Table of Contents
Are planks and pushups safe with osteoporosis? In most cases, yes — provided the variations are appropriate, the spine stays neutral, and the loading is progressive. The trouble is that “plank” and “pushup” each describe a wide spectrum, from a wall-supported entry-level hold to a full floor variation that loads the upper body with the better part of body weight. What’s safe at one end of that spectrum is contraindicated at the other.
This guide walks through which variations are appropriate at which stage, what to avoid outright, and how to think about progression in the context of bone health, fracture risk, and the everyday spinal loading that planks and pushups are uniquely positioned to support.
Judy recently contacted me with a question regarding her exercise program. Like many people, Judy is doing everything she can to build the strength of her body and bones but she is receiving conflicting, confusing and incomplete messages from people she consults.
Here are Judy’s questions:
- Is it okay to do pushups and planks without risk [of a vertebral compression fracture] to the spine?
- The muscles in my upper body need to be built up. I had been working on pushups and planks with my trainer until my doctor recently did an X-ray of my back and discovered two vertebral fractures in the middle of my spine. He told me to stop doing pushups and planks.
- I can’t understand why pushups would be bad since the spine seems to stay in a neutral position.
- I’ve tried to research this issue on the internet but can’t find anything for or against pushups and planks for those with osteoporosis. Do you believe pushups and planks are good for osteoporosis? Are they helpful or risky?
Key Takeaways
- Modified planks and pushups are generally safe with osteoporosis when performed with a neutral spine and without breath-holding.
- Wall and table progressions are the entry point. Full floor variations are a goal, not a starting place.
- Planks build the trunk stability that protects the spine during everyday loading. They are not, by themselves, osteogenic.
- Pushups are one of the few practical ways to weight-bear the upper body — relevant to wrist, forearm and shoulder bone health.
- Active vertebral fractures, severe kyphosis, wrist pathology, and recent distal radius fracture are clear contraindications to standard floor variations.
Are Pushups Good for Osteoporosis?
Push ups are a very effective upper body strengthening exercise. However, individuals with osteoporosis, osteopenia or low bone density need to be more mindful when it comes to push ups. This section covers the questions many people have.
Are pushups safe with osteoporosis?
Yes — and they’re one of the best upper-body exercises a person with osteoporosis can do. Two reasons. First, they’re functional: they translate directly to pushing open heavy doors, pushing a wheelchair, pushing a stroller — and they let you practice breath control, core stability, and the confidence to push something heavy without feeling vulnerable. Second, they’re one of the very few practical ways to load the upper body, and most people lose bone faster in the upper body than the lower body simply because they don’t load it enough.
A pushup is a plank in motion — and that’s what makes it so functional. Whether you start at the wall, the countertop, a step, or the floor, every variation involves weight-bearing through the upper body. The standard contraindications apply: recent fracture through the wrist, forearm, or shoulder, or active shoulder injury. Outside of those, there’s a variation that’s right for almost everyone.
What pushup modifications are safe for low BMD?
The right modifications depend on the individual — upper body and core strength, plus any wrist arthritis, prior shoulder injury, or healing fractures. What stays constant across every variation: best posture, controlled tempo, and coordinated breath. Exhale down, inhale up.
Three faults tend to surface as people fatigue. The midline starts to sag — often felt as low back stress before it’s seen. The head drops forward as the chest seeks the surface, a habit that carries into every door and stroller you push for the rest of your life. And going too deep — past the line where the upper arm is parallel to the surface — stresses the front of the shoulder.
A practical self-correction: place a yardstick along your back from head to sacrum and feel the contact points as you move. Women can slip it through a bra strap; some clients use a headband to anchor the top. Film yourself with your phone — most faults are visible in five seconds of video.
Advance when you can do two or three reps beyond your target with full form intact. If you’re ready for more challenge but not the next progression level, add a single-leg variation or place your feet on a soft surface to introduce ankle instability. Back off the moment breath, posture, or alignment slips — pushing through bad form teaches the body to move badly.
Are wall pushups safe with osteoporosis?
Wall pushups are the entry point — the safest pushup variation, and appropriate for almost everyone. In decades of clinical practice, I’ve never met a client I considered unsafe to start with one, with the obvious exceptions of recent wrist, forearm, or shoulder fracture, or active shoulder injury.
The caveat: wall pushups build endurance well, but build strength less efficiently. A client of mine was doing three sets of thirty wall pushups three times a week — impressive endurance, but below the threshold for the strength she actually wanted. Moving her to the fourth step of her staircase, fifteen reps with slower tempo and proper alignment did more for her than ninety wall pushups had. Wall pushups are a starting point, not a destination.
Even patients with healed compression fractures can begin here. Once the fractures are healed, not progressing toward upper-body weight bearing is its own risk — life involves pushing things, and the upper body needs to be ready.
Are there pushup alternatives if I cannot do a wall pushup yet?
Yes — and they sit beneath the wall pushup, not beside it. The pushup has three components you can train separately.
- The isometric hold: a plank in pushup position, no movement, just stability through wrists, elbows, and shoulders. Hold as long as form holds.
- The scapular pushup: arms straight (a slight elbow softness if you tend to lock), moving only the shoulder blades — drawing them together, then pressing them apart. This trains the protraction-retraction pattern the full pushup will demand once movement is added.
- The shallow eccentric pushup: go down two or three inches, then return slowly, controlling the descent. Eccentric loading takes more control than concentric pushing; building it first makes the full movement easier.
You can also start a wall pushup very vertically — feet close to the wall, hands high — and walk the feet back two inches at a time as it gets easier. Resistance bands and lying chest presses build the same muscles, but they skip the upper-body weight-bearing that matters most for bone.
Do pushups build bone density?
The honest answer: no study has directly measured pushups against forearm or wrist bone density. DEXA testing in exercise trials almost always looks at hip and spine — where the standard fracture markers sit and where research budgets go.
But the underlying question has a clearer answer. At a recent World Congress on Osteoporosis, a presenter discussed how older adults lose bone faster in the upper body than the lower body. When I asked whether that was simply because most older people don’t load their upper body, the answer was direct: yes, exactly.
The clinical pattern holds. Clients who do regular upper-body weight-bearing — pushups, planks, hands-and-knees work — tend to sprain their wrists in falls, not break them. I worked with one client from age 95 to 97. We built crawling into her routine because falls worried me most. She fell one night and crawled from her living room to her bed without injury — she had no memory of doing it, but the bone quality her practice had built carried her through.
This is the distinction worth holding. Pushups may not move the number on a DEXA report. What they reliably change is bone quality — the resilience of bone and the readiness of muscle — that determines whether a fall ends as a sprain or as a fracture.
Are Planks Good for Osteoporosis?
Planks are a very effective core strengthening exercise. This section covers the questions many people with osteoporosis, osteopenia and low bone density have about the safety and effectiveness on planks.
Are planks safe if I have osteoporosis?
For most people with osteoporosis or osteopenia — once active fractures have healed and you have clearance to exercise — the plank is one of the most important exercises you can do.
The reason is anatomical. Your thoracic spine is stabilized by the rib cage. Your lumbar spine — the bottom five vertebrae, supporting everything above — has no bony support. Its only stabilizers are the muscles and fascia of your midsection: transverse abdominis, the obliques, and the deep paravertebrals. The plank is how you build that corset.
What makes it safe is what it isn’t: no flexion, no rotation, no side bending. Done with a neutral spine, it strengthens the trunk without putting the vertebrae at risk. And the value extends beyond the exercise itself. The plank is a template — how you train your body to hold its alignment when you vacuum, garden, lift a grandchild, or carry groceries. All the small daily moments where flexion and rotation accumulate are where vertebrae actually get injured.
What plank variations are safe with spinal osteoporosis?
Every plank variation can be safe — but only if you can maintain a neutral spine without rotation or breath-holding, with head and pelvis in alignment. If you progress too fast, three failure modes surface: the head drops forward, the pelvis sags under load, or the shoulders give. I’ve had clients strain their shoulders holding a plank that was too aggressive.
Choose the variation actively. Don’t let the plank dictate where your body ends up; choose the version you have the strength to hold. Lifting the hips an inch or two makes a plank easier without compromising form — that’s a deliberate scaling decision, not a failure.
A side photo is the best self-check. The ear should line up with the shoulder, the shoulder with the hip, the hip with the knee. If that line is broken, the variation is too hard.
One thing to discourage: long holds. Stuart McGill’s work on spine biomechanics shows that isometric holds can reduce blood flow to the spinal muscles after about ten seconds — relevant for anyone with a history of back trauma. I cap planks and side planks at thirty seconds. A 20-second plank with great form is more useful than a 60-second plank with anything less.
Can I do a plank with a compression fracture?
Yes — absolutely. Once you’ve been cleared to exercise after a compression fracture, the plank is one of the first exercises you should return to. It’s how you re-establish the alignment every other exercise depends on. Without that template, how do you ensure your shoulder and pelvic girdles stay aligned during a triceps press, a row, or the daily movements life demands?
Start at the easiest variation — usually a wall plank — and progress gradually. Don’t move up until every component is ready: neck extensors, shoulder stabilizers, core, hips, ankles. For many of the women I work with, the weak link is the shoulder girdle, not the core.
This matters especially after a compression fracture, because the risk of a second fracture is significantly higher than the first. The plank and side plank are the safest abdominal exercises to begin alongside the back-extensor work that does the most to reduce that risk.
How often should I do planks if I have osteoporosis?
Twice a week, spread evenly — Tuesday and Friday, or Monday and Thursday. Like any muscle group, the core needs recovery between sessions.
Within each session, multiple short holds beat one long one. Six ten-second holds with good form do more than a single sixty-second plank — which usually shows weakness before it ends. Each entry and exit also gives the bone a fresh loading stimulus, almost as good for upper-body bones as a small jump is for the lower body.
When it’s time to progress, increase intensity rather than hold time. A harder variation held for ten seconds with full form is more valuable than an easier variation held for sixty.
Do planks build bone density?
The honest answer: no study has used planks as a sole intervention with repeat DEXA, so I can’t tell you that planks alone increase bone density. But the question is the wrong one. Bone density is only half the picture; bone quality is the other half, and arguably the more important.
The EFOPS study from Erlangen, Germany — sixteen years of follow-up in postmenopausal women — found that regular exercisers didn’t always improve their bone density, but they did show meaningful reduction in fracture risk. That gap is what bone quality describes. And more than half of fragility fractures occur in people whose DEXA scores fall in the osteopenic range, not the osteoporotic. The number on the report isn’t where the trouble lies.
Planks contribute in two ways. First, they build the trunk strength that — through Dr. Sinaki’s work on back-extensor strengthening and balance — has been shown to reduce fall risk. Falls are the most common path to fracture, so reducing falls is reducing fractures. Second, the plank is the foundation that lets you safely do the higher-magnitude exercises that actually move bone density. Without a strong core, those exercises become risky.
Plank vs Pushup for Bone Health
Are Pushups and Planks Good for Osteoporosis?
When done with proper form, both the pushup and plank are excellent exercises for people with osteoporosis. I will briefly discuss each exercise type.
Pushups for Osteoporosis
The pushup is in the Exercise for Better Bones program. In fact, I have several variations of the pushup — each one targeted at a specific program level.
The key things to keep in mind with regard to pushups are:
- Progress slowly and build up your strength. This is why I offer several variations starting with the wall pushup all the way to the pushup with a twist.
- Focus on form and make sure you maintain postural alignment (explained more detail below.)
- Counter balance your pushup with exercises that strengthen the back.
- Make sure you work on flexibility, otherwise you risk compromising your posture.
In Exercise for Better Bones, I provide very specific guidance on how to maintain form. Make sure you watch the video that accompanies the exercise in the program.
I think the big concern your doctor may have is that both exercises strengthen the pectorals (chest muscles). Unless you counter balance them with back strengthening exercises (such as the Floor M) and ensure that you keep the muscles flexible (doorway stretch and elbow press, under Postural Exercises) that the process of strengthening the pectorals muscles can promote a more rounded kyphotic posture.
A kyphotic posture can lead to further stresses on the vertebrae and could cause vertebral compression fractures.
I would ensure you emphasize your back exercises in your routine. Do them when you are feeling fresh and energetic and make them a priority in your workout.
Planks for Osteoporosis
The plank exercise can be very effective for people with osteoporosis for several reasons.
- The foundation of movement (and exercise) is good posture. A strong core contributes to a good posture and a good posture reduces your risk of a spinal compression fracture.
- The increased strength from a strong core reduces your risk of a fall (because you have the strength to catch yourself if you lose your balance.)
My book Strengthen Your Core and my online course, Building a Stronger Core, provide clear instructions on how to safely increase your core strength through the plank and side plank. I provide several examples of each type of plank below in this post.
Free Osteoporosis Exercise Course
Push ups and planks are great exercise but you need more than these to build bone and reduce fracture risk. Sign up below for my free seven day email course on osteoporosis and exercise. You will learn the fundamentals of safe and effective exercise if you have osteoporosis or osteopenia.
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Pushup Exercise Variations
What push up is best for you? Where should you start and how should you progress your pushups? My video below safely steps you through whole process while keeping you challenged.
How to Do the Plank Exercise
The plank exercise is a great core exercise. When done correctly, it can improve posture, enhance performance and strengthen you from your head to your toes.
However, when done incorrectly it can encourage poor postural alignment such as a kyphotic posture. This posture is not good for your breathing or your spine and is of especial concern for people with osteoporosis, osteopenia and low bone density.
In the video, I show how to adjust your plank that supports your alignment and posture. I am going to discuss the importance of doing planks with good alignment, form, and posture.
Plank Exercise Done Incorrectly
Here is a demonstration of planks that I often see clients come in with, and they’ve either been doing these in their yoga class, Pilates class, part of an exercise routine.
The plank is often done in a way that they’re just trying all they can.
They lock out the elbows.
They’re on their hands and on their toes. This is a very unsafe plank, especially if you have low bone density or osteoporosis because of the flexion loads.
Plank Exercise Done Correctly
Ideally, you want to bring your plank in a position that supports your alignment and supports your posture.
- This might mean that you don’t start on your hands and your toes.
- It may mean that you start your plank at a higher position so that you can then support all of the musculature of the shoulder, of the hips, of the ankles, of your spinal alignment.
Ultimately, you want to be strong with nice alignment.
If you do your plank in the first position that I showed you, you’re going to be supporting an alignment that’s kyphotic. That posture is not helpful on your breath, on your spine or anything else. You should work on good postural alignment and getting the most out of your planks.
How to Do a Side Plank
Side plank exercises are a great way to build core strength and increase stability. I will cover two side plank exercises, the beginner level and then the active level. Both of these can be found in my book, Strengthen Your Core.
Beginner Side Plank Exercise
In this video I demonstrate the Side Plank Exercise Roll core exercise for beginners from the Strengthen Your Core exercise program.
During the Roll, you transition as a block, with perfect form, between the Plank exercise and Side Plank exercise. This one of a number of core strengthening exercises for beginners in Strengthen Your Core.
Core Exercise for Beginner Tips
In this section we cover core exercise tips for beginners. We start with how to support your shoulder.
Shoulder Support
For many individuals, weight bearing through one shoulder is quite a challenge. Here are a few tips to add shoulder support:
- In the side plank from the chair, you can add support on the shoulder with the upper arm.
- You can also take weight, if that shoulder is your limiting factor, through this bottom arm.
Those are things that can help you start to build strength through the shoulder and not feel defeated because the amount of pressure that you’re experiencing through the shoulder.
Arm Support
With the planks and especially with the side planks, as opposed to just resting on the chair, I want you to press into the chair.
- To provide additional support, place a folded yoga mat under the arm so that it feels more cushioned through the forearm.
- Draw the shoulder blade down while pressing into the chair.
- If I just let the chair support me, this is what’s going to happen. I hang on with my ligament and that’s not going to be comfortable or beneficial.
- Press into the chair, drop the shoulder blade down and then align your head with the rest of your body. This is an important component of the beginner’s side plank 90.
- When we take the side plank into a 45 we can take a break and reset and then position our body at a 45, position the leg at a 45 and then drop the body and again think of it drawing the shoulder blades down and back.
- Your hand can stay at the chair if you want a little additional support through the supporting shoulder or it can come by your side.
- It can rest on the shoulder that’s supporting you, but again your whole body should maintain that neutral position.
Side Plank Roll Core Exercise for Beginners
Now let’s do the side plank roll core exercise for beginners. To demonstrate this, I will turn away from you and take the roll onto the chair.
- Based on my body size, this chair is just a little bit tall for me.
- Press to stay drawn down.
- My ideal chair height would probably be about 16 inches to do the roll from my knee and this is about 17 inches.
- In this position press firmly down and hold each position for five seconds.
- Roll and keep everything tight.
- Now go into a full plank from your knees.
- Roll into the 45 degree side plank.
- Draw your shoulder blades down and back and right into complete the beginner.
Active Side Plank Exercise
In this video I show several variations of how to do side plank exercise for the Active level in the Strengthen Your Core exercise program.
I demonstrate the side plank exercise at both a 90 and 45 degree angle. I also show how to modify your lift or change the duration of your lift.
How to Do Side Plank Exercise
Let me start with the 90 degrees because that allows me to keep talking to you straight on with the camera.
- Make sure your elbow is tucked in slightly from the shoulder.
- It’s going to feel a little bit awkward because it is going to feel like it’s a little bit tight in, but that’s going to allow you to have your humerus straight in a vertical position once you lift up.
- As you drop back, the elbow is in a little bit closer to the body, but as you lift up it’s sitting just directly underneath, and that’s going to be the most comfortable for the shoulder joint.
- In Strengthen Your Core, it shows the thigh being straight in line with the body, but if you attempt this and you’re going, “Well, that intensity is a little higher than I hoped for”, but you don’t feel like going back to the active level four, you can bring your bottom knee forward slightly, 20 or 30 degrees.
- By doing so, that’s going to reduce the intensity of this side plank.
- The other thing you can play with is the distance that your hip is lifted off from the ground.
- Lift off just a little bit is going to be less intense than if you lift off and create that straight line into the side plank.
Side Plank Variation
Another variation that you can do, as opposed to holding the plank for the entire 20 seconds, is to lift and lower during that time. This gives you some ideas for positioning yourself and modifying the side planks, both the 90 and 45, to work best for you.
- You want press into the floor.
- Press into the floor and engage all of the muscles around the shoulders to support you.
- If you’re going to come up, you can take this hand to give yourself a little more support at the shoulder, if that’s helpful.
- Your head is in a neutral position.
- If that’s feeling too intense, just drop down and pull back up again, and drop down and pull back up, which allows you a variation within the active level side plank, 90 degrees.
- We can take the same concepts into the 45.
- Either your leg is going to be straight with your body when you turn onto a 45 degree, or you are going to allow yourself to have a little bit more flexion at the hip.
- This little bit more flexion is going to make the intensity much less for the abdominal wall.
- Here’s the 45.
- Press in and engage the musculature around the shoulder girdle.
- If you need more support, bring it up through here.
Dynamic Plank Exercise
The Dynamic Plank Exercise Roll for Active Level from the Strengthen Your Core program requires that you do both the Plank and Side Plank exercises in perfect form as you transition between the poses.
I have seen many clients who struggle to do this exercise well. Often they focus on trying to get the side plank “working” and as they progress through the roll, they lose control and start to lose form (and with that, the effectiveness of the exercise).
I work with them closely as they progress from one stage of the roll to the next and coach them along the way so that they maintain good form and get as much benefit as possible from the side plan exercise roll. Of course, once they successfully execute the roll, I give them a big pat on the back!
In this video I demonstrate the dynamic plank exercise roll so that you can follow along and execute it flawlessly. Be patient and take the time you need to build up to this. And once you are there, contact me and I will give you your pat on the back.
Dynamic Plank Exercise Roll
Let’s go through the active level dynamic plank exercise roll step by step. We will go from the side plank 90, to the side plank 45, to the full plank and finally over onto the opposite side.
- Tuck your elbow in slightly.
- Lift yourself up.
- Hold for five seconds.
- Take it over to the 45.
- Five, four, three, two, one.
- The objective here is that throughout the dynamic plank exercise, I endeavour not to move anything between my knees and my head.
- I keep everything else, as I’m rolling everything staying as stable as possible.
- The dynamic plank exercise roll is something that you want to do as an additional challenge.
- Once you’ve gone through your maximum holds for your 90 degree planks and 90 degree side planks.
FAQs: Planks and Pushups for Osteoporosis
Margaret Martin
Further Readings
References
- Sinaki M, Itoi E, Wahner HW, et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10-year follow-up of postmenopausal women. Bone. 2002;30(6):836–841.
- Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593–596.
- Giangregorio LM, Papaioannou A, MacIntyre NJ, et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int. 2014;25(3):821–835.
- Giangregorio LM, McGill S, Wark JD, et al. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporos Int. 2015;26(3):891–910.
- Sinaki M. Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Pain Pract. 2013;13(1):68–75.
- Kemmler W, Bebenek M, Kohl M, von Stengel S. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int. 2015;26(10):2491–2499.
- Massini DA, Nedog FH, de Oliveira TP, et al. The effect of resistance training on bone mineral density in older adults: a systematic review and meta-analysis. Healthcare. 2022;10(6):1129.
- Cui W, Li D, Jiang Y, Gao Y. Effects of exercise based on ACSM recommendations on bone mineral density in individuals with osteoporosis: a systematic review and meta-analyses of randomized controlled trials. Front Physiol. 2023;14:1181327.
- Schoenfeld BJ, Contreras B, Tiryaki-Sonmez G, Willardson JM, Fontana F. An electromyographic comparison of a modified version of the plank with a long lever and posterior tilt versus the traditional plank exercise. Sports Biomech. 2014;13(3):296–306.
- Calatayud J, Escriche-Escuder A, Cruz-Montecinos C, et al. Tolerability and muscle activity of core muscle exercises in chronic low-back pain. Int J Environ Res Public Health. 2019;16(19):3509.
- Song J, Liu T, Zhao J, et al. Causal associations of hand grip strength with bone mineral density and fracture risk: A Mendelian randomization study. Front Endocrinol. 2022;13:1020750.
- Kim SW, Lee HA, Cho EH. Low handgrip strength is associated with low bone mineral density and fragility fractures in postmenopausal healthy Korean women. J Korean Med Sci. 2012;27(7):744–749.
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