Table 5.

Movements or scenarios that can predispose a person with osteoporosis to fracture, and suggested alternatives to reduce the risk

Movement	Example activity using the movement	Alternative ways to do it safely if indicated
End-range trunk flexion*	Picking up object from floor Yoga/Pilates movements that involve forward bending of the trunk or spine	Bend with knees and hips, not spine, or use grabber tool Supported flexion, not to end-range e.g. modified downward dog with hip hinge and chair, rather than flexing with spine motion
End-range trunk rotation*	Sweeping, getting out of a car Trunk rotation exercise machine Yoga/pilates twisting postures	Step to turn, slow, controlled twisting, not to end-range Side plank on wall or floor Slow, controlled twist in supine, not to end-range
Precarious balancing	Standing on unstable footstool, chair or ladder	Use a step stool with a wide base of support and non-slip materials on the stepping surface and interface with floor.
Lifting objects into or lowering from high storage areas	Lifting heavy objects into cupboards Placing luggage in overhead storage	Step stool to reduce lift/lower height, hold load close to body. Ask someone to do it for you, check luggage
Lifting objects into low storage areas	Placing objects in low cupboards, putting laundry on floor	Avoid lowering or lifting from the floor – store at waist height. Bend with knees and hips not spine, stand close to load when bending, hold load close to body
Lifting using maximal strength	Moving furniture	Avoid – get someone else to lift it always
Rotation with feet planted	During vacuuming or raking	Step to turn, so that leading foot and torso face same direction
Walking or stepping onto slippery surfaces	Wet bathroom or kitchen floor, entryway, pool decks	Wear shoes or slippers with good traction, even in pool areas. Walk slowly, look and take test step before you walk.
Twisting or bending in combination with lifting	Bend & lift mattress to make bed Shoveling	Bend with knees and hips, not spine, use lower body to help lift, stand close to load. Leading foot and torso face same direction while task performed, step to turn.
Transitions – Lying Standing	Getting out of bed	Slide arm out alongside ear, log roll onto side, bend knees 90°. Use other arm to push against bed to upright, place feet on floor, support weight on both hands, scoot bottom to edge of bed, use hip hinge to initiate forward movement and push through lower limbs to stand, using arms only if needed
Transitions – Standing Lying	Getting onto floor in supine or prone, or rolling over	Get down one knee at a time with neutral spine. Hip hinge forward to place hand on floor, gentle twist to place bottom on floor. Slide arm closest to floor out onto floor to lie on side, log roll into position
Prolonged sitting	Watching TV Long car rides	Intersperse prolonged sitting or standing with 5–10 minute periods lying in supine to reduce loads on spine Stop car to get out and walk around, adjust headrest to ensure it isn’t pushing head too far forward

The table is to be used as an example for individuals for whom the activity and associated alternatives have been deemed acceptable by a health care provider. It is not assumed that all individuals with osteoporosis can use the recommendations in this table and not be at risk of fracture. For example, someone with multiple vertebral fractures and pain may need guidance from a trained health care professional to safely perform many activities here, or may need to avoid them. Refer to “Are there daily activities that I normally do that I shouldn’t, or that I should do differently?” section for recommendations on safe performance of activities of daily living

^*Of particular concern when loaded (e.g., holding weights, in seated) or resisted