If you are female, are approaching menopause or you have gone through it, it’s likely that your care provider has suggested that you obtain a DEXA scan to evaluate your bone mineral density (BMD) and that you have been thinking about ways to keep your bones as strong and healthy as possible. Side note: Men also should consider bone health and ways to keep their bones strong as they are also impacted by changes.
Being told that you have osteopenia or osteoporosis can be scary and many people associate the diagnosis with loss of height, changes in posture, fracture and loss of function. You have read or been told that you cannot make positive changes in your bone density without medications and that exercise is not an effective tool to help to limit bone density changes or to improve bone health. I won’t speak to the medication aspect of treatment to prevent or to limit bone changes; that is a discussion to be had with your medical provider, hopefully taking into consideration your family history of osteoporosis, your medical history, and your overall health and function.
I can speak to exercise and movement and bone health, and love to do so!
Let’s consider first what we mean by changes in bone health, density and strength.
Bone is added as we grow and mature, reaching its peak density at around age 25-30. Between the ages of 25-50, the bone density tends to stay stable with equal amounts of bone formation and resorption. After around the age of 50 (in women), bone loss outpaces formation (NOTE: we still add some bone…just not as much as we might lose), especially around the time of menopause and a decrease in levels of estrogen.
Osteopenia (low density but not yet in osteoporosis range) and osteoporosis are measured by bone density scans, providing us with baseline information. Osteopenia and Osteoporosis can increase the risk of fracture, postural changes, pain, and possibly loss of function. All things to be avoided! And things that we can do something about!
So in addition to healthy diet, consideration of supplements with calcium, magnesium and other minerals (speak with your provider but recommendations for Calcium in food and supplementation combined are 1200mg after menopause), protein and vitamin D, limiting alcohol consumption and not smoking, what can be done to build bone and lessen loss?
Exercise! What is the best exercise? The long time answer is “exercise that you will do (and enjoy)” and there is truth to that. Most studies demonstrate positive changes in bone density after at least 6 months of program; we need to find ways to keep those programs going and offer a variety of input to the bones and muscles for greatest effect. Bone health truly is a “use it” issue. In the past years, numerous studies have shown positive effects of exercise on the bone density in the lumbar spine and femur in menopausal women and older adults. The best programs were those that created several types of stress through the bones:
- Weight-bearing (more aerobic) exercises such as walking, dancing, stair climbing, tai chi, jogging and more.
- Strength and /or resistance exercises creating tension and stress through the muscles and thereby resistance through the bones.
Walking alone might not be enough to modify the loss of bone mineral density, but it does help to maintain other aspects of cardio health and function. If we combine walking with the addition of uneven surfaces, intensity and speed, stepping (and jogging for those who have trained to do so), these activities are able to limit the reduction of bone density. And can we add the use of trek poles into the above suggestions for increased balance, upper body use and increase cardio work?
Combined exercise including weight-bearing, balance training, low impact loading as well as muscle strengthening and functional tasks can help to preserve bone density and possibly increase it. It is very important to note that a program should be built to the individual needs that consider baseline strength and mobility, posture, health and overall ability. We are not all the same size and our bone building program should not be, either! In addition to use of weight machines, free weights and bands, pilates, yoga and Tai Chi can all be beneficial, especially when combined with other mobility and strength programs.
So….I have heard all of this before. Now how do I begin a program that will meet my needs and that I can stick with?
Ask a professional! Find out what their experience, training and interest is. Not every trainer or Physical Therapist is knowledgeable about osteopenia and osteoporosis or comfortable with developing a program for you. There are many ways to create weight-bearing and strength-building programs; many of the programs that I help people with include working with their trainer, pilates, or yoga instructors, using their local gym, or creating a program for home and modifying the program to meet them where they are.
When I meet with and work with someone to help them develop their program, I look at various measurements clinically for posture, balance, strength and mobility. We discuss what you enjoy and how much TIME you believe you can put into your program (don’t think that beginning with small amounts isn’t enough. It’s a start!!). I add functional activities into your bone building program in order to protect and build during the day. And I try not to say “don’t do that exercise”, but if I do, I explain why it might not be the best for right now, and then offer a different exercise to build appropriate stress through the bone.
It’s also important to note that your program should “meet you where you are” and not be one sized for all. Starting with a little is something; please don’t feel that you must begin with the max recommendations and that if you are not able to begin there, you don’t have great options, because clinically, we see good changes even with basics!
The big question: Are you ready to Build your Bone Health?
Give a call to learn options and ways for you!
The Effectiveness of Physical Exercise in Osteoporotic Patients (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323511/)
As a Physical Therapist working with all genders and ages, Rebecca Meehan believes in finding solutions that bridge the gap between rehabilitation and movement for her clients, looking at the entire person, and not treating them as a body part or diagnosis. After two decades of practicing in orthopedic physical therapy with a focus on sports medicine and acute care, Rebecca’s passion for holistic wellness, prevention, and integrative health led her to obtain her certification in Medical Therapeutic Yoga and training in Bones for Life and the Franklin Method. She is a board-certified Women’s Clinical Specialist through the APTA, with specialist training and education in pelvic health, core, and pregnancy physical therapy.
Rebecca is the owner of Embody Physiotherapy & Wellness, LLC and can be reached at rebecca@embody-pt.com with questions.
