Silent and irreversible, osteoporosis can portend the beginnings of a deadly spiral—but it can be prevented or slowed from childhood through the senior years.
Osteoporosis develops as the result of diminishing bone mineral density and mass or when the structure and strength of bones change and decline. “It often has no signs or symptoms until you actually suffer a fracture,” observes exercise physiologist Shane Merrell of Jupiter Medical Center.
“A broken hip, wrist, vertebrae, or femur is especially concerning in older people,” he says, because the patient may become sedentary on bedrest or hesitant about activity. This can lead to a downward spiral of being unable to tolerate exercise, bone density and height loss, chronic pain, and becoming weak and less able to perform activities of daily living.
But this all-too-common scenario can be avoided. Bone mineral density builds up and peaks in the late 20s, Merrell explains, and begins to decrease with age. After approximately age 40, bone mineral density begins to fall at about 0.5-1.0 percent per year. For women, the onset of menopause can be particularly perilous, with an average loss of 5-10 percent of overall bone mass. “Following menopause, however, bone mineral density pretty much levels back off to its original rate of decline. This can lead to women losing as much as 50 percent of peak bone mineral density throughout their lifetime.” While the risk of fracture due to osteoporosis is especially concerning for post-menopausal women, men can be at risk of fracture too.
For those middle-aged and older, “the goal is to slow or pause osteoporosis progression and rebuild bone,” Merrell says. “At a certain stage, you should incorporate fall prevention exercises into gentle workouts to avoid fractures. Resistance training’s role in balance should not be overlooked,” Merrell stresses, “The stronger you are, the more you can control your body.”
Merrell recommends “bone loading”—weight-bearing activities with a variety of motions that use one’s own body or free weights for resistance. These include running, jumping, weightlifting, squats, deadlifts, lunges, step-ups, and push-ups. For added resistance, weights or bands can be incorporated into a workout.
Playing sports such as tennis, pickleball, or softball fit the bill while also providing other health benefits, as do calm forms of exercise, such as yoga, Pilates, and tai chi. They “improve balance and control of movements, which can reduce the chance of falls and other mishaps,” Merrell says. For those with osteoporosis, Merrell warns against forceful rotation or rounding the spine such as in Russian twists or standing toe touches.
Finding the most appropriate program, customized to each individual, is essential. “It’s never a good idea to immediately start with a high-intensity exercise,” he advises. “Although someone younger can progress from walking to multidirectional aerobics quite easily, which is an optimal bone-loading activity, those who have already been diagnosed should place more emphasis on safety and work with a trainer or exercise physiologist to avoid injury to derive the greatest benefits from their sessions.”
Begin lightly and work your way up, with 12-15 repetitions of moderate difficulty, which allows bones, muscles, and tendons to adapt. “When doing resistance training, start with lighter loads then slowly progress to heavier. The modality can be anything—bands, free weights, or machines. Progress to the point where you’re doing 10-12 challenging repetitions. It’s all about increasing mechanical tension progressively over time.”
Osteoporosis can be driven by genetics, lifestyle, diet, and simply the aging process. Prevention starts in childhood with diet and physical activity. “Parents should involve their kids in a variety of sports as young as possible,” Merrell advises, whether it’s soccer, baseball, running, dance, or gymnastics. Bone loading through diet and exercise is optimal for helping adolescents achieve their highest peak bone mineral density.
Other ways to help prevent or mitigate osteoporosis:
Make it a point today to include strength training in your regular schedule. Exercise may be hard at first but choose something you will enjoy. “Anything is better than nothing, especially if you’ve been sedentary,” emphasizes Merrell. “Keep going back, even if you don’t fall in love with it the first few times. Allow yourself time to familiarize yourself with it and develop self-confidence.”