Good for you for keeping up and staying abreast of contraindications. This is a wide-spread condition in our population. One out of every two women and one out of every four men aged 50 or older will suffer an osteoporosis related hip, spine or wrist fracture during their lives (National Osteoporosis Foundation 2005), so good for you for getting heads up!
Osteoporosis is defined as a systematic skeletal disease with an increase in bone fragility. Osteopenia is mildly reduced bone mass indicating the onset of osteoporosis. These conditions are diagnosed through bone mineral density -- scores of -1 to -2.5 indicate osteopenia, while greater than -2.5 indicated osteoporosis. You need to know which you are working with first.
Physical activity plays a huge role in not only halting further bone loss, but reversing it. Pilates is a safe way to provide physical exercise, but you should have special training and be fully aware of all of the risks and contraindications. As always, get clearance from a doctor. It is best to work with a client's doctor and/or physical therapist and to be absolutely clear on what their limitations are. Medical professionals will be able to give you more information on a client's condition and advise you not only on what to omit but what to include. Be sure to ask what medications they are on and what other physical activity they are doing such as weight lifting and/or walking.
Also ask to be kept updated on any repeat tests so you will know if their condition is progressing, or halting. The thoracic spine is the areas of greatest concern. The bones there are smaller and bone density tests are unable to view this area due to its proximation to the ribs and sternum. Generally, if someone has lumbar bone density loss, assume that the same holds true for the thoracic spine. If their is osteopenia of the lumbar spine - assume that there is osteoporosis of the thoracic spine. Contraindicated exercises include forward flexion of the spine as this position causes excess compression force on the anterior surface of the vertebrae. Additionally, compression forces on the vertebra are greater during lateral flexion exercises. Generally adapt or omit exercises that include spinal flexion, exercises which combine forward flexion with rotation (the full Saw) and lateral flexion (Mermaid Stretch). These limitations do not mean to remove all of the exercises which ideally include these components- it may mean using building block versions and props. For example, using a spinal wedge (available online through Macino Mat) and keeping the head down for the hundred is a good modification that will help promote abdominal strength and axial elognation. General guidelines: Extension exercises help strengthen the spinal erectors.
There has been research which shows a correlation between strong back extnesors muscles and higher bone density in the spine (Sinaki et. all 1986); Build adominal strength safely; progress slowly as strength and confidence builds; consider how to safely transition clients between exercises and on and off equipment; plan in advance what to leave in, modify, and what to omit. To allow you a bit of insight into how to create a modified mat workout for a client: Start with fundamentals: Imprinting to teach correct placement of spine on mat, breathing, ISO-ABs, Knee Folds - use a wedge 100 Building Block head down, knees bent, feet on flow OMIT the Roll UP One Leg Circles with hipflexor and hamstring stretches preceeding or following OMIT Rolling like a Ball Single Leg Stretch Building Block head down on wedge Double Leg Stretch Building Block - head down on wedge- part teach initially Lower Lift Building Block head down on wedge Spine Stretch Forward Building Block sit and breathe only - focus on posture and axial elogation Omit - Open Leg Rocker, Corkscrew, SAW Flight Goal Post Arms Swan I Single Leg Kick Double Leg Kick - part teach initially Shoulder Bridge Prep - lift up and down in one piece Building Block Side Kick Series OMIT - Teaser Leg Pull Front Support Leg Pull Back Building Block - supine Table OMIT- Mermaid you may substitute a side plank if client is capable of this OMIT - Mermaid Stretch OMIT Seal Push ups - from floor - no walking out and in (may do them on wall if needed)
Please remember this is general information and is based on the PPS-I terminology and exercise vocabulary. If this is a population that interests you greatly, you may consider a continuing education course to learn more.