Osteoporosis is a condition where the body makes too little bone, loses too much bone, or both. As a result, bones may become weak and break from a fall, or in some more serious cases, from sneezing or minor bumps.

Whatever the age, habits adopted now can affect bone health for the rest of life.

Read on to learn more about osteoporosis and how exercise is a key factor in preventing it.

Healthy versus osteoporotic bone:

The word osteoporosis means “porous bone”. When viewed under a microscope, healthy bone looks like a honeycomb. The holes and spaces in the honeycomb become much larger in osteoporotic bone than in healthy bone. In addition, bones lose density and mass, and have an abnormal tissue structure. This causes osteoporotic bone to become weaker and more likely to break. The word osteopenia is used to describe bone that is weaker than healthy bone but has not progressed to the point of osteoporosis. Osteopenia and osteoporosis, if they happen at all, are more likely to occur after the age of 50.

Osteoporosis is common:

About 54 million Americans have osteopenia or osteoporosis. Studies suggest that up to one in two women, and one in four men over the age of fifty will break a bone due to osteoporosis. Osteoporosis is often called a silent condition because the weakening of bones is not felt.  Commonly, the first sign of osteoporosis is a fracture (often in the thoracic spine or mid-back).

Osteoporosis is serious:

Breaking a bone is a serious complication of osteoporosis, especially for older individuals. These breaks tend to occur most commonly in the hip, spine, or wrist. Osteoporosis can cause a loss of height, and when this affects vertebrae, causes a more stooped posture. A more stooped posture can result in increased pain and has a negative impact on balance and lung capacity. Osteoporosis may limit mobility which can lead to isolation and depression. Data here is a little grim: twenty percent of seniors who fall and break a hip die within one year either from complications of the fracture or surgery to repair it. Many require long term nursing home care.

Osteoporosis is costly:

According to the American Journal of Managed Care (AJMC), by 2025, it is predicted that in the United States, osteoporosis will be responsible for three million fractures at a cost of $25.3 billion annually.

Osteoporosis causes:

Some medical conditions or medications may increase the risk of osteoporosis. Follow up with your doctor if you have concerns about these issues, particularly if you are older than the age of fifty.

Bone Density Test:

A bone density test will determine if an individual has normal bone density, low bone density (osteopenia) or osteoporosis. Usually, the amount of bone is estimated in the hip or spine, but also sometimes other bones. The lower the bone density, the greater the risk of bone fracture.

Osteoporosis prevention:

While osteoporosis is more common in those older than fifty, the condition and the broken bones it may cause are not a normal part of aging. There is a lot that can be done to protect bones throughout life. Whatever the age, habits adopted now can affect bone health for the rest of life.

Building strong bones in childhood is essential to preventing osteoporosis. While care for bones is important throughout life, peak bone mass is reached in early adulthood. Bone density tends to decline from this point, so the higher the peak in early adulthood, the better.

The National Osteoporosis Foundation recommends:

• Consume enough calcium and vitamin D and eat a well-balanced diet
• Engage in regular exercise (more details below)
• Eat foods that are good for bone health, such as fruits and vegetables
• Avoid smoking, and limit alcohol to 2-3 drinks per day

Medication as treatment for osteoporosis:

The goal of osteoporosis therapy is to try and restore the balance of bone resorption and bone formation. It can be done by slowing the resorption by use of antiresorptive medication, or promoting bone formation using anabolic medication. By doing so, these therapies lower the risk of fracture, which is the goal of treatment.

Exercise is good prevention and treatment for osteoporosis:

According to The National Institute of Health, exercise is one of the best ways to preserve bone density and to prevent falls with aging. Exercise can reduce the risk of fracture in one of two ways, helping build and maintain bone density, and by enhancing balance, flexibility, and strength, all of which reduce the chance of falls.

Building and maintaining bone density:

Bone is a living tissue and responds to exercise by becoming stronger. Just as a muscle gets stronger and bigger with use, a bone becomes stronger and denser when required to bear weight. Both weight-bearing exercises and resistance exercises are important for developing bone density.

Weight-bearing activities are those that are performed against gravity. Weight-bearing exercises may be high impact, such as jogging or playing tennis, or low impact, such as walking, climbing stairs, and using elliptical training machines. Resistance exercises are those that use muscle strength to improve muscle mass and strengthen bone, such as using free weights, weight machines, or performing calisthenic (body weight resistance) exercises.

Reducing the risk of falling:

Balance: This is the ability to maintain body stability while moving or standing still. Balance can be improved by activities such as Tai Chi and Yoga. The information the brain gets from the vestibular system (inner ear) and visual system (eyes) is fundamental to balance. Having these two systems functioning at their best is key to effective balance rehabilitation and training. Physical therapy plays an important role in determining balance ability, what part of balance system is the problem (vestibular, visual, somatosensory {inherent knowledge of where your body is in space at any one time}), and customizing a balance training program to address those specific problems.

Flexibility: This is the range of motion of a muscle or a group of muscles. This can be improved a variety of different ways, including specific stretching, swimming, yoga and Tai Chi.

Strength: This refers to the body’s ability to develop and maintain strong muscles. Challenging muscle function or lifting weights helps improve muscle strength.

Preventing Injury and Moving Safely:

Prevention of falls is a top priority for osteoporosis, because of the risk of fracture. It is also important to avoid unintentional injuries, especially those of the spine, which can occur in everyday activities. It is important to use good posture in sitting and standing (avoid being stooped over). Good body mechanics for daily activities such as emptying or lifting a laundry hamper or garbage can are important. Keep good alignment of the spine and avoid too much twisting or forward bending of the spine, especially with carrying a load.

The National Osteoporosis Foundation has some good resources for what body movements or positions are safer, and what to avoid, for yoga and Pilates. To access these flyers, click HERE for YOGA, and HERE for PILATES.

Falls at home:

According to the National Institute of Health, 6 out of 10 falls occur within the home. This is where people spend most of their time, especially as they get older. For most, pandemic public health safety measures have meant more time at home. Many falls at home can be prevented by making some simple changes. Please see our prior Blog post on June 17, 2020, FALL PREVENTION AT HOME for a list of tips and suggestions.

Exercising safely with osteoporosis:

It is important to get plenty of exercise if you have osteoporosis. However, you may have to choose your activities carefully. Consider avoiding activities with:

• a higher risk of falling, such as skiing, or jogging on uneven terrain
• increased bending and twisting such as golf
• high impact exercise such as jogging and jumping rope – while the impact and weight bearing can promote better bone density, the impact could be too much for bones that are more severely osteoporotic to begin with.

For those with osteoporosis, the fear of falling and breaking another bone may result in being more sedentary, which leads to further loss of bone and muscle. Practicing proper posture and learning the correct way to move can protect bones while remaining physically active. Every activity can be adapted to meet age, ability, lifestyle and strength differences. Your physical therapist can help you develop a safe and effective exercise program based on your individual needs, even within your own home.

Author: Kathryn Thornburg DPT, OCS, FAAOMPT