Hi Angela! It all depends on the degree of osteopenia or osteoporosis that the client is dealing with. If they are osteopenia and/or mildly osteoporotic (i.e. just over the T score of -2.5) then you can have them get clearance from their doc and begin a fairly “standard” routine. If they are severely osteoporotic, i.e. above -3.5 and/or have had a fracture already then it may be better to refer them to a physical therapist to get worked up and have the PT write up a “yes/no” plan for the type of exercises that they can do. Generally speaking you want to avoid exercises that will cause too much movement in the spine or lateral movement in in lower body. Great exercises for osteoporosis are ball squats, smith squats, leg presses, push ups/bench presses, assisted lunges, weighted step ups (not too high, perhaps a step). Work on balance activities as well to protect from falls. For core work, focus on stabilizing activities like planks, avoid crunches and sit ups. Generally, Don’t be too light on the weight as that will not provide sufficient load to stimulate the bone remodeling. Start in the 10-12 rep range (meaning weight is too heavy to get a 13th rep) and slowly add weight while decreasing the reps to the 6-8 rep range for optimal increases in bone density. Most trainers are too conservative with osteoporosis patients, they provide insufficient weight to produce significant result. Start them at the 12 rep range and once they develop sufficient strength to do the exercises with good control, then increase to 6-8 repetition range with a cadence of 3-4 seconds up, 3-4 seconds down.