Osteoporosis is a metabolic bone disease that silently steals bone mass. It’s a condition that, if left untreated, is progressive and gradually increases the risk of falls and fractures. Fortunately, bone is a living tissue, and it can be improved through certain types of exercise.

Pharmacological intervention is important, but exercise prescription and education are pivotal in the management of osteoporosis. Physiotherapists can support clients to improve bone density, muscle mass, balance, fall risk, self-esteem and lifestyle choices.

Senior Physiotherapist Mark Summers says physiotherapists are in an ideal position to provide advice and guidance in formulating an appropriate and effective load-bearing and resistance exercise program.

“This is an essential part of a physiotherapist’s management plan for people with osteoporosis.

“Exercise is good for all ages to help strengthen bones. It must be the right exercise, be carefully monitored, and the intensity must be gradually increased to avoid injury.”

Informing clients about osteoporosis risk and management is also a priority for physiotherapists.

“Educating those with osteoporosis or those in high-risk groups is the first step in order to prevent further deterioration of bone mass or injury.”

There are many misconceptions about osteoporosis, explains Mr Summers, and the most common are at odds with best-practice treatment for the disease.

“One of the biggest misconceptions is that people with osteoporosis should not lift weights or partake in high-intensity exercise programs as they will break bones.

“Another is that people with osteoporosis should only do low impact exercises such as swimming and bike riding.

“While these types of exercise are good for overall cardiovascular fitness and muscle strength, they are not the most effective exercise for bone strength.”

A recent Australian study called the LIFTMOR trial proves that high impact exercise and resistance training improves bone health, muscle strength and balance for those with low bone density.

Risk of developing osteoporosis is two-fold

Genes are a significant factor when it comes to the risk of developing osteoporosis, but there’s more to it.

“Some people with a genetic predisposition to developing osteoporosis say that it just happens, and you can’t do anything about it.

“The phrase, ‘Gene’s load the gun, but lifestyle factors pull the trigger’ is an apt way of explaining how the condition progresses.”

A family history, being a woman (due to hormone changes post-menopause) and medical conditions such as diabetes, hyperthyroidism, digestive malabsorption diseases, rheumatoid arthritis and chronic kidney and live diseases all increase risk of developing osteoporosis, explains Mr Summers.

It’s not all bad news, though.  Lifestyle factors also play a part, and it pays to start young.

“Bone density develops during childhood. It’s important to exercise as a child, especially during early puberty when bones are growing most rapidly.

“Bone growth slows for women in their late teens, and early twenties for men, and this is the time when you reach your peak bone mass. After reaching peak bone mass, it slowly decreases over time.”

Physiotherapist Michael Dermansky agrees, saying osteoporosis is a primary priority for women over age sixty, but it should be a consideration for all women and men in their twenties.

“We really have the best chance to create the largest base in bone density at this age to prevent the effects of osteoporosis in older age.”

Research is now showing that lifestyle factors such as exercise cannot only reduce the rate of bone density loss but may even stop the decline.

“We knew that weight-bearing exercises could hopefully reduce the rate of loss in bone density as you get older.

“Studies now show, and we have seen firsthand, that adding classic strength and conditioning exercises, especially combined with osteoporosis medication such as Prolia, can see a real improvement in bone density, which has made us very excited.

“Age is not a limiting factor, and even women in their eighties and nineties can lift weights to improve bone density,” says Mr Dermansky.

The protective factors that minimise bone density loss include exercise and a healthy diet, says Mr Summers.

“If you have a sedentary lifestyle and do not exercise, you will lose more bone mass and develop brittle bones-osteoporosis.

“Consuming a healthy diet with calcium-rich foods is also beneficial.

“Ensuring that the body’s vitamin D levels are maintained is important, as vitamin D helps the body absorb calcium which can impact on bone density.”

Lifestyle and exercise choices are also significant when it comes to minimising risk and reducing the severity of osteoporosis, adds Mr Dermansky. 

“Smoking, excessive alcohol and caffeine intake are all factors we can control and change the risk of and reduce the progression of osteoporosis in our lives.

“Start weight-bearing exercise under the guidance of a qualified physiotherapist or an exercise physiologist two to three times a week to use major muscle groups.

“Take a pro-active step in improving bone density and reduce the risk of osteoporosis affecting your life or lifestyle.”