Osteoporosis

What is Osteoporosis?

Osteoporosis occurs when our bones  gradually become fragile then break easily. Bones become honey combed when very osteoporotic. The struts within the honey comb mesh (trabecular bone) become thin causing the bones to become fragile and break easily. (Introduction to osteoporosis, National Osteoporosis Society). 80% of our bone is corticol bone, 20% is trabecular bone. The trabecular bone is more likely to fracture with this condition. The vertebral bodies in the spine, neck of femur and wrist are composed of trabecular bone. Loss of bone density affects the trabecular bone most.

Osteoporosis in its early stages is a silent, painless condition that signifies low bone density. This condition mainly affects women post menopause when oestrogen levels drop. However various drug medications and treatments, genetics, the ageing process and lifestyle factors can also pre dispose one to it and men, although not as commonly, can also be affected. Having low bone density thoughdoes not mean you are going to have a fracture.

Bone Biology

Bones are very active tissues with a good blood supply. Bone modelling occurs throughout life to create and repair bone. Basically, Osteoblasts build bone and they repair and create bone. Osteoclasts break bone down and release calcium from the bone by a process called resorption. These essential processes help to form part of the life cycle of bones. During and after menopause with hormonal changes and the reduction of oestrogen the net balance between the osteoblasts and osteoclasts changes and there is more emphasis on the breaking down of bone.

A DEXA scan (Dual Energy Xray Absorptiometry) is the most accurate method used to measure bone density.  The scan usually measures the bone density in your lumbar spine and  hip including the neck of the femur which is vulnerable to fracture. The thoracic spine is difficult to Xray because the ribs are in the way. If there is low bone density in the lumbar there is likely to be low bone density in the thoracic which is more vulnerable to fracture.

(click on the dexa link image below this article)  The T score is the statistical measure which measures your bone density relative to that of a 30 year old. The Z score compares your bone density to other men and women of your age.

Interpreting the T Score

Above  -1 is normal

-1 to -2.5 is osteopenia (a mild stage of bone density loss)

-2.5 or lower is in the osteoporosis stage.

The main fracture sites are the spine, hip and wrist. Having osteoporosis means you have a greater risk of fracture if you fall. Most common site is thoracic T7,T8,T9 causing a kaiphosis (excessive curvature of the upper spine)

The World health Organisation has developed a 10 year  assessment tool  FRAX (Fracture Risk Assessment Tool) to help predict a persons risk of fracture between the age of 40 and 90.

What can be done to stabilise or indeed reverse osteoporosis?

Research and National Osteoporosis Society guidelines strongly recommend the right kind of exercise which includes weight bearing, resistance, dancing and perhaps even careful jogging! In other words, staying active with controlled exercise which promotes and improves balance as part of a Falls Prevention Programme. Physically active adults are less likely to have fragility fractures. The key is to maintain strength engaging in weight bearing and progressive muscle resistance activities to stimulate bone remodelling.

Some types of exercise are considered to be risky. This  includes excessive forward flexion, loaded flexion and pronounced sit ups. It is best to modify some of the traditional Pilates based exercises which involve loaded flexion through the thoracic spine ie the Roll over, Rolling like a ball and a few others like the Teaser (loaded pressure on lumber spine) to be safe. Instead, do more prone work as in the Pilates Push Up or Plank to work and strengthen your anti gravity muscles which keep you upright and help you to maintain good standing posture.

Appropriate exercise in conjunction with a healthy diet (foods containing calcium and vitamin D) can certainly help and sunshine between April and September is very helpful too. However eating a healthy diet of leafy greens, oily fish, nuts and seeds and calcium fortified milks is advised too.

Here is a graph below depicting the results of 6 dexa scans carried out between 2007 and 2018 showing a downward trajectory. There is a bigger drop in bone density indicated by a downward trend in the first 2-3 years following menopause then the rate of decrease slows.

Download graph DEXA scans (.xlsx)

Medical Treatment

If you have any concerns please do see your GP who may suggest that you have a DEXA scan should you meet the criteria.  Commonly prescribed  drugs include Alendronate and Risedronate are both bisphosphonates, often prescribed to  strengthen the existing bone and help to prevent or slow down further bone loss. However some people may find they cannot tolerate certain antiresorptive agents. There are other alternatives and new quite recent drug treatments are now available for example, Denosumab and Romosozamub.

Another alternative?

HRT . many women have found this to be of great benefit but you need to discuss and weight up the pros and cons with your health professional.

You may find that many GPs are reluctant to prescribe HRT to women at 60 years +. In a recently shown TV programme entitled The truth About the Menopause (BBC1 Nov 2018)  the research illustrates that the  risks of being on HRT from 60 years out weigh the benefits. There is the increased risk of breast cancer or having a stroke. HRT combined with alcohol intake (a regular glass of wine or two) and obesity has been shown to increase the risk even more!

Many people with a diagnosis of  osteoporosis are indeed fortunate to feel incredibly fit and healthy in advancing age (over 60) and may even have a  total absence of muscular aches and pains. They still enjoy an excellent quality of life and work!

However the reality is that at some point in time they may need to be on a type of bone medication to avoid the prospect of a vertebral or hip fracture which would undoubtedly be life changing with negative consequences. Osteoporosis is a natural part of the ageing process and many older people are likely to  have it but just not know it.

Keep exercising, develop and maintain muscle strength and continue to work on your balance! Pilates is great for maintaining and improving posture, balance and strength!

The following research article http://www.jfsf.eu/articles/v03i04_155.pdf recently published in the December 2018 Journal of Frailty, Sarcopenia and Falls, identifies safety issues associated with physical activity for exercise for adults with osteoporosis and osteopenia with reference to mind body exercises such as yoga and equestrian sporting activity.

Eating the right diet to include calcium rich foods including greens is essential. Personally I include some dairy foods such as Greek style yoghurt, cheese, and eggs. Chick peas , pulses, fish and broccoli are excellent sources but in general, I aim to eat healthily akin to a mediterranean style diet with lots of fruit and vegetables and food high in protein for helping to maintain muscle mass as we tend to lose 1.5% each year after the age of 35 -40.

Calcium is vital for strong bones and teeth as it gives them strength and rigidity. We also need Vitamin D to absorb calcium, to keep muscles strong and prevent falls in older people. You may notice that many high quality calcium supplements apsrt from containing Vitamin D also contain magnesium and Vitamin K to aid absorption and utilisation of calcium. Other minerals like boron and zinc also have a role in bone formation and maintenance as well as vitamin C (oranges are good!). There are supplements containing different forms of calcium ie calcium carbonate and calcium citrate. The former is best absorbed with food. The latter can be taken without food as its more absorbable but more expensive. I suggest you look into this more.

The UK government advisory committee recommend that in addition to sunlight exposure (we don’t have enough in Scotland!) we should supplement our food intake with a Vitamin D supplement of 10 micrograms a day, particularly in the winter.

But the best way is to get enough Vitamin D from natural sunlight is when we are outside between late March and September when we can expose our face, arms and legs even just for 10 -15 minutes or short periods of time to bathe in the suns rays!

Pilates Exercise for Osteoporosis

Your anti gravity muscles keep you upright and improve your posture. These are the best muscles to keep strong and maintain in good standing posture. One or two useful exercises for encouraging back extension can be done in prone alignment : Baby Swan

Prone swimming is another exercise you can do to stretch and lengthen your spine, engaging your abdominals and glutes :

The Dart creates extension in the thoracic spine and engages glutes, abdominals and the shoulder girdle, it is great for promoting improved posture :

To Conclude :

Over many years since qualifying as an educator in schools, the fitness industry and studying complementary therapies to degree level, I personally adopt a holistic approach to healthy living and lifestyle. I was diagnosed 20 years ago at age 47 with osteoporosis and guess what? Pilates based exercise, nutrition, sleep hygiene and a positive mindset has and continues to keep me strong, especially now as I have recently become a granny !!