Osteoporosis after 65: what does research really say about physical activity?

/0 Comments/in /by

When it comes to osteoporosis, the recommendation to “stay physically active” is now widely recognised. Fragility fractures of the hip, spine and wrist are among the leading causes of loss of independence in people over 65. But what scientific evidence supports the effectiveness of physical activity in preventing osteoporosis and its consequences?

A systematic review published in the International Journal of Behavioral Nutrition and Physical Activity sought to answer this question. The review was conducted to inform the World Health Organization (WHO) guidelines on physical activity and sedentary behaviour in adults aged 65 and over.

What is osteoporosis?

Osteoporosis is a systemic skeletal disease characterised by a reduction in bone density and quality, making bones more fragile and susceptible to fractures.

“During childhood and adolescence, the body gradually builds up its bone mass, reaching peak bone mass at around the age of 30” – explains Dr Maria Chiara Reitano, a specialist in Physical and Rehabilitation Medicine at ISICO. “After this point, bone resorption gradually begins to prevail, and as we age, this process can contribute to the development of osteoporosis. Because osteoporosis is often referred to as a ‘silent disease’, it is frequently diagnosed only after a fracture has occurred, although tests such as dual-energy X-ray absorptiometry (DXA) can detect it at an earlier stage”.

As we age, bone loss results from the interaction of physiological changes, reduced muscle strength, lower levels of physical activity and other risk factors, including chronic diseases, certain medications and an increased risk of falling. “This is why prevention should combine any necessary pharmacological treatments with an active lifestyle, in which physical activity plays a key role” – Reitano emphasises.

What does scientific research show?

The systematic review examined the available studies to assess the effects of physical exercise on bone health in older adults. Its findings confirm that physical activity plays a fundamental role in counteracting the effects of ageing on the musculoskeletal system and helping to reduce the risk of fragility fractures.

Physical activity has a dual benefit. On the one hand, it helps preserve bone mineral density, with particularly consistent results in the lumbar spine. On the other, it improves muscle strength, balance, coordination and mobility, reducing the risk of falls, one of the leading causes of fractures in older people. Another important finding concerns the type of exercise performed.

“The programmes that have shown the best results are progressive and individually tailored, combining aerobic activity, resistance training and specific exercises to improve balance and movement control” – explains Reitano. “There is no single ‘miracle exercise’: the greatest benefits come from combining different types of exercise, adapted to each person’s individual needs and abilities”.

Walking regularly is an important habit, but it may not be enough on its own. To maintain strong and healthy bones, it is essential to combine walking with muscle-strengthening exercises and activities specifically designed to improve balance and coordination. This approach not only supports bone health but also helps preserve independence in everyday activities. Every exercise programme should be tailored to the individual’s clinical condition, age, fitness level and any coexisting medical conditions. For this reason, it is advisable to seek guidance from qualified professionals, such as physiotherapists, medical specialists or exercise science professionals, who can identify the most appropriate exercises and ensure that activity progresses safely.

“It is important to remember that physical exercise is one of the cornerstones of prevention, but it does not replace pharmacological treatment when this is indicated” – concludes Dr Reitano. “For people already diagnosed with osteoporosis or with significantly reduced bone mineral density, treatment must be determined by a physician and may involve a combination of medication, physical activity, appropriate nutrition and measures to reduce the risk of falls.”

The available evidence therefore reinforces a simple but essential message: it is never too late to start being physically active. Regular, well-structured physical activity tailored to individual abilities is one of the most effective ways to protect bone health, maintain independence and improve quality of life, even after the age of 65.

References

Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour.

Lavinia Abate: from ISICO patient to Miss Italy: her story for the World Rehabilitation Alliance

/0 Comments/in /by

From being diagnosed with a 53-degree scoliosis curve to winning Miss Italy 2022: Lavinia Abate has chosen to share her journey with ISICO by taking part in an international initiative promoted by the World Rehabilitation Alliance, a network of the World Health Organization (WHO).

The World Rehabilitation Alliance (WRA) has launched the Champions Programme, an initiative that brings together authentic stories of people who have undergone rehabilitation. The aim is to select Rehabilitation Champions: individuals who, through their personal experiences, can help raise awareness of the importance of rehabilitation and its impact on everyday life.

The stories collected may also contribute to awareness-raising initiatives linked to World Rehabilitation Day, which will be celebrated on 24 February 2027. Among those who responded to the invitation is Lavinia Abate, an ISICO patient and Miss Italy 2022, who completed the application form by sharing her experience of five years of conservative treatment for scoliosis at ISICO.

Five Years of Treatment, a 25-Degree Reduction in Her Spinal Curve

Lavinia was just 13 years old when, during a period of rapid growth, her family noticed an asymmetry in her back. She was diagnosed with severe scoliosis, with a 53-degree curve, for which several specialists had recommended surgery.

“My family and I turned to ISICO, where, taking into account my remaining growth potential, I was offered a conservative treatment programme based on bracing and scoliosis-specific physiotherapeutic exercises” – recalls Lavinia Abate. “For five years, I followed the treatment consistently, initially wearing the brace for 23 hours a day and regularly performing postural exercises. The results exceeded all expectations: my spinal curve was reduced by 25 degrees” – Lavinia writes in the testimony she submitted to the WRA.

Those five years were demanding, but scoliosis did not prevent her from pursuing her passions.

“It wasn’t an easy journey, but I never allowed scoliosis to define my limits. I continued dancing and singing throughout my treatment. This experience taught me that determination and perseverance can take us beyond what may seem already written.“

From Scoliosis to Winning Miss Italy

In 2022, the same year she completed her treatment, Lavinia won the Miss Italy title. In her account, this achievement holds a meaning that goes far beyond physical appearance: “For me, it wasn’t just about winning a beauty pageant, but about proving to myself that I had overcome five years of sacrifices and had become stronger and more self-aware“.

She concludes her testimony with a reflection on the meaning of beauty, shaped in part by her experience with scoliosis: “I believe that beauty also comes from a person’s inner depth, their story, and the strength with which they face life’s challenges“

Lavinia’s story highlights not only a significant clinical improvement, but also the value of a rehabilitation journey during which she continued to nurture her passions and pursue her goals. Through her participation in the World Rehabilitation Alliance’s Champions Programme, her experience may now help raise international awareness of the tangible impact rehabilitation can have on people’s quality of life.

ISICO International Master: 12th edition now open!

/0 Comments/in /by

Eleven years of education, 371 professionals trained and a network spanning 66 countries worldwide. These figures tell the story of ISICO’s International Master in Conservative Scoliosis Treatment, now preparing to launch its twelfth edition. Enrolment is officially open, with an early bird deadline of December 6, 2026.

Since 2016, the Master has brought together healthcare professionals across geographical and professional boundaries, creating opportunities for exchange and collaboration among physicians, physiotherapists, chiropractors, orthotists and other specialists involved in scoliosis management.
The International Online Master Principles and Practice of Scoliosis Conservative Treatment (PPSCT), delivered entirely in English, offers evidence-based education closely connected to clinical practice. The programme combines recorded lectures, scientific readings, clinical case discussions and live sessions with instructors, providing a flexible yet interactive learning experience.

A Decade of Experience Presented at SOSORT

The value of this educational model is also documented in an abstract presented by Dr Fabio Zaina, ISICO physiatrist, and the ISICO research team at the latest international SOSORT Congress in May 2026, entitled Global Reach and Clinical Impact of a Blended Online Course in Conservative Scoliosis Management.

The study reviews the course editions from 2016 to 2025, highlighting its remarkable international growth: from 15 participating countries in the first year to 66 in 2025, of which 63 are UN Member States (33% of 193).
Significantly, the Master has also reached 35 participants (10.4%) from 17 countries classified by the World Bank as low- or lower-middle-income.

The analysis also highlights the importance of interaction between participants and instructors: 73.7% of respondents rated the discussion groups as very important, while live lectures and recorded content received consistently positive feedback.
Above all, the opportunity to immediately apply newly acquired knowledge to everyday clinical practice emerged as one of the Master’s key strengths. The programme goes beyond scientific updates, encouraging clinical reasoning and the ability to make informed decisions based on the best available evidence.

One of our main goals has always been to make high-quality, evidence-based education in conservative scoliosis treatment accessible to healthcare professionals worldwide, regardless of where they live or the resources available to them” – explains Professor Stefano Negrini, ISICO Scientific Director and Director of the International Master – “Reaching professionals in low- and middle-income countries is particularly meaningful because it shows how online education can help overcome geographical and economic barriers, bringing scientific knowledge into everyday clinical practice”.

From Australia: A Participant’s Perspective on the Master

This is precisely what Chi-Jui “Gary” Huang, a healthcare professional at Perth Scoliosis Clinic in Australia, emphasised after recently completing the programme:

“I have really enjoyed the course, not only because of the quality and depth of the teaching, but also because of the discussions and interactions with all other doctors, physio, chiro, etc. I have learned so much throughout the course and feel that it has really helped me update and strengthen my knowledge and clinical reasoning when making clinical decisions. One thing I particularly appreciated was seeing that some of the clinical decisions I have been making in my everyday practice were consistent with the approaches and reasoning discussed by the instructors. This gave me a lot of reassurance and confidence in my clinical practice. At the same time, the course has challenged me to think more critically and has helped me further develop my clinical reasoning and understanding of the available clinical evidence.
I will definitely recommend this course to my colleagues and friends who are interested in scoliosis management”.

His words capture the essence of an international educational experience in which sharing knowledge and expertise becomes a practical tool for improving the clinical management of scoliosis.

Enrolment Open for the 12th Edition

The ISICO International Master is now preparing to welcome a new group of professionals from around the world, continuing its commitment to education that brings together scientific knowledge, multidisciplinary exchange and practical clinical application.

Enrolment is now open, and early bird registration is available until December 6, 2026.

For the full programme, participation details and registration, visit the official website: www.scoliosismaster.org

Is a Heavy School Backpack Really Bad for Your Back?

/0 Comments/in /by

At the start of every school year, the weight of school backpacks becomes a concern for many parents. Can a heavy backpack damage the back, alter posture or contribute to spinal problems?

A recent study published in the European Spine Journal examined 65 healthy schoolchildren under different loading conditions: without a backpack, with a load of 10–15% of body weight, and with a heavier load averaging about 19%. Researchers assessed changes in spinal and pelvic alignment while the children were standing. 

The body adapts to the load

As backpack weight increased, children tended to lean further forward and showed a small increase in thoracic kyphosis. However, these changes were temporary responses to carrying the load rather than evidence of permanent postural alterations. 

The study identified around 16% of body weight as the value that best distinguished children who developed a significant forward trunk imbalance while carrying the backpack. This should not be considered a strict universal threshold, but rather a practical reference. 

Physical fitness also matters

An interesting finding was that children with greater grip strength showed less forward imbalance under load, suggesting that the ability to manage a backpack depends not only on how much it weighs, but also on the child’s physical capacity. 

The practical message is therefore twofold: avoid unnecessarily heavy backpacks, using 15–16% of body weight as a reasonable reference, but also encourage children to stay active and physically fit. And importantly, school backpacks do not cause scoliosis.

ISICO ranks first for scientific publications in a new international analysis of scoliosis rehabilitation research

/0 Comments/in /by

A new bibliometric study published in 2026 (Scientific literature landscape analysis of researches on rehabilitation in scoliosis over the last 30 years)  has mapped international research on scoliosis rehabilitation over the past three decades, identifying ISICO – the Italian Scientific Spine Institute – as the institution with the highest number of publications in the dataset analysed.

Published in Spine Research, the study included 308 articles and reviews and involved 540 institutions and 1,392 authors.
ISICO ranked first among institutions for publication output, while Stefano Negrini, ISICO Scientific Director, ranked first among authors for number of publications and was also the most co-cited author. Fabio Zaina, ISICO specialist in Physical and Rehabilitation Medicine,  and Michele Romano, Physiotherapy Director of Isico, ranked second and third respectively for publication output. 

Not an isolated finding

The new study is particularly interesting when considered alongside three other independent bibliometric analyses published in recent years, each exploring a different area of scoliosis research.

A 2024 analysis of exercise therapy for adolescent idiopathic scoliosis found ISICO tied for first place among institutions for number of publications and first for total citations within the dataset analysed. Five ISICO researchers appeared among the ten most prolific authors: Stefano Negrini, Michele Romano, Fabio Zaina, Alessandra Negrini and Sabrina Donzelli. 

Another 2024 study, focusing on orthotic treatment and bracing for adolescent idiopathic scoliosis, highlighted the contribution of individual ISICO researchers. Stefano Negrini ranked second and Fabio Zaina third among the most prolific authors in the dataset, while Negrini was also the third most co-cited author. 

Finally, a 2025 bibliometric analysis examining adolescent idiopathic scoliosis treatment as a whole, including both conservative and surgical approaches, found that the 2016 SOSORT Guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth, with Stefano Negrini as first author, were the most co-cited paper in the dataset. The previous 2011 SOSORT Guidelines also appeared among the ten most co-cited publications. 

Four different analyses, a converging picture

Bibliometric studies do not establish which institution provides the best clinical care. They measure specific aspects of scientific activity — such as publication output, citations and the influence of individual papers — within a defined research field and dataset.

The value of a single ranking is always relative, because every bibliometric study is based on a specific dataset, time period and research question. What is more interesting here is the convergence of four independent analyses, focused on different areas of scoliosis research, which repeatedly identify ISICO, its researchers or their scientific work among the most productive, cited or influential contributors.
“This is especially meaningful for us because research has always been an integral part of our clinical work: it allows us to test our approaches, contribute to international knowledge and continuously improve patient care. However, the fact that four independent analyses, covering different areas of scoliosis research, repeatedly identify ISICO, its researchers or their scientific contributions among the most productive, cited or influential provides a converging and independently verifiable picture of ISICO’s contribution to international scoliosis research – ends Negrini”.
This is particularly noteworthy considering that several of these analyses cover research periods beginning before ISICO was founded in 2003.

Bibliografia

Stefano Negrini at the forefront of global rehabilitation research

/0 Comments/in /by

Stefano Negrini, Scientific Director of ISICO, has been named joint winner, together with Christopher Maher (Australia), of the fourth edition of the four-yearly King Salman International Award for Disability Research, in the Rehabilitation and Social Sciences category.

It is perhaps the most prestigious international award dedicated to research in the fields of disability and rehabilitation. This year, it received more than 770 nominations from 111 countries, involving professionals from across the entire rehabilitation and disability field. Following a six-month evaluation process, the ten best candidates in each category were initially selected, followed by three finalists and, ultimately, the winners.

The award recognises the value and impact of a scientific career built through years of research, international collaboration, and commitment to advancing evidence-based rehabilitation, from spinal disorders and scoliosis to rehabilitation research and global health.

Full Professor of Physical and Rehabilitation Medicine at the University of Milan, Stefano Negrini is the founder and former director of CochraneRehab, and has worked extensively with the World Health Organization to bring together the best available scientific evidence to support global health decision-making in rehabilitation. He also founded and has held leading roles within SOSORT, the international Society on Scoliosis Orthopaedic and Rehabilitation Treatment, contributing to the development and worldwide dissemination of rehabilitation research.

His scientific and professional activity has also developed through long-standing collaborations with major international rehabilitation and spine societies, including ISPRM, ESPRM, ISSLS, EUROSPINE and the Scoliosis Research Society, further strengthening the international reach of his work.

For several years, he has also been included in the Stanford/Elsevier ranking of the world’s top 2% most-cited scientists across all scientific disciplines, further reflecting the international impact of his research.

“One of the most important awards in the field of rehabilitation”: this is how Stefano described the recognition. A definition that conveys the significance of an award that celebrates not a single study, but the contribution and global impact of an entire scientific career.

“This recognition is the result of a long journey, one that I have never travelled alone. I am deeply grateful to ISICO and to all my colleagues and collaborators who, over the years, have contributed to my personal, professional and scientific growth. Above all, I thank my patients, who remain my greatest teachers. It is also thanks to this collective effort that I have been able to reach such an important milestone today.”

A scoliosis camp in Beijing: an unexpected experience

/0 Comments/in /by

Our Physiotherapy Director, Michele Romano, was in China to teach a SEAS (Scientific Exercises Approach to Scoliosis) course for physiotherapists. While in Beijing, he was also scheduled to provide training on scoliosis treatment at Beijing Children’s Hospital. But when he arrived, he discovered that something completely different had been organized. This is his account of those four unexpected and intense days.

“I was in Beijing around Mid-August to provide training for physiotherapists on scoliosis treatment at Beijing Children’s Hospital. But on the first day, I realized that something completely different had been organized. I walked into the room where I was supposed to meet a small group of physiotherapists and instead found an auditorium packed with around 90 people. Adults and children.

After my initial surprise, I asked what was going on and they told me that a ‘Camp’ had been organized: an event to teach scoliosis-specific exercises to young patients, with their families actively involved as well.

I thought about it for a minute and then I got started.

First, a plenary introduction for the whole audience, with general information about scoliosis. Then I started assessing the patients. There were 26 of them.

With the help of four physiotherapists with little experience, whom I trained on the spot, we began measuring all the patients and collecting the information we needed to decide how to treat them. The physiotherapists assessed the patients and then brought me a form with the data they had collected. I checked the information and then decided how to treat each patient’s curve.

The following day, we started treatment. Twenty-six individual stations where I taught the basics of treatment and then entrusted each patient to one of the supporting physiotherapists. An incredibly exhausting day. The next day, we checked what they had learned and taught them the exercises. We ended the day with a Q&A session with everyone.

We closed the Camp on the fourth day with a final discussion with the parents, certificates for the young participants and a very moving final hug!”.

Training and Research: International Exchange in the First Half of 2026

/0 Comments/in /by

566 professionals trained, 30 SEAS courses and more than 25 countries involved. These are some of the figures from the first seven months of 2026, during which ISICO’s international activities brought together training, research and scientific exchange.

From the Philippines to Indonesia and Japan, from China to Kazakhstan, from France to the United States, and as far as Brazil and Argentina, between January and July we organised 23 SEAS Level 1 and 7 Level 2 courses, involving 439 and 127 professionals respectively. In addition, 32 participants attended our online Master’s programme, alongside the professionals reached through webinars and other educational activities.

“These figures are particularly meaningful because of what lies behind them,” comments Stefano Negrini, ISICO Scientific Director. “Training brings us into contact with professionals working in very different healthcare and cultural settings. We share what we have learned from research and clinical experience, while the questions and experiences that emerge during our courses provide new insights and stimuli for our own work.”

The same exchange continues within the international scientific community. ISICO specialists have taken part in numerous congresses and scientific meetings, from ESPRM in Krakow to the EARM Meeting in Lyon, from ISSLS in Cape Town to IRSSD in Novi Sad, as well as the PREPARE Annual Meeting and the Brazilian Congress on Scoliosis.

One particularly significant event was SOSORT 2026 in Turin, where ISICO presented 23 scientific contributions – 19 oral presentations and 4 posters – and Francesco Negrini received the SOSORT Award.

“Training, research and clinical practice are not separate worlds,” concludes Negrini. “New evidence needs to find its way into everyday clinical practice, but it is equally important that the challenges we encounter with our patients generate new research questions. Exchange with colleagues from other countries is essential: it pushes us to test what we do, compare it with different experiences and, when necessary, change our approach.”

After the summer break, courses and scientific events will resume, with a new international programme already scheduled for the second half of the year.

Friendship and Scoliosis: the bonds that last

/0 Comments/in /by

There is a kind of friendship that begins in the most unexpected moments. Not during carefree afternoons or between school desks, but in those times when life asks you to grow up a little sooner than you expected. That is how they met: at a summer camp for teenagers with scoliosis. Not the typical camp filled only with games and laughter, but a place where every backpack carried something more. A brace. A struggle. A quiet fear.

At first, there were only shy glances and hesitant smiles. Then came whispered conversations in the evening, jokes to lighten the mood, and small gestures of encouragement when wearing that brace for just one more day felt almost impossible. And without even realizing it, a true friendship was born. The kind that needs no explanations.

The years passed. The brace came off, life moved on, and their backs changed. But some things are never left behind. They simply transform. And then comes a special evening: Anna’s eighteenth birthday.

Anna walks into the room wearing an elegant, light, beautiful dress. A dress that reveals her back. The very same back that, just a few years earlier, had been enclosed in a rigid shell of plastic and perseverance. But those who are there with her do not see only the dress. They see the journey. They remember the tears held back, the laughter they shared, the difficult days and the ones when it felt as though they could fly.

They look at each other and understand, without needing to say a word:

“We made it.”

And above all:

“We’re still here.”

This is for all of you—boys and girls who are facing scoliosis and wearing a brace today. I know it isn’t easy. There will be days when it feels unfair, heavy, endless. But please remember this: you are not alone.And what you are living through now, even if it feels like nothing more than a burden, can become something incredibly precious.

Because somewhere between an adjustment and a moment of discomfort, between a restless night and a difficult day, you may find people who truly understand you.

And perhaps, a few years from now, you too will find yourselves together again—laughing, celebrating, looking back with pride.

With a different back, yes. But above all, with bonds that were never broken.

Back pain and menopause: why posture changes after 50 and how to protect your spine

/0 Comments/in /by

We often tend to think of scoliosis as a condition linked exclusively to adolescence, those growing years when parents constantly reminded us to “stand up straight”. However, there is a lesser-known yet very common reality: scoliosis that appears or worsens in adulthood, often during a delicate stage such as menopause. If, after the age of 50, you have started to notice persistent lower back pain or changes in your posture, you are not alone. Understanding what happens to our spine is the first step towards continuing to move freely and confidently.

“De novo” scoliosis: a new challenge after 50

There are two ways scoliosis may present in adults. Some people have lived with a spinal curve since their youth, which may become symptomatic again over time.
For many others, however, what doctors call “de novo” scoliosis develops. As the name suggests, this is a completely new curvature that appears in people who previously had a well-aligned spine. It is not caused by abnormal bone growth, but by the natural wear and tear of the structures that support the back. In most cases, this form affects the lower back (lumbar or thoracolumbar region) and presents with gradual postural changes associated with pain.

At the root of the condition are asymmetrical degenerative changes: the intervertebral discs thin unevenly, the joints between the vertebrae lose stability, and muscles and ligaments become less efficient. This creates an “asymmetrical load”: the spine tilts, weight distribution becomes uneven, and a vicious cycle begins, accelerating degeneration and progression of the curve. Over time, these changes may also lead to a reduction in the normal lumbar curvature (lordosis) and, in some cases, to small vertebral slippages or narrowing of the spinal canal.

Why women in particular? The role of menopause

Statistics speak clearly: adult scoliosis affects women more frequently and increases with age. It is estimated that prevalence rises from around 13% in people under 60 to over 30% after the age of 60, with even higher rates among older populations. With the onset of menopause, the body undergoes a true hormonal revolution that affects bone mineral density (osteoporosis), ligament elasticity, and muscle tissue quality. But it is not only a matter of more fragile bones.
The higher prevalence in women appears to result from a complex combination of factors: disc degeneration, osteoarthritis, ligament laxity, and muscular changes, which together make the spine more vulnerable to these small structural “failures”.

What can you do today for your back?

The good news is that we are not passive spectators when it comes to the health of our spine.

Stay active

Exercise is your greatest ally. Intense activity is not necessary: the important thing is to counteract sedentary habits and loss of muscle mass (sarcopenia). Strong muscles support the spine like a true “natural corset”.

Self-correction exercises

If scoliosis causes asymmetries or pain, modern physiotherapy offers very effective tools. Specific exercises teach the body to regain balance and improve posture actively. In particular, SEAS self-correction exercises have been shown to be effective in improving or slowing the progression of adult scoliosis.

Listen to your body’s signals

Do not ignore persistent pain, tingling in the legs, or difficulty walking for long periods. In more advanced cases, symptoms related to nerve involvement may appear, such as radiating pain (radiculopathy) or reduced walking tolerance (claudication). In these situations, it is important to consult a specialist. By carrying out daily home exercises aimed at improving trunk support, it is possible to reduce the impact of spinal degeneration on both pain and quality of life.