Osteoporosis

POSTED: 11 Jun, 2021

Osteoporosis is very common in Australia. THe AIHW showed that in 2017-18, 3.8% of the population were diagnosed with Osteoporosis, 924,000 Australians to be exact. Osteoporosis is a condition where the bones in our body become fragile and brittle, putting us at greater risk of fracture from minor accidents. Although we aren’t able to purchase new bones, we can still reduce the rate of decline and even strengthen them through exercise-based intervention!

So what is Osteoporosis?

Osteoporosis is a skeletal disorder putting individuals at risk of fracture, typically through reductions in bone strength. One key indicator when diagnosing Osteoporosis is bone mineral density (BMD). A BMD T-score between -1.0 and -2.5 is classified as Osteopenia, a pre-curser to Osteoporosis which indicates low bone mass, and anything below -2.5 is considered Osteoporotic. Low bone mineral density is when the bone loses its minerals before the body has the chance to replace them. Osteoporosis is more common in women, affecting 1 in 4 women above the age of 75.

Risk factors

• Sedentary lifestyle
• Ageing resulting in reduced testosterone and oestrogen levels
• Menopause
• Previous fracture
• Excessive alcohol consumption
• Previous or current smoker
• Insufficient Calcium and Vitamin D intake
• Androgen-deprivation therapy treatment for prostate cancer
• Medications such as Thiazides (anti-diabetic medication) and Glucocorticoids (asthma medication)
• Chronic Kidney Disease, including those receiving dialysis treatment

How can exercise help?

Exercise that is bone building, otherwise known as osteogenic, is very important from early childhood through our teenage years. These are the years where the body accrues the most BMD, and lays a solid foundation leading into later life. Once we reach the age of 30, we experience a peak in BMD and from there, we naturally lose bone due to the aging process.

Exercise has been scientifically proven to help in the treatment and management of Osteoporosis by slowing the decline or increasing bone strength. Bone remodelling can take approximately 9-12 months to occur, so to see improvements in bone strength, exercise should be maintained as a part of our weekly routine.

3 main exercise types commonly used to treat osteoporosis:

1. Resistance Training (RT)

Resistance training (RT) is considered the most effective way of increasing skeletal muscle mass and strength, and should be the cornerstone of any exercise program designed to reduce the risk of fracture.

Evidence suggests a frequency of 2 days per week, with approximately 8 exercises at 2-3 sets of 8 repetitions targeting major muscle groups, more specifically hip and spinal regions which are the most common sites for Osteoporosis. RT should be performed several weeks prior to any impact loading exercise, as a way of developing a baseline of strength.

2. Balance Training

Evidence suggests that balance training should be performed 4 times per week, with a duration of approximately 30 minutes before or after RT or impact loading sessions (specific to tasks the person may encounter in everyday life). Each exercise can be progressed by reducing the base of support and surface modification. The objective is to complete each activity without holding onto something as a way of achieving a certain time (e.g. seconds), however if you feel the need to hold onto something before achieving the desired outcome then the exercise may be too difficult. It is recommended that a novice trainer holds onto something in the early stages (weeks) of training.

3. Impact Loading

Impact loading is a form of osteogenic exercise, comprising of movements designed to stimulate bone growth in fast, multidirectional ways. Evidence suggests that these types of exercise should be performed 4-7 days per week, consisting of up to 50 repetitions broken up into bouts of 10. Increasing difficulty can be challenge with this type of exercise, but fear not! This is where an Accredited Exercise Physiologist (AEP) can help!

Here are some examples:

• Moderate impact activities: running, stride jumps, jump rope, side steps, highland-type dancing, jump take offs and hops
• High impact activities: landings from jumps (high vertical jumps, star jumps, tuck jumps, and drop landings
• Moderate-high impact activities: all activities listed above

Before AEPs prescribe any impact loading exercise, they consider the risk based upon the condition that the individual may present with. If the person doesn’t have low bone density (Osteopenia or Osteoporosis), then they’re able to perform this type of training. If the person has Osteopenia, then they engage in moderate-high impact activities. If Osteoporotic, then moderate impact exercise only.