Understanding Bone Density
According to the International Osteoporosis Foundation one in three women and one in five men over age 50 will experience a broken bone due to osteoporosis.
Osteoporosis and osteopenia are often thought of as silent diseases since many people do not know they have it until they experience a fracture.
What are Osteoporosis and Osteopenia?
Osteoporosis means porous bones and is condition in which the bones have become thinner and less dense. This reduction in the quality of the bone makes them weaker and more vulnerable to fractures. Osteopenia is also the loss of bone density over time and is considered the precursor to osteoporosis. Osteopenia can develop into osteoporosis if left untreated.
Our bones continue to grow and strengthen until our early 20s when we are at peak bone density. Throughout our lives old bone is consistently replaced by new bone keeping our skeletal system strong. However, with osteoporosis bone is being lost and not replaced with enough new bone. This leads to thinner and more brittle bones.
Osteoporosis can be hard to diagnose because there are not outward symptoms of the disease. Two visible signs that you might have osteoporosis are the curved forward posture of the spine and a loss of at least 4cm in height (just of 1.5 inches).
Risk factors for osteoporosis:
Age, the older you are the greater risk
Gender, women are at greater risk
Family history of osteoporosis
Previous fractures from a minor fall
Having gone through menopause or had a hysterectomy
Medications that lower bone density
Other diseases that affect bone density
Smoking and heavy alcohol use
While many of these risk factors are things you cannot change there are two important way you can impact the quality of your bones.
A bone healthy diet and regular physical activity.
Why an Active Lifestyle Helps?
Physical activity keeps our body strong and this includes our bones. Putting our bones under stress causes them to build more new bone.
Impact specifically from weight bearing activities or resistance based exercises put force onto our bones. The bones respond to this by remodeling and creating new bone. This impact on our bones can be outside force like your foot hitting the ground or it can be internal like your muscles working against load and putting force against the bones.
What Kind of Exercise is Best?
When bone density is a concern we are looking for physical activity that causes impact to the bones, improves posture, strengthens the core, and challenges balance.
Impact - this could be external like walking and the Pilates jump-board or internal like muscles working against the bone in resistance/strength training. While we want activity that causes impact on our bones we also want to make sure that impact will not cause damage, so it is important to look for activities that are controlled or have guided instruction.
Posture - Exercise that improves posture can be particularly important because it strengthens the muscles around the spine which support and protect the spine. Working the muscles connected to the spine also puts force on the vertebrae increasing their density. Better posture also reduces kyphosis and forward head postures, which aides in balance educing the risk of falls.
Core -a strong core also helps keep the spine, pelvis, and hip joints safe by strengthening around them and putting force against those bones. It also provides stability for the whole body helping to increase overall strength.
Balance - one of the best ways to prevent fractures is to limit falling in the first place. Finding activities that safely challenge balance are a great way to improve this over time.
This is why walking, tai chi, some forms of yoga, and Pilates can be excellent choices of physical activity.
Pilates for bone density
Pilates in particular puts the bones under stress by putting them under the tension of the springs or placing the body-weight against gravity. It focus on strengthening the core and the muscles of posture while also providing opportunities to maintain mobility. A pilates class also provides this movement in an environment that is guided and with force that is well controlled making it a safe place to challenge your body.
In a Pilates class that is focused on bone density you will stay mostly in a neutral spine. This is the a safe position for your spine to receive load. There will also be a focus on exercises to strengthen both the muscles of the core and the mid-back to promote a stable base of support and good posture. Additional impact may be added by using the jump-board, which additionally engages the muscles of the lower limbs and feet. Balance can be safely challenged through single leg exercises, standing exercises, and taking you off your center of gravity.
Precautions in fitness
When working out with osteoporosis or osteopenia there are movements that need to be avoided or limited. Below are some of the general guidelines, but with all condition each body is different. Whether you have osteopenia or osteoporosis, other overlapping conditions, and your previous movement history will all affect how these guidelines are put into practice.
Loaded flexion - Flexion is the curving of the spine forward. When we put the spine in this position and then add load like weights, gravity, our body weight it is more vulnerable to fracture.
Flexion with rotation - If we take a flexed spine and also rotated this makes the vertebrae very susceptible to fracture it considered unsafe for osteoporosis
Loaded Lateral flexion - extreme lateral flexion of the spine (side bending) especially under a load puts the spine at risk for fracture. Some gentle side bending for mobility is still encouraged
Extreme range of motion - for any spinal movement or joint we want to keep it within a range of motion where you have strength to support the joint. This is even more the case when a larger load is being used.
Precautions in life
Working out is not the only time that you should be mindful of the way you are moving. In every day life we often move our spine into positions that could put us at increased risk for a fracture. Taking time to think about what shape your spine is in when you do activities especially those involving a heavy load can save you from silent fractures.
The next time you unload the groceries, work in the yard, or pick up a child take a moment to evaluate how you are moving your spine.
References
Cleveland Clinic. (2023, October 27). Osteopenia. https://my.clevelandclinic.org/health/diseases/21855-osteopenia
International Osteoporosis Foundation. (n.d.). About osteoporosis. https://www.osteoporosis.foundation/patients/about-osteoporosis
Kim, Y., & Kim, Y. (2023). The role of high-intensity and high-impact exercises in improving bone health in postmenopausal women: A systematic review. Cureus, 15(1), e34137. https://doi.org/10.7759/cureus.34137
Kumar, Y., & Hooda, K. (2023). Vertebral fractures. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547673/
Mayo Clinic Staff. (2022, October 20). Osteoporosis exercise: Stay safe while staying active. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis/art-20044989