Updated: Apr 19, 2022
The number of hip fractures in women will decrease slightly over the next 20 years, however, the NUMBER OF HIP FRACTURES IN MEN WILL INCREASE MORE THAN 50 PERCENT. The two lifestyle factors that are under your control which have major impact on the strength of your bones, are diet and exercise. However, the inclusion of evidence-based exercise therapy for many chronic diseases including osteoporosis is long overdue.
In this blog I am going to concentrate on exercise. There are precautions regarding exercise depending on whether you have been diagnosed with osteopenia or osteoporosis. Many people have a combination of osteopenia and osteoporosis, which makes exercise selection challenging when you do not know exactly which bones are at the level of osteopenia (T-scores of –1 and –2.5) and which bones are at the level of osteoporosis ( T-scores of –2.5 or less:). Be aware that an average of all T-scores may state you have osteopenia however, can also include bones that in fact be osteoporosis. Bone density tests should be repeated regular (usually every two years) so that you can make an educated decision on the treatment plan.
Exercise with OSTEOPOROSIS
When you have been diagnosed with osteoporosis (with or without a previous fracture) you should avoid activities that put high stress on the bone. To be beneficial the exercise should challenge your skeleton and you need to build up to a level that provides moderate to vigorous activity. Exercise should include strengthening muscles of the hip, trunk, pelvis and lower body. Use expert supervision and/or a qualified health fitness professional when you have challenging medial conditions and want to gradually incorporate more higher intensity level exercises.
Exercise after a hip fracture of receiving a new hip: follow your doctor’s recommendations, initially there maybe movements top avoid to reduce the risk of dislocating the new hip.
Exercise after vertebral fracture: incline exercise to maintain proper posture, if the fracture heal in a misaligned position, posture itself can cause repeated fro cures and your balance may also be compromised.
Exercise must be weight bearing to benefit bone density. The American College of Sports Medicine states that walking by itself is not enough and recommend to increase intensity with burst of very fast walking and /or walking briskly up hills. The best program is one that incorporates multiple types of activities.
Site-Specific: For exercise to benefit your bone density it must also be site-specific which means that the bone must be directly stressed to receive benefits. Resistance training or strength training can have positive effects on bone health because the muscle contractions required to lift, push or pull resistance place stress on the bones. The added benefit of resistance training is that the exercises are also beneficial in falls prevention, fracture prevention, improve and/or maintain balance, enhance mobility and posture. Exercise should emphasize muscles of the hip, trunk/spine, pelvis and lower body, and exercise should be challenging to rigorous to be beneficial, and you should try to do most if not all exercises while standing(weight-bearing).
To improve a bone, you must challenge it!
“An exercise load must impose greater strains in bone than regular loading to get stronger, which means that walking and light resistive training will be an ineffective stimulus for most normal active individuals, even older adults.” (ACSM Exercise Prescription for Osteoporosis Volume 50, Number 2, April 2022.
Bone responds slowly and bone density is lost when you stop exercising. For best results you need to make a lifelong commitment.
Influence of Medication on Bone Density
There are many drugs on the market to improve bone density. Remember that these drugs may reduce fracture risk, however none are 100 percent effective. It is important to consider all factors hat contribute to fracture risk such as your diet, state of hydration or dehydration, poly pharmacy(taking multiple medications), balance problems, muscle weakness, incontinence, and falling. New studies question the long-term safety aspects of taking drugs for bone density.
These drugs maintain in your system up to five years after you discontinue taking them. Bone remodeling is a natural process that allows the body to repair micro trauma due to everyday wear and tear on the bone. if these drugs that remain in your system prevent bone renewal, bone could become brittle and increase fracture risk. For example, stopping Prolia can cause an increase in the number of multiple vertebral fractures often within a year of stopping.
Compliance to taking medication for treatment of osteoporosis is notoriously poor, it is therefore extremely important that you find out about your risks and benefits in the short-term as well as long-term.
Evidence-Based Exercise Therapy versus Medication:
The inclusion of evidence-based exercise therapy for many chronic diseases including osteoporosis is long overdue. How otherwise can we make an informed decision on what treatment plan to follow to benefit our health and function for many years to come.
You might wonder what the drug companies want to keep out of the public knowledge by not having research studies that compare lifestyle choices such as diet and targeted exercise versus taking a medication to improve and sustain bone health for life.