Osteoporosis: Does Exercise Really Matter?

Osteoporosis is a disease in which bones become more fragile and the person with osteoporosis then becomes at greater risk for getting a bone fracture. It is estimated that more than 10 million Americans have osteoporosis. It is a silent disease as no one “feels” osteoporosis until a fracture occurs, and fractures in those with osteoporosis can occur with only minimal trauma. These fractures are common, with the most frequent sites being the spine, hip and wrist.

About one out of every two Caucasian and Asian postmenopausal women will experience an osteoporosisrelated fracture at some point in her lifetime, as will approximately one in five men. While osteoporosis is less frequent in African-Americans, patients in this group with osteoporosis have an increase in fracture risk similar to those of a Caucasian patient.

Osteoporosis is detected by using a special imaging technique called dual-energy x-ray absorptiometry, otherwise known as a DXA scan. This x-ray detects how dense the bones appear (also known as the bone mineral density). An individual with osteoporosis has thinner bones with more holes or pores in them, similar to a sponge, making the bone less resilient to physical stress and trauma.

What is the purpose of diagnosing and treating osteoporosis?

When a fracture occurs, it may be followed by a full recovery. Alternatively, it can result in long-term pain, difficulty participating in daily activities or even death. If an older person has a fracture, it can often mean that person cannot return home, as the loss of ability to get around to care for oneself can result in having to move to an assisted living or nursing home for care. People can also experience loss of self-esteem, depression, anxiety, or fear of future fractures. Osteoporosis can be diagnosed and treated before any fracture occurs. However, if a fracture does occur, there are treatments which can decrease the risk of future fractures.

What does exercise ha ve to do with osteoporosis?

Much of the focus on treatment of osteoporosis includes adequate intake of calcium and vitamin D, avoidance of tobacco, avoidance of excessive alcohol intake (more than two alcoholic beverages per day for women or three alcoholic beverages per day for men), treatment of other risk factors such as poor vision, and use of prescription medications. In addition, exercise and fall prevention are part of the mainstays of treatment. It is well known that physical fitness is an important element of maintaining a healthy lifestyle. The benefit of exercise is also seen in prevention and treatment of osteoporosis. While exercise may increase the bone mineral density, much of the benefit of exercise is thought to be related to fall prevention. Regular weight-bearing and muscle-strengthening exercise can improve one’s strength, posture, balance and agility, all of which may decrease the risk of falls.

What, exactly, is weight-bearing exercise?

Weight-bearing exercise is activity in which the bones and muscles work against gravity, while the feet and legs support one’s own body weight. Highimpact weight-bearing exercises include jogging, running, high-impact aerobics, dancing, tennis or stair-climbing. Low-impact weight-bearing exercises may also help to keep bones strong, offering a safe alternative if you are unable to perform high-impact exercises. Examples include low-impact aerobics, stairstep or elliptical machines, and walking. Walking for 30 to 40 minutes three to four times per week may provide the benefit needed. While swimming can provide good cardiovascular exercise, because the water places an individual in a “weightless” environment, it is not considered to be a weight-bearing activity. Even children have been shown to benefit from exercise to strengthen their bones: one study showed that just jumping up and down increased their leg bone density. The National Osteoporosis Foundation (NOF) strongly recommends that individuals participate in lifelong physical activity at all ages.

Muscle-strengthening exercises include weight training or resistance training such as those using resistance bands, free weights or even use of weight machines--that last under supervision! Maintaining muscular strength can slow the loss of bone. And better muscle strength may help prevent falls that in turn increase the chance of fracture. Examples of muscle-strengthening exercises include standing and rising on your toes and lifting your own body weight. Experts recommend performing strength-training exercises two to three days per week.

Balance exercises such as Tai Chi can strengthen your leg muscles and help you stay steadier on your feet. Posture exercises can improve how you stand, reduce the “sloping” shoulders associated with osteoporosis, and decrease your risk of fractures, especially in the spine. Balance and posture exercises should be performed daily.

Even yoga and Pilates can improve strength, balance and flexibility if you have osteoporosis. But some of the movements associated with these programs including forward-bending exercises – can increase the risk of fracture. These should only be participated in after you discuss this with an expert, your endocrinologist, who may in turn have you see a physical therapist to help check out what you can safely do.

Where do I start?

Certain high-impact activities may not be appropriate for patients with prior fractures or those at high risk for breaking a bone. If you have osteoporosis and are looking to start a vigorous exercise program, it is recommended you discuss this with your primary care physician or endocrinologist before beginning.

Dr. Adrienne Barnosky is a Fellow in Endocrinology at Loyola University Medical Center. She graduated from A.T. Still University of Health Sciences - College of Osteopathic Medicine in Kirksville, Missouri. She completed her post-graduate training in internal medicine at the Medical College of Wisconsin where she also served as a Chief Medical Resident. Dr. Barnosky has participated in research projects on osteoporosis and diabetes management in specialized populations.