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Writer's pictureRobin R Varghese, PT.
Sep 106 min read

"Exercise and Osteoporosis: How Physical Activity Supports Bone Health and Reduces Fracture Risk"




  • Bone loss is considered a universal feature of aging and is associated with increased fracture risk, especially in older women.(1)

  • Bone loss may not be an inevitable consequence of aging. Indeed, in the Utterite women, who engage in heavy daily manual work, no age-related decrease in BMD has been detected.(1)

  • Bone loss and related fractures are very common in osteoporosis.

  • Osteoporosis is defined as a condition characterized by reduced bone strength and high propensity to fractures. There is a cause-and-effect relationship between osteoporosis and fragility fractures.(1)

  • You may also check out blog on Osteoporosis here.


Can exercises be of help?

  • Exercise improves quality of life, and specific types of exercise increase muscle strength, a known predictor of bone strength, and coordination and balance, and so reduce the risk of fall related fractures.(1)

  • Observational studies and clinical trials in children have consistently shown the beneficial effects of exercise, and the deleterious effects of the lack thereof, on bone characteristics and fracture risk.(1)

  • Studies have shown that weight-bearing exercise, resistance training, or WBV training help maintain or improve bone mass, and improve the BMD of postmenopausal women, thereby promoting health and improved quality of life.(2)

  • Exercise should definitely be the mainstay of the prevention and treatment of osteoporosis.(1)

  • Regular exercise helps keep the bone healthy and improve bone health by stimulating bone formation and strength through mechanical loading, even if it does not significantly improve BMD.(2)


How do bones benefit from mechanical force of exercise?

  • As described by Robling et al., mechanical forces applied to bone tissue induce the movement of interstitial fluid along tubules and bone cell pores, thereby causing cell-level shear stress and deformation of bone cell plasma membrane. These changes lead to the beginning of the bone remodeling process and stimulate bone resorption and formation cycles.(2)

  • Mechanical forces led to remodeling of bone and appear to act via forces on cells to maintain a physiological balance(3)

  •  BMD is on average higher in athletes with sporting activities involving jumping (volleyball, basketball ball rugby, soccer, and martial arts) compared to those who do not have these mechanical characteristics, such as swimming, rowing, and cycling.(4)

  • Several clinical trials have tested the hypothesis that exercise increases bone mass in children and adults, with mixed results.(1)


Are the value of exercises being downplayed?

  • Physicians don’t have enough know-how for evidence based prescription of exercise.(1)

  • Moreover, the lack of facilities for safe implementation of the exercise programs compound the problem.(1)

  • Patients are typically given by the caring physician only a generic advise to increase physical activity such as, for instance, walking, swimming or stretching or, at best, they are advised to attend a gym but rarely receive an individualized, clear and detailed prescription of the type and amount of the exercise likely to be effective in his/her particular case.(1)

  • Even more rarely, a follow-up schedule is provided such that exercise- related improvements are recorded and used in the global management of the patient.(1) 

  • The reasons for downplaying the value of exercise in the osteoporosis management are both cultural and practical; on one hand physicians often ignore the principles of exercise for metabolic diseases and on the other hand there is a lack of facilities devoted to train these difficult patients: many gyms even exclude from their membership patients with a diagnosed osteoporosis.(1)

  • Medical management of osteoporosis and exercise programs adequate to prevent falls through improvement in balance and muscle and bone strength be provided in the same setting.(1)


Osteogenic exercises

  • Osteogenic exercises (Osteo=bone & Genic=stimulates growth) are the type of exercises that stimulate the growth of the bone and increase bone density by applying load to the bones. This load can be:

    • High-impact, such as jumping or running,

    • Low-impact, such as walking, or resistance training.(5)

  • Osteogenic exercises are thought to work by increasing the number of bone-forming cells and by stimulating the production of new bone tissue. (5)

  • Osteogenic exercises are often recommended for people with osteoporosis because this can help increase the bone mineral density and reduce the risk of fractures. Bone mineral density increases through exercise are important when attempting to prevent and treat osteoporosis.(5)

  • They also have advantages like reduction of bone loss and risk of fracture, improves bone density and physical fitness and reduces falls .(5)


    What is the right choice of Exercise?

  • Based on literature review,

therapeutic exercises for osteoporosis can be ranked in two types of activities:

i.    Weight-bearing aerobic exercises, such as impact activities or any other exercise in which arms, feet, and legs are bearing the weight, (i.e., walking, stair climbing, jogging, volleyball, tennis and similar sports, Tai Chi, and dancing).

ii.   Strength end/or resistance exercises, in which the joints are moved against some kind of resistance, in the form of free weights, machines, tubing, or one's own body weight.(4) 

  • However, it is still not clear which exercise is the best suited and how long it would take to obtain an appropriate result.

  • While the isolated exercise (single bout training) seems to give a fleeting osteogenetic stimulation, a longer training, for example, 2 times a day for 5 weeks, seems to provide a better stimulation.(4)

  • From a mechanically-centric point of view, activities that generate higher intensity or quicker loads (such as resistance training and leaping) are excellent for promoting bone health because they stimulate existing bone cells in a significant way. Consequently, bone-healthy exercise encourages mesenchymal stem cells to differentiate into osteoblast lineages, thereby producing more healthy bone cells.(2)

  • the prescription of exercise in the elderly and osteoporotic patient must always be preceded by a careful evaluation: indeed, it is essential to define the type, intensity, and duration of a proposed program. The decision is based on the subject's muscle strength, range of motion, balance, gait, cardiopulmonary function, comorbidities, bone density, and history of previous fractures, as well as the risk of falling.(4)

  •  In clinical practice, however, the most intense exercises, such as high impact activities, that are effective in increasing bone mass in young subjects may not be indicated for some elderly osteoporotic subjects. The progression of the exercise must always be respected, and, in patients with severe osteoporosis, the activities involving the flexion or rotation of the trunk must be avoided.(4)

  • Exercise has the potential to be a safe and effective way to avert bone loss in postmenopausal women. The summary of a Cochrane review presents the effect of exercise on bone mass in postmenopausal women. The results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups.(6)

The review shows that for postmenopausal women

-        Exercise will improve bone mineral density slightly.

-        Exercise will reduce the chances of having a fracture slightly.(6)


Multicomponent training:

 The multicomponent training consists of a combination of different exercises (aerobics, strengthening, progressive resistance, balancing, and dancing) and it is aimed at increasing or preserving bone mass. This implies that the same interventions are provided to all people, differently from multifactorial training, customized on the individual characteristics.

The combination of multiple types of exercise would have a significant effect on BMD at three sites: femoral neck and greater trochanter, but the maximum benefit would be achieved at the spine level.(4)


Training with Vibrating Platforms

The vibration of the entire body is a physiotherapy intervention based on the use of a high frequency mechanical stimulus generated by a vibrating platform (Whole Body Vibration or WBV) that activates the mechanoreceptors of the bone favoring osteogenesis. The results of the studies included in two systematic reviews conclude that the treatment with a WBV seems to be more effective than simple walking and of similar efficacy to strength training to improve bone mass at specific sites (femoral neck and spine) in postmenopausal women.(4)


Research

  • Despite controversy on some forms of exercise, physical exercise is generally recognized as an effective means to stimulate bone osteogenesis after the fourth decade of life and in osteoporotic patients. Supplementation with Vitamin D has not yet demonstrated any additive effect on bone mineral density, when combined with exercise.(5)

  • Postmenopausal women with osteoporosis may achieve more significantly improved lumbar spine BMD with HiRIT( high-intensity resistance and impact training) than with MiRIT. (moderate -intensity resistance and impact training).(7)

  • Exercise interventions during the maturation phase, and especially during peripubertal development, are likely to be highly beneficial for maximizing peak bone mass; this is because exercise during skeletal growth is more osteogenic than exercise during adulthood.(5)



At Valley Healing Hands, we provide the best Physical Therapy treatment for bone loss, muscle loss or any other conditions that require physical therapy care. We provide an atmosphere developed for our patients with a one on one ratio for the best quality of care needed for maximum outcomes and return to your favourite routine. Our physical therapist are highly qualified and ever willing to plan an individualized treatment program, customized to your specific needs. Our patients are highly satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will! We can get you back in the game!!!




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