Yoga guide
Yoga is safe for most people with osteoporosis or osteopenia if you change a few poses, and it helps balance and back strength. It hasn't been shown to build bone: in 11 studies of 591 women, bone density didn't change significantly with yoga or Pilates, and the popular "12 poses" study had no comparison group.
UK experts recommend yoga among balance and strength exercise at least twice a week, alongside strength training, impact and bone medicine where it's needed. The main change is to bend from your hips with a long back, rather than rounding your spine deeply or repeatedly.
This guide covers the evidence for bones, balance and falls, the poses to change and why, what the fracture case reports show and don't, yoga after a spinal fracture and the warning signs. It ends with a free 30-minute class with the swaps built in.
The UK consensus recommends balance and strength exercise, including yoga, at least twice a week. Canada's guideline says yoga can be encouraged "if they can be done safely or modified for safety", in addition to, not instead of, balance, functional and strength training.
In 11 studies (591 women), bone density didn't change significantly with yoga or Pilates. Bones need strength training and impact, and exercise is "an adjunct rather than an alternative" to bone medicine where it's needed.
"Movements or exercise that involve sustained, repeated or end-range flexion should be modified or avoided." Fold from the hips with a long back (the hip hinge) instead of deep seated or standing folds, head-to-knee, plough and the full fold in sun salutations.
"Rotation (twisting) movements should be safe if performed smoothly and comfortably." If your fracture risk is high, Canada adds limits on fast, held, weighted or end-range twists, and Osteoporosis Canada suggests a gentle twist lying on your back instead of a seated twist.
Case series describe spinal fractures after yoga with deep forward bending. They show it can happen, not how often, and reviews of exercise in osteoporosis found such fractures rare. That's why the advice is to change those poses, not to stop yoga.
Yoga improved balance a little in people over 60, but a UK chair yoga trial found no fewer falls. To prevent falls, do balance-challenging exercise 3 or more times a week.
Osteoporosis makes bones weaker and more likely to break. It "is not usually painful until a bone is broken", and "a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine", the NHS says. Osteopenia is the stage before: bone density lower than average for your age, but not low enough to be called osteoporosis.
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A spinal bone squashes down and heals in its new, compressed shape, usually within about three months, which can mean height loss and a more curved upper back. The Royal Osteoporosis Society lists back pain and a change in body shape among the symptoms, and says not all spinal fractures cause pain.
"Bending forward is generally safe and won't cause a spinal fracture. But you may 'over-flex' your spine if you push yourself to the limit", the Royal Osteoporosis Society says, especially with uncontrolled, repeated, sudden or loaded movement. The direct evidence is thin: one small 1984 study, case series and expert agreement.
Balance and strength work, back-strengthening poses such as locust, a low cobra and the seated upper-back lift, and practice at standing tall. What it doesn't give is the strength training with weights and the moderate impact that load bone: yoga poses produce low forces through the feet.
The UK consensus is called "strong, steady and straight": strength training and impact for your bones, balance for falls, and back exercises for posture. The NHS says weight-bearing and resistance exercise are particularly important for bone density. Two or three yoga sessions a week can cover the steady part and some of the straight part, and count towards the UK Chief Medical Officers' advice for adults over 65 to do activities that improve strength, balance and flexibility on at least 2 days a week.
Women and men with osteoporosis or osteopenia, with or without a past spinal fracture. If you've been told your fracture risk is high, or you've had a spinal fracture or several broken bones from minor falls, follow the stricter Canadian limits on twists and side bends in the poses section.
In 11 studies of 591 women aged 45 to 78 (12 to 32 weeks, two of them at least a year), Pilates or yoga didn't change bone density significantly against control. A 2025 review of trials in healthy people found no significant effect in 2 pooled trials, and 8 months of Ashtanga yoga in 34 women aged 35 to 50 didn't change bone density. Canada's guideline: yoga's effects on bone density, falls and fractures "are uncertain".
Across 11 trials of mind-body exercise in women around and after the menopause (tai chi, yoga, Pilates, qigong and others), bone density improved a little. Across 74 trials, mind-body exercise did best for bone when combined with strength training. Neither tested yoga on its own.
The "12 poses" study (2016) asked volunteers recruited online to hold 12 poses for 30 seconds each, daily, from a DVD. It had no comparison group: 227 of 741 volunteers were judged compliant, each person's scans before joining were compared with those after, and the main comparison rested on 72 to 83 people, with 18 to 29 per bone site in the best-documented group. The hip result wasn't significant, practice was self-reported, "Some subjects used the electronic scorecard incorrectly", and the authors called for proper randomised trials.
People who sign up for a yoga study and keep it up may differ in other ways, and the paper doesn't describe accounting for bone medicines (our reading of the full text). Its 12 poses include three twisting poses, one of them the revolved triangle. We found no published critique, but the design can't show that yoga raised bone density.
In 30 women with osteoporosis after the menopause, 6 months of yoga poses went with a small change in bone density score (from -2.69 to -2.55), with no comparison group.
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In a lab study of 28 hatha poses, yoga produced low forces through the feet, unlike the moderate impacts the UK consensus recommends for bone. It's one small study.
In 6 trials of 307 people aged 60 and over, yoga improved balance and mobility by a small to moderate amount, and the authors said more research was needed to see whether that prevents falls. In 32 women with osteoporosis, adding 2 minutes of tree pose a day to exercise improved one-leg standing at 6 weeks.
The Royal Osteoporosis Society suggests balance exercise on at least two days a week, and says that in yoga, Pilates, tai chi or dance, "it is best to stand up if you can".
Yoga hasn't been shown to prevent falls: in a UK trial of chair yoga in 454 people aged 65 and over, falls didn't differ significantly, and in older women yoga's effects on balance, walking and leg strength were inconsistent. Exercise that challenges balance and function cut the rate of falls by about 23% in 108 trials (high certainty), and the world falls guidelines advise it 3 or more times a week.
The world falls guidelines note that "supervised holistic exercise interventions in community settings, such as Pilates or yoga, had the largest effect sizes in reducing concerns about falling".
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In 118 people aged 60 and over with a curved upper back, an hour of yoga 3 days a week for 24 weeks improved one measure of the curve by 4.4%, but not another measure, physical performance or quality of life. Spine strengthening and posture training reduced the curve by 3 degrees in 99 older adults, and in 50 women, 2 years of back strengthening was followed 8 years later by fractures in 1.6% of spinal bones, against 4.3% without it.
UK: "Balance and muscle strength exercise (including activities such as Tai Chi, dance, yoga and Pilates) are recommended at least twice a week to reduce the risk of falls especially in older age", and after a spinal fracture, "Yoga and Pilates and similar exercise programmes should be considered to help with posture and pain". Canada: yoga and Pilates "may improve physical functioning and quality of life in older adults", with uncertain effects on bone density, falls and fractures.
"Movements or exercise that involve sustained, repeated or end-range flexion should be modified or avoided", and "Any exercise that causes the back to curve excessively especially with an added load should be modified or avoided", the UK consensus says. The Royal Osteoporosis Society names touching your toes among exercises that can put pressure on the spine, and suggests the hip hinge instead.
Our swaps: fold from the hips with a long back, or leave out deep forward folds (seated, standing, wide-legged and head-to-knee); in sun salutations, fold only halfway, with a flat back.
"Rotation (twisting) movements should be safe if performed smoothly and comfortably", the UK consensus says, and the Royal Osteoporosis Society agrees. If your fracture risk is high, Canada's guideline says twisting or bending that is "rapid, repetitive, sustained, weighted or end range-of-motion" may need to be changed, and Osteoporosis Canada's booklet says "if your class is doing a seated twist, you can do a gentle twist while on your back".
Osteoporosis Canada's booklet lists side bending, with forward bending and twisting, among the Pilates moves to avoid or change at high fracture risk. Our suggestion is to treat yoga's side bends the same way: with a high fracture risk, keep triangle, side angle and gate pose small, or leave them out.
Leave out plough and shoulder stand, as their pages and our yoga for seniors guide advise. Leave out headstand too (our suggestion): headstands and shoulder stands are among the poses most often named in case reports of harm from yoga, and NCCIH (the US National Center for Complementary and Integrative Health) advises anyone new to yoga to avoid them.
In one spine clinic's series, yoga injuries came mostly from extreme bending forwards or backwards, and experts writing on adapting yoga for osteoporosis suggest avoiding the end of the range in any direction. Our suggestion: leave out deep backbends such as camel, wheel and bow, and keep a low cobra and locust small and steady.
The UK consensus says people who are experienced, have a flexible spine and "can manage the movements comfortably and smoothly" may carry on. If you're unsure, or you've had a spinal fracture, use the swaps.
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The hip hinge fold's page gives 5 slow folds, 3 breaths at the bottom, and says to stop when your back starts to round. The Royal Osteoporosis Society teaches the hip hinge for bending safely.
See the movement on the 3D figure: Hip hinge fold
Three healthy people with thin bones developed pain or spinal fractures after yoga poses that bent the spine forwards. In another series, 9 people (8 women, median age 66) had spinal compression fractures from 1 month to 6 years after starting yoga with forward bending, 6 of them in the upper back; 4 had osteoporosis and 2 osteopenia beforehand. Of 89 people treated for yoga injuries at one spine clinic, 13 had compression fractures, mostly linked to extreme bending forwards or backwards.
They can't tell you how often this happens, because nobody counted the people who did the same poses without harm. They come from specialist clinics, which see the people who were hurt. Some people had other causes of weak bones, such as a parathyroid problem, high-dose steroids or earlier fractures. And they can't prove the pose broke the bone, rather than revealing a fracture waiting to happen.
Reviews of exercise in osteoporosis judged spinal fractures from bending moves, such as some yoga poses and sit-ups, rare, and a review for Osteoporosis Canada rated the evidence on yoga in people at risk of fracture as very low certainty.
Change the poses with deep, repeated or loaded forward rounding, as the guidance says, rather than stopping yoga. A review in a yoga therapy journal says the same, and warns against one routine for everyone.
It reported "no reported or X-ray detected fractures or serious injuries" in more than 90,000 hours of practice, but this rests on what a self-selected group reported, with incomplete follow-up (our reading of the full text).
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"Yoga and Pilates and similar exercise programmes should be considered to help with posture and pain through teaching form, alignment and muscle strength and relaxation." Classes should, if possible, be led by an instructor trained to work with older people or people with osteoporosis, and back exercises are suggested daily, repeated 3 to 5 times and held for 3 to 5 seconds.
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See a physiotherapist first if your spinal fractures are causing pain and other symptoms, the Royal Osteoporosis Society says. Wait until the bone has healed, which can take up to three months, before building up strength exercise, but keep moving while it heals.
In a Cochrane review, exercise after a spinal fracture probably sped up a walking test (the timed up and go) by about a second, not a change people would notice, and its effects on fractures and falls are unknown. In a pilot of mindfulness and physiotherapist-led "medical yoga" in 20 women aged 60 and over, 15 finished, with better sleep, stress and social life but not pain, and no harms reported.
In England and Wales, the British Wheel of Yoga is the national governing body for yoga and accredits teacher training; in the US, Yoga Alliance registers schools whose standard 200-hour training covers techniques, anatomy and teaching practice. Neither makes a teacher an osteoporosis specialist, so ask about their experience (our suggestion). NCCIH advises practising "under the guidance of a qualified instructor".
The UK consensus: balance and strength exercise at least twice a week. The NHS lists yoga among muscle-strengthening activities for adults, alongside 150 minutes of moderate activity a week. Our editorial starting point: our 30-minute class, or a class with the swaps, 2 or 3 times a week, plus strength training on 2 or 3 days and, if you haven't had spinal fractures, about 50 impacts such as heel drops on most days, as our osteoporosis exercise guide sets out.
The UK consensus suggests back exercises repeated 3 to 5 times and held for 3 to 5 seconds. Our seated upper-back lift page gives 3 to 5 repetitions, each held 3 to 5 seconds, at least twice a week; locust and a low cobra work the same muscles lying down.
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Exercise "should be viewed as an adjunct rather than an alternative to pharmaceutical treatment where this is indicated". Never stop or change a bone medicine because you've started yoga; talk to your GP.
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Osteoporosis Canada suggests keeping a wall or support nearby for balance poses. To get up from the floor, roll onto your side and push up with your arms rather than sitting straight up (our suggestion, as in our Pilates for osteoporosis workout).
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The UK consensus notes that leaking urine can get in the way of impact exercise, and treating it may come first. Our pelvic floor guides cover the exercises.
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Seated upper-back lift: 3 to 5 repetitions, each held 3 to 5 seconds, at least twice a week (the move's page, from the UK consensus). Low cobra: 5 lifts held 3 to 5 seconds; locust: 3 to 5 lifts held 3 to 5 seconds; bird dog, one limb at a time: 5 each arm and leg, holding 3 to 5 seconds; sphinx: 2 holds of 3 to 5 breaths (our yoga for posture class). Y-T-W raises: 5 of each letter (our kyphosis exercises for seniors).
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoLow cobra (Bhujangasana)Beginner · No equipment
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoSphinx pose (Salamba Bhujangasana)Beginner · No equipment
3D demoProne Y-T-W raisesBeginner · No equipmentMountain pose: 5 to 10 slow breaths, 2 or 3 times (the move's page). Chair pose: 3 holds of 5 breaths; warrior II and high lunge: 5 breaths each side; tree pose: 3 to 5 breaths each side, twice, fingertips on a wall; tandem stance: 30 seconds each way round, then 10 steps; sit to stand: 8 to 10 slow stands (our yoga for balance class). Single-leg stand: 2 holds of 20 to 30 seconds each leg, beside a wall (our Pilates for osteoporosis workout).
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoChair pose (Utkatasana)Beginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipment
3D demoHigh lunge (crescent lunge, Ashta Chandrasana)Intermediate · No equipment
3D demoTree pose (Vrksasana)Beginner · No equipment
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSingle-leg standBeginner · A wall
3D demoSit to stand from a chairBeginner · A bench or boxHip hinge fold: 5 slow folds, 3 breaths at the bottom, stopping when your back starts to round (the move's page). Seated twist: 5 each side with 5-second holds, smooth and comfortable (our chair yoga class). Lying twist: 45 seconds each side, smoothly, both shoulders down (our yoga for menopause class). Cat-cow: 5 or 6 slow rounds, keeping the rounding small; pelvic tilt into bridge: 6 to 8 slow reps, lifting only part of the way (our Pilates for osteoporosis workout).
Deep forward folds (seated, standing, wide-legged and head-to-knee): fold from the hips with a long back, or leave them out. Sun salutations: fold only halfway, with a flat back. Plough, shoulder stand and headstand: leave them out. Boat pose: keep the knees bent and the back long. Revolved triangle and seated twists: smooth and comfortable; with a high fracture risk, twist gently lying on your back instead (Canadian advice). These follow our yoga for seniors swaps and each pose's page.
3D demoSeated forward fold (Paschimottanasana)Intermediate · No equipment
3D demoHead-to-knee pose (Janu Sirsasana)Beginner · No equipment
3D demoWide-legged standing forward fold (Prasarita Padottanasana)Beginner · No equipment
3D demoSun salutation A (Surya Namaskar A)Intermediate · No equipment
3D demoPlow pose (Halasana)Advanced · No equipment
3D demoSupported shoulderstand (Salamba Sarvangasana)Advanced · No equipment
3D demoSupported headstand (Salamba Sirsasana)Expert · A wall
3D demoBoat pose (Navasana)Intermediate · No equipment
3D demoRevolved triangle pose (Parivrtta Trikonasana)Advanced · A step
3D demoHalf lord of the fishes (Ardha Matsyendrasana)Intermediate · No equipmentHeel drops: 20 to 30 drops at first, building toward about 50 impacts on most days (the move's page, from the UK consensus). With spinal fractures or several broken bones from minor falls, keep them gentle or march instead. Our bone-strengthening workout adds the strength training.
Our 30-minute class 2 or 3 times a week, plus the bone-strengthening workout on 2 or 3 days. The Pilates for osteoporosis, yoga for posture, yoga for balance and yoga for menopause classes already use the swaps; the chair yoga class avoids rounding under load. After a spinal fracture, start with the kyphosis routine and a physiotherapist's advice.
A 30-minute yoga class for osteoporosis: standing strength, balance at a wall, back-strengthening holds and hip hinges in place of deep forward folds.
30 minBeginner19 movesA bench or box, A wallA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesA wall, A bench or boxTwenty-five minutes of back-strengthening yoga for posture: arm and leg reaches, face-down back lifts and standing poses with the arms raised.
25 minBeginner15 movesNo equipmentThirty minutes of standing yoga for balance: strong standing poses, one-leg poses at the wall, and side steps, backward steps, reaches and sit-to-stands.
30 minBeginner16 movesA wall, A bench or boxThirty-five minutes of standing strength, balance, back strengthening and a long relaxation for the menopause, with no deep forward folds or shoulder stands.
35 minBeginner15 movesFirm cushionA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxThese follow the NHS, the Royal Osteoporosis Society and our osteoporosis exercise guide. A&E means accident and emergency. In the US, call 911 for 999.
Call 999 for either of these:
Get advice soon for any of these:
Stop the session for any of these:
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Some stiffness or soreness for a few days after new movements.
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These change what is right for you:
Ask for an urgent GP appointment or call 111 for back pain with feeling hot, cold, shivery or generally unwell, or severe pain that starts suddenly or gets worse quickly. Call 999 or go to A&E for back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, changes in your bladder or bowels, changes in how your genitals feel during sex, chest pain, or after a serious accident.
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Stop any pose that brings on sudden back or rib pain, and don't push through pain in a fold, twist or backbend. Sudden new back pain after a bend, lift, cough or minor fall needs a GP (our suggestions).
Controlled studies found no significant change in bone density, and the 12-minute study had no comparison group. Strength training, impact and bone medicine do the bone work.
The UK consensus asks you to modify or avoid sustained, repeated or end-range rounding of the spine, the Royal Osteoporosis Society names touching your toes among moves that can put pressure on the spine, and case series link deep forward bending in yoga with spinal fractures. Bend from the hips instead.
The study had no comparison group, 227 of 741 volunteers were judged compliant, the numbers per bone site were small and the hip result wasn't significant.
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"Rotation (twisting) movements should be safe if performed smoothly and comfortably." Canada adds limits on fast, held, weighted or end-range twists at high fracture risk.
The UK consensus recommends yoga among balance and strength activities, and for posture and pain after a spinal fracture, and Canada encourages it if it's done safely or modified for safety.
Yoga poses produce low forces through the feet, unlike the moderate impacts the UK consensus recommends for bone.
Yoga improves balance a little, but a UK chair yoga trial found no fewer falls. Balance-challenging exercise 3 or more times a week prevents falls.
Yes, with some changes. The UK consensus recommends yoga among balance and strength exercise, at least twice a week. Bend from your hips rather than rounding, twist smoothly, and leave out plough and shoulder stand.
It hasn't been shown to: controlled studies found no significant change. For bone, add strength training and impact, and take bone medicine if it's been prescribed.
Deep or repeated forward folds (seated, standing, wide-legged and head-to-knee), the full fold in sun salutations, plough and shoulder stand: fold from the hips with a long back instead. Keep twists smooth, and if your fracture risk is high, keep twists and side bends small.
The study behind them had no comparison group, and its results rest on small numbers of volunteers. Its standing poses are fine; keep the twists smooth and small, and don't use the routine in place of strength training or medicine.
Rarely. Case reports describe spinal fractures after deep forward bending in yoga, mostly in people with thin bones; they show it can happen, not how often, and reviews judge such fractures rare. That's why the advice is to change those poses, not to stop yoga.
Yes, with the same approach: yoga for balance and back strength, and strength training and impact for bone. Use the same swaps for deep forward folds.
Yes, once you're able, ideally with a teacher trained to work with osteoporosis: the UK consensus says yoga and Pilates should be considered to help with posture and pain. See a physiotherapist first if it still hurts, and let the fracture heal, which can take up to about 3 months, before building up strength work.
It's a gentle start, and our chair yoga class avoids rounding under load. Standing poses holding a chair train balance better than sitting.
It improves balance a little, but it hasn't been shown to prevent falls. To lower your risk, do balance-challenging exercise 3 or more times a week.
Neither has been shown to build bone. Both fit the advice if you use the swaps, and our Pilates for osteoporosis guide covers the Pilates version.
Sudden new back pain after a bend, lift, cough or minor fall, or new height loss or a change in the curve of your upper back, can be signs of a spinal fracture: see your GP. Not all spinal fractures hurt.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
