My wife was diagnosed with osteoporosis last winter and is on a medically supervised weight-bearing exercise program at a local gym, as well as taking Fosamax.

We have had no difficulty finding sources of advice and information about exercise *FOR* osteoporosis (such as yours) but we've had a hard time finding information about exercise *WITH* osteoporosis.

What do I mean by this? Advice about therapeutic exercise for osteoporosis is easy to come by, but exercise and physical activity is not only a therapeutic activity it's also recreational. My wife has enjoyed a life of physical activity such as hiking, biking, mountain climbing, cross- country skiing, etc. We met 20 years ago climbing a mountain. She would like to continue to be as active as possible.

One activity she looks forward to a great deal is bicycling. Many of our friends go on long (50-100 mile) bike trips on the weekends and our region is blessed with a network of bicycle trails built on old railroad beds that allow bike travel over great distances. We are also members of the Appalachian Mountain Club that promotes skiing, snow shoeing, climbing, hiking, etc.

As you can imagine, all of these activities involve occasionally FALLING, and that prospect alarms me with my wife's BMD of ~2.8 SD's below normal, hip, lumbar spine, and wrist. She's more cavalier about it, but really, neither of us have any hard data about whether these are ill-advised or not for osteoporosis sufferers.

Her doctor has no background or data on this. Neither does the NOF. If they don't, who does? Where can we get information about what's safe and what's not for someone in her condition? Does she need to give up biking, cross-country-skiing, or mountain hiking or are these still okay for someone with osteoporosis?

This is a difficult question to answer. The guidelines from the major health organizations advise individuals who have osteoporosis to NOT engage in activities that put them at risk for falling. These activities include the ones that you and your wife enjoy participating in. I agree with these recommendations as being sound public health policy. However, as a person who enjoys these activities, I understand that to remove these sports from your lifestyle, is essentially removing one of your life's greatest pleasures. The advice that I give older women who enjoy these sports and have participated in them for a long time is as follows.

First, make sure that you are doing regular strengthening exercises so that your muscles are strong. The strength training routine outlined in Strong Women, Strong Bones is a targeted strength-training program for women who are at risk for osteoporosis and for women who already have osteoporosis.

If you decide to continue to participate in activities that do put you at risk for falling, you need to understand the consequences of what might happen if you fall. You DO have a greater risk of having a fracture if you fall. Use your head and do not participate in the sport if the conditions are poor - i.e., don't ski if it is icy or if the cover is poor and you might hit rocks! In addition, do not participate in the sport if the people you are doing it with are not at your level. Use common sense. Certainly, it is safest not to participate in risky sports - but you also need to live!