Osteoporosis is a long-term condition that affects bone.
What is it?
Osteoporosis is when the bones don’t reach peak bone mass during the first two decades of life and or when bone remodelling becomes imbalanced. Our bones are always changing and always remodelling. Throughout our entire life, we’re always remodelling our bones. This means the bone cells that we had at the beginning of our life are not the same bones that we have at the end of our life.
At our 20’s to 40’s we are in our peak bone mass. Where our bone mass isn’t increasing and isn’t decreasing. Osteoporosis is a change in the balance and remodelling of the bones, so bone density begins to reduce. There are two types of osteoporosis type 1 and type 2.
Type 1
So type 1 osteoporosis is more common and is connected to getting older and hormonal activity, in females after menopause. Osteoporosis that is related to ageing isn’t as clear. But less calcium intake and less Vitamin D, plus hormone changes are cited to be the main reasons why the bone thickness starts to reduce over time. It also means people who this condition are more likely to experience bone fractures.
Type 2
Type 2 osteoporosis is related to the use of steroids which may be prescribed to treat clinical conditions like asthma, rheumatoid arthritis, inflammatory bowel disease and multiple sclerosis (MS). The main steroid prescribed is called corticosteroids.
Causes of osteoporosis
- Low body mass index (BMI less than 19)
- Premature menopause (under the age of 45)
- Delayed onset of puberty
- Absence of menstruation
- Never given birth
- Smoking
- Alcohol misuse
- Physical inactivity
- Calcium deficiency
- Lack of Vitamin D that you get when the skin makes Vitamin D from sun exposure
- Depression
- Corticosteroid use
The more you have of these risk factors throughout your life then the more likely you are to experience osteoporosis.
Signs and symptoms
Someone may not have the condition until after they have a bone fracture, in the hip, wrist, or spine. Other signs include a stopped posture.
Osteopenia
Osteopenia is a stage before osteoporosis which is where the bone mineral density has dropped. Which is between -1.0 and -2.5 on a T-score test. If you have more than or equal to -1.0 then you have normal bone mineral density. Then anything below -2.5 is classed as osteoporosis, which is how it’s diagnosed.
Management
Lifestyle management and medications can help lower the rate of bone mineral density loss and improve bone health. Which can improve posture and reduce the rate of falls. There are 8 recommendations for 8 interventions for improving lifestyle.
Regular weight-bearing exercise – which includes moving the weight of the body like walking. Using weight by strength training. Something like swimming isn’t as effective because you’re suspended in water.
Lifestyle changes
1. Increase calcium intake
2. Increase Dietary Vitamin D and or taking a Vitamin D3 supplement
3. Reducing caffeine intake and carbonated drinks
4. Lower foods high in sugar and salt
5. Stopping or limiting smoking
6. Maintain a healthy level of alcohol
7. Maintain a healthy weight
8. Increase time spent in sunlight
Medications
1. Hormone Replacement Therapy (HRT)
2. Biphosinates
3. Calcinonin
Exercise Guidelines
Physical activity is more of preventive than a cure as you cannot reverse it. Weight baring exercise should be a focus. Less effective are activities like swimming cycling, and any other activity that is not weight baring. Resistance training has been shown to be beneficial because it can improve muscle tone, posture and stability. However resistance machines may not be as effective because it does not load the joints. So think bodyweight training, free weights like resistance bands, kettlebells, dumbbells, barbells, and power bags.
It is important to target areas of the body where there is low bone density. So for example, if it was on the wrist then you would do some exercise upper-body exercises.
Contraindications
This is where there may be high risk involved. However, this would be case-by-case depending on how severe osteoporosis is on the person.
Twisting movements
High-impact exercises which are things like jumping or vigorous leaping will increase the likelihood of bone fractures happening in the spine and through the bone which has low mineral density.
Excessive rounding and back bending of your spine would be if your back has a severe rounding of the spine.
Exercises on your stomach or back depend if you have a rounded spine and severity.
Absolute contraindications
These are exercises or situations that you should avoid. If you have pain in the bone and if you have fractures that haven’t healed. This is where you would get the fracture healed before starting exercise.
The main thing to be aware of with osteoporosis is falling and a fear of falling and potentially fracturing a bone. Having a stooped posture may experience a shift in the centre of gravity which can lead to losing agility, balance and co-ordination. Which can affect walking and you may shuffle and take smaller steps.
You may find cardiovascular exercise more challenging So try to maintain a good posture, work on walking heel through toe and work on breathing.
Exercise Recommendations
The focus should be on bone health and strengthening exercise. So it’s recommended to do a minimum of 2 strength days per week. However, it’s still important to aim to work towards a minimum of 150 minutes of moderate-intensity or 75 minutes of vigorous activity per week. To ensure you improve your health. Which can be broken down into 3-5 days of aerobic training per week. Also, aim to do some balance exercises. However, some physical activity is good more is better.
Ensure the environment you’re performing physical activity and movement is clear of potential trip hazards and reduces any risk of falling. Consider the floor surface you’re using.
In short making lifestyle improvements with weight-bearing exercise and resistance training, nutrition like Vitamin D, and calcium, and maintaining a healthy weight can help lower bone loss.
