Osteoporosis and Chiropractic: What You Need to Know Before Getting Adjusted
- Elizabeth Wells
- Jul 9
- 4 min read
Understanding Osteoporosis and Osteopenia
Osteoporosis is a bone disease characterized by weakened, thinned bones that become fragile and vulnerable to fracture. Osteopenia is a precursor condition where bone density is lower than normal but not yet at the osteoporotic level. Both conditions require special consideration when receiving chiropractic care.
The Importance of Bone Density Testing
When to Get Tested
Screening Guidelines:
Screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, such as having a parent who has broken a hip.
Post-Menopausal Women: When deciding which postmenopausal women younger than 65 years to screen, the USPSTF suggests a 2-step approach. Clinicians can first determine the presence of risk factors for osteoporosis and fracture, including:
Low body weight
Parental history of hip fracture
Cigarette smoking
Excessive alcohol consumption
Earlier Testing Benefits: Many guidelines suggest women should start getting bone density tests to detect osteoporosis at age 65, but earlier testing may help prevent more fractures.
DEXA Scan Basics
The dual-energy X-ray absorptiometry (DEXA) scan is the gold standard for measuring bone density.
Results are reported as T-scores:
Normal: T-score above -1.0
Osteopenia: T-score between -1.0 and -2.5
Osteoporosis: T-score below -2.5
Frequency of Testing
The recommendations are to get a central DEXA scan:
Every two years for high risk
Every 3 to 5 years for moderate risk
Every 10 to 15 years for low risk.
Benefits of Modified Chiropractic Care for Patients with Osteopenia / Osteoporosis
Pain Management
Gentle chiropractic techniques can help manage pain associated with:
Postural changes due to vertebral fractures
Muscle tension from compensatory movement patterns
Joint stiffness and reduced mobility
Functional Improvement
With appropriate modifications, chiropractic care can be a safe and beneficial component of a comprehensive osteoporosis management plan, potentially helping with:
Improved posture and spinal alignment
Enhanced mobility and flexibility
Better balance and coordination
Reduced fall risk
Exercise Guidance
Chiropractors can provide valuable guidance on:
Safe, bone-building exercises
Balance and proprioception training
Activities to avoid
Progressive strengthening programs
Chiropractic Adjusting and Osteoporosis: Safety Considerations and Injury Risks
Increased Fracture Susceptibility
Patients with osteoporosis and osteopenia face significantly higher risks of certain injuries during manual therapies:
Vertebral Compression Fractures: The most concerning risk is spontaneous or treatment-induced compression fractures of the vertebrae, particularly in the thoracic and lumbar spine. These can occur with minimal force due to weakened bone structure.
Rib Fractures: The ribs are particularly vulnerable in osteoporotic patients and can fracture with relatively gentle pressure or manipulation.
Other Fracture Sites: Hip fractures, wrist fractures, and fractures at other sites become more likely with any fall or excessive force application.
How Chiropractors Modify Treatment: Low-Force Techniques
Modern chiropractic practice emphasizes the importance of using low-force techniques and individualized care plans to ensure safety and effectiveness for patients with compromised bone density.
Activator Method: This instrument-assisted technique delivers controlled, low-force impulses that are particularly suitable for osteoporotic patients. Research has documented successful treatment of geriatric patients with osteoporosis using this approach.
Mobilization vs. Manipulation: Chiropractors often substitute joint mobilization (gentle, sustained pressure) for high-velocity manipulations that could pose fracture risks.
Drop-Table Techniques: These use specialized tables that assist movement while reducing the force required from the practitioner.
Other Treatment Modifications
Chiropractic adjustments can be safe for people with osteoporosis if the chiropractor is aware of the condition and takes the necessary precautions.
Comprehensive Evaluation:
Review of DEXA scan results and T-scores
Assessment of fracture history
Evaluation of current pain patterns
Coordination with medical providers
Individualized Care Plans Treatment protocols are customized based on:
Severity of bone loss (T-scores)
Location of osteoporotic changes
Patient’s functional goals
Comorbid conditions
Gentle Soft Tissue Techniques:
Light massage and myofascial release
Gentle stretching protocols
Postural education and ergonomic advice
Exercise prescription for bone health
Areas of Caution
Contraindicated Techniques: Certain traditional chiropractic techniques are avoided, including:
High-velocity spinal manipulations in severely osteoporotic regions
Rotational manipulations of the thoracic spine
Aggressive manual therapies
Red Flag Awareness: Practitioners monitor for signs of compression fractures, including sudden onset back pain, height loss, or postural changes.
Questions to Ask Your Chiropractor
Before beginning treatment, discuss:
Your medical history, including
If you've been diagnosed with osteoporosis or osteopenia
DEXA scores and when you had your last scan
Medications and supplements you take pertaining to bone health
Calcium or vitamin D deficiencies
Any history of fractures and/or falls
Their clinical experience, including:
Specific techniques they plan to use
How they will modify treatment based on your DEXA scores
Their protocol for monitoring your response to care
Osteoporosis Red Flags: When to Seek Immediate Medical Attention
Contact your primary care doctor immediately if you experience:
Sudden, severe back pain
New loss of height
Changes in posture or spine curvature
Difficulty breathing (may indicate thoracic compression fracture)
New numbness or tingling in arms or legs
Regardless of if you are seeing a chiropractor, these signs of fracture are important to be aware of. Osteoporosis can occasionally cause "spontaneous fractures" that occur suddenly and seemingly with no cause, and "stress fractures" which occur from repetitive overuse and stress on a bone.
Conclusion
Chiropractic care can be safely provided to patients with osteoporosis and osteopenia when appropriate precautions are taken. The key is working with a knowledgeable practitioner who understands the condition and utilizes low-force techniques tailored to your specific needs. Regular bone density testing is crucial for monitoring your condition and ensuring that treatment approaches remain appropriate as your bone health changes over time.
Always maintain open communication between all members of your healthcare team to ensure coordinated, safe, and effective care for your osteoporosis management.
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References
1. Cook A, Moss T. Osteoporosis: A Review for Chiropractic Clinicians. Journal of Contemporary Chiropractic. Available at: https://journal.parker.edu/article/78097-osteoporosis-a-review-for-chiropractic-clinicians
2. CDC. Facts About Bone Density (DEXA Scan). Centers for Disease Control and Prevention. Updated January 31, 2025. https://www.cdc.gov/radiation-health/data-research/facts-stats/dexa-scan.html
3. USPSTF. Recommendation: Osteoporosis to Prevent Fractures: Screening. United States Preventive Services Task Force. Updated January 14, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening
4. Chiropractic spinal manipulative therapy for a geriatric patient with low back pain and comorbidities of cancer, compression fractures, and osteoporosis. PMC3315872. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315872/
5. Johns Hopkins Medicine. Bone Densitometry. Updated August 8, 2021. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-densitometry
