As we age, our bones get thinner – it’s a fact.
The rate at which we break down bone cells surpasses the rate at which we build new bone cells.Â
This progressive loss, at a certain point, can bcome osteoporosis.
The stage before, osteopenia, is often a warning sign for many (women) at a certain age. For some it may have already progressed to the osteoporosis stage before they have had a chance to combat it.Â
This is why bone health is so important.
Strong and healthy bones are essential as we age, especially for those with reduced bone density – osteoporosis – who consequently have an increased risk and incidence of fractures.
Adolescence is a particularly critical period for bone health. The failure to achieve peak bone mass by the end of your teens can leave one with less reserve to withstand the normal losses later in life.Â
While peak bone mass is in part determined by genetics, it is also influenced by modifiable factors such as diet and exercise.
It is currently estimated that 66% of Australians over the age of 50 had been diagnosed with osteoporosis or osteopenia in 2022, the true prevalence is likely to be higher than this as many cases are left undiagnosed.
What is Osteoporosis?
Osteoporosis is defined as a progressive loss of bone mass and volume due to a decreased presence of mineralised bone density.Â
This degeneration of bone health also causes a decline in functional strength and an increased likelihood of fractures and dislocations.
Osteopenia is a less severe loss of bone density that also should be addressed as we age.Â
The classification of Osteopenia and Osteoporosis is typically determined via a bone density scan. and its results, known as T-Scores indicate:
- Normal bone density (-1 and above)
- Osteopenia (Between -1 and -2.5)
- Osteoporosis (-2.5 and below).
Osteoporosis: Who is at Risk?
Due to the unavoidable and physiological process of ageing, all individuals are susceptible to bone loss, which naturally declines from the age of 30.Â
This decline is often inspired by hormonal changes (menopause), smoking, physical inactivity,low calcium/vitamin D intake, frequent falls, and family history.
Osteoporosis: Why does it happen?
While bone density loss is inevitable with increased age, there are several modifiable and non-modifiable factors which contribute to its development. And unfortunately for some it can come down to genetics.
Osteoporosis: What are the Risk Factors?
Hormone Changes
- For postmenopausal women and younger women who cease menstruation sooner (e.g. thin athletes or those with anorexia); the rapid drop in estrogen levels impairs the bones’ ability to produce new cells and minerals faster than the rate at which older ones are deteriorating
- Lower levels of testosterone in males have also been linked to lower levels of bone density as men convert testosterone into bone-preserving estrogen, which may also seen a decline with age
- Thyroid hormone changes seen in both men and women such as hyperthyroidism, hyperparathyroidism, hypercortisolism and several other subtypes can also dictate how efficiently the body utilises calcium
Low Calcium Intake
- Human bones store calcium and phosphate
- The human body requires a constant flow of calcium in the bloodstream as primary organs (heart, muscles, nerve chains, etc.) rely on calcium as a part of their fuel source
- Ultimately it becomes a domino effect; if there isn’t enough calcium available, the bones’ capacity to offer calcium becomes exhausted, causing bones to become frail and brittle which then reduces their ability to house and protect these organsÂ
- Without an effective intake of calcium from our daily meals, the body doesn’t receive the tools it needs to remodel our bones and keep up with the demands of our everyday lives at a physiological level
Lack of Vitamin D
- Vitamin D has also been shown to enhance intestinal absorption of calcium and phosphate, ultimately increasing bone density and volume
- Increased via supplementation or more time spent outdoors for absorption from the sun
Sedentary Lifestyle
- The human body is highly adaptable and dependent on its external environment, stressors, and overall input for change
- If the body is not challenged or placed under any physical stress or requirements to adapt, our muscles and bones can become lazy and unmotivated to improve the physiological processes that all improve our ability to complete everyday tasks
- “Use it or lose it”; a lack of physical activity and demands leads to an increased rate of deterioration for the human body and its physiological functions
Smoking
- The direct and toxic effects of nicotine have been shown to impair the body’s ability to utilise calcium and vitamin D; who each play an important role in bone health
Excessive Alcohol Consumption
- The human body does have the ability to heal and repair bones post-fall, but excessive alcohol consumption can prevent calcium and vitamin D absorption, causes hormone deficiencies, and increase our falls risk when intoxicated
Other Medical Presentations and Co-morbidities
- Other health conditions such as cystic fibrosis, cancer, or physical paralysis can cause a loss of bone density due to the body’s ability to manage the calcium demands of physiological impairment or it’s physical capabilities to move the bones as needed
Medication Side Effects
- Certain medications such steroids have also been shown to effect bone health
- Although modifying or ceasing of these medications should be reviewed with your GP due to other potential co-morbidities or health issues needing to be addressed with specific medications
Osteoporosis: How Do You Combat it?
Lifestyle changes
- Increase calcium intake with foods such as milk, cheese, yoghurt, tofu, leafy greens, salmon, beans, lentils, protein supplements, etc.
- Enhance vitamin D absorption through increased exposure to sunlight, medical supplementation, and dietary changes
- Minimise alcohol consumption as excessive intake can prevent calcium and vitamin D absorption, causes hormone deficiencies, and increase our falls risk when intoxicated
- Regular physical activity and exercise can help minimise further bone degeneration through weight-bearing and strength-based training
Physical Exercise
- Regular physical activity and exercise can help minimise further bone degeneration through weight-bearing exercise and strength-based training
- This may include activities such as strength training, walking, stairclimbing, tennis and stomping while walking
- Strength training should involve carrying out multi-joint movements with weights or resistance bands that encourages the body to work harder and adapt so that muscles may undergo hypertrophy (allowing them to grow back bigger and stronger)
- Strengthening the muscles, which are attached to the bones, as a result makes the bones stronger
- Weight bearing influences an individual’s ability to tolerate physically demanding tasks that solely use their own body weight as a form of resistance; this may be in the form of repeatedly stepping up and down off a step, carrying out a bodyweight squat/push-up, or engaging in balance challenges to also minimise falls risk
- Although strength training and weight-bearing exercises are the most revered methods of exercise to address osteoporosis, it should be introduced as an additional form of exercise in your routine rather than a supplementation or replacement for other forms of physical activity, it is still important to do what you love!
- It is also important to note that both strength training and weight-bearing exercises should be introduced in a progressive manner to minimise injury onset whilst giving the body time to adapt to an increased presence of physical activity that may take longer for certain individuals depending on their exercise history
Medications
- Speaking to your GP is always the first and best course of action when it comes to addressing and diagnosing OP, depending on the severity, your GP may advise a medical prescription
- Drug related therapies include but are not limited to the use of Prolia, Bisphosphonates, Menopausal Hormone Therapy, etc.
- It should be noted these medications may also have unfavorable side effects based on other health presentations, so it is always best to consult your GP before taking any action
Osteoporosis Management at RedoHealth
At Redohealth we offer several services that can help you manage Osteoporosis.Â
The first step is to seek out an initial consultation with our Exercise Physiologist who can review your overall physical wellbeing, functional capacity and strength tolerance based on Osteoporosis severity and/or other underlying health conditions.
Following this review, our Exercise Physiologist can help you get started on your treatment journey with enrolment in one of our two exercise-based class:
- Rebound for Healthy Bones: a moderate-high intensity exercise class involving weight-bearing exercises and balance training. Aims to not only enhances functional strength and muscular gains, but to also rehabilitate or manage any pre-existing or current injuries.
- Ideal for those recently diagnosed or living with osteopenia and/or osteoporosis.
- Ideal for those with current injuries or physical limitations, exercise beginners, or those looking to restart their exercise journey.
- Refit for Healthy Ageing: a high intensity strength and conditioning class involving a mix of upper and lower body exercises conducted at a fast-pace to also address one’s aerobic capacity and minimise the onset of any heart or lung-based comorbidities.Â
- Ideal for current exercisers looking to increase their exercise frequency/quality of training
- Suitable for those with osteoporosis or osteopenia with more exercise experience.
If you are dealing with any specific aches/pains or movement restrictions, out EP pay prefer you to one of our Physiotherapists for a comprehensive full body assessment.
Alternatively, our Exercise Physiologists can also offer guidance and advice via an extended consultation for those wishing to exercise independently in a home or gym-based setting with an individualised exercise program. These consultations may also be followed up with regular reviews to address any exercise concerns, changes in health, or exercise program updates.
If you’re concerned about your bone health, chat to Exercise Physiologists at Redo Health today to discuss the right exercise program that is tailored to your specific needs.Â
References
Glaser DL, Kaplan FS. Osteoporosis: definition and clinical presentation. Spine. 1997 Dec 15;22(24):12S-6S.
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https://www.osteoporosis.foundation/patients/about-osteoporosis/risk-factorsÂ
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https://www.osteoporosis.foundation/patients/treatmentÂ
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https://www.healthline.com/nutrition/15-calcium-rich-foods#Frequently-asked-questionsÂ
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https://www.healthline.com/nutrition/how-to-increase-vitamin-d#Supplements-101-Vitamin-DÂ
https://www.healthline.com/health/osteoporosis/osteoporosis-and-alcohol#reversal