Did you know, approximately 10 million Americans have osteoporosis, 80% of them are women. Have you recently been diagnosed with osteoporosis or has your doctor mentioned you have low bone mineral density?  What about experiencing frequent fractures?

All of these relate to osteoporosis, which as you’ll learn in this article is something that you can train strategically and intentionally to increase your bone density and reduce risk of osteoporosis or prevent it from occurring.   

What Is Osteoporosis? Osteoporosis is a disease of the bone leading to decreased content and weakening of the bone. The weakening of the bone can lead to fractures, especially in the spine, hip and wrist. It is diagnosed by the T-score of bone mineral density (BMD) scan. The number is the number of standard deviations above or below a reference value (young, healthy caucasian woman). 

• The World Health Organization (WHO) established this as the criteria:
• Normal -1.0 or higher
• Osteopenia -1.0 to 2.4
• Osteoporosis -2.5 or less

Risk Factors:

Primary Osteoporosis: postmenopausal, Caucasian or asian descent, family history, low body weight, little or no physical activity, diet low in calcium and Vitamin D, and smoking. Additional risk factors - prolonged bed rest and advanced age

Secondary Osteoporosis: develops secondary to other medical conditions such as GI disease, hyperthyroidism, chronic renal failure, excessive alcohol consumption) and the use of medications such as glucocorticoids 

For the purpose of this blog we are focusing on primary osteoporosis and prevention strategies and lifestyle modifications.

Bone Basics

Our “bone is living tissue that responds to exercise by becoming stronger”. Bone remodels and is continually replacing itself in response to daily demands. There’s a cycle in the cells, the bone cell (osteoclasts) resorb bone- especially when calcium is needed for a body function and there is not enough available from one’s diet. The other bone cell (osteoblasts) builds bone. This cycle is usually kept in balance with reabsorption equaling to bone replacement until the third decade.  Crazy, I know! As we age, there is a shift to greater resorption - especially those with a sedentary lifestyle.  For women, resorption is accelerated during menopause due to the decrease in estrogen. 

What Can You Do?

As Strength Docs at Inside Out Strength and Performance we love exercise and creating customized exercise programs to help others find safe and effective exercises to promote health, pain free activity and longevity.

Load your bones. By participating in exercise and activity that loads bone it has been shown to be associated with increased bone density.  The current research states mechanical strain with high loads are best.  For example resistance exercises that are site specific. Therefore if we’re trying to strengthen bones in the legs we would focus on hip and lower extremity exercises such as a squat or sit to stand with resistance, rather than an upper body exercise. The research also indicates that the stimulus must be dynamic, variable and unique.  More often than not we aren’t loading our bodies enough to see true adaptation and change.  When you’re looking for types of exercises to promote building bone density and strength incorporating weight bearing exercise will help slow the loss leading to more resilient bones. 

What about if I’m A Pre or Post- Menopausal Women? As mentioned above due to the reduction of the hormone estrogen in women pre and post menopause, the risk and rate of bone resorption is accelerated.  We recommend aerobic-style exercise with impact and resistance to help increase and maintain bone density. 

Did you know? With continued exercise, women can maintain BMD rather than losing the typical 1%/year after menopause (without Hormone Replacement Therapy, with Calcium/D).

Resistance Training Recommendations

So we’ve talked about what osteoporosis is, the risk factors and now seeing that resistance training can be helpful with prevention and long term bone health.  So where should I begin? Below are recommendations supported by the current evidence and research:

• Ideal Intensity of training: 70-80% of 1 repetition maximum (1RM)
• 8-12 Reps to temporary muscle failure or fatigue
• 15-20 Reps is low intensity or more endurance training and not as effective for building strength or bone 
• Target muscle groups over isolated muscles

Resistance training is great for most if not all people. For those with low bone mineral density, osteopenia or osteoporosis it’s important the exercises chosen are intentional and specific.  Training should focus on multicomponent or multi-joint movements rather than isolated movements.  We advise training in a more ideal trunk position and appropriate lower body mechanics with safe trunk extension strength and endurance. 

We love recommended weighted vests as an option to add some resistance and load for individuals during their walks. With the longterm use of weighted vests it is shown in the research to prevent hip bone loss in postmenopausal women and have a positive effect on posture and back extensor strength-all great things!  

How Often Should I Train? For How Long? As many things go when it comes to training and programming, we are all unique and it truly does depend on what your activity level is starting at and any other considerations with your personal health history and situation.  In general it’s recommended for a frequency of resistance training  2-3 times per week, for 20-30 minutes.  Incorporating balance exercises and posture exercises within your program. We want to reduce risk of falls, especially when bone density is low. Include in your program weight bearing endurance and aerobic exercise 3-4 times per week for up to 45 minutes.

Avoid unnecessary trunk flexion and rotation, especially in combination together to reduce stress on vertebrae and the intervertebral disc. Now, as doctors of physical therapy we always want to empower you to be confident in your body. When we work with individuals with osteoporosis we are going to challenge you and help develop the best and safest plan for you. We’re not saying avoid bending forward or twisting ever, it’s more in regards to repetitive movements or at the extremes with load. If you have a history of osteoporosis, history for bone fractures or you would like to speak with one of our Doctors of Physical Therapy, follow the link to set up a free phone call today to discuss your current exercise program or answer any questions you may have. 

How Intense Should I Be Training?

Current research supports targeted resistance exercises performed at adequate intensity to increase or maintain bone mineral density. According to the “Too Fit to Fracture” recommends an effort level of 5-8 out of 10 on the Borg Scale for Rate of Perceived Exertion Scale. Descriptors for those level for 5 is medium effort, harder to talk during activity but doable up to level 8 which is heavy breathing and could hold this pace for a few minutes.

5 Lifestyle Habits & Modifications To Prevent Osteoporosis 

-Diet rich in calcium and vitamin D

-Weight bearing exercise

-Healthy lifestyle with moderate alcohol consumption and no smoking

-Talking to a health care provided

-Testing bone for its density and medication if needed

The Does and Don’ts of Osteoporosis Guidelines for Fitness and Leisure 

• Do’s
• Supine extension exercises
• Deep breathing exercises
• Spinal stabilization
• Regular Weight Bearing exercises 
• Regular strength training
• Balance & agility
• Don’t
• Jumping, jarring, high impact
• Resistive flexion or torso twisting
• Resistive hip adduction/abduction from sitting/standing
• Any activity which increases risk of fall

4 Exercises to Get You Started:

These exercises were shown to promote bone density5 with appropriate and intentional programming, frequency and intensity. Supervision may be advised for those new to resistance training programs. We recommend notifying your physician before starting an exercise program and work with an exercise specialist such as a physical therapist before you begin for safest and best results.

Sit To Stand - Add a load for more intensity 

Goblet Squat

Dumbbell Deadlift

Dumbbell Overhead Press

Now you have more information about what Osteoporosis is, the risk factors and also the prevention tips and strategies for lifestyle modifications to safely build back more bone density and continue to live a life strong and confident for years to come.

We understand how frustrating it is to try different things without getting the results you had hoped for. You shouldn’t have to waste your time and money on options that don’t work.  Click here to fill out a contact form to request an appointment or phone call to help develop a clear and specific plan to reach your goals. We help active adults in our local Southern California practice and throughout the country through our remote services.