Osteopenia & Osteoporosis: What You Need to Know

Many people assume that just staying active is enough to keep their bones strong. I’ve had multiple clients come to me frustrated after doing Pilates three times a week for decades, only to find out they have osteopenia—and that their Pilates instructor never told them they needed more than Pilates to build bone density. That’s mildly upsetting, to say the least, because on some level, there should be more awareness about what actually stimulates bone growth and what doesn’t.

Let’s break it down.

What Is Osteopenia, and How Is It Diagnosed?

Osteopenia is the stage before osteoporosis—a condition where bones become weaker and more prone to fractures. It’s diagnosed through a DEXA scan (Dual-Energy X-ray Absorptiometry), which measures bone mineral density (BMD). The results are given as a T-score:

• Normal bone density: T-score above -1.0

• Osteopenia: T-score between -1.0 and -2.5

• Osteoporosis: T-score below -2.5

While osteopenia doesn’t necessarily mean you’ll develop osteoporosis, it does indicate that your bones aren’t as strong as they should be—which means you need to take action before it gets worse.

What Causes Bone Loss?

As we age, bone turnover slows down. Up until about age 30, our bodies build more bone than they break down. After that, bone resorption outpaces bone formation, leading to gradual bone loss. However, some factors speed up this process, including:

• Lack of weight-bearing exercise (more on this below!)

• Hormonal changes (e.g., menopause, low testosterone)

• Nutritional deficiencies (calcium, vitamin D, magnesium, and protein)

• Certain medications (steroids, proton pump inhibitors, some antidepressants)

• Sedentary lifestyle

Why Pilates Alone Won’t Prevent Osteopenia

Pilates is great for core strength, mobility, and flexibility, but it doesn’t provide the necessary stimulus to increase bone density. Bone remodeling happens through mechanical stress, specifically weight-bearing and resistance training that creates microtrauma in the bone—stimulating it to rebuild stronger.

Think about muscle growth: When you lift weights, you create tiny tears in the muscle fibers, and they repair stronger. Bone works the same way. Without progressive overload (adding resistance over time), your bones won’t adapt—and that’s exactly why people can do Pilates for decades and still develop osteopenia.

How to Reverse Osteopenia & Prevent Osteoporosis

1. Strength Training (Progressive Overload)

• Lifting weights, especially with compound movements like squats, deadlifts, and overhead presses, provides the necessary impact and mechanical load to stimulate bone growth.

• It’s not about lifting heavy immediately, but about progressively increasing resistance over time.

2. High-Impact Weight-Bearing Exercise

• Activities like jumping, plyometrics, and even brisk walking help stimulate bone formation.

• Low-impact exercises (like Pilates and swimming) don’t create enough mechanical stress for significant bone-building.

3. Nutritional Support

• Calcium (1,000–1,200 mg/day)

• Vitamin D3 (essential for calcium absorption)

• Magnesium, vitamin K2, and protein (all play a role in bone health)

4. Hormonal Considerations

• Women going through menopause should discuss hormone therapy options with their doctor, as declining estrogen levels accelerate bone loss.

5. Medications (If Needed)

• In more severe cases, medications like bisphosphonates, denosumab, or teriparatide might be prescribed to slow bone loss or stimulate bone formation.

Will Osteopenia Always Turn Into Osteoporosis?

No, but without intervention, it can progress. The good news? Osteopenia is reversible with the right exercise, nutrition, and lifestyle changes. If you take action early, you can prevent osteoporosis and maintain strong bones well into old age.

What’s Life Like with Osteoporosis?

Osteoporosis significantly increases the risk of fractures, particularly in the hip, spine, and wrist. Hip fractures, in particular, can be devastating—many people never regain full mobility after one. Vertebral fractures can cause chronic pain, height loss, and a hunched posture. In severe cases, osteoporosis can lead to disability, loss of independence, and a higher risk of mortality after a fracture.

Final Thoughts

If you’ve been relying on Pilates or yoga alone for bone health, it’s time to rethink your approach. Adding resistance training and weight-bearing exercises is non-negotiable if you want to preserve bone density and prevent fractures. Your bones are not static—they adapt to the stress you place on them. So if you want stronger bones, you need to challenge them.

If this post resonates with you, and you’re unsure where to start, reach out—because bone health is something you don’t want to ignore until it’s too late.