The Birth of BoneSmart Pilates®

Imagine getting your DEXA (bone density test) results and learning you have osteoporosis. You’re frightened you’re going to “break,” and the first thing your doctor suggests is medication.

Sound familiar?

Unfortunately, that scenario is all too common.

Here’s the story of how I came to specialize in bone safe movement

The year was 2010, and the wife of a Stanford professor came to me for an evaluation and treatment plan.  She’d just been diagnosed with osteoporosis and wanted “out of the box” ideas to address her bone health.  For the sake of privacy, I’ll refer to her as “Clara.”  Her doctor had discussed prescription drugs as a recommended treatment approach.

Taking extra time to explain her test results in ways she could understand, I also had her complete the online FRAX assessment, which calculates your estimated personal risk of fracture.  I listened and answered her questions.

I shared with her the kind of movements that help build bone and the types of movements and postures to avoid that increase her risk of fracture.

teaching alignment at a workshop

Teaching alignment at a workshop

Like a sponge, Clara soaked it all in.

I taught her the spine sparing hip hinging technique with the use of a dowel to ensure optimal alignment. For her homework, I asked her to practice this technique whenever she needed to bend over—also, any time she transitioned from sit to stand or stand to sit.

She learned my BoneSmart ABCs for maintaining and building bone. These principles of Alignment, Balance, and Contraction (as in muscle strengthening contraction and contraction from impact like stomping) are the cornerstone of my method.


This remark she made still gives me pause.

“Why didn’t the doctors tell me any of this?”  You might be asking yourself the same thing.

Why don’t doctors share this movement information?

In many cases, movement and exercise for osteoporosis is not their area of training or expertise. The medical model often defaults to drugs as the first line of defense.  I’m not saying osteoporosis meds are bad. They are appropriate for some people, but not all people in all situations.  In addition, many lifestyle changes can help your bone health.  (I won’t get into them here. That’s another article-my focus here is on movement.)

The link between the pink pole, Clara, and BoneSmart Pilates.

On our next appointment, Clara proudly presented her homemade dowel, fashioned from a Home Depot closet rod which she festively festooned in neon pink tape!

It was clear to me that she’d done her homework and was applying the principles of safe movement and bone-building exercise in her life.  The trajectory of her bone health took a turn for the better. Her infectious enthusiasm and that pink pole fueled me to do more.

Encountering more people with excessive bone loss

After that experience, I continued to meet more people of all ages dealing with excessive bone loss. Some people were quite young, experiencing the effects of bone loss due to secondary causes like the adverse effects of drugs, eating disorders, and cancer. All had little understanding of the ways to move safely with bone loss or the movements to avoid that might cause a break.

She broke her back

pilates exercise rollover

                           Pilates exercise, “Rollover”

Another incident that spurred me on… my client has a sister with osteopenia, and she fractured her spine doing a “rollover” in a Pilates class.

This is a typical move in Pilates but one that you should avoid if you have osteopenia or osteoporosis. The reason being that position puts compressive loads on the spine predisposing you to fracture.

Although she didn’t have full-blown osteoporosis, the movement guidelines are the same for osteopenia and osteoporosis

Because this teacher was not well informed of the need to modify for her client with excessive bone loss,  the client broke her back.

The realization hit me that too many Pilates teachers and general exercise instructors don’t understand the movement guidelines for their clients with excessive bone loss. Unknowingly, they are putting their clients at risk of injury with every unmodified Pilates or exercise class they teach.

Enhancing my expertise and the birth of BoneSmart Pilates

To bolster my expertise in this area, I immersed myself in research and trained with experts such as Sherri Betz PT and geriatric specialist Sara Meeks PT, a pioneer in osteoporosis work and whom I consider a mentor.

In 2013, I created the BoneSmart Pilates method and produced my first DVD BoneSmart Pilates®: Exercise to Prevent or Reverse Osteoporosis. Met with critical acclaim, it won the  Pilates Style Magazine’s best DVD award.  Soon after, Sara Meeks endorsed my DVD, which now appears on the cover.

Because osteoporosis is a silent disease that affects people of different ages, it was important to me that my first DVD had diverse demonstrators. Each demonstrator represents a different decade from their 40’s to ’80s, as seen here on my DVD cover.  I intended to create a DVD relatable to people of varying ages.   



Teaching the teachers

Teaching Pilates Instructors in Costa Mesa, CA

I made it my mission to continue to spread the word about bone-healthy movement by presenting educational workshops to Pilates teachers.

My goal, to empower them to work safely with their clients that have osteopenia or osteoporosis.  There are so many healthy alternatives to improve muscle and bone strength. No more crunches or “Rollover”  fractures!


Spreading community awareness

Leading an American Bone Health presentation

In 2012,  I became an ambassador for the national organization American Bone Health.  I continue to serve as a volunteer educator, leading bone health awareness community presentations.  Topics include fall prevention,  fracture prevention, bone safe exercise, and proper nutrition to support bone health.


The genesis of the Aging Strong DVD Series

As an active ager myself, I know firsthand the physical challenges that seem to creep in with aging.  How does one safely navigate exercise with arthritis, joint replacements, and the plethora of itis’s and issues that come with aging?  I realized I needed to create something that spoke to a broader audience, not just those with osteoporosis.

This was the seed of inspiration for creating my 2 volume BoneSmart Pilates® AGING STRONG DVD set.   I wanted to address the needs of our active aging population that would benefit from safe Pilates.   “Motion is Lotion.”  We need to keep moving, but we need to do it safely and efficiently.

These DVDs pick up where “Exercise to Prevent or Reverse Osteoporosis” left off. They increase challenge and complexity while still observing the rules of bone safety.  My AGING STRONG DVDs speak not only to bone loss but to common challenges seen with aging, such as sarcopenia (age-related muscle loss), compromised joints, arthritis, and disc herniations.

All of my DVDs and live or virtual classes are bone safe, spine safe, and active aging friendly.

My diagnosis

I used to wonder if people would listen to me since I didn’t have excessive bone loss.  In the last year, due to risk factors like increasing age, low body weight, petite body frame, and being a female, I’ve been diagnosed with osteopenia.  While this may have been a stress point in the past, I’m confident that I have the knowledge to ensure my safety and bone health.

Connecting through movement

I also believe that what I have to share is helping more people than I realize.  It warms my heart to get a call or email from someone I don’t know reaching out to tell me how my work, my movement ideas, have improved their bone health and quality of life. That means more to me than any sales target.  You may think it silly but I still have many of those first letters I received from some of you mounted where I can enjoy them.  Seeing them keeps me motivated.

One bright aspect of the pandemic: It forced me to learn to teach virtually, and this has increased my outreach more than I could imagine. Moving together virtually has helped deepen our connections across our community.  I hope you feel that. I surely do.

I’ve loved experiencing this journey of spine health, bone health, and aging strong with all of you, whether we’ve connected through my DVD, through virtual class, or my live classes.  Together we’ve gained new perspectives on our perceived limitations and the surprising extent of our physical and mental resiliency. We are, in essence, co-creators of our well-being.


I’m honored and grateful that you have allowed me into your lives and trusted me in this journey of transformation. I commend you for committing to live your lives with intelligence, mindfulness, and an energetic, playful spirit.


About the author


Teresa Maldonado Marchok PT is the creator of the BoneSmart Pilates® Method and award-winning DVD series.  Her passion for bone-safe exercise and active aging is reflected in the classes she teaches and the way she lives her life.

Her DVDs have national and international exposure, and her products have received over 200 Amazon 5 star reviews.

2 replies
  1. Donna Folden
    Donna Folden says:

    loved reading your story and the background! I first learned of your work through the Sara Meeks PT endorsement. As a PT, having attended her osteoporosis seminars, I bought your first DVD which she promoted. Thank you for all you do!
    Donna Folden,
    Warm Springs, Ga

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