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  • Carol Michaels

What Should You Know About Osteoporosis as Fitness Professional?

Osteoporosis means porous bone and is a disease that weakens the bones. It is a serious health issue with 44 million people at risk for this debilitating disease. Bone density decreases and the bones become fragile and break easily. Although it can cause a break in any bone, the most common sites for breaks are the hips, spine and wrist. A broken hip or spine usually requires a hospital stay or surgery so they are of particular concern. It can lead to permanent pain, disability, or death. Our bodies are always breaking down bone and replacing it with new bone. In the reabsorption stage, the old bone is broken down and in the formation stage, new bone is built. It is constantly being renewed throughout our lives. As we age the replacement process slows down. Bone is a living issue which has little spaces which get larger as we lose bone density. To make matters worse, the outside of the bone thins as well. Calcium and phosphate are essential for bone formation. If you do not get enough calcium or your body does not absorb enough calcium, it will hurt bone production. Bone loss occurs in everyone as we get older. Bone forming cells begin to slow down which causes bone to be lost at a faster pace than it is formed. Osteoporosis occurs as a result of an acceleration of this process which is called primary osteoporosis. Secondary osteoporosis is caused by some medications and disease processes. Half of the women and men older than age 70 may have this disease. It occurs in older people and women after menopause. The leading causes of osteoporosis are a decrease in estrogen in women at menopause and a drop of testosterone in men. It is a silent disease because it progresses without visible symptoms. There are no symptoms in the early stages. Most people do not know that they have it until a bone breaks. It can be from a fall or something as slight as a bear hug. A sneeze or sudden movement can be enough to break a bone in someone with severe osteoporosis. Later in the disease you can notice kyphosis or a stooped posture. A dowager’s hump becomes apparent. There can be neck or back pain due to fractures or bone tenderness. Loss of height can occur even up to 5 or 6 inches. Reduced bone density can be seen on a DEXA scan. Your clients over 50 have this routinely done to test bone mineral density. A score of –1 to –2.5 standard deviations indicates osteopenia which indicates the beginning of osteoporosis. A standard deviation of more than- 2.5 is considered osteoporosis. This number is called a t score which compares bone density to a 25 year old. This test focuses on the lower spine and hip. Many times osteoporosis begins in middle age as hormone levels change or at an older age associated with a vitamin D deficiency.

​Who is at risk?

There are various risk factors; some are controllable, and some are not.

Women are at higher risk than men. They have smaller bones and there may be issues which increase risk such as: late menarche, amenorrhea, and hysterectomy at young age. Older people are at risk as their bones get thinner. Osteoporosis seems to run in families, and those that have had a fracture after 50 are considered higher danger. Caucasians and Asians are at higher risk, as are smokers and alcohol use, being thin, doing little exercise, and a diet without sufficient vitamin D and calcium. Other risk factors: rheumatoid arthritis, type 1 diabetes, anorexia, premature menopause, asthma, multiple sclerosis, lupus, some antacids, cancer treatments, and thyroid, gastrointestinal, blood and renal disorders.​Why is osteoporosis increasing?​​

A very large percentage of your clients over 50 probably have osteopenia or osteoporosis. My fitness colleagues and I have been noticing that a larger percentage of our clients have this disease. Some of that increase can be attributed to an increase in testing of women at age 50. Lack of physical activity and poor diet is increasing the prevalence of osteoporosis. Only a small percentage of us have jobs that involve physical activity and most people have sedentary lifestyles. Osteoporosis is increasing for many of the same reasons as the increase in our obesity problem.

There are medications which help control this disease but there may be side effects. The best advice that you can give your clients is to have them participate in weight bearing exercise and follow a bone healthy diet. Our goal is to keep the bones dense; strength training not only increases muscle mass it also can stimulate the bone. We want to increase the muscle mass so there is more of it pulling on the bone.

We will now cover the specific exercises that are necessary for bone health and guidelines for daily life activity to prevent factures. As a fitness professional you can play an invaluable role in the bone health of your clients by noticing the early signs of osteoporosis and teaching them how to manage this disease through exercise, diet, and healthy lifestyle.

Managing Osteoporosis through exercise.

Exercise is an important component in the treatment of osteoporosis. A well-designed program may help your client decrease bone loss and the risk of fractures. We will discuss how to start a strength-training program and which exercises are the best for increasing bone density. We will also learn which exercises should be avoided because they may potentially cause fractures. If you have a client with osteoporosis or osteopenia you should understand this disease in order to teach them how to exercise properly and safely in order to decrease the risk of the progression of this disease. According to the National Osteoporosis Foundation, half of all women and 1 out of 4 men over 50 will have a wrist, hip, or spine fracture due to osteoporosis. Effective and safe exercise can improve their quality of life, overall health, and keep osteoporosis under control.
Studies have shown that exercise can reduce the risk of osteoporosis. This is because when the muscle pulls on the bone the bone mass increases. There is evidence demonstrating that exercise can slow loss of bone density and that osteoporosis is typically less prevalent in people who are active. Exercise may also prevent osteopenia from becoming osteoporosis.
It is a good idea to start building bone mass at a young age so that your clients will start with a higher level bone mass as they age. The activity of bone forming cells begins to decrease at age 35. Weight-bearing exercises are the best exercise for increasing bone density. This type of exercise not only will strengthen bones, it will also keep your clients’ hearts healthy and muscles strong and help with weight control.
An understanding of osteoporosis and its pathology is needed in order to create safe and effective programming. After medical clearance, someone with osteoporosis can begin to exercise. Warm up before starting and cool down afterwards. Teach your clients to use proper body mechanics during the exercise session and throughout the day. The body needs to always be aligned properly so there is less stress on the spine. This will help them to maintain good posture, which also helps with kyphosis. This forward head and upper back curve can be noticed in those with osteoporosis, sometimes caused by small fractures in the spine.
An effective exercise program includes aerobic (weight bearing), strength training, posture and balance exercise. Weight bearing exercise is where the weight of the body is transmitted through the bones. Walking, dancing and hiking are examples of weight bearing exercise. This should be done three to five times a week for 45 minutes. If using a treadmill, hold on to the handle. A recumbent bicycle is ideal because its use eliminates the risk of falling. Do not do high impact exercise, which can cause a fracture. Swimming and water exercise, although good for the heart is not as effective for bone density.
Strength training or resistance exercise generates muscle tension on the bone. We start our clients with a light weight performing one set of ten repetitions. Then we gradually increase to two sets, and add weight slowly. Strength training should be done two to three times per week without working the same muscle group two days in a row. Improving muscle strength will also help improve balance.
It is important to focus on exercise designed to treat osteoporosis by strengthening bones and muscles leading to better posture and balance. Strength training actually stimulates the bone because the muscle is pulling on the bone. We lose muscle mass as we age and with less muscle, there is less tugging on the bones. Bones lose density because there is less use or need for density. So not only does strength training increase our muscle mass, which has numerous benefits, but also stimulates the bones. Exercising while standing is more effective and can help with balance as well.
Balance exercises are also crucial for this population. It is important to work on balance in order to prevent falls. Falling and fear of falling is a serious problem for someone with osteoporosis. You should instruct your clients to always wear the proper footwear. Balance exercise should be performed daily and simply practicing standing on one leg for ten seconds will help and can be done anywhere. It is important to keep the major muscle groups of the legs and core strong, which will also help their balance. Due to a fear a falling some people become inactive which only accelerates loss of bone mass.
Postural exercise is also important. A goal is to decrease the risk of rounded shoulders and spinal fractures. Emphasize body awareness and alignment during exercise and activities of daily living. Posture exercises help maintain proper body alignment and can be performed a few times a day. You should show your clients how to be mindful of their posture throughout the day. A good stretching program will help. Focus on stretching the chest muscle and strengthen the back muscles to prevent rounded shoulders. Keeping muscles strong and flexible will also help with an emphasis on spinal stability.
All fitness professionals need to learn about the precautions to take for clients with osteoporosis. Your client may know their lumber spine DEXA numbers - but they are not given a test (DEXA) for the thoracic spine. The same caution needs to be taken for the thoracic spine as well. Bending forward from the waist, side bending and rotation is contraindicated. Your client needs to be very clear on this before they begin to exercise. Therefore, doing something as simple as reaching for the toes can be harmful. If they have to bend forward they must keep the back straight, hinging from the hips, without rounding the back.

As a fitness professional, you need to teach your client how to move in ways which will avoid compression fractures. Movement that involves forward bending or rounding the spine has been found to increase spinal fractures in this population. Since an abdominal crunch and other traditional abdominal exercises and some abdominal machines are contraindicated, it is necessary to do other abdominal exercises that do not have forward flexion. With that in mind it is important to know what exercises are safe to strengthen the core if bone mass is low. Some examples of exercises that are safe are the dead bug, pelvic tilt, and leg raises.
Extreme twisting of the trunk is also contraindicated. A large percentage of Pilates and Yoga exercises have to be modified in order to avoid bending, twisting, and forward bending with rotation. Pilates exercises done in flexion can be modified. For example, you can do the hundred, double leg stretch, and the criss cross with your head on the floor. There are still a lot of Pilates exercise that can be done such as single leg circles, and the corkscrew. Back extension exercises such as swimming are fine. Spinal extension exercise should be performed because it has been found that those with stronger back muscles have higher spine bone density. The posterior of the vertebra contain cortical bone, which is strong. Therefore, back extension is safe. Sports that your client participates in need to be examined. For example, a golf swing might create too much force for the spine and might have to be modified. A properly designed practice can strengthen the skeleton and improve balance thereby decreasing the risk of future falls. It can also improve posture and rounding of the back. As a fitness professional you will be helping your client by teaching them about strength training, posture and balance, and to be mindful of their condition during their daily activities.

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