Osteoporosis is often called a silent disease — and for good reason.
Most people don’t know they have it until they fracture a bone.

In a recent episode of The Art of Pilates, I sat down with Professor Belinda Beck, one of the world’s leading researchers in osteoporosis and the founder of the Onero™ bone-loading program. What followed was an honest, nuanced, and sometimes confronting conversation about medications, exercise, fracture risk, and what actually helps protect your bones as you age.

This blog pulls together the key insights — in plain language — so you can make informed decisions without fear.

The Reality of Osteoporosis Medications (Including Prolia)

One of the most important — and least discussed — realities is this:

Starting certain osteoporosis medications may commit you to long-term medication use.

Medications like Prolia are effective at reducing fracture risk, but stopping them can lead to a rapid and significant loss of bone density unless another treatment replaces it. In many cases, people are transitioned onto a bisphosphonate to prevent this rebound loss.

This is not a failure of medicine — it’s the current state of science.

Researchers are actively hoping for new drugs that are just as effective but without these risks. Some newer medications (like anabolic agents) show promise, but they are often:

• Time-limited (e.g. 18 months of use)

• Not suitable for everyone

• Contraindicated for people with certain medical histories, such as heart disease

It’s a fraught space, and understandably, many people want to avoid medication if possible.

Can Exercise Reduce the Need for Medication?

This is the question almost everyone asks:

“If I exercise properly, can I avoid medication?”

The honest answer is: sometimes.

Some people experience remarkable increases in bone mineral density through targeted, high-load exercise — enough to move them back into a safer zone.
Others, particularly those with very low bone density, may need both medication and exercise.

What matters most is understanding this:

Exercise is never wasted.

Even when medication is required, exercise may:

• Improve bone density

• Strengthen muscles

• Improve balance

• Reduce falls risk

• Potentially mute bone loss when medications are stopped

There is emerging observational data suggesting that people who continue structured bone-loading exercise may experience less dramatic bone loss after stopping Prolia — although formal trials are still needed.

Why Muscle Strength Is Gold

One of the most powerful takeaways from the clinic is not just about bones — it’s about life.

People often say:

“I came for my bone health — I stayed for everything else.”

Stronger muscles mean:

• Better balance

• Fewer falls

• More confidence

• Less pain

• Greater independence

We also see improvements in conditions like back pain and knee osteoarthritis — not because joints are “fixed”, but because strong muscles protect joints and improve movement quality.

This is not anti-ageing.
It’s ageing better.

Where Do Osteoporotic Fractures Happen Most?

Bone loss occurs everywhere (except the skull), but fractures most commonly occur in:

1. The wrist
   Often from falling onto an outstretched hand — a classic early warning sign.

2. The spine
   Vertebral fractures often occur silently and lead to height loss, kyphosis (stooping), and increased falls risk.

3. The hip
   The most devastating fracture. Hip fractures dramatically increase mortality, particularly in older adults, and can result in permanent loss of independence.

Fractures don’t just affect bones — they affect breathing, posture, balance, confidence, and quality of life.

Kyphosis, Breathing, and Falls Risk

Spinal fractures often occur at the front of the vertebrae, creating a wedge shape. Over time this leads to:

• A stooped posture

• Reduced thoracic space

• Altered centre of gravity

• Increased falls risk

Even everyday things — like a long dressing gown — can become trip hazards when posture and height change.

Osteoporosis is rarely just about bones. It’s a cascading system-wide issue.

What About the Jaw, Teeth, and Chewing?

Here’s something rarely discussed:

Bone responds to load — even in your jaw.

Chewing provides mechanical loading to the jaw bones.
If you move to a very soft diet, those bones can lose density over time.

So yes — smoothies are nutritious, but they don’t replace chewing.

Crunchy vegetables, nuts, and foods that require chewing help maintain jaw bone health. This is also why replacing lost teeth matters — it maintains loading through the jaw.

Medications That Harm Bone

Some medications significantly accelerate bone loss, including:

• Long-term corticosteroids (e.g. prednisone)

• Aromatase inhibitors used in breast cancer treatment

These medications can be lifesaving — but they require proactive bone protection strategies alongside them.

This is where exercise becomes especially important.

Is Osteoporosis Really “Silent”?

Mostly — yes.

The strongest predictors are:

• Family history

• Loss of height

• Development of kyphosis

• Previous fractures

DEXA scans remain the gold standard.
And while osteopenia is often dismissed as “not that bad”, most fractures actually occur in people with osteopenia, simply because there are more of them.

Osteopenia is a warning sign — not a free pass.

Are There Exercises We Should Avoid?

Yes — especially for those with low bone density.

Exercises to approach with caution include:

• Deep forward flexion

• Loaded spinal flexion

• Extreme rotational movements

• the combination of flexion and rotation

These positions increase the risk of vertebral fractures.

This doesn’t mean don’t move — it means choose smarter movement.

Where Does Pilates Fit?

This part is important — and often misunderstood.

Pilates is excellent for:

• Balance

• Coordination

• Posture

• Body awareness

• Confidence

The Big Picture

Osteoporosis is not about fear.
It’s about strategy.

Medication may be necessary.
Exercise is always necessary.
Strength, balance, and confidence change everything.

As Professor Beck puts it:

There is no circumstance where exercise does not help.

And that might be the most hopeful message of all.

Listen to the full podcast here!