does not show traditional Pilates significantly increasing bone density.

However, that does not mean Pilates has no role in osteoporosis management.

Far from it.

Pilates offers tremendous benefits for:

• Balance

• Posture

• Body awareness

• Coordination

• Functional movement

• Core strength

• Falls prevention

Belinda described Pilates as an excellent exercise choice on the days when people are not completing their specific bone-loading exercise sessions.

In my own studio, I often see clients combine Pilates with progressive resistance training. Pilates helps build confidence, movement quality, and postural awareness, while heavier loading programs provide the stimulus required for bone adaptation.

It's not necessarily an either-or situation. For many people, it can be both.

Exercises to Avoid with Osteoporosis

One of the most important topics we discussed was movement safety.

Belinda advised caution with exercises involving deep forward spinal flexion.

Examples include:

• Deep yoga forward folds

• Rolling the spine forward repeatedly

• Standing roll downs

• Loaded flexion exercises

Research has shown that certain extreme forward-bending positions may increase vertebral fracture risk in individuals with low bone density.

This does not mean people should become fearful of movement.

In fact, Belinda emphasised the importance of avoiding fear-based messaging.

Instead, the goal is to choose safer alternatives that maintain spinal integrity while still allowing people to move confidently and effectively.

For those with osteoporosis or significant osteopenia, maintaining a more neutral spine and incorporating extension-based exercises may be a safer approach.

Why Strength Matters

Perhaps one of the most powerful takeaways from our conversation was that healthy ageing is not just about bone.

It's also about muscle.

Loss of muscle mass, known as sarcopenia, often occurs alongside declining bone density.

When muscle strength decreases:

• Balance worsens

• Falls become more likely

• Functional capacity declines

• Fracture risk increases

Strong muscles act as protective armour around joints and bones.

Many people who entered the Bone Clinic seeking help for osteoporosis discovered additional benefits:

• Reduced back pain

• Improved knee osteoarthritis symptoms

• Better mobility

• Greater confidence

• Increased independence

These outcomes remind us that exercise affects the whole person, not just a DEXA scan result.

Medications and Bone Health

Many people come to exercise programs hoping to avoid medication.

Belinda explained that while exercise can significantly improve bone health, medication is sometimes still necessary.

She discussed medications such as:

• Bisphosphonates

• Prolia (denosumab)

• Evenity (romosozumab)

Each has potential benefits and limitations.

Importantly, Belinda noted that exercise may help support bone health during medication transitions, although more research is needed in this area.

She also highlighted medications that can negatively affect bone density, including:

• Long-term corticosteroids such as prednisone

• Aromatase inhibitors used in breast cancer treatment

For people taking these medications, proactive bone health management becomes even more important.

The Importance of Nutrition

Bone health is not just about exercise.

Nutrition plays a critical role.

Belinda emphasised the importance of:

• Adequate calcium intake

• Protein consumption

• Overall dietary quality

She also discussed something many people don't consider: chewing.

The bones of the jaw require loading just like the rest of the skeleton. Crunchy foods, chewing, and maintaining dental health all contribute to preserving jaw bone structure.

It's a fascinating reminder that the body responds to load everywhere.

Can You Tell If You Have Osteoporosis?

Unfortunately, osteoporosis often develops without symptoms.

According to Belinda, some warning signs may include:

• Family history of osteoporosis

• Loss of height

• Developing a rounded upper back

• Previous fractures

However, many people have no obvious symptoms at all.

This is why screening and DEXA scans are so important, particularly for women after menopause and anyone with known risk factors.

The Take-Home Message

If there was one theme that emerged throughout our conversation, it was hope.

Osteoporosis is not simply an inevitable consequence of ageing that we must accept.

Through appropriate exercise, nutrition, screening, and when necessary, medication, people can take meaningful steps to protect their bones and maintain their independence.

As Pilates instructors and movement professionals, we have an important role to play in helping people move safely, build confidence, improve balance, and stay active throughout life.

Because healthy ageing isn't about slowing down.

It's about staying strong enough to keep doing the things you love.

Listen to the Full Interview

To hear my full conversation with Professor Belinda Beck, including her insights into osteoporosis, exercise, fracture prevention, Onero™, and healthy ageing, listen to this episode of the Art of Pilates Podcast here for part one. and part two here.

Your bones are living tissue. They are constantly adapting.

And it's never too late to start giving them a reason to stay strong.