Bone Loss: Exercise for Preventing and Managing Osteoporosis

According to The Mayo Clinic, “Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.”  Osteoporosis is a bone disease where bone mineral density is reduced.  It most commonly occurs in women over the age of 50, but it can affect anyone.  It causes bones to become brittle which increases the risk of fractures.  Our bones not only support our body’s structure, but they also protect vital organs, play a role in blood cell production, our immune system, the storage of calcium, the release of essential hormones, among other functions.   

Our bones are made of living tissue and mainly contain bone marrow, cartilage, membranes, nerves, blood vessels and three different types of cells.  Like other cells in our body, the cells in our bones are constantly being broken down and subsequently replaced.  This process in our bones is called bone remodeling or bone-rebuilding.  The bone remodeling process allows the body to repair broken bones, reshape the bones as we grow, and regulate calcium levels.  Many factors contribute to bone remodeling.  Some of these factors are the parathyroid hormone, vitamin D, estrogen, and testosterone.  This bone remodeling process of breaking down old bone and increasing our bone mass when new bone is made, slows down as we age.  The process starts to slow as early as our 30’s and as we continue to age it’s possible that bone mass is lost faster than new mass can be created.   

Risk Factors for Osteoporosis Can Include: 

• Low calcium levels 
• Vitamin D deficiency 
• Smoking tobacco 
• Using corticosteroids 
• Estrogen deficiencies (common during menopause) 
• Family history of osteoporosis/Genetic factors 
• Age (risk increases after 50) 
• Having an inactive lifestyle 
• Body frame size (men and women who have small body frames tend to have less bone mass to draw from as they age) 

This is not a complete list of the potential causes of osteoporosis, but it can help us identify ways to help maintain or increase our bone mineral density and let us know who might be most at risk.   

How do you know if you have osteoporosis? 

There are no typical symptoms in the early stages of bone mineral density loss.  Once you have osteoporosis, you might experience signs like; back pain (caused by a fractured or collapsed vertebra), loss of height over time, a stooped posture or a bone that breaks easily.   

A bone density test is the only way for doctors to determine if you have osteoporosis or osteopenia.  Osteopenia is a loss of bone mineral density, which means your bones are weaker but not yet to the point of osteoporosis which is a more severe loss of bone mineral density (bones are brittle or almost brittle).  There are not usually any symptoms of osteopenia.  It may be helpful to know if your bones have weakened to this point so you can work with your doctor to determine a treatment plan to prevent it from worsening to osteoporosis.   

How to prevent osteoporosis? 

To help prevent osteoporosis, Johns Hopkins Medicine suggests; limiting alcohol consumption, stopping smoking if you smoke, consuming adequate amounts of calcium and Vitamin D as well as having an adequate protein and vegetable intake.  They also mention that weight bearing exercise can help build strong bones and slow bone loss.   

Just like our muscles break down under stress (like resistance training) and then repair themselves to become stronger, our bones have a similar process.  If a bone comes under increased stress over time, for example during weight bearing exercise, the parts of the bone under the most pressure will become thicker over time.  Exercise helps maintain or increase bone density no matter when you start, but if you start exercising regularly when you are young and continue throughout your life you will reap the most benefits. 

Exercising with Osteoporosis 

If you have osteoporosis or osteopenia, ask your doctor or physical therapist before starting a new exercise routine about what exercises are right for you.   

In general, with osteoporosis, it is recommended to avoid excessive bending or twisting of the spine and to be careful of high impact activities like running or jumping.   

In 2022, the British Journal of Sports Medicine (2022; 56 [15]) published exercise guidelines for people with osteoporosis.  A multidisciplinary group of experts met in 2017 to create these guidelines based on their review of research and expert opinions.  They wanted to clear up any uncertainty about what types of exercise and how much physical activity are safe and effective in individuals with osteoporosis.  We know that physical activity and exercise can optimize bone strength, reduce fall, and fracture risk but they wanted to create these guidelines to be more specific on the type and duration of exercise as well as how to minimize any potential risks of exercise.   

They concluded the following recommendations for all people with osteoporosis: 

1. Those at risk of falls should start with targeted strength and balance training. 

1. Perform resistance training 2-3 days a week to maintain bone strength.  Start at 8-12 reps of each exercise, building up to three sets.  Begin with lower intensity exercises to ensure good technique before increasing intensity. 

1. Target all muscle groups but especially focus on the back to promote a healthy spine. 

1. Spread physical activity throughout the day to avoid prolonged sitting. 

1. Include impact exercise 4-7 days a week (like jumping 3-5 sets of 10-20 jumps with 1-2 minutes of rest between sets). 

1. Avoid movements involving a high degree of spinal flexion (in both exercising and in daily life). 

They also found that “There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks.” 

Activities that can help prevent bone loss, maintain bone density and are safe for those with osteoporosis: 

• Weight bearing aerobic activities – activities on your feet with your bones supporting your weight.  Examples include walking, dancing, low impact aerobics, elliptical machines, and stair climbing. 

• Strength training – including using dumbbells, resistance bands or your own body weight to strengthen all major muscle groups.   

An example of a full body strength training routine that’s great for beginners: 

Complete 10-12 repetitions of each exercise before moving to the next.  Then repeat each exercise three more times, resting in between each set. 

1. Squat – Start with your feet shoulder width apart.  Bend your knees as you shift your hips back, keeping your back straight and leaning partly forward.  Squeeze your glute muscles and return to a standing position. 

1. Push Up – Put your hands slightly more than shoulder width apart on the floor (or if a beginner, on a countertop or wall).  Bend your elbows and bring your chest toward the floor (or other surface) keeping your body in a straight line and all moving together. 

1. Standing on One Leg – Have a sturdy piece of furniture nearby in case you need to grab something for balance.  Stand on one leg for as long as possible – up to a minute.  Repeat with the other leg.   

1. Side Leg Lifts – Start with your feet hip-width apart.  Shift your weight to your left foot.  Flex your right foot and keep your right leg straight as you lift it to the side.  Bring the right leg down then repeat the lift on the right leg 10-12 times then switch to the other side. 

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.  Regardless of age or osteoporosis risk or osteoporosis status, exercise has a positive impact on strength, mobility, and bone density in addition to improving overall health. It’s never too late to start.  Regular exercise can help to prevent and even reverse some bone loss.  It also can improve balance and flexibility which is key for preventing falls which are the most common reason for bone fractures.