How to Exercise With Osteoporosis for Stronger Bones and Improved Function
I once heard someone say, "Bones are dumb. They only do what muscles tell them to do."
It's true, without the muscles to support and move our bones, we'd just collapse into a heap on the floor.
But bones aren't stupid. They're living connective tissue. Having strong bones can prevent common health problems like hip fractures.
You can expect to lose bone mass as you age. But a lack of physical exercise, smoking, drinking alcohol, and other factors can make things worse.
Osteoporosis is the progressive loss of bone density, resulting in weak and porous bones.
In this article, you'll learn some of the causes of osteoporosis, the risks to older adults (especially women), and how you can use exercise to manage osteoporosis.
What is Osteoporosis?
Osteoporosis occurs when the body's ability to create new bone can no longer keep up with the loss of bone.
The average person begins to lose bone mass around the age of 35. The majority of bone loss occurs in the inner part of bone. Bone loss on the outside of the bone occurs later (around age 40).
Thirty-five-year-old women, as well as men between the ages of 50 and 55, experience about one percent of bone loss per year. Many older adults have some level of osteoporosis.
The loss of bone density makes bones weaker. Its effects on the spine can contribute to poor posture, leading to other related health problem.
How Common is Osteoporosis?
More than 200 million people worldwide have osteoporosis, and its prevalence is increasing with the growing senior population.
Fragile bones increase the risk of fractures, which is the primary complication of osteoporosis. This leads to a higher rate of disease and mortality, and it lowers the quality of life for older adults. [^2]
A report on osteoporosis and low bone mass in older adults found that among all adults in various age groups, more women have osteoporosis than men. The prevalence of osteoporosis among both genders and different age groups were: 1
| Group | Age: 50-64 | Age: 65+ |
|---|---|---|
| All Adults | 8.4% | 17.7% |
| Men | 3.3% | 5.7% |
| Women | 13.1% | 27.1% |
Over time, researchers observed an increase from 9.4% to 12.6% in fifty-year-old adults when comparing 2017-2018 with 2017-2018 data. 1
The growing rates of osteoporosis emphasize the need for exercise and other modifications that help older adults increase bone density while avoiding fractures and other health issues.
Types of Osteoporosis
There are two types of osteoporosis:
- Primary Osteoporosis
- Secondary Osteoporosis
Understanding the differences between the two, as well as their contributing factors, can help you minimize and manage bone loss through the aging process.
Primary Osteoporosis (Two Types)
Primary osteoporosis consists of Type I and Type II osteoporosis.
- Type I osteoporosis is the result of low levels or estrogen. It can occur in both women and men, and typically in the 50-75-year age range. Commonly affected parts of the body include the spine, hips, and wrists.
- Type II osteoporosis is linked to a vitamin D deficiency and hyperparathyroidism. This group is usually over 70 years of age and bone loss occurs in both the outer and inner layers of bone. Fractures commonly occur in the hips and spine.
Secondary Osteoporosis
Secondary osteoporosis is the result of some other disease (anorexia nervosa, cystic fibrosis, Crohn's disease) or the use of certain medications.
Alcohol abuse, smoking, and other lifestyle factors can also contribute to the diseases related to secondary osteoporosis.
Women are eight times more likely to experience Type I osteoporosis. They are twice as likely to have Type II osteoporosis. 3
What are the Signs of Osteoporosis?
The signs of osteoporosis include progressive rounding of the spine (thoracic kyphosis) and bone fractures.
Below is side-view of normal and osteoporotic vertebrae in the spine. The loss of bone mass causes the vertebrae to become smaller, resulting in a rounded spine.
Osteoporosis can lead to rounding of the spine (thoracic kyphosis).
Fractures commonly occur at the hips, wrists, and spine. They can affect a person's mobility while also increasing morbidity and mortality rates.
The loss of mobility affects activities of daily living and a person's quality of life. Preventing fractures is one of the most important steps to take as we age.
If you've experienced a fracture in the past, your risk of suffering another fracture increases. 5
Why Does Osteoporosis Affect Women More Than Men?
Osteoporosis affects one in three women, with women suffering 175,000 femur fractures and 500,000 vertebral fractures in the U.S. 7
Women have a higher risk for osteoporosis because estrogen levels decrease during menopause. Estrogen protects bone, which is especially important for women with thinner and smaller bones.
Young women may develop osteoporosis, but it's mainly seen in older women.
Factors that can contribute to osteoporosis in women include vitamin D and calcium deficiencies, lack of exercise, and the loss of the menstrual period (amenorrhea).
Smoking, medications, and eating disorders can also play a role in the onset of osteoporosis.
Medical Treatment for Osteoporosis
Osteoporosis is a progressive condition. This makes medical management challenging.
Calcium and vitamin D supplementation can help manage osteoporosis. Calcitonin and bisphosphonates can also be given along with calcium supplementation to slow down the process in deeper parts of bone.
Hormone replacement therapy using estrogen and/or progesterone can be an effective treatment for osteoporosis. But the effects may only last up to 3 years after treatments have ended.
Some long-term studies have shown a higher risk of breast cancer with hormone replacement therapy. 3
Selective estrogen receptor modulators (SERMs) attach to estrogen receptors on bone cells and produce the protective estrogenic effect on bone. 6 This can help improve bone density.
Medications work by reducing resorption and increasing bone formation. Amino bisphosphonates and calcitonin reduce resorption. Calcium supplementation works by increasing the formation of bone and increase density.
How Exercise Helps Increase Bone Mass
Exercise is one of the most effective ways to increase bone mineral density. The weight-bearing effect of exercise stimulates the formation of new bone.
The application os stress to bones and other connective tissue increases their strength. Removing that stress results in a loss of strength, and exceeding the physiological limits of the tissue can cause dysfunction or injury.
This is known as Wolff's Law, which was first described by anatomist Julius Wolff.
Wolff's Law applies to any exercise that loads the bones and connective tissues of the body.
When it comes to osteoporosis and exercise, a combination of weight-bearing activities and balance exercises can enhance bone mass. Corrective exercises for postural alignment should also be incorporated.
When performing resistance (strength) exercises, be careful not to exceed your body's ability to resist the weight.
Individuals with osteoporosis need enough of a load that stimulates the connective tissues without causing injury.
Remember, the goal is to improve function.
Improving the strength and stability of the bones and joints is key. Significant loss of bone density or other medical conditions require a lower intensity level.
Exercise can prevent osteoporosis and increase bone mineral density in clients who have osteoporosis by increasing muscle strength. The contraction of muscles transfers forces through the tendons that attach to bones, which stimulates bone mass.
But stronger muscles also improve function and balance, which reduces the risk of falls and related injuries.
If you're exercising to prevent or manage osteoporosis, you should undergo regularly scheduled bone scans. This is the best way to determine if your exercise program, medication(s), supplementation, and other efforts are working.
Goals of Exercise for Osteoporosis
The following are the primary goals when using exercise to manage osteoporosis:
- Improve or maintain your ability to walk and bear weight
- Improve function for your daily activities
- Improve strength and joint ROM in your upper and lower extremities
- Maintain or increase your bone mass
Is Medical Exercise Appropriate for You?
Medical exercise may not be appropriate for everyone. If you have osteoporosis, you need to have a medical clearance from your physician.
Older adults who want to use exercise to manage osteoporosis should be able to walk, either independently or with an assistance device like a walker.
Adults in their later years can have problems with orientation (e.g., time and place) or alertness. This can make it difficult for them to begin and maintain an exercise program.
Pressure sores resulting from prolonged bed rest and other factors may also prevent a person with osteoporosis from exercising.
Consult with your physician before starting an exercise program if you have osteoporosis or other medical conditions.
Exercise Precautions for Osteoporosis
If you're starting an exercise program with osteoporosis, you want to avoid activities that cause pain or swelling.
Muscle soreness is okay. But if pain interferes with your daily function, then you'll need to modify your routine.
You should avoid high-impact exercises. Anything that involves jumping, running, and fast movements can increase the stress on the bones and joints.
Exercises that require to flex your trunk excessively may also increase the risk of injury if you have osteoporosis.
If you've suffered a fractured vertebra, you should avoid exercise and follow your doctor's recommendations before starting an exercise program.
Exercises who have osteoporosis should only work in a pain-free range of motion. It's not a good idea to "work through pain". Listen to the signals your body is sending you so you avoid injury.
Exercise Guidelines for Osteoporosis
Cardiovascular/Aerobic Exercise
Cardiovascular exercise can be an easy way to get started with regular physical activity.
For the individual with osteoporosis, a goal of 3 to 5 days each week of cardio exercise can be beneficial.
If you have mild to moderate osteoporosis, intensity levels for cardiovascular exercise should be light to moderate.
Emphasize weight-bearing activities, such as walking, running, or stair-climbing. But be mindful of the impact that running can put on the body, and adjust your exercise according to your needs.
Cases that involve severe osteoporosis should avoid running and stick to low- or no-impact exercises such as walking and swimming. Cardiovascular exercise sessions can be between 30 to 60 minutes.
Strength/Resistance Exercise
Strength exercises performed 2 to 3 days out of the week at a moderate intensity level can stimulate bone and muscle mass development.
You can perform 2 to 3 sets per exercise with 8 to 10 repetitions for each set. Rest periods between each set can be between 2 to minutes to provide adequate recovery before performing another set.
Flexibility Exercise
Stretching and other flexibility exercises can be performed 5 to 7 days each week.
Improving your flexibility can offset the effects of a sedentary lifestyle or repetitive activities performed at work or in sporting activities.
Muscles become tight, which can affect range of movement and daily activities. Stretching on a daily basis is one of the best ways to stay fit and functional as you age.
If you have osteoporosis, stretching all of the major muscle groups can be appropriate. You just want to be careful not to overdo it.
Stretch until you feel a mild level of discomfort (or what I like to call a "comfortable stretch").
If a stretch is painful, you need to ease up and progress slowly.
Hold each stretch for 15 to 30 seconds, and perform 2-3 stretches per muscle or muscle group.
The charts below summarize exercise recommendations for men and women with osteoporosis. 3
Resistance training
| Mode | Frequency | Intensity | Volume |
|---|---|---|---|
| Machines, free weights, bodyweight, bands, etc. | 2-3 sessions/week | Moderate intensity, exercises that use multiple joints and muscle groups | 2-3 sets per exercise, 8-10 repetitions, 2-5 min. rest between sets |
Cardiovascular/Aerobic training
| Severity of Osteoporosis | Frequency | Intensity | Volume |
|---|---|---|---|
| Mild-Moderate Osteoporosis | 3-5 sessions per week | Light to moderate, weight-bearing | 30-60 min./session |
| Severe Osteoporosis | 3-5 sessions per week | Light to moderate, weight-bearing, low- or no-impact | 30-60 min./session |
Flexibility training
| Frequency | Intensity | Volume |
|---|---|---|
| 5-7 days per week | Stretch to mild discomfort (not pain) | 3 stretches per muscle group, 15-30 sec. hold |
Exercise can help you manage osteoporosis. Weight-bearing activities stimulate the growth of new bone while minimizing the loss of bone that occurs with aging.
Over 80 percent of the 10 million Americans with osteoporosis are women.4
This highlights the importance of resistance exercise in women's health.
Knowing how to exercise when you have osteoporosis helps you avoid injuries and ensures that you achieve your health goals.
Darwin Ruiz is a Medical Exercise Specialist who helps clients use exercise to manage medical conditions and improve their daily function. If you'd like to learn more about Medical Exercise, or if you're not sure if Medical Exercise is appropriate for you, click here to schedule a complimentary call today.
References:
(1) Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi.org/10.15620/cdc:103477
(2) Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006 Feb;38(2 Suppl 1):S4-9. doi: 10.1016/j.bone.2005.11.024. PMID: 16455317.
(3) Jacobs, P. L. (2018). Nsca's Essentials of Training Special Populations. Human Kinetics.
(4) U.S. Department of Health & Human Services. (n.d.-a). Osteoporosis. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/osteoporosis#:~:text=Osteoporosis%20affects%20more%20women%20than,likely%20to%20get%20osteoporosis%20because%3A&text=Women%20usually%20have%20smaller%2C%20thinner%2C%20less%20dense%20bones%20than%20men
(5) Dobbs MB, Buckwalter J, Saltzman C. Osteoporosis: the increasing role of the orthopaedist. Iowa Orthop J. 1999;19:43-52.
(6) Kastelan D, Giljevic Z, Kraljevic I, Korsic M. Selective estrogen receptor modulators: A possible new treatment of osteoporosis in males. Med Hypotheses. 2006;67(5):1052-1053. doi:10.1016/j.mehy.2006.04.040
(7) Jones, PhD, PT Michael. Post-Rehab Exercise Protocols Manual. Medical Exercise Specialist Training Course. American Acdemy of Health, Fitness and Rehab Professionals (AAHFRP).
Image Credits:
- BruceBlaus , CC BY-SA 4.0 , via Wikimedia Commons
- Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013. , CC BY 3.0 , via Wikimedia Commons
- James Heilman, MD , CC BY-SA 3.0 , via Wikimedia Commons
- _Bibliothèque interuniversitaire de Santé , Licence Ouverte, via Wikimedia Commons_
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