In an older patient with osteoporosis, which intervention is MOST appropriate to reduce vertebral fracture risk?

• A. Hamstring stretches with trunk flexion
• B. Postural exercise to decrease lumbar lordosis
• C. Instruction to carry loads in front of the body
• D. Back extensor strengthening exercises

Answer: (D)

Strengthening the back extensor muscles is the most protective approach because these muscles stabilize the spine and help maintain an upright, neutral posture. When the back extensors are strong, they counteract forward bending and the flexion moments that increase loading on the vertebral bodies. This reduces the tendency toward kyphosis, improves balance, and lowers the risk of vertebral compression fractures during daily activities and lifting.

Carrying loads in front, or performing trunk flexion or stretches that promote bending, actually increase forward spinal loading or encourage a flexed posture, which can raise the stress on fragile vertebrae. Targeted back extensor strengthening directly enhances the spine’s resistance to forward flexion and helps preserve spinal alignment, making it the most appropriate intervention to reduce vertebral fracture risk in an older patient with osteoporosis.