The Role of Exercise in Osteoporosis Treatment
Exercise is a critical component of osteoporosis management. Osteoporosis is a condition that causes bones to become thin, brittle, and more susceptible to fractures. Exercise places beneficial stress on bones, causing them to thicken and grow stronger in response. Experts recommend combining weight-bearing exercise and strength training for optimal management of osteoporosis through exercise. A physical therapist can guide osteoporosis patients through a customized, safe, and effective exercise program to combat osteoporosis.
How Osteoporosis Develops
Osteoporosis is a condition that develops due to decreased bone mineral density that causes bones to become thin, brittle, and more susceptible to fractures. Fifty-five percent of Americans over age 50 are affected by osteoporosis, the majority of whom are women.
Bones are dynamic living tissue that is constantly rebuilding and breaking down. With osteoporosis, the body is unable to replace bone tissue at a rate that keeps pace with bone tissue that is broken down, causing porous bones. This lessens the bone’s ability to withstand the typical forces of daily living and can contribute to fractures from everyday situations that wouldn’t normally happen with healthy bones. These fractures are called fragility fractures. Fragility fractures can result in increased morbidity, mortality, hospitalizations, and reduced quality of life for osteoporosis patients. One in three women and one in five men over age 50 will experience an osteoporosis-related fracture in their lifetime.
There are a number of factors that heighten the risk of developing osteoporosis. Avoidable risk factors include smoking, excessive alcohol intake, an inactive lifestyle, excessive caffeine intake, low calcium or vitamin D intake, lack of weight-bearing exercise, poor health, and drugs such as steroids. There are several unavoidable risk factors such as having a smaller frame, advanced age, genetics, a predisposing medical condition, early menopause before age 45, going one year without a period in pre-menopausal years, and hormone levels.
Women experience osteoporosis at a higher rate than men due to the effect that menopause has on women’s bone health. With menopause, the equilibrium between bone rebuilding and bone breaking down is broken due to the estrogen deficit in the body. Estrogen protects bone cells; however, during menopause, there is a natural decline in estrogen which causes women to lose bone density faster and increases osteoporosis risk.
The Role of Exercise in Osteoporosis Treatment
Exercise is a crucial component of osteoporosis management. Exercise helps to improve bone density by directly loading the bone and increasing muscle mass, which places mechanical stress on the skeleton. Exercise places beneficial stress on the bones, causing them to thicken and grow stronger in response. The bone is stimulated to thicken through the contraction of the muscle that pulls on the bone the muscles attach to and through the contact of the bones with the ground when standing and moving on your feet.
According to the AAOS, weight-bearing and strength training exercises are most effective for bone building and the management of osteoporosis. Combining weight-bearing and strength training is considered optimal for bone health and has been shown to slow total hip bone mass density loss and lower the risk of fractures in osteoporosis patients.
Experts recommend that osteoporosis patients participate in a long-term exercise program designed to improve postural stability, mobility, and movement quality for sustained bone density improvements. In 2020, researchers found that a 12-week exercise program supervised by a physical therapist improved muscle strength, balance, and fear of falling in women with osteoporosis and a history of vertebral fractures.
Beneficial types of exercise for osteoporosis include:
Weight-bearing exercise: exercise that requires a person to move against gravity to stay upright. This places stress on bones to maintain and improve bone density. Weight-bearing exercises can be high-impact like dancing, hiking, running, or stair climbing or low-impact like fast walking, ellipticals, or stair-step machines. For those in more advanced stages of osteoporosis, low-impact weight-bearing activity is recommended.
Strength training: exercise in which a person works against gravity to build muscle using one’s body weight, additional weights, or resistance bands. In strength training, individuals can isolate specific muscle groups to improve balance and stability.
Balance and flexibility training: Balance training helps those with osteoporosis enhance their stability and reduce fall risk. Balance training can involve standing on one foot or on an uneven surface, sidestepping, and forward and lateral step-ups. Flexibility exercises allow muscles to contract properly within their range of motion.
Aquatic therapy in a warm water therapy pool is a safe alternative for land exercises when weight-bearing physical activity is not tolerated or if there is a high risk of fracture in the osteoporosis patient. Aquatic therapy interventions help address balance deficits, range of motion and strength deficiencies, and posture issues. The viscosity of water helps the patient maintain an upright posture, while the buoyancy of the water supports the joints and body which eliminates the impact of movement on the individual’s joints and decreases weight-bearing stress on the joints. Researchers have noted that osteoporosis patients are able to gain strength and functional improvements during an aquatic therapy exercise program.
When engaging in exercise, avoid repetitive bending and twisting, rowing, lifting with a bent spine, certain yoga and dance movements, and strenuous house and yard work. These positions increase pressure and friction within the spine, which can lead to a compression fracture.
Physical therapy can help osteoporosis patients engage in exercise safely and effectively through a customized treatment program. Physical therapy has numerous benefits for osteoporosis and building up bone strength including improving balance and posture, increasing muscle strength and range of motion, providing better bone support, and decreasing pain. Physical therapy treatment can include posture and body alignment training, education on home environment modifications, targeted strength training, aerobic conditioning, aquatic therapy, and balance training.
If you have osteoporosis or are concerned that you may be at risk for the condition, work with a physical therapist who will guide you through a safe, effective exercise program to restore healthy movement and function and rebuild bone strength.
