How exercise can help Osteoporosis & Osteopenia:

Emily Stephens

November 22, 2021

Osteoporosis is a condition of the bones that causes them to become brittle, weak and thin. Osteoporotic bones are more susceptible to fractures, and fractures may happen following a trip or fall that would otherwise only result in a bruise. Osteopenia is the precursor condition whereby bone mineral density is lower than the normal population however not as low as people with a diagnosis of osteoporosis.

Prevalence:

Osteoporosis (OP) and osteopenia has been reported in approximately 924,000 Australians during 2017-18 National Health Survery. With 20% of people aged 75 years and over having osteoporosis. Of this population 29% of women over 75 had OP compared to 10% of men. OP has further implications other than an increased risk of fractures. Australians over 45 years old living with OP reported lower health status, increased levels of pain and higher levels of psychological stress compared to those without the condition. OP is more commonly seen in postmenopausal women due to the gradual reduction of estrogen seen in menopause. 

Treatment options:

A combination of treatment options can be applied to people with OP to help reduce the rate of bone loss. These may include an individualised exercise program to improve bone strength and reduce the risk of falls, a balanced diet to ensure that appropriate nutrients are included, avoiding smoking and alcohol, and medication or hormone therapies to stimulate new bone formation. Physiotherapists work as part of the multi-disciplinary team to ensure the appropriate level and type of exercise is applied to the individual. 

Benefits and type of exercise recommended:

              Aerobic non-weight bearing exercise is sufficient in improving general cardiovascular fitness however this type of exercise may not provide enough force on the bone to promote bone stimulation. It is recommended that people participate in a combination of aerobic training for general fitness as well as impact weight bearing and strengthening exercises to ensure they are still receiving bone strengthening benefits.

Aerobic exercise

Resistance training is beneficial for stimulating BMD by providing forces on the bone such as tension, compression and torsion which helps promote bone building and possibly reducing bone breakdown. However, resistance training is not as beneficial as a high-impact or power based training program. Resistance training is beneficial for older patients with OP as it improves physical function and activities of daily living, and tends to be safer for those who are at risk of falling. Improved muscle strength can play a protective mechanism to reduce the risk of falls and ultimately reducing the risk of a fracture.

Resistance training

Balance exercises are important for maintaining position awareness and postural movement. These exercises may include Tai Chi and ballroom dancing, or more structured exercise such as balance boards and trampolines as part of a structured exercise program.

Studies show that high impact exercise is the most beneficial for increasing BMD however this is not always feasible in the population of people with OP who are generally older, and may have other co-morbidities that limit high-impact exercise. As mentioned above patients that fall into this category can still get a benefit from resistance and aerobic based exercise and therefore it is important to tailor a program that includes these components.

Lifestyle factors

60% of bone growth occurs in adolescence and therefore this is an important time for adolescents to participate in exercise that promotes good bone strength. As we continue to age mechanical stimuli plays a key role for maintenance of bone health. Therefore, it is essential for people to maintain an active lifestyle throughout different age points to maintain good bone health. In conjunction with an active lifestyle, dietary and other life choices play an important role. Early chronic alcohol consumption compromises bone health, this continues for older adults with those drinking larger amounts daily showing greater bone loss compared to those who had minimal alcohol intake. Nutrition plays another important role in bone development with the nutrient intake during the bone forming years the most crucial. Vitamin D plays an important role in aiding the uptake of calcium and therefore a vitamin D deficiency can be detrimental to bone mineral density. Dietary replacements can be used to ensure adequate nutritional uptake as well as maintaining a healthy weight.

Summary:

Physiotherapists can assist in treatment and prevention of progression of osteopenia and osteoporosis by prescribing individualised and progressive exercise programs to target strength training and falls prevention. These exercises can be prescribed for home or may be completed as a strength and stability class in the clinic. For further information call the clinic on 52772151 or book an appointment online at our Geelong or Torquay clinics.

About Emily:

Emily Stephens has a strong interest in treating peri/post menopausal women, pregnancy related pain/ pre and post natal patients and is commencing post graduate certification in both Pelvic Floor Physiotherapy and Exercise & Women’s Health at Melbourne University. Emily takes both pregnancyGLA:D, Strength & Stability and Clinical Pilates exercise classes.