One out of two women and one out of four men age 50 and older will suffer an osteoporosis related fracture of the hip, spine or wrist. Of women over 50, one out of two have low bone density. Osteoporosis is not a normal age related process. It is a silent, gradual loss of bone which wasn’t recognized as a disease until 1994. Many don’t even know they have the disease, until they notice their height has decreased or they suffer a fracture. Most fractures are caused by everyday life. As the disease progresses bones can become so fragile they will break by simply bending over or trying to open heavy doors.
Strong bone is developed mostly during childhood and adolescence peaking by our mid 20’s. Bone remodeling is the cycle of old bone being replaced by new bone. Bone formation and bone resorption (loss) happen throughout life, but it slows as we age and hormones decrease. We have two different types of bone, cortical bone (compact bone) and trabecular bone (spongy bone). Cortical bone is arranged in a long, parallel, compact line. It is found in the long bones of the body such as the femur and the humerus. It is able to endure large amounts of mechanical stress. Trabecular bone is a formation of rods and plates resembling a sponge. It has large amounts of red bone marrow and acts as a shock absorber. It is found at the end of long bones, in the vertebral bodies of the spine and in the neck of the femur. It has a high metabolic turnover rate, 80% faster than cortical bone. This makes it susceptible to density changes at an earlier age due to estrogen deficiencies. Luckily only 20% of our bones are trabecular bone. The other 80% is cortical bone.
A DEXA (dual energy x ray absorptiometry) scan is the primary tool to measure bone density. It is recommended to have a baseline scan by the age of 40 and one every two years thereafter. The hip (neck of the femur), lumbar spine and the wrist are the most common sites scanned. But the majority of breaks occur at T6, T7 and T8. The thoracic spine is not scanned during a baseline screening. Risk factors for osteoporosis include:
Premature or early menopause:
Caucasian female- slight build, fair skinned and blonde
Heavy alcohol consumption
History of cortisone therapy
In the Pilates studio we have clients with osteoporosis at younger and younger ages. I believe diet and a sedentary lifestyle are major components to this disease. If you have been diagnosed with osteoporosis in one area we must assume you have it throughout the body. Our goal with the osteoporotic client is to reduce the risk of falling and improve functional ability. We do this by improving posture and balance, working on gait and coordination and strengthening the hip and trunk musculature.
Bones become stronger in response to increased stress (exercise). The amount of bone and its density are directly related to weight bearing forces and resistance placed on it. But some movements are no longer safe. Trunk flexion due to the increased compression of the anterior bodies of the vertebra as well as loaded spinal rotation and lateral flexion are contraindicated especially if someone has already experience a compression fracture. Focus will be shifted to hip and back extension, standing exercises that include impact, dynamic resistance and multidirectional movement.
In conclusion, exercise is an important component of managing this disease along with diet and medical supervision. There is no cure, but you can slow the progress and in some cases stop the advancement of this silent disease.