Osteoporosis

Bone is constantly being demolished and rebuilt. If reconstruction lags behind demolition, then bone is lost. Osteoporosis is a disease in which the bones thin and become more porous. The disease generally progresses without pain until a bone fractures. Risk factors for osteoporosis include a small body frame, excessive alcohol consumption, cigarette smoking, loss of estrogen, family history of osteoporosis, low dietary calcium intake, and use of some medications such as prednisone and other steroids.

Exercise for Osteoporosis

For patients who have osteoporosis, exercise is an essential part of treatment. Just as regular workouts build muscle, they also maintain and may even increase bone strength. By strengthening your muscles and bones and improving your balance, exercise can reduce the risk of falls and resulting fractures. Exercise works well with estrogen or other medications that increase bone density and strength. Exercise, medication, and proper diet combat osteoporosis more effectively together than any one treatment alone could do. Remember that you're never too old to exercise.

Here are some tips on how to start a program of weight-bearing exercise and resistance training that will benefit your bones and muscles and also help your general health. Two types of exercises are important for building and maintaining bone mass and density: weight-bearing and resistance exercises. Weight-bearing exercises are those in which your bones and muscles work against gravity. This is any exercise in which your feet and legs are bearing your weight. Jogging, walking, stair climbing, dancing and soccer are examples of weight-bearing exercise with different degrees of impact. Swimming and bicycling are not weight-bearing.

Weight-Bearing Exercise

For most people who have osteoporosis, brisk walking is ideal. It can be done anywhere, requires no special equipment, and carries minimal risk of injury. If walking is too difficult or painful for you, workouts on a stationary exercise cycle are a good alternative.

The full benefits of walking come from a regular schedule--at least 15 to 20 minutes 3 to 4 days per week. But if you haven't been active for years, you may need to start modestly. Start at whatever level is comfortable for you. Five-minute walks are fine at first, but try increasing their length by 1 minute every other time until you reach the optimal exercise level.

Walk briskly enough to become slightly short of breath. A little puffing shows that you're working your body hard enough to improve your fitness. If you have certain lung, heart, or other medical conditions, you should consult your doctor about a safe level of activity.

Resistance Training

The second type of exercises is resistance exercises or activities that use muscular strength to improve muscle mass and strengthen bone. These activities include weight lifting, such as using free weights and weight machines found at gyms and health clubs. Lifting weights or using strength-training machines strengthens bones all over your body, especially if you exercise all of the major muscle groups in your legs, arms, and trunk. Following a program designed by your doctor or a physical therapist is important. Joining a gym or fitness facility is a good way to begin because there you may have access to trainers who can advise you on proper technique.

Strength training is a slow process, so start at a low level and builds up gradually over several months. For each exercise, select weights or set the machine so the muscle being trained becomes fatigued after 10 to 15 repetitions. As muscles strengthen, gradually add more weight. But don't increase the weight more than 10% per week, since larger increases can raise your risk of injury. Remember to lift with good form, and don't sacrifice good form to lift more weight.

Most weight-bearing and resistance exercises place health demands on bone. Daily activities and most sports involve a combination of these two types of exercises. Thus, an active lifestyle filled with varied physical activities strengthens muscles and improves bone strength.

CAUTION: If you are frail, have had a fracture, fall frequently or have osteoporosis you should take extra caution. Certain movements like twisting of the spine, high impact aerobics or bending from the waist can be harmful.

Tips for Trouble-Free Exercise

• Lift and lower weights slowly to maximize muscle strength and minimize the risk of injury.
• It's best to perform your resistance workout every third day. This gives your body a chance to recover.
• Avoid exercise that puts excessive stress on your bones, such as running or high-impact aerobics. Avoid rowing machines--they require deep forward bending that may lead to a vertebral fracture.
• Stiffness the morning after exercise is normal. But if you're in pain most of the following day, your joints are swollen, or you're limping, stop the program until you are again comfortable, and cut your weights and repetitions by 25% to 50%. If bone, joint, or muscle pain is severe, call your doctor.
• If a particular area of your body feels sore right after exercise, apply ice for 10 to 15 minutes. Wrap ice in a towel or baggie, or just hold a cold can of soda to the spot.
• Vary your routine to make it more interesting. For example, if your strength-building program involves 12 separate exercises, do six in one session and the other six in the next.

Bone is living tissue that responds to exercise by becoming stronger.


Just as a muscle gets stronger and bigger the more you use it, a bone becomes stronger and denser when you place demands on it.

If your bones are not called upon to work, such as during physical activity, they do not receive any messages that they need to be strong. Thus, a lack of exercise, particularly as you get older, may contribute to lower bone mass or density.

You cannot see your bones respond to exercise, but when you strike a tennis ball or land on your feet after jumping, chemical messengers tell your arm and leg bones to be ready to handle that weight and impact again. In fact, if you x-ray the arms of a tennis player, you would see that the bones in the playing arm are bigger and denser than the bones in the other arm.

Building strong bones, especially before the age of 30, can be the best defense against developing osteoporosis, and a healthy lifestyle can be critically important for keeping bones strong.

There are several steps you can take to prevent osteoporosis:

Osteoporosis is largely preventable for most people. Prevention of this disease is very important because, while there are treatments for osteoporosis, there is currently no cure. There are four steps to prevent osteoporosis. No one step alone is enough to prevent osteoporosis but all four may. They are:

• A balanced diet rich in calcium and vitamin D
• Weight-bearing exercise
• A healthy lifestyle with no smoking or excessive alcohol use
• And bone density testing and medications when appropriate

Calcium

People of all ages require calcium as part of a good diet: children to build strong bones, adults to keep them strong. Dairy products are good sources of calcium. People who avoid dairy products can obtain calcium from other foods and from calcium supplements Calcium is needed for the heart, muscles and nerves to function properly and for blood to clot. Inadequate calcium is thought to contribute to the development of osteoporosis. Depending on your age, an appropriate calcium intake falls between 1000 and 1300 mg a day.

Vitamin D

Vitamin D is needed for the body to absorb calcium. Without enough vitamin D, you will be unable to absorb calcium from the foods you eat, and your body will have to take calcium from your bones. Vitamin D comes from two sources: through the skin following direct exposure to sunlight and from the diet. Experts recommend a daily intake between 400 and 800 IU per day, which also can be obtained from fortified dairy products, egg yolks, saltwater fish and liver.

Exercise

Exercise is also important to good bone health. If you exercise regularly in childhood and adolescence, you are more likely to reach your peak bone density than those who are inactive. If you have been sedentary most of your adult life, be sure to check with your healthcare provider before beginning any exercise program.

Medications for Prevention and Treatment

Although there is no cure for osteoporosis, currently bisphosphonates (alendronate and risedronate), calcitonin, estrogens, parathyroid hormone and raloxifene are approved by the US Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis.

Bone Mineral Density Tests

A Bone Mineral Density test (BMD) is the only way to diagnose osteoporosis and determine your risk for future fracture. Since osteoporosis can develop undetected for decades until a fracture occurs, early diagnosis is important.

A BMD measures the density of your bones (bone mass) and is necessary to determine whether you need medication to help maintain your bone mass, prevent further bone loss and reduce fracture risk. A bone mineral density (BMD) test is a special type of test that is accurate, painless and noninvasive.

The Consequences of Osteoporosis

Two-thirds of those who break a bone due to osteoporosis will never fully recover and regain their previous level of functioning. People have to be careful not to fracture their spine.

Often people tend to think of osteoporosis as an issue of women's health; however, it is not an exclusively female condition. Although the condition is more frequent among women, with 1 in 3 women over the age of fifty developing osteoporosis, up to 1 in 12 men will also be affected. Women are more likely to develop osteoporosis than men because women have smaller skeletons, their bone loss begins earlier, and menopause brings on a period of rapid bone loss. There are also factors that place men at a greater risk.

Preventing osteoporosis: diet, exercise, and good medical care

Many cases of osteoporosis can be prevented. Other cases can be controlled, to reduce the risk of fracture and disability. Osteoporosis prevention has been described as a "three legged stool," because it is based on diet, exercise, and good medical care.