Osteoporosis

Uncategorized Aug 08, 2020

Osteoporosis is a major health concern for many Be Mobile Clients both in our studio and online. Many people with osteoporosis are concerned about exercise, especially resistance training for various reasons. This blog will address some of these questions and concerns. But first, let’s clarify a few things about osteoporosis.

 

What is Osteoporosis?

Osteoporosis translated from ancient Greek means “porous bone”. It is a skeletal condition where there is a decrease in bone mineral density - classically seen in post-menopausal women. Osteoporosis is diagnosed by a bone density scan. A T score of -2.5 or below indicates osteoporosis whereas a score between -1 to 2.5 indicates osteopenia - a milder form of bone mineral density loss.

 

Why is it important to be aware of?

Osteoporosis massively increases the risk of fractures resulting from falls. It also makes the skeleton less resilient to stress which can result in things like vertebral compression fractures that present as the hunched posture commonly seen in elderly women. Identification of osteoporosis and osteopenia means we can implement treatment to improve bone density straight away.

 

How is it treated?

People with osteoporosis are often prescribed medicines that help to improve bone density. In addition to this exercise plays a crucial role in treatment for two main reasons:

  • Building and maintaining bone mineral density
  • Reducing falls risk

As physiotherapists, we focus on the exercise side of treatment. The following will address some of the misconceptions we commonly hear:

 

What is the best form of exercise for osteoporosis?
When choosing exercise for improving bone density we have to consider HOW exercise makes bones more dense. Just like our muscles, if we stress our bones through exercise they adapt and become stronger. However, just like muscles there are certain forms of exercise that are more effective than others. 

A lot of guidelines suggest weight bearing exercises like walking for improving bone density. While walking has a range of health benefits, it is not enough loading to induce ample changes in bone density. From landmark studies like the LIFTMOR Trial we know that the best forms of exercise for improving bone mineral density are high intensity resistance and impact training. The LIFTMOR trial compared 2 groups of women over 58 for 8 months. 1 group did heavy resistance training (lifting weights they could only handle for 5 repetitions in one go) and impact training consisting of an arm assisted jump while the other group did a bodyweight and light resistance exercise home program. The study showed that the heavy resistance training caused a significant clinical improvement in bone mineral density while the home exercise group did not improve. 

 

Isn’t lifting heavy weights dangerous with osteoporosis?
Like any exercise, lifting weights involves some amount of risk. However, resistance training has an incredibly low injury rate in the general population - likely because it can be very easily controlled by manipulating weight, repetitions and sets. Over the course of the 8 months of resistance training in the LIFTMOR trial, only one participant missed training sessions as a result of injury. This was a mild back strain that caused them to miss two sessions before returning to the program. This shows that high intensity resistance training is safe for people with osteoporosis. We can minimise the risk of injury by starting with loads that are well within the capabilities of the person and very slowly build up over time. 

 

What are the best resistance exercises to perform to build bone mineral density?
It's one thing knowing that resistance training is important to prevent and treat osteoporosis, and another thing altogether knowing exactly how to do it and where to start!

Here are some good rules around choosing exercises if your goal is bone density:

  • Full body movements performed in standing in order to load as much of the skeleton as possible. 
  • Exercises should allow the person to handle a sufficient load in order to induce changes to the bone structure.
  • Exercises should be able to be gradually progressed by increasing the amount of weight.
  • The exercises should include some high impact movements like jumping as per the LIFTMOR trial. 

    Examples of exercises that meet these guidelines are squats, deadlifts and overhead presses. These are the exercises used in the LIFTMOR trial and are coincidentally some of the best choices for improving other markers of health and fitness like functional capacity, strength and muscle mass. Be Mobile Online members will recognise these lifts as routine movements in our strength workouts. 

 

How much weight should I be lifting?
There is no one answer to this question as it will depend on the strength of the person for a given exercise. The LIFTMOR trial showed that resistance training had to be at a high intensity in order to reap the benefits for bone health. The subjects in the study lifted weights that were challenging by the 5th repetition. For the purpose of improving bone density you should be working as close to this intensity as possible. Now it's important to acknowledge that in the study there was an initial period of familiarisation with the exercises where they used light weights while they practiced the movements. Anyone new to resistance training should do the same - start with weights they can handle comfortably and slowly build up over time in order to reach weights adequate to illicit the changes in bone health we are after!

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