Strong women need strong bones. Menopausal women may suffer from osteoporosis, the bone-thinning disease often responsible for fractures in older women. Check out our advice on simple ways to improve bone health in midlife.

Where menopause comes in is it can significantly increase the incidence of osteoporosis as estrogen levels fall. Bone is a living tissue made up of proteins and minerals. Calcium makes bones hard.

One thing that is unequivocally recommended is exercise. Weight-bearing or stretching exercises and regimes such as Pilates are invaluable in enabling you to maintain flexibility and muscle strength. Not only do they help with alignment of the spine, but the emphasis on concentration and breathing will improve your balance and, therefore, reduce your likeliness to fall.

Talk to your healthcare provider before beginning any exercise program. Many health professionals are now more aware of osteoporosis and the benefits of Pilates, for instance, but there are some precautions. If possible, attend a class geared toward people with bone conditions, or talk with your instructor before taking the class. You should not flex your spine (roll forward) or practice exercises that involve front and side bending or rotation of the spine. That said, don’t be put off; there are many valuable exercises, particularly those that involve lying on your side or stomach or resting on hands and knees.

According to the Mayo Clinic (www.mayoclinic.com), exercises that gently stretch your upper back, improve your posture and focus on strengthening the muscles between your shoulder blades can help to reduce harmful stress on your bones and maintain bone density. These specially adapted exercises are designed to prevent or treat osteoporosis.

Standing PostureLearning to stand properly improves your seated and walking posture. To practice correct standing posture:

• Stand with your head, shoulders and buttocks against a wall, with your heels 2 to 3 inches from the wall.
  
• Relax your shoulders and pull in your chin.
  
• Tighten your abdomen and buttocks.
  Press your back against the wall, leaving room for your hand to fit flat behind the curve of your lower back.
  
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Walking PostureWalking strengthens your legs and heart and improves your
balance. To maintain proper walking posture:

• Hold your head high and keep your back and neck as straight as possible.
  
• Keep your chin parallel to the ground.
• Gently tighten your abdominal muscles.
• Let your shoulders move freely and naturally.
  
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Chest StretchTo stretch your chest and straighten your back: Sit on a chair with your
feet flat on the floor. Keep your back erect and look straight ahead. Stretch your arms out to the side, keeping them level with your shoulders

• Bend your arms at the elbows and
  bring your hands toward your chest.
  
• Repeat 5 to 10 times, depending on your ability.
  
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Shoulder Blade SqueezeTo stretch your chest and strengthen upper back muscles: With your feet flat on the floor, sit slightly forward in a sturdy chair, keeping your back and neck straight. Look straight ahead, bending your arms at the elbows.

• Gently move your elbows and shoulder blades back as far as you comfortably can.
• Hold the position for 5 seconds while breathing normally. Return your arms to the starting position. Repeat this exercise 5 to 10 times, depending on your ability.
  
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Sitting Knee ExtensionTo strengthen your thigh muscles: Sit on a chair with your back straight and your hands on your thighs. Tighten your abdominal muscles and look straight ahead.

• Slowly straighten one knee while lifting your heel a few inches from the floor. Don’t slouch or round your back.
  
• Hold this position for a few seconds while breathing normally. Relax and return to the starting position. Repeat 5 to 10 times with each
  leg, depending on your ability.
  
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Calf StretchTo stretch your calf muscle, heel cord and the back of your thigh: Stand with your feet parallel, hip-width apart. Place your hands on the back of a chair for balance.

• Bend your knees, flatten your stomach and straighten your back and shoulders. Slide one foot backward, keeping it flat on the floor, until your back leg is straight.
  
• Lean your weight forward onto your bent front knee. Hold this position for a few seconds while breathing normally.
  
• Repeat 5 times with each leg.
  
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Upper Back LiftTo strengthen your back muscles: Lie facedown on the floor with a pillow under your abdomen and hips.

• Use a rolled towel to cushion your forehead, if you wish. Keep your arms at your sides as you tighten your abdominal muscles. Keep your head in line with your neck and torso. Focus on keeping your shoulders down—don’t let them shrug up toward your ears. Inhale and raise your head and chest a few inches from the floor.
  
• Hold for 5 seconds, breathing normally, before returning to your starting position. Rest for a few seconds. Repeat 5 to 10 times, depending on your ability.
  
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Pelvic TiltTo strengthen your lower back and abdominal muscles: Lie on your back with your knees bent and your feet flat on the floor.

• Maintain a normal curve in your back; don’t arch your back. Tighten your abdominal muscles. Roll your pelvis down to flatten your back
  against the floor
  
• Avoid using your leg and buttock muscles. Hold the position for 5 seconds while breathing normally, and then relax. Repeat this exercise 10 times.
  
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Relaxation PoseOnce you have completed the exercise routine, end with this relaxation exercise: Lie flat on your back with arms resting comfortably along the sides of the body, palms upward.

• Make sure your legs are extended and slightly turned outward all the way down to ankles and feet.
• Close your eyes. Working from the top of your body, start by relaxing your forehead.
• Relax the jaw and let your chin drop down. Feel your tongue slacken, and release any muscular tightness in the face. Relax your neck and shoulders. Focus on your breathing, keeping it steady and deep. Carry on down your body, all the way to the tips of your toes, allowing tension to melt away.
• Remain here for 2 to 15 minutes.
  
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For those of you familiar with Pilates, here are two exercises that are not restricted for people with osteoporosis:

The SpiderThis exercise improves posture: Stand with feet in the Pilates stance (heels pressed together and toes pointed outward at 45-degree angles) facing a wall. Place your palms flat against the wall, and stand far enough from the wall so that your arms are slightly bent.

• Engage your core muscles, inhale and begin to
  walk your fingers up the wall, as though you are typing, until your arms are fully extended. Make sure shoulders stay down, with shoulder blades coming together.
  
• Continue the stretch—if you feel stable enough—by lifting your heels off the ground, and stand on the balls of your feet, growing as tall as possible. Open your chest.
  
• Walk down the wall slowly. Exhale.

90/90 Lower Abs Leg Lowering This is a modified version of The Hundred. It builds core strength and improves stamina and coordination.

• In the supine position, with pelvis and lumbar spine in neutral, bring knees and hips to 90-degree angles. Place arms gently against the thighs. Arms serve as markers to keep the hips in correct alignment. Keep elbows straight throughout movement.
  
• Inhale to prepare. Exhale as you bring navel to spine, pubic bone pointing down, and tailbone pointing upward. Simultaneously begin to lower your right leg. Extend your right knee and point foot to where ceiling meets wall. Lower your leg, but stop descent of leg when you can no longer keep your low back flat on the mat.
  
• Continue to move into posterior tilt and press your lumbar spine into the mat, drawing in the inner abdominals. Relax your neck, throat and jaw.
  Inhale and bend your right knee back to the starting position.
  
• Perform 5 to 10 repetitions, alternating right and left leg extension.