Massage and Osteoporosis: Fragile Bones, Pressure and Fracture Risk

Urgent Signs First

Stop the session and seek medical care if you feel a sudden, severe pain in the back or ribs during or after massage, or after a fall. In one published case, severe upper back pain began abruptly while a woman used a massage chair, and imaging showed a spinal fracture. [1]

Call 911 in the US (the NHS says 999 in the UK) for back pain together with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, or bladder or bowel changes. [2]

What Osteoporosis Is

The NHS describes osteoporosis as a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a fracture. [3] The most common breaks are in the wrist, hip and spinal bones (vertebrae), and sometimes a cough or sneeze can break a rib or partly collapse a spinal bone. [3]

Two points follow for massage. Osteoporosis is not usually painful until a bone breaks, so you can have it without knowing. [3] And fractures in the spine are a common cause of long-term pain, so an injury that seems minor deserves attention. [3]

The NHS also describes osteopenia, lower bone density than average that is not low enough to count as osteoporosis. [3] Sources we read do not say whether massage advice differs for osteopenia.

What the Reports Show

The evidence is case reports. They show a fracture happened after massage in a particular person. They cannot show how often it occurs, and in each case other factors may have contributed.

• NCCIH says there have been rare reports of serious side effects including bone fracture, and that some involved vigorous massage or people who might be at increased risk of injury, such as older adults. [4]
• A 2013 case report described a 66-year-old man with osteoporosis who had a fracture of a back bone (a vertebral pedicle) after a back massage. He also had long-standing low back pain, nerve compression symptoms and other spine changes, and needed surgery. The authors said the case raises awareness that low-energy trauma from alternative medicine can cause such a fracture. [5]
• A 2019 case report described an elderly woman with a fracture of a thoracic vertebra after using an electric automated massage chair. She had no known risk factor for fragile bones, but a scan then confirmed osteoporosis. She was treated with a brace and medication and the fracture healed over six months. The authors advised that people with or at risk of osteoporosis should be cautious with deep tissue massage chairs. [1]
• Cancer Research UK says massage may need to be adapted for people with bone fractures. [6]

What We Did Not Find

Proper evidence not found for pressure limits, safe techniques or areas to avoid specific to osteoporosis. We read the NHS osteoporosis page, the US National Institute of Arthritis and Musculoskeletal and Skin Diseases and MedlinePlus osteoporosis pages, and a bone health foundation's safe-movement page, and searched PubMed for massage with osteoporosis and fracture. These gave either no mention of massage or only the two case reports above. We also did not find a regulator or medical society rule. Any pressure advice should come from your own clinician, who knows your bone density and fracture history.

Questions to Ask Your Clinician

• Is my bone density low enough that firm pressure on my back, ribs or hips is a concern?
• Have I had a spinal or other fracture, and does that change which areas are safe?
• Should I choose light, gentle massage rather than deep tissue work?
• Do my other conditions or medicines change this?

Practical Points

• Say so up front: tell the therapist about osteoporosis, osteopenia, past fractures, and medicines that affect bones. The NHS lists long-term high-dose steroid tablets and anti-estrogen tablets taken after breast cancer among factors that can affect bone strength. [3]
• Pressure is your call: ask for light pressure, and stop the session if anything feels sharp. Pain is not something to push through.
• Mechanical devices: the chair report involved a machine with a rolling mechanism. [1] For hand-held percussion tools, see massage guns and percussive devices.
• Falls matter too: the NHS lists steps to reduce falls, such as removing home hazards and having regular sight and hearing tests. [3] Getting on and off a massage table is a fall risk, so ask for help.
• Older adults: see massage for older adults and the wider topic of osteoporosis and bone health.

Read the full massage safety overview and deep tissue massage risks and pressure limits.