Can I massage a client with osteoporosis?

Short answer: yes, but not with deep tissue, tapotement or any percussive work — and not on the spine or ribs.

Osteoporosis is not a blanket contraindication, and refusing outright is both clinically unnecessary and hard to defend under the Equality Act 2010, where a long-term bone condition is likely a disability. The realistic risk is a vertebral compression fracture or rib fracture from pressure a healthy skeleton would shrug off. In advanced cases those happen from coughing, so a therapist leaning through the thoracic spine is well within range.

What to adapt:

• Ask directly at consultation: any previous fracture, a DEXA scan result, long-term oral steroids (a common cause of secondary osteoporosis), or treatment such as alendronate. "Any medical conditions?" rarely surfaces it.
• Drop the pressure. Effleurage, gentle petrissage and light holding work only. No tapotement, no elbows, no percussive gun, no spinal mobilisation or end-of-range stretching.
• Rethink positioning. Prone lying is uncomfortable and unsafe with thoracic kyphosis — use side-lying with pillow support, or seated. Watch the transfer on and off the couch: a fall in your salon is the bigger hazard.
• Skip hot stones placed along the spine, and be cautious with heat generally if the client is on medication affecting skin sensitivity.
• Stop for sudden severe back pain, new height loss or a sharp catch on movement. That is a possible vertebral fracture — same-day GP, not a rebooking.

Don't comment on their medication or bone density results. Record what you asked, what you adapted, and what the client told you.