Osteoporosis and Weight-Bearing Exercise

Osteoporosis is a chronic disorder of the skeletal system in which bone mass deteriorates, increasing the risk of bone fractures, particularly of the wrists, forearms, vertebrae, and hips. Because one often does not know the fragility of their bones until a fracture occurs, it is sometimes referred to as a “silent disease”. Osteoporosis affects one out of every three women and one out of every five men greater than 50 years old (Shanb & Youssef, 2014). Risk factors include age, menopause, smoking, excessive alcohol intake, low testosterone levels in men, immobility, having broken a bone after age 50, a family history of osteoporosis, small body frame, those who have not received adequate calcium and vitamin D long-term, osteopenia (weakening of the bones), and certain medications such as steroids. Physical activity is important in not only preventing osteoporosis but also in managing the condition.

Bone is structured like a honeycomb, and the body is under a constant process of building and breaking down bone, which also aids in the maintenance of calcium and phosphorus homeostasis. More bone is built than broken down during youth, increasing bone density and strength. Around age 30, bone resorption and bone building are nearly equivalent. After age 50 in women, the rate of bone breakdown increases, particularly after menopause. Bone loss starts later in life with a slower progression in men because of a larger frame and no rapid hormonal change. For men, bone breakdown equals that of women around age 70. As the “honeycomb” structure of bone loses the density to support the outer layer, the risk of bone fracture increases. After one’s first fracture, the risk of subsequent fracture more than doubles in the next 6-12 months for up to 10 years. Moreover, approximately one out of every three pass away within 3 months after a hip fracture, 40% will not be able to walk independently or will be institutionalized, and 60% will still need mobility assistance a year later (Daly et al., 2019).

Daly et. al (2019) describe the development of bone fracture.

Besides getting the adequate amount of calcium and vitamin D appropriate for one’s age and gender and addressing other modifiable risk factors, the proper amount and type of physical activity plays an important role in both the prevention and management of osteoporosis. Exercise can help increase muscular strength, improve balance, maintain or improve posture, relieve or diminish pain, and decrease the risk of fracture (Mayo Clinic Staff, 2019). Current guidelines recommend physical activity to both maintain bone mass and to slow down the rate of bone loss, but not all forms of exercise are equally effective. Multi-modal training programs are currently recommended to prevent osteoporosis and fractures because they not only affect the skeletal system but also affect fall-related risk factors, such as flexibility and balance (Daly et al., 2019). A combination of weight-bearing aerobic activity, strength/resistance training, and flexibility and balance exercises should be included in this regimen, with the consultation of a doctor. Weight-bearing activity forces one to work against gravity while on one’s feet, causing bone to be rebuilt, especially in the spine and hips. Strength/resistance training is also important because as muscles are worked, they pull on the bone, increasing their strength. Flexibility exercises help stretch the muscles to increase or maintain range of motion. Balance is also important in increasing stability to decrease fall risk.

Weight-bearing exercise can fall under either high-impact or low-impact activities, which is important to distinguish for those diagnosed with osteoporosis or are at risk of osteoporosis or fracturing/breaking a bone. The National Osteoporosis Foundation includes the following as forms of high-impact weight-bearing exercise: dancing, high-impact aerobics, hiking, jogging/running, jumping rope, stair-climbing, and tennis. The following are classified as examples of low-impact weight-bearing exercise: elliptical machines, low-impact aerobics, stair-step machines, and fast walking on a treadmill or outside (National Osteoporosis Foundation, n.d.). Activities such as swimming and cycling do have aerobic benefits, but they do not provide the weight-bearing aspect necessary for bone production. For those diagnosed with osteoporosis or are at risk of fracture, certain activities may need to be avoided, such as high-impact weight-bearing exercises, strength training activities requiring bending or twisting of the spine, any activity that requires jerking, and even some yoga and pilates positions that require bending or twisting which may increase the risk of a spinal compression fracture. Activities such as bowling, tennis, and golf also may not be safe for those with osteoporosis or at risk of fracture. If you have been diagnosed with osteopenia or osteoporosis or are at risk or suspect you are at risk of a bone fracture, please consult with your doctor for a medical assessment and a proper exercise regimen. Once medically diagnosed and treatment/prevention options discussed, your doctor can partner with a physical therapist or personal trainer to help you safely and effectively implement your exercise prescription.

Hugs,

The UFit Team