A good support structure is a prerequisite for everyone to thrive. This holds true for the body too, whose support structure — the skeletal system — needs nurturing, care and attention. The bones not just provide form to the human body but are also key for mobility. Care of bones is essential to avoid their deterioration (osteoporosis) in the latter years of life.
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Osteoporosis: The silent disease
Osteoporosis is a silent chronic condition in which the bones become weak. It goes unnoticed until a fall and a fracture unexpectedly leads to its diagnosis. Though it is observed across race, age groups and gender, it is widely prevalent among Caucasians, in women post menopause, and the old. The main causes include deficiency of vitamin D and calcium. It can be diagnosed using a CT-BMD (computed tomography-bone mineral density) or DEXA (dual-energy X-ray absorptiometry) scan.
Studies show that bone is most dense around the age of 25-30 years. The bone tissue is continuously lost and rebuilt again by the process of mineral resorption and bone formation, respectively. Factors such as menopause and ageing create an imbalance in the resorption and formation rate. When the resorption rate becomes higher than the formation rate, the risk of fractures and osteoporosis increases.
Preventing osteoporosis with exercise
The age-old adage that prevention is better than cure holds true for osteoporosis too. And exercise is one of the most effective means.
A review article, An Insight into the Effect of Exercises on the Prevention of Osteoporosis and Associated Fractures in High-risk Individuals, published in the Rambam Maimonides Medical Journal elaborates on the various exercises and their impact on bone density. High-impact loading exercises can increase femoral neck bone mineral density (BMD) and high-intensity progressive resistance training may improve vertebral height, lumbar spine and femoral neck BMD. Walking increases the stiffness in calcaneus (heel bone) and Tai Chi can reduce bone loss.
“As the age increases, bone density decreases,” says Dr Sachin Jain, an orthopedic surgeon from Jaipur, Rajasthan. “This depends on how much you have walked, exercised, toned your muscles, [your] intake of calcium and how much sunlight you were exposed to in your lifetime. If you have maintained a proper lifestyle, avoided certain medications that can lead to osteoporosis, then osteoporosis sets in later. It may not occur also.”
A lifestyle where exercise is a regular part makes a huge difference.
“Once you turn adult your capacity to regenerate becomes lesser,” says Pooja Pandey Tripathi, founder of Arogya Physiotherapy, Bengaluru. “So, it is important that you do at least 30 minutes of activity every day for five days a week. You can do moderate aerobic activity and then do a little bit of strength training. Make sure that you are already loading your bone and muscles — that itself will prevent osteoporosis. Weight-bearing exercises are also very good. It can be your own weight as well — like planks or squats. Impact exercises can also be done.”
Treating osteoporosis with exercise
Exercise and making dietary changes to increase calcium intake and absorption is the first step in treating osteoporosis, says Dr Jain.
“There are some injections which cause the bones to break down a little slower and to form the new bone,” says Dr Jain. “But those are to be prescribed only when there is a high risk of osteoporotic fractures and when the condition cannot be treated by any other osteoporosis treatments.”
Exercise forms a major part of the osteoporosis treatment process. “If you do not have any other medical condition like osteoarthritis or similar, walking from 7am to 8am (in early sunlight) or from 4pm to 5pm will be helpful,” says Dr Jain.
Sunlight is important for the synthesis of vitamin D. The UV-B rays in sunlight stimulate the skin to produce vitamin D, which is important for calcium metabolism.
“Whenever it is available in adequate level, the calcium will be transported from the blood to the bones,” says Dr Jain. “If you have low vitamin D, then the transport will not happen. This causes osteopenia [bone loss] and osteoporosis in the later ages.”
The exercises prescribed are based on the issues faced by the individual. If the problem is posture stability or mobility, then these particular aspects are focused upon.
“You must work to increase the overall muscle strength to improve the balance, avoid fractures, decrease the risk of falls, maintain and improve the posture to decrease the pain and relieve the stiffness,” says Tripathi. “But if the patient is having more symptoms on the knee, then you will work on overall strengthening but with more focus on the knee.”
Tripathi suggests bodyweight exercises should be done before graduating to resistance bands.
“Then slowly get into loading, like half squats,” says Tripathi. “We put them into a dumbbell-strengthening programme or overhead dumbbells. So, for bone strengthening, slight loading is required but it should not be a vigorous loading. It must be very gentle loading and systemised. There should be no risk of fracture involved in any of the exercises. Once your strength training is achieved, you start weight-bearing activities. After that you can start doing weight-bearing aerobic activity, a little yoga or brisk walk or maybe a low-impact dancing or some stair climbing. We should avoid high-impact exercises like jumping, running, etc. Swimming is very good for osteoporosis patients because the impact is less.”
It is essential that the exercises are done under medical supervision.
It is the small things that make a huge difference while dealing with osteoporosis, much like life – a little sunshine, good diet with adequate calcium and other minerals, and consistent exercising.
- Osteoporosis is a silent chronic bone disease that makes the bones weak. It is mostly observed in the old and women post menopause.
- Calcium and vitamin D are crucial to manage osteoporosis.
- It can be avoided by regular exercising, which stimulates the bone to grow and increases bone density.
- Slight loading, strength-training, weight-training and low-impact exercises help decrease the rate of osteoporosis progression.