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Bone health in patients with chronic disease


The information in this blog was from an industry presented ACSM webinar that I want to share with you. The American College of Sports Medicine represents 70 sports medicine professions, and with more than 50,000 members and certified professionals from 90 countries. ACSM advances and integrates scientific research to provide educational and practical applications of exercise science and sports medicine. The American College of Sports Medicine® (ACSM) helps people worldwide live longer, healthier lives.


The health of our skeletal is essential for living an active and healthy life throughout our age span. What you do has an IMPACT on your bones. Bone health is 60 to 80% dependent on our genetics and 20 to 40% determined by our lifestyle:

  • nutrition

  • exercise and physical activity

  • hormones

  • smoking, alcohol and prescription medication.


Our medical system is not set up to prevent fractures, it is set up to prevent secondary fractures. That is a little late, because by then “the horse has left the barn". The most common way of diagnosing osteoporosis is a fracture. IF this fracture is severe enough, it can cost you your life, ability to live independently and/or quality of life without any warning. For women, age 65 is too late to get this initial bone density scan. It gets you the initial T-score for bone density, however your need two or more bone density scans to determine the trajectory of bone loss and to determine if you are in trouble. In one study performed by ACSM, women with average age of 46, 40% had low bone density or osteopenia and 10% had osteoporosis.


Fall and Fracture Facts:

Most older adults want to remain independent living in their own home when they age (aging in place). However, 1 in every 2 women over the age of 50 will fracture and 1 in 4 men over the age of 50 will fracture. Nearly 80% of Americans with a fracture do not get tested for osteoporosis. 24% of hip fracture patients over the age of 50 die within 1 year if surgical corrected. 30% of Medicare patients die within 1 year of hip fracture. 50% of hip fracture patients never regain full function and 300.000 hip fracture patients each year end up in long term care.


Who is most at risk for fracture and disability?

  • Older people

  • People with small 'ish" bones

  • People with low bone building or no bone building activity

  • People that had fractures

  • Older women

  • People with confirmed risk factors for osteoporosis: primary hyperparathyroidism, chronic and episodic inflammation, autoimmune diseases (ankylosing spondylitis, celiac disease, lupus, Graves disease, IBD, Type 1 diabetes, MS, Fibromyalgia, Addison's disease, Rheumatoid Arthritis (RA), Hashimoto's disease, and Psoriatic Arthritis), and disordered eating, people with bariatric surgery.


An independent risk factor for osteoporosis is active inflammation within the bone and systemic inflammation increased fracture risk. Unfortunately what people get prescribed to treat the inflammation are also risk factors for osteoporosis and fracture risk.


Medications having a negative effects on BMD and/or heightened risk for fracture:

  • Glucocorticoids (GCs)

  • Immunosuppressive drugs

  • Aromatase inhibitors

  • Corticosteroids

  • Opioids

  • Prednisone

  • Proton pump inhibitors

  • Heparin

  • SSRI’s

  • Metroxyprogresterone acetate (MPA)

  • Zoladex (goserelin) and Lupron (leuprolide)

  • Androgen deprivation therapy


Children placed on asthma medication during bone building years are at risk for osteoporosis and increased fracture risk.


What has been determined that there is a low bone density or low bone mass particularly at the femoral neck often due to low physical activity. Know your T-Scores, especially at the femoral neck. Two T-Scores provide you with the trajectory of bone loss. One T-Score is just a point in time. Fracturing your bones due to treatment of a chronic condition also impacts your quality of life.


Exercise is Medicine. Prevention is better than treatment. Targeted physical activity that includes load bearing exercise and movement, balance training, and resistance training (both isometric and isotonic) has been proven to benefit bone health in the prevention and treatment of low bone density.


For more information on exercise to treat osteoporosis with exercise please visit Being Active when YOU have Osteoporosis


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