Exercise for the prevention and management of Osteoporosis

The US National Institute of Health Consensus Panel in 2000 defined Osteoporosis as a skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture. Nearly two thirds of Australians over 50 suffer from low bone mass (70% female and 30% male). According to a published analysis by Watts et al. we saw close to 400 osteoporotic fractures per day in Australia in 2013. The disorder is a major personal, societal and economic burden as those fractures are associated with substantial morbidity and mortality. In other words if you are not suffering from it you want to ensure you never will and if you are suffering from it you want to ensure you undertake the right interventions/programs.

Exercise is widely recognised for the development and maintenance of bone strength throughout life. Some studies show that brisk walking may have some effect in the counteracting bone loss. Other studies suggest minimal effect and an increased risk of falling for older adults. We know that simply prescribing walking as the only form of exercise has only little to no effect on bone health. The evidence is much stronger for exercise programs that utilise weight-bearing impact exercise (hopping & jumping) and/or progressive resistance training – the combination appearing to be more beneficial. These forms of exercise may improve bone mineral density (BMD) and cause positive changes in the structure of bone. For resistance training loads must be quite high to show a real positive effect. This means performing exercises targeting major muscle groups that are attached to our hip and spine with heavy weights for 2-3 sets of about eight repetitions (e.g. squats, deadlifts, lunges). Impact loading exercises include vertical and multidirectional jumping, bounding, hopping and skipping amongst others. Finally, any program addressing Osteoporosis should include exercises that promote muscle function, balance and gait stability for the prevention of falls (e.g. singe leg stance, backwards walking, pivot turns).

Now you may think this sounds inappropriate for a 50+ year old person, but the evidence suggest it is exactly what we should do. Key to success and to avoid injury is a strong focus on good technique development and gradual exposure, meaning starting with what your abilities allow and then progressively increasing load, volume, difficulty and complexity. In addition, the history of injury and other medical conditions needs to be considered when designing such an exercise program. We certainly advise to seek help from a professional before commencing an exercise program if you suffer from Osteoporosis. This is where your Exercise Physiologist or Physiotherapist come in to help you achieve your goals with minimal risk for adverse effects. So let’s get jumping and lifting.

Thomas Wendt

References:

Beck BR, et al. Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. J Sci Med Sport (2016)

Osteoporosis Prevention D, and Therapy. NIH Consensus Statement Online, 2000.

Watts J, Abimanyi-Ochom J, Sanders KM. Osteoporosis Costing All Australians. A New Burden of Disease Analysis – 2012 to 2022. Sydney, 2013.

Martyn-St James M, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone 2008; 43(3):521–531.

Hatori M, Hasegawa A, Adachi H et al. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcif Tissue Int 1993; 52(6):411–414.

Borer KT, Fogleman K, Gross M et al. Walking intensity for postmenopausal bone mineral preservation and accrual. Bone 2007; 41(4):713–721.