What is Osteoporosis?
Osteoporosis occurs when bone structure becomes compromised becoming weaker and less dense. This leads to an increased risk of fracture (by 2-3 times). The most common bones to be affected by osteoporosis are the hip, wrist and spine. By 2022, it is estimated there will be 6.2 million Australians over the age of 50 with osteoporosis or osteopenia (transitional stage before osteoporosis). This equates to a fracture every 2.9 minutes or 501 fractures per day!
Who is at risk of osteoporosis?
2/3 of people over the age of 50 have osteoporosis or osteopenia (70% of these women and 30% are men). The risk of fracture is just as great with a diagnosis of osteopenia as osteoporosis. Those most at risk people include:
- Post-menopausal women and men with low testosterone levels
- People with a genetic predisposition: family history of osteoporosis
- People with Coeliac disease, Inflammatory Bowel Disease and other mal-absorption disorders
- Some cancer treatments and corticosteroid use increase risk
- Some medical conditions-Rheumatoid arthritis, kidney or liver disease, thyroid conditions, diabetes, anorexia nervosa
- Lifestyle factors-smoking, excessive alcohol consumption, low activity levels, low vitamin D levels, low calcium intake
How do you know you have Osteoporosis?
Osteoporosis is a silent condition unless it leads to a fragility fracture (a fracture as a result of a minor incident) or you have had bone densitometry screening (DXA scan). Osteopenia and osteoporosis themselves do not cause pain or warn you of their existence.
Diagnosis is based on an estimation of bone mineral density (BMD) measured using a DXA scan. The result for each area assessed, usually lumbar spine, neck of femur (hip) and wrist gives one of three classifications: within normal range, osteopenic range or osteoporotic range for each area.
Can osteopenia and osteoporosis be prevented?
It is suggested that achieving a 10% higher peak bone mass in adolescence could delay the onset of osteoporosis by about 13 years and reduce the lifetime risk of fracture by 50%. Evidence suggests that strengthening your bones in your youth translates to greater bone strength over a lifetime. The benefits of targeted bone exercise appear to be sustained even after the intervention stops if initiated in childhood but this is not the case if the intervention only occurs as an adult. It is clear then that exercise prescription for the prevention of osteoporosis should begin in childhood and continue throughout life. However, the literature also suggests it is never too late to start.
Are there treatments available for osteopenia and osteoporosis?
Management of osteoporosis has largely been with pharmaceutical intervention. Physiotherapy and exercise have consistently been shown to improve BMD but not at levels significant enough to reduce fracture risk. Recent research from Griffith University in QLD has established that High Intensity resistance and impact training (HiRIT) performed for 30 minutes twice a week is superior to moderate or low impact programs in improving bone health. It can be undertaken safely in small groups by people with low to very low bone density by taking into consideration other pre-existing medical and musculo-skeletal complications and providing appropriate supervision by a physiotherapist or exercise physiologist.
Studies show that athletes engaged in high or unusual impact weight-bearing sports with rapid rates of loading (gymnastics, volleyball, basketball, ballet dancing, football, powerlifting, tennis/squash, and figure-skating) have superior bone mass at loaded skeletal sites than non-athletes or athletes in lower impact sports.
Management of fracture risk associated with low bone density should always include a significant focus on falls prevention. Exercises to improve strength, balance and flexibility should be an integral part of any programme aiming to enhance bone health.
Impact loading needs to be equivalent to 4.2 times body weight which has been shown to occur with running (not jogging or walking) and various types of jumping.
There is also some evidence to support the use of a biodensity machine which uses maximum muscular recruitment in 4 set positions of optimum leverage and biomechanics to produce self-controlled axial loading of bone. This may have a greater role to play in individuals who are unsuitable for the HiRIT programme.
The human body tightly controls circulating blood calcium levels and as such if not enough calcium is readily available it will be leached from the bones to maintain the optimal blood concentration. It is very important to maintain adequate dietary intake of calcium and vitamin D (to aid the absorption of calcium) and particularly important to achieve this if you are exercising to promote bone health. It is also worth noting that you cannot use a blood test to confirm adequate dietary intake of calcium for the very same reason.
What is the Osteofit Class at ESSC?
- 60min 2x/week
- High Intensity Resistance and Impact Training
- Jumping (200-350 pw)
- Strength training 80-85% max muscular effort across large joints 2x pw
- Balance
- Based on current validated research (Griffith University)
- Modified to meet individual needs
- Rate of perceived exertion hard/very hard
- Progressing gradually and safely in appropriate time frames to reach this level of exertion. This is an important reason for performing this programme under appropriate supervision.
Speak to your physiotherapist at Eastern Sports and Spinal Care to discuss you and your family’s bone health status and guide you to appropriate management plans.