Osteoporosis: exercise as prevention and treatment (Part 1)

Osteoporosis: exercise as prevention and treatment (Part 1)

More than 10 million people ages 50 and older have osteoporosis, according to the National Osteoporosis Foundation (NOF), a Washington, D.C.-based organization that raises awareness of osteoporosis and its prevention and treatment. A further 34 million adults in the same age group, or of people ages 50 and above, have osteopenia (low bone mass). This condition increases an individual's exposure to osteoporosis. Contrary to popular belief, people of all ages, sexes, races and ethnicitles can develop osteoporosis, although the disease is four times more common in women than men.


Osteoporosis literally means porous bones. When magnified, osteoporotic bone appears to have gaping holes and whole areas of bone missing, bearing little resemblance to the Swiss cheese appearance of normal bone. The images on this page comparing osteoporotic and normal bone show why debilitating fractures can occur spontaneously or with minimal musculoskeletal trauma, such as coughing or bending over, in individuals with severe osteoporosis. 


Susceptibility to fracture

About 50% of women and 25% of men will experience a fracture resulting from osteoporosis after age 50. With the majority of fractures occurring after age 65. The major sites for osteoporotic fractures are the hip, spine, wrist and, to a lesser extent, the ribs.


Fragility fractures can cause pain, disability and deformicy, such as kyphosis. More commonly known as dowager's hump, kyphosis creates changes in body mechanics that increase the risk of falling. For older adults with osteoporosis, falls often result in hip fractures, which have the potential to cause serious health problems and/or complications that result in death.


According to NOF, almost one-quarter Of 50-plus adults hospitalized for a hip fracture die within one year of the event. And just one-third of hospitalized hip fracture patients regain the level of independence they enjoyed prior to their injury. The Atlanta-based National Center for Injury Prevention and Control, one of the Centers for Disease Control and Prevention, says that half of all hip fracture patients cannot return home or live independently afterwards.


Older women are particularly at risk for hip fracture. A NOF factsheet states that a woman's likelihood of hip fracture equals her combined risk of breast. uterine and ovarian cancer. The prevalence of hip fracture also rises exponentially with age among both men and women (Samelson et al. 2002). Individuals in the 85 and above age group have a 10—15 times greater risk of hip fracture than those aged 60—65 years (Scott 1990).


In 2002, Dr. C. Conrad Johnston, Jr., president of NOF, said, "... the Current estimated price tag for America in direct medical costs for treating fractures resulting from steoporosis is $17 billion annually. These costs will surge if people do not take steps today to build stronger and healthier bones."


Preventing and treating the disease

  • Numerous factors contribute to the development of osteoporosis, including:
  • Age-related decline in bone mass;
  • Heredity;
  • Lifestyle factors, i.e. smoking. excessive alcohol use, poor nutrition and inactivity; and
  • Decline in bone tissue following the onset of menopause in women. 


For the average woman, the body's balancing act between bone formation and resorption (or tearing down) shifts with menopause. Lower levels of estrogen cause bone loss to speed up and outpace bone formation. In fact, women can experience bone mass reducuons of up to 20% in the five to seven years after the onset of menopause. At about age 60, bone loss stabilizes and continues at a slower rate.


According to the Mayo Clinic, the risk of developing osteoporosis "depends on how much bone mass you build between ages 25 and 35 (peak bone mass) and how rapidly you lose it later," Women may lose as much as 35-50% of bone mass in their lifetime, while men may lose between 20-35%.


There have been advances in the prevention and treatment of osteoporosis.A diagnostic tool called a bone mineral density (BMD) test allows healthcare providers to identify individuals who have the disease before a fracture occurs. Using BMD tests, a physician can also predict a patient's fracture risk and determine his/her rate of bone loss and response to treatment. In addition, BMD tests can detect those who have low bone mass, a condition associated with a greater likelihood of fracture and of developing osteoporosis.


By receiving a diagnosis before a fracture, individuals can benefit from medical and lifestyle interventions aimed at either building or maintaining bone density, or at least slowing the decline.


Medications approved by the U.S. Food and Drug Administration for preventing and treating osteoporosis include bisphosphonates. calcitonin, parathyroid hormone, raloxifene and estrogens.


In addition to BMD tests and medications, NOF recommends lifestyle interventions to prevent and treat osteoporosis:

  • Avoid smoking and excessive alcohol;
  • Eat a healthy, balanced diet that includes recommended amounts of calcium and vitamin D; and
  • Do regular, weight-bearing exercise.


In healthy, postmenopausal women, "regularly performed aerobic exercise has positive effects on bone health," according to the American College of Sports Medicine's (ACSM) 1998 position stand on exercise and physical activity for older adults. The document also states that heavy resistance training by older adults can "offset the typical age-associated declines in bone health by maintaining or increasing bone mineral density and total body mineral content." NOF also recommends "resistance exercises or activities that use muscular strength to improve muscle mass and strengthen bone."


Clients With osteoporosis

For professionals working in the health and wellness industry, the prevalence of osteoporosis and osteopenia in the 50-plus population means many older clients will be somewhere on the bone loss continuum. But osteoporosis is a "silent epidemic." Many adults are unaware they have the disease until they notice a loss of height or a curve in their upper back, or they experience a fracture, by which time the disease is more advanced.


The simple questionnaire on this page can help health and wellness professionals flag a person who may have osteoporosis.


Age and inactivity also increase a person's risk for osteoporosis. This fact makes it all the more essential for health and wellness professionals to ensure older clients have a medical check and obtain a doctor's consent before starting any exercise program.


Professionals should also get a complete medical history from individuals to help them identify other things that may affect their clients' movement.


Exercise and osteoporosis

Established osteoporosis has two primary effects on exercise, according to Drs. Susan A Bloomfield and Susan S, Smich, who wrote the chapter on osteoporosis in ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities (Second Edition):


"First, many of these individuals are likely to be more unfit than the average population because of the decreased mobility common in persons with diagnosed osteoporosis, mandating a Iow-intensity program at the outset. Second orthopedic limitations may slow progress or mandate the use of additional supports during walking."


Dr. Bonnick. author of The Osteoporosis Handbook, writes that women with osteoporosis can exercise safely, as long as they avoid some activities and exercises:


"Any activity that requires repeated forward bending from the waist with the back rounded (called trunk flexion) may increase the risk of spinal fracture. This would include toe touches or sit-ups. High-impact activities, like running or rope jumping, could place too much stress on the weakened spine, causing it to collapse. She must also avoid activities, like skiing, skating, or exercising on slippery floors, that increase her likelihood of falling. Safe and beneficial exercises include back-extension exercises in which the back is arched. Low-impact, weight-bearing activity, such as walking, is also both desirable and safe. Even weights or exercise machines can be safely utilized..."


Bonnick also recommends avoiding any exercise or activity that requires leg abduction and adduction against resistance.


NOF cautions people "who are frail, have had a fracture, fall frequently or have osteoporosis" to take extra caution, as "certain movements like twisting of the spine, high impact aerobics or bending from the waist can be harmful." ACSM's Bloomfield and Smith recommend modifying exercises to avoid "forward flexion and twisting of the spine, particularly in combination with stooping."


According to Dr. Ethel S. Siris, lead author of the National Osteoporosis Risk Assessment (NORA). "Deciding what exercise is appropriate for a person requires thought. For instance. the right exercise for a healthy 50 year-old woman with slightly low bone mass could be strikingly different than that for a 60 year-old woman with a low score at the spine."


Generally, an exercise program for older adults with osteoporosis should include strength, balance, flexibility and aerobic training.


Dr. James S. Skinner, professor in kinesiology at Indiana University in Bloomington, says, "The general idea is to increase the mechanical loading on the bone so that the bone will react by increasing its size and density," He adds that "there needs to be a balance in the amount of stress applied to the bone," as too little stress means bone loss will continue and too much increases the likelihood of fractures.


This article is provided courtesy of the International Council on Active Aging www.icaa.cc