The Role Between Exercise and Osteoporosis As We Age
The role between exercise and osteoporosis as we age. Osteoporosis, unfortunately, is just one of those things that happens as we age. Sarcopenia, also known as a loss of muscle mass and strength is another condition of aging. These two “naturally” occurring, age related changes, can then cause a myriad of other health issues. You could have loss of balance, falls, and fractures. But, what if you had the power to put a stop, or at least pull the break, on osteoporosis? Exercise may just be the perfect solution.
Yes there are pharmaceuticals and supplements that one can take to help improve bone mineral density, slow down the progression of osteopenia to osteoporosis, and maybe even reverse this. But the potential short and long term side effects may not make taking these drugs worthwhile.¹
Osteopenia and Osteoporosis
To understand how exercise has a positive effect on our bone mineral density, we need to understand certain things. What is osteopenia and osteoporosis? How are Osteopenia and Osteoporosis diagnosed? Why the heck do we even go through these “natural” age related changes?
Osteopenia– This means you have lower than normal bone mineral density. It is not classified as a disease, but it is a warning that you could be developing osteoporosis.
Osteoporosis– This is a true diagnosis of loss of bone mineral strength and density. The inside of your bones become more porous and the outside layer becomes thinner. Having this amount of bone mineral density loss makes you more susceptible to fractures. This can also lead to so many different problems and limitations in your day to day life.
Osteopenia and osteoporosis are classified based on DEXA scans and T-scores. DEXA scans send x-rays through your bones, measuring their density, producing a T-score. This score then tells you where you are on the bone mineral density continuum.
The World Health Organization has established the following classification system for bone density:
Your bone density score is considered normal if your T-score is –1
If your T-score is between –1 and –2.5: you have low bone density, osteopenia.
When your T-score is –2.5 or less: you have osteoporosis.
Okay, good information, but why does this happen to use as we age? What is the role between exercise and osteoporosis as we age?
The simple and most obvious answer, good ole’ menopause and the hormonal changes that we get to go through.
Estrogen specifically helps to regulate bone mass accretion. So you can imagine as estrogen levels decline, so does bone mass growth.² Other hormones play a large role too, such as thyroid and thyroid-stimulating hormones, glucocorticoids, growth hormones, and I think you get the idea. But these hormones also change as we age or with other diseases and disorders.³ Simply put, there are lots of hormones and changes as we age that contribute to a decrease in bone density.² ³
There are other factors that contribute to these changes as we age, including genetics, nutrition, smoking, and physical activity levels.²
That is why pharmaceuticals have developed a reputation for helping with osteoporosis, they can help with hormone regulation and bone growth. But lifestyle factors such as nutrition, smoking, and exercise are also all key components that can be addressed. If we worked on these things, the need for costly medication with potential side effects could be avoided.
So, for now, let’s focus on how exercise can help stop or reverse osteoporosis.
Use of exercise to prevent or reverse osteoporosis. The role between exercise and osteoporosis as we age.
Weight or load bearing exercise, including high impact exercise, promotes stimulation of bone growth and increases in bone density.⁴ Wolff’s law explains this;
“Your bones will adapt based on the stress or demands placed on them. When you work your muscles, they also put stress on your bones. In response, your bone tissue remodels and becomes stronger.”
Essentially, your body adapts to the stress placed upon it.
As you place load and stress through your bones, growth will be facilitated. As you use you Bone growth can be created as you use your muscles. The pulling and tightening of muscle fibers and the tendons will pull on their attachment sites of your bones.
High impact may have once seemed scary and daunting to us, but the impact and the jolt of stress to our bones creates more bone!
The trick is to work diligently within what your body can handle. Don’t start jumping off a 24 inch box if you have not done that in decades!
Instead, start with light jogging in place, easy jump rope, or simply hopping in place. Then as you learn and see what your body can handle without pain, you can appropriately progress. Soon you will be doing things you never thought possible. And in doing so you will also be improving the strength of your bones and muscles. Your balance will improve, decreasing your risk of falling. Ultimately you will decrease your risk of sustaining a life altering injury or fracture.
What does the research show?
There is so much research on osteoporosis and the impact exercise can have. But today, I want to highlight a landmark study.⁵
This research was in 2017, just a few years ago. This study took a little over 100 women who had at least a -1 T score (see above for a reminder on T scores).
High Intensity resistance training group. The role between exercise and osteoporosis as we age.
Half of these women were put into a high intensity resistance training program for 8 months. They worked out 2 times a week for 30 minutes. The work outs included use of a barbell for squats, deadlifts, and overhead presses. These lifts were performed at 85% of their 1 rep-max. These lifts were done for 5 sets of 5 repetitions with a linear progression model. Meaning, if they could demonstrate 7 repetitions with good form, 5 pounds could be added to their lift.⁵
Something very interesting was added, jumping chin ups. Jumping chin ups provided a controllable form of impact when landing from the chin up, back on to the ground. This impact is easy to control, based on how much assistance the arms were providing on the way back down to the ground. As these women developed strength and confidence they could increase the amount of impact on landing and the amount of power and explosiveness when they jumped up.⁵
These two groups of women in the study were compared.
Physical Therapy Group
This control group, instead of performing high intensity resistance training, performed more Physical Therapy, rehabilitation based exercises at only 60% of their 1 rep-max.⁵
The differences between the groups was significant.
The high intensity resistance group improved both their bone mineral density and overall function.
Both the lumbar spine and femur improved in bone mineral density.
In terms of function, objective measures improved including the: Timed up and go test, 5 time sit to stand test, back extensor and leg strength, vertical jump height, functional reach test, and all without serious injuries except for a minor muscle strain in one participant.⁵
There were benefits in this group after 8 months. These benefits were maintained over time, even if they stopped at 8 months. But those that chose to continue exercising, continued to see even more improvements.⁵
This research article shook up the osteoporosis world. But you cannot deny the research. High intensity resistance training and high impact exercise definitely has a role in preventing bone mineral density loss. It also improved what loss has already occurred.
A follow up study was done to assess the occurrence of any vertebral fractures (fracture of the spine, especially of the mid back).⁶
Obviously they had to because of the talk that the high intensity resistance exercise study received.
And what did they find?
This exercise program did not cause any vertebral factors and instead, improved thoracic kyphosis (the amount of rounding in the mid back that is a classic sign of osteoporosis) in post-menopausal women, even with very low bone mass.⁶ This follow up study only continued to support the use of exercise for osteoporosis.⁶
Does high intensity resistance training and high impact exercise sound scary to you?
I get it, it scared me at first.
It goes against what we learned growing up. But just as technology, computers, phones, ways of communication advance, so does our knowledge on the human body.
You should start off by creating general workout habits. Get moving, get your blood pumping, stretch, and get a sense of how it feels to work up a sweat.
Once you gain some confidence in your body, do some additional research, or work with a healthcare professional. A physical therapist or personal trainer can create the right exercise program for you and your goals.
I will go into more depth on what creating an exercise program looks like in future posts. For now, lets all start on the path to moving more and getting our heart rate up.