What you should know about osteoporosis and exercise.

I always tell my students that if you think of maintaining bone mass like using a bank, you are making more deposits than withdrawals when you are young. You build your savings to the highest levels in your twenties. In your thirties and forties, you start to make small withdrawals, and then after menopause, you go on a bit of a spending spree. Both men and women begin to lose bone at a similar rate in their mid-30s; at menopause, women typically have bone loss of about 3 to 5% per year for the first five years post-menopause and another 1% per year afterwards.

The formal definition for osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.[1] Simply put, osteoporosis is a condition in which bones become thinner (bone quality) and more porous (bone density). Thinning bone can lead to decreased strength and subsequent increased risk of fracture.

Osteoporosis is responsible for about 80% of all fractures in people over 50. These "fragility" or "slow-impact" fractures are usually injuries that wouldn't happen if the same force was applied to a healthy bone.

Fractures from osteoporosis usually happen at the wrist, shoulder, in the spine, and at the hip. According to Osteoporosis Canada, risk factors include age, sex, if you have had a parent who has had a hip fracture, experiencing an unusual fracture, having a medical condition that limits your ability to absorb certain nutrients or taking medications that are known to contribute to bone loss.[2]

One in 3 women will develop osteoporosis. Women can also be at risk for what's called secondary osteoporosis as a result of other conditions (e.g., chronic kidney disease, some types of cancers) or when taking different types of medications.   

We know from research that regular exercise, especially aerobic exercise combined with strength training, has a positive impact on bone health. Improvements seem to be a result of applying tension and load to a bone that, in turn, stimulates bone formation.[3]

Look for four these things in your physical activity program, if you have been diagnosed (or at risk) with osteoporosis.

1. It's essential to get medical clearance from your doctor to make sure that it's safe for you to exercise. 

2. Fall prevention should be top of mind. Choosing exercises that match your current level of balance, strength, and mobility is vital.

3. Focus on safe movements in your body mechanics and check for postural alignment to protect the spine.

4. Think about adapting your activities in your daily life. Focus on not having too much repetitive flexion (this means when you bring the body closer to itself, like in a forward bend), or rotation (side-to-side movement, like a twist), or any sustained flexion. In other words, we can also create a risk for injury if we bend forward or twist quickly or too often, or if we lift something heavy while twisting.

Think about improving poor body mechanics wherever possible (e.g., not slouching while lifting). You can also practice spine sparing strategies by bending at your hips and knees and not at your spine, by and turning your whole body rather than twisting from your spine.

The recommendations for exercise for women with osteoporosis are as follows:

1. Make sure to engage in a multi-component exercise program that includes strength training in combination with balance training and aerobic training. Individuals with osteoporosis shouldn't engage in aerobic activities without doing resistance or balance training also.

2. If you have been diagnosed with osteoporosis, you should see a specialized exercise professional or physiotherapist to make sure that you're doing safe and appropriate exercises. 

3. Include strength training at least two days a week into your program. Your exercises could include body weight, bands, or weights. Routines should target the legs, arms, chest, shoulders, and back. Make sure you're doing 8 to 12 repetitions per exercise.

4. Practice balance exercises. You can do balance exercises every day. Balance exercises include things like centre of gravity weight shifting and changing your base of support. It's best to learn balance exercises in a program specific to balance.

5. Focus on your posture. One of my favourite and easy ways to gently correct position is to think about wearing a fancy necklace. Lift your chest and gently tuck your chin in to show off your necklace.

6. Along with all these things, you will also want to do aerobic exercises. The current recommendations for healthy adults are 150 minutes of moderate to vigorous-intensity activity in bouts of 10 minutes or more per week.

Having a diagnosis of osteoporosis can make you feel like your activities will be limited. The good news is, that exercise is recommended for all people with osteoporosis, even those who have had a previous fracture. Just remember to see your doctor for clearance and seek advice from a practitioner who has a specialization in prescribing exercises for those with osteoporosis.

Your sister in health,

[1] NIH Osteoporosis and Related Bone Diseases National Resource Center. https://www.bones.nih.gov/

[2] Osteoporosis Canada: https://osteoporosis.ca/

[3] Ubago-Guisado, E., Sánchez-Sánchez, J., Vila-Maldonado, S., & Gallardo, L.(2019). Soft tissues and bone health in sedentary women: A cross-sectional study. Journal of Human Sport and Exercise,14(2), 469-479.