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Osteoporosis is a chronic bone disease characterised by low bone densitywhich results in more fragile bones and a higher risk of fractures. Osteoporosis is more common in women especially after menopause due to the large role that oestrogen plays in bone growth and health. Osteoporosis is extremely prevalent in the older population with one study stating that 89% of women over 79 years of age had osteoporosis.
There are no symptoms of osteoporosis so women don’t usually know that they have the disease until they have a bone density scan or if they sustain a fracture. Diagnosis is made by having a bone mineral density scan. It is important to know if you do have osteoporosis so that you can prevent the disease from worsening as well as preventing any fractures.
Risk Factors for osteoporosis and fractures:
Age >50
Female
Family history
Low calcium intake
Vitamin D deficiency
Medical history: low hormone levels, thyroid conditions
Previous fracture
Smoking
Low BMI
Alcohol (>3 drinks a day)
If you have been diagnosed with Osteoporosis here is what you can do:
Lifestyle Changes:
Calcium builds and maintains bones and vitamin D allows calcium to be absorbed by our bones as well as helping regulate calcium levels in the blood. Sunlight provides a major source of Vitamin D.
Increase calcium intake: 3 serves of calcium rich foods per day, calcium supplements
Increase vitamin D: 6-8 minutes of direct sunlight exposure to the hands, face and arms every day, Vitamin D supplements
Alcohol and smoking have negative effects on bone health as well as the role that alcohol has in risk of falls. Therefore it is recommended to reduce smoking and alcohol intake to <2 drinks a day.
A low BMI is associated with increased fragility of bones due in part to an inadequate diet. It’s important to maintain a healthy BMI of 20-25.
Medication:
Medication targeting bone density as well as increasing oestrogen can both be used in managing osteoporosis. Your GP will be able to advise you if this is appropriate for you.
Exercise:
Exercise can slow down rates of bone loss, increase bone density and reduce falls and is therefore an essential component of managing osteoporosis. Exercise programs need to include strength training, cardiovascular exercise and balance training.
The recommendations are:
30 minutes of cardiovascular exercise such as fast walking 3-5 times a week
Strength or resistance training including balance exercises 2-3 times a week
There is evidence to support exercise for osteoporosis that is tailored to each individual person and their needs. Targeting the large muscle groups in the body and incorporating resistance training, balance and postural/core stability exercises.
At PROmotion we have a number of exercise options for effective and individualised management of osteoporosis:
Small group exercise gym classes
Mature Movers strength and balance class
Physio rehab small group sessions utilising pilates equipment.
Before you start a class it is best to book an appointment with one of our Physiotherapists or Exercise Physiologists who can discuss the best management option for you.
References:
McNamara LM. Perspective on post-menopausal osteoporosis: establishing an interdisciplinary understanding of the sequence of events from the molecular level to whole bone fractures. J R Soc Interface. 2010;7(44):353-72. DOI:10.1098/rsif.2009.0282.
Walsh P. Physiotherapy in obstetrics and gynaecology. 2nd ed. / edited by Jill Mantle, Jeanette Haslam, Sue Barton
foreword by Linda Cardozo.. ed. Mantle J, Haslam J, Barton S, Polden M, editors. Edinburgh
New York: Edinburgh; New York : Butterworth-Heinemann; 2004.
Henry M, Pasco J, Nicholson G, Kotowicz MA. Prevalence of osteoporosis in Australian men and women: Geelong Osteoporosis Study. Med J Aust. 2011;195(6):321-2. DOI:10.5694/mja11.10571.
Practitioners TRACoG. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. Victoria: The Royal Australian College of General Practitioners; 2010.
Committee OAMSA. Risk Factors for Osteoporosis 2014. Available from: http://osteoporosis.org.au/risk-factors.
Bhalla A. Management of osteoporosis in a pre-menopausal woman. Best Pract Res Clin Rheumatol. 2010;24(3):313-27. DOI:10.1016/j.berh.2010.01.006.
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-81. DOI:10.1007/s00198-014-2794-2.
Royal Australian College of General Practitioners. RACGP Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men [Internet]: RACGP; 2010 [2015 April 18]. Available from: http://www.racgp.org.au/download/documents/Guidelines/Musculoskeletal/racgp_osteo_guideline.pdf.
Osteoporosis Australia. Is your patient (man or woman) over 50? [Internet] 2014 [2015 April 18]. Available from: http://www.osteoporosis.org.au/sites/default/files/files/GP_Snapshot_2nd_Ed_05-14.pdf.
Osteoporosis Australia. Prevent the next fracture- A guide for consumers [Internet] 2006 [updated 2009 April2015 April 18]. Available from: http://arthritisnsw.org.au/wp-content/uploads/2013/01/Stop-the-next-fracture-Consumer.pdf.
Kerr D, Ackland T, Maslen B, Morton A, Prince R. Resistance Training over 2 Years Increases Bone Mass in Calcium-Replete Postmenopausal Women. J Bone Miner Res. 2001;16(1):175-81. DOI:10.1359/jbmr.2001.16.1.175.
Kerr D, Morton A, Dick I, Prince R. Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res. 1996;11(2):218-25. DOI:10.1002/jbmr.5650110211.
Küçükçakır N, Altan L, Korkmaz N. Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis. J Bodyw Mov Ther. 2013;17(2):204-11. DOI:10.1016/j.jbmt.2012.07.003.
Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating Pilates Exercise into an Exercise Program for 65+ Year-Old Women to Reduce Falls. J Sports Sci Med. 2011;10(1):105-11. Available from: