Most people believe that osteoporosis is a degenerative bone disease that affects older adults, especially women, and is a part of the aging process. Bone is a living tissue that receives a constant supply of the minerals calcium and phosphorus and continuously undergoes bone rebuilding. Cells called osteoclasts breakdown down old bone and cells called osteoblasts replace it with new bone tissue. As we age, this cycle of remodeling bone tissue changes and more bone is broken down than replaced with resultant bone that becomes weak and more prone to fractures. Generally, these fractures can occur at the spine, wrist and hip. Osteoporosis occurs predominately in women that are postmenopausal due to the decrease in the production of estrogen with resultant calcium level decreases. This in turn reduces bone mass or density by as much as 3 –7% per year. In the first 5 –7 years following menopause, women can lose as much as 20 % of their bone mass or as much as 1 – 2 % per year.

Osteoporosis develops in three stages:

1. Bone building, from childhood to early adulthood;
2. Osteopenia, when evidence of reduced bone mass is detected;
3. Osteoporosis, when bone loss is obvious.

Symptoms of osteoporosis are not usually apparent until the disease has progressed. A Bone Mineral Density (BMD) is currently the only way to diagnose osteoporosis. The World Health Organization (WHO) has set standards for measuring bone loss, comparing the optimal BMD of a 30-year-old adult. It is important to remember that bone density testing does not accurately predict that risk of fracture. Bone mineral content relates to the quantity not quality of bone. It does not reveal the actual strength, micro-architecture, rate of turnover, size or shape of the bone.

Osteoporosis was once considered a part of the aging process. However, it has been determined to be generally preventable. Most people can reduce their risk of osteoporosis with regular exercise and a nutrient-rich diet. Calcium supplements alone do not appear to prevent fractures, and may be harmful. The “sunshine vitamin” or Vitamin D along with bone-building nutrients, including magnesium, boron, manganese and trace minerals are thought to benefit bone health through a healthy well-balanced diet. It is important to consult a qualified nutritionist before taking any supplements. Also, eliminating habits, such as, smoking, inactivity, heavy drinking, low body weight, low testosterone levels, prolonged steroid use, the use of some medications and genetics may contribute to the prevention of decreased bone density.

It has been determined that exercise plays a strong role in the prevention of osteoporosis. Previously, weight-bearing cardiovascular exercise had been recommended to help preserve bone density. However, current research shows that resistance training may provide a better stimulus for bone building cells. The force of muscles pulling against bone stimulates bone remodeling and bone formation. Exercise for the prevention and treatment of osteoporosis should be comprised of two kinds of activity (1) cardiovascular exercise on a hard surface and (2) anaerobic exercise which strengthens muscle. Included in these activities, attention should be paid to increase balance, stability and flexibility. And YES – let’s not forget those all-important postural muscles!

It is important to take charge of your health and discuss your concerns with your primary care physician. Our trainers at FirstHealth of Andover are experienced in determining a program that is suited to you and your health concerns and will discuss them with you and your doctor. Start the New Year in a healthy way and get started on keeping your musculoskeletal system strong.

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Sources:

Charlton, K. 1996. Adapting exercise. IDEA Personal Training, 7(5), 22 –31.
Chopra, A. 2002. Impact and pathogenesis of osteoporosis. www.mmhc/nhm/articlesNHM0203/chopra.html; January 2, 2003
Daniels, D. 2000. Exercise for Osteoporosis. New York: Hatherleigh Press.
Frontera, W.R. & Skinner, J.S. Osteoporosis and Exercise Guidelines for Exercise Professionals. Life Fitness Academy.
Northrup, M.D., Christiane. Health Wisdom for Women.9 (11), 1- 6. November 2002.
Stein, A. Building Strong Bones – Osteopororosis is preventable , not inevitable. The Rotarian, 2003, 10.
Weller, Janet, MS. Osteoporosis and Exercise, Idea Personal Trainer, Nov.-Dec. 2002, 35-45.
World Health Organization (WHO). 1999. Osteoporosis: Both health organizations and individuals must act now to avoid an impending epidemic. www.who.int/inf-pr-1999/en/pr99-58.html; December 2002.
WHO Geneve 1994. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series 843.

- Donna Schneider, BS, PFT, CEAS