Exercise for Osteoporosis

Prevention of osteoporosisDr Z.BonakdarRheumatologistAssessing the risk of developing OP Family history: Parental history of hip fracture Medical history: Advanced age; frailty; hyperthyroidism; hyperparathyroidism; celiac and other malabsorption syndromes; BMI < 20 kg/m2 or weight loss; long-term glucocorticoids , > 3 months of prednisone 7.5 mg; rheumatoid arthritis; or chronic liver or kidney disease Gender risks: For men, androgen deficiency (primary or secondary); For women, estrogen deficiency, menopause age < 45 years, or cessation of menstruation for 6-12 consecutive months Lifestyle: Smoking (current or former), daily alcohol > 3 units, caffeine > 4 cups/day, inadequate calcium / vitamin D intake, lack of sunlight, prolonged immobility / lack of weight-bearing exercise3Assessing the risk of falls and fracturing within 10 years Previous fragility fracture (hip, vertebra, humerus, wrist) or fall in the past year High risk of falling, physical frailty or significant weight loss; poor strength, balance, gait, visionIndication of BMD

Exercise for Osteoporosis

Bone accretion occurs during adolescence and peak bone mass is normally achieved after puberty and into the third decade of life

Bone mass declines with age, about 0.3- 0.6% in cortical bone and 0.8- 1.2% in trabecular bone annually

At menopause, an acceleration of bone loss occurs over approximately 5 to 8 years, with an annual 2 to 3 percent loss of trabecular and 1 to 2 percent loss of cortical boneOver lifetime, women lose approximately 50 percent of trabecular and 30 percent of cortical bone, where as men lose two thirds of these amounts

After 50 years of age, there is an exponential rise in fractures such that 40 percent of women and 13 percent of men develop one or more osteoporotic fractures

We lose so much muscle as we age that by the time we're 70, we only have about 50% to 55% of our muscle mass left.If you persist with your weight training, even a 1% change in bone density every year adds up to a 10% difference after ten years. That's a lot of bone. If you have osteoporosis in your spine, don't lift more than 20 to 25 pounds with your arms or against your trunk, and avoid movements that have you twisting your trunk or bending forward extensively.Three types of exercise for osteoporosis are: Weight-bearingResistanceFlexibilityAll three types of exercise for osteoporosis are needed to buildhealthy bones.

Weight-bearing exercise for osteoporosis are: Walking Hiking Dancing Stair climbingRacquet SportsSports like bicycling and swimming are great for your heart and lungs.However, these are not weight-bearing exercise for osteoporosis.At least half an hour of moderate to vigorous exercise five times a week.Walking four hours a week cause a 41% lower risk of hip fractures.

Resistance exercise for osteoporosis includes:Free weights or weight machines at home or in the gymResistance tubing that comes in a variety of strengthsWater exercises, any movement done in the water makes your muscles work harder. For best results, do resistance exercises two or three times a week. Resistance helps with osteoporosis because it strengthens muscle and builds bone.

For best results, do resistance exercises two or three times a week. the exercise more challenging by gradually adding weight or repetitions. Work all your different muscles -- including arms, chest, shoulders, legs, stomach, and back. Give each muscle group time to recover. Flexibility exercise for osteoporosis include these:Regular stretchesT'ai chiYoga Flexibility is another important form of exercise for osteoporosis. Having flexible joints helps prevent injury.

Tai ChiTai chi a form of slow, graceful moves builds both coordination and strong bones. A study reported inPhysician and Sports medicinefound that tai chi could slow bone loss in postmenopausal women. The women, who did 45 minutes of tai chi a day, five days a week for a year, enjoyed a rate of bone loss up to three and a half times slower than the non tai chi group. Yogayoga can build bone health in your hips, spine, and wrists -- the bones most vulnerable to fracture. Yoga also sharpens your balance, coordination, concentration, and body awareness and thus helps prevent falls.

Body Vibration [WBV] In a study of healthy, postmenopausal women, a 24-week whole body vibration program was shown to improve muscle strength, balance and hip bone density. The Bone Mass Density (BMD) of the hip increased by 1% .Research indicates that the highest muscle reflex response may occur between 30Hz and 40Hz. The duration of the vibration exercise programs was between 20-30 minutes.

Dynamic Motion Therapy (DMT) Avoid a Slip, Fall, or Fracture

Diet and osteoprosisNutritionCalcium and vitamin D prepubertal children 800 mg/day adolescents 1300 mg/day women and men 1000 mg/day women and men over 50 years 1500 mg/day women and men 400 IU/day women and men over 50 years 800 IU/dayTea contains fluoride and phytoestrogens with positive role in bone healthExcess caffeine > 4 cups should be avoidedExcess dietary sodium > 2100 mg/day or 90 mmol/day should be avoided

NutritionExcessive alcohol should be avoidedCigarette smoking should be stoppedExcessive vitamin A should be avoidedHigh protein diet should be avoidedVitamin K may be efficacious in slowing bone loss but has not been shown to be superior to Ca and vitamin DPopulation with high phytoestrogen intakes have lower rates of fractureMultinutrient supplement 600 mg magnesium, 15 mg zinc, 120 mg vitamin C, 80 mg vitamin K, 3 mg boron- all nutrients believed to be important for bone health

You can get ample calcium from any of the following:Low-fat or fat-free dairy productsCalcium fortified juices and foodSardines with bonesCertain vegetablesSoy productsCalcium supplements

Types of calcium supplements include:Calcium carbonate, which is 40% elemental calcium.Calcium citrate, which is 21% elemental calcium. While lower in elemental calcium than calcium carbonate, calcium citrate is easier to digest and does not causeconstipationas much as other types of calcium supplements.Calcium gluconate and calcium lactate, which contain a low amount of elemental calcium.

Vitamin D can be obtained through minimal sun exposure (10 minutes a day) and from your diet. Vitamin D is in foods such as salmon, tuna, and mackerel.Other foods with vitamin D, but in small amounts, include cheese, egg yolks, and beef liver. You can also get vitamin D from fortified foods such as milk and some cereals, orange juices, yogurts, margarines, and soy drinks.Recommended calcium and vitamin D by age Age Recommended Recommended calcium intake vitamin D intake (milligrams a day) (international units a day) 1-3 years 700 600 4-8 years 1,000 600 9-18 years 1,300 600 19-50 years 1,000 600 Males 51-70 1,000 600 Females 51-70 1,200 600 71 and older 1,200 800

Breakfast Foods Average Calcium (mg)Cereal, calcium-fortified, 1 cup 100 - 1000Soy milk, calcium-fortified, 8 ounces 80 - 500Milk, 1 cup 300Yogurt, 1 cup 300 - 400Orange juice, calcium-fortified 200 - 340

Lunch, Dinner, and Snack Foods Average Calcium (mg)Canned sardines, 3 ounces 320Swiss cheese, 1 ounce 270Cheddar cheese, 1 ounce 200Canned salmon, 3 ounces 200Turnip greens, 1 cup 200Kale cooked, 1 cup 90Broccoli, raw, 1 cup 90

High Calcium Intake Linked to Heart Disease, DeathIn contrast, a recent meta-analysis concluded that calcium supplementswithout co-administered vitamin D were associated with an increase in therisk of myocardial infarction by around 30 % . Cardiovascular outcomes were not primary endpoints in any of the studiesand the association remains the subject of some controversy. They found that women who consumed more than 1400 mg of calcium dailyhad a higher rate of death from all causes (hazard ratio [HR], 1.40; 95% CI,1.17-1.67) than women who consumed between 600 mg and 1000 mg daily.Women who consumed more than 1400 mg of calcium daily also had a higherrisk of death from cardiovascular disease (HR, 1.49; 95% CI, 1.09-2.02) andischemic heart disease (HR, 2.14; 95% CI, 1.48-3.09) but not stroke.