Is skiing permissible for a person with osteopenia?

Can You Ski With Osteopenia?

Yes, you can ski with osteopenia, but you must implement comprehensive fracture prevention strategies, optimize your bone health treatment, and carefully assess your individual fracture risk before hitting the slopes. 1

Risk Stratification Framework

Before making a decision about skiing, you need to quantify your fracture risk using validated tools:

• Calculate your FRAX score to determine your 10-year probability of hip fracture and major osteoporotic fracture. High-risk thresholds are >4.5% for hip fracture or >30% for major osteoporotic fracture. 1
• Assess your T-score severity: Osteopenia is defined as T-score between -1.0 and -2.5. 2, 3 If your T-score is approaching -2.5 (closer to osteoporosis), your fracture risk is substantially higher. 1
• Review your fracture history: Any recent fragility fracture within the past 12 months or multiple vertebral fractures should make you strongly reconsider high-impact activities like skiing. 1

Who Should NOT Ski

Absolute contraindications to skiing with osteopenia include:

• Recent fragility fracture within the past 12 months 1
• Multiple vertebral fractures or severe spinal deformity 1
• T-score below -3.0 (technically osteoporosis) without established treatment response 1
• Very high FRAX scores (hip fracture risk >4.5% or major osteoporotic fracture risk >30%) without specialist clearance 1

Pre-Skiing Optimization Requirements

If you decide to ski, you must optimize your bone health first:

Pharmacologic Treatment

• Ensure you are on appropriate osteoporosis prevention therapy if your fracture risk warrants it. First-line options include bisphosphonates (alendronate or risedronate), with second-line agents like denosumab or zoledronate. 4, 1
• Document treatment response with BMD testing showing improvement or stabilization before engaging in high-risk activities. 1
• Treatment decisions should be based on your overall fracture risk using tools like FRAX, not just your T-score alone. 2, 5

Nutritional Optimization

• Consume adequate calcium (1,000-1,200 mg/day) and vitamin D (800-1,000 IU/day) through diet or supplements. 4, 1
• This is particularly important during skiing trips where appetite may be affected by altitude and cold. 1

Physical Conditioning

• Engage in a comprehensive exercise program for at least 2-3 months before skiing that includes: 4
  • Balance training to reduce fall risk
  • Resistance/progressive strengthening exercises for legs and back 6
  • Flexibility and stretching exercises 4
  • Endurance training 4
• Multicomponent exercise undertaken 2-3 days per week for at least 10 weeks reduces fall risk and may positively influence BMD. 4
• Pre-ski conditioning focusing on leg and back strength and endurance is critical for injury prevention in all skiers. 6

Risk Mitigation Strategies While Skiing

Once cleared to ski, implement these safety measures:

• Ski within your ability level and maintain control at all times. Avoid speeds inconsistent with your skill level. 6
• Stop before fatigue sets in, as fatigue is a major risk factor for falls and injuries. 6
• Ensure proper equipment: Have bindings professionally adjusted and test releases daily before skiing. Equipment should match your size and expertise. 6
• Consider protective gear such as hip protectors, though evidence for their efficacy in skiing is limited.
• Avoid high-risk terrain including moguls, steep slopes, and icy conditions that increase fall risk.

Common Pitfalls to Avoid

• Don't assume cardiovascular fitness compensates for fracture risk. These are independent risk domains requiring separate evaluation. 1
• Don't delay treatment. If your fracture risk is elevated, establish treatment response before skiing rather than waiting until after an injury occurs. 1
• Don't ignore the progressive nature of osteopenia. Without intervention, bone loss continues and fracture risk increases over time. 7
• Don't rely solely on your T-score. Your age, clinical risk factors, and FRAX score provide a more complete picture of fracture risk than BMD alone. 5

The Bottom Line Algorithm

1. Get recent BMD testing (within 1-2 years) to confirm your T-score. 1
2. Calculate your FRAX score and assess clinical risk factors. 1
3. If you have any absolute contraindications listed above, do not ski. 1
4. If your fracture risk is moderate to high, optimize treatment for 6-12 months before skiing. 1
5. Implement a 2-3 month conditioning program focusing on strength, balance, and endurance. 4, 6
6. Ensure adequate calcium and vitamin D intake. 4, 1
7. Ski conservatively with proper equipment, within your ability, and stop before fatigue. 6

The overall injury rate in skiing is approximately 3 per 1,000 skier-days, making it one of the riskiest routine adult recreational activities. 6 However, with proper preparation and risk mitigation, many individuals with osteopenia can safely enjoy skiing while minimizing their fracture risk.