Reader Question: I was diagnosed with Osteoporosis two years ago. I started an aggressive weight bearing exercise program with brisk walking and stair climbing 7 days a week for more then 1 hour. I have also been taking a bisphosphonate as well as adequate calcium and vitamin D. However, I recently had a bone density test and my scores did not increase at all. What went wrong? Was it all for nothing?
This is a common question that I am asked and a recurrent source of frustration for my patients.
First of all, it is important that one is fully evaluated by their physician to ensure that there is nothing else that could be stopping them from improving their bone density. This could include a secondary condition such as thyroid disease, improper intake of their osteoporosis medication such as taking it with food, or inadequate calcium and vitamin D intake. Once these possibilities are eliminated, we can address the value of exercise.
There have been numerous studies in the past that have emphasized the benefits of weight bearing exercise.
In a recent article in the journal Bone, the authors did a meta-analysis (a combination of many studies to prove an outcome) to see if walking had any benefit on bone density. They reviewed eight trials that lasted up to 2 years. They concluded that this exercise regimen did not show any improvement of bone density at the spine and that it showed positive, although inconsistent results at one of the areas of the hip (femoral neck region).
However, this study shouldn't stop you from exercising. First of all, the study did not show that there was a loss of bone density in these individuals. This is obviously important as one may continue to lose bone density as one ages and exercise may therefore help maintain ones bones. In addition, the positive value of exercise has been shown in many studies. It is important for maintaining your posture and balance as well as improving your overall fitness.
Exercise works by keeping your muscles strong to support your bones, by improving your balance and preventing falls and by directly stressing the bone in order to maintain its strength and mineralization. Other studies have clearly shown that the risk of fracture, which without a doubt is the most important outcome and goal, decreases with an exercise program, even in cases were there was no improvement in bone density.
Exercise programs should be weight-bearing. This includes brisk walking, jogging, hiking, dancing, aerobics, stair climbing, elliptical, and numerous team sports such as soccer, baseball and basketball. They should be done at least 4 times per week, for 30 minutes.
Immobility (not moving regularly) clearly has been shown to be a major risk factor for fractures. The new National Osteoporosis Foundation guidelines give as much value to this as to steroid use, recommending aggressive treatment if one has osteopenia (decreased bone density) and either one of these risk factors.
If one already has osteoporosis or osteopenia, certain activities are not advised since they can precipitate a fracture. Risky activities include excessive forward bending, heavy lifting, twisting movements and high impact activity involving sudden starts and stops as well as abrupt weight shifting.
One must be careful to exercise properly but only after consultation with your physician.
Published On: July 15, 2008