Mitigate Osteoporosis impacts with bone building exercises | Sunday Observer

Mitigate Osteoporosis impacts with bone building exercises

20 October, 2019

As the world shines its global torch on Osteoporosis today, it is a lamentable fact that many who are afflicted with it or at risk of developing it, are ignorant of the symptoms or even what the disease, described as a silent stalker whose symptoms are recognised too late, means .

Osteoporosis is a debilitating condition which affects more women than men and surpasses other chronic Non Communicable Diseases NCDs) like breast cancer (in women) and prostrate cancer (in men). Yet it can be avoided and its impacts mitigated on those already afflicted with a few simple exercises says a leading Physiotherapist.

Here, Chartered Physiotherapist Dr Gopi Kitnasamy shares his knowledge with the Sunday Observer, gleaned from many years of experience in treating patients with this condition, on how Osteoporosis could be avoided/mitigated with some simple exercises and low cost interventions.

Excerpts …

Q. As many victims of Osteoporosis are still ignorant about this condition, tell us what is osteoporosis?

A. Osteoporosis is a chronic, debilitating disease where the mass and quality of bone are reduced. The bones become porous and fragile, the skeleton weakens, and the risk of fractures greatly increases. The loss of bone occurs ‘silently’ and progressively, often without symptoms until the first fracture occurs, most commonly at the wrist, spine or hip. Osteoporotic fractures negatively affect the quality of life and often result in pain, loss of function and, in the worst cases, death. Approximately, one out of three women over 50 would have a fracture due to osteoporosis (more than breast cancer) as would one out of five men over 50 (more than prostate cancer).

There is nothing permanent about living bone. Like a muscle, it can grow and it can shrink. It is in a constant state of change. Unfortunately, the biggest change comes with age. As people get older their bones begin to deteriorate. Even as early as age 40, bones are no longer as strong as they once were.

Q. Can we prevent its onset?

A. The bones that make up our skeleton are made from living tissue, which renews itself continuously throughout our life.

If our skeleton is to do this effectively and remain strong, it needs regular stimulation from physical activity. Exercise is fundamental to slowing the progression of osteoporosis.

Q. How often should we exercise to improve our muscles?

A. Bones need a variety of brief, frequent loads every day (e.g., normal daily activities like walking and climbing stairs) to maintain their strength, and bones need to be loaded a bit more than usual (exercise) to improve their strength.

Q. What are the most common adverse impacts of osteoporosis? How and why do they occur?

A. Fractures caused by osteoporosis of the bones in the spine (vertebrae) usually occur in the lumbar (lower) or thoracic (middle) areas of the spine. It is estimated that only one out of three vertebral fractures come to clinical attention. The most common cause of kyphosis (curvature in spine) in adults is from vertebral fracture due to osteoporosis. Kyphosis causes loss of height, poor posture, and a shift in the centre of gravity - greater risk of falling – fracture.

Q. What are the factors that put people at risk of osteoporosis?

A. Risk factors can be controlled or modified. Those that can be modified call for a change in lifestyles and eating habits. They include: Excessive alcohol consumption, smoking cigarettes - Toxins from cigarettes destroy cells that contribute to healthy bone mass density. Individuals who are excessively skinny (including those who suffer from Anorexia) are at higher risk of osteoporosis and are twice as likely to suffer fractures. Malnutrition: A diet that does not include the 5 food groups will lead to nutritional imbalance, and malnutrition, e.g. of calcium, vitamin D, and protein. Lack of exercise: Individuals who do not exercise are at higher risk of developing osteoporosis. Office workers who sit for more than 9 hours a day are 50% more likely to have osteoporosis than people who sit 6 hours a day. Diet: Consumption of more than 1 teaspoon of salt, 3 glasses of tea or coffee, and 4 or more cans of soda per day, as well as intake of protein 10-15% in each meal, can lead to osteoporosis. Too much protein can prevent efficient calcium absorption by the body

Q. What are the risk factors that cannot be controlled?

A. Sex: In terms of cases and onset, women develop osteoporosis faster than men. Especially post-menopause or if ovaries have been removed. Bone deterioration is heightened due to hormone deficiency, leading to approximately 40-50% of women at risk of fracture. Age: Bone mass density peaks at around 30 years of age, gradually decreasing thereafter. Genetics: If a family member has a history of osteoporosis and fracture, this would increase the chances of the younger generations having osteoporosis. Nationality: Caucasians and Asians are at higher risk of osteoporosis. Medication: Certain types of medication (steroid medication) can contribute to lower bone mass density. History of fracture: Individuals with fracture have 2.5 times higher chance of another fracture occurring

Exercising your back during middle-age can help prevent your vertebrae from weakening or fracturing when you get older. Posture correction exercises, abdominal and back muscle strengthening will relieve pressure on the spine, help to improve posture and reduce discomfort. People with medical conditions or those who have not been exercising regularly should consult a Doctor / a Physiotherapist before starting any exercise program.

Q. Describe a typical exercise program? Is it tailored to specific needs of the patient?

A. All our programs are custom tailored. Start slowly and progress gradually.

Short duration, intense exercise builds bone most efficiently.

If exercise time needs to be reduced, it is better to reduce the length of each session rather than the number of sessions per week.

Children should get plenty of exercise to help build their peak bone mass. Younger, active people produce more new bone tissue than they lose, and therefore their bone density increases. Generally we achieve maximum bone density and strength (peak bone mass) around the age of 30. Bone density gradually begins to decline as we age, and most of us also become less active. For women, bone loss is usually most rapid during the first few years after menopause.

Q. How do we measure bone mineral density?

A. Bone densitometry, also called DEXA or DXA, is commonly used to measure Bone Mineral Density (BMD) and to diagnose osteoporosis, to assess an individual’s risk of developing osteoporotic fractures. DXA is simple, quick and noninvasive. It’s also the most commonly used and the most standard method for diagnosing osteoporosis.

Q. When should you measure Bone Mineral Density (BMD)?

A. Individuals without risk factors: Should start BMD check-ups aged 60 and above. Individuals with high risk factors: Those with a family history of fractures as a result of osteoporosis, or individuals who consume steroid medication should actively seek regular BMD check-ups.

Q. Exercises to avoid?

A. High impact exercise. Abdominal curl-ups/ forward bending from the waist, trunk rotational torsion movements with any loading, jarring or twisting movements, heavy lifting.

Also, avoid using the following exercise machines e.g. abdominal exercisers, bicep-curl machines, cross-country ski machines, rowing machines, stationary bicycles with moving handlebars, and any other machine that involves trunk rotation or forward bending.

Q. Exercises good to engage in?

A. Weight-bearing and high impact exercise is required to stimulate bone formation. Sports that involves walking, running, sprinting, jumping, skipping, jogging, stair-climbing, weight-lifting, aerobics, tennis, dancing, are good.

Low impact, low load sports like swimming and cycling are beneficial for cardiovascular health and improving muscle strength. Remember, muscle strength and bone strength are related. Muscle strengthening exercises can help to rebuild bone in those who have developed osteoporosis.

Q. Precautions to take to minimise risks of at risk persons in one’s home?

A. Every year, about two out of five people over 65 will fall at least once. Simple steps you can take at home to prevent indoor accidents, prevent fractures from falling, or any impacts that can cause imbalance, especially, in older family members. Remove objects that can cause falls or tripping such as electrical wires, telephone cords, ropes, rugs and doormats. Instal handles along the walls and a rubber mat to prevent slipping in and around the bathroom. Make sure there is enough light in your home, especially in stairs and hallway areas around.

If you are moving around at night, always make sure to turn the lights on. Ensure that there are no slippery areas; and clean up any spills immediately to prevent risk of accidents. The stairs should not be slippery and should ideally be wide, not steep, have handles or banisters to grip onto; stairs should be well lit. Wear shoes that are not slippery. Some medication may cause dizziness that can lead to falls; similarly one should limit alcohol consumption or quit drinking altogether, to reduce the risk of accidents.

Q. Your word of advice to readers?

A. Maintain a balanced, healthy diet and lifestyle – exercise alone cannot prevent osteoporosis. Calcium and vitamin D are also required for building and maintaining bone mass, and avoid unhealthy habits that lead to bone loss e.g. smoking and excessive alcohol intake