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Things You Should Know About Osteoporosis and Exercise

Keep Your Bones Strong Throughout Life

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Updated January 31, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The Squat

Load your bones with the squat

(c) Paul Rogers

As people age, certain hormones decline, which can lead to weaker bones. But this weakening can be delayed or minimized with appropriate lifestyle action, if you start early enough. When it comes to exercise, you need to do sufficient dynamic, impact exercise at an appropriate intensity -- and while enormously helpful, it may not always be enough.

Case in point: Recently a woman told me she had been exercising and losing weight, and when she checked her DXA test for bone mineral density (BMD), she had lost a little bone density, too. She was devastated. Unfortunately, this isn't unusual -- middle-aged women who lose weight are vulnerable to bone loss, and while exercise is helpful, it's not a magic wand. Sometimes patience is required -- continuing with workouts, maintaining an ideal weight and eating nutritiously should recover that bone loss, to some degree. If needed, bone-building medications can help, as well.

To assist in stabilizing or increasing bone density, an exercise program needs to be somewhat "physical" for best effect, and that may not be practical for some women (and men). In addition, the catabolism (cell breakdown) related to weight loss does not help in the effort to build or even maintain bone.

The best way to have excellent bone density is to have a lifelong history of healthy diet, exercise and weight, making it vital for young women and their parents to understand this. Not only that, but how smoking, binge drinking, poor diet, lack of physical activity, under-eating and extreme dieting in this age group can be a disaster for their bone health, especially in later years.

Facts About Bone Mineral Density

  • More than a quarter of adult bone mass is laid down between the ages of 12 to 14 years in girls and 13 to 15 years in boys.
  • Genetics determine 60 to 80% of peak bone mass.
  • Diet and physical activity are predictors of bone building during growth.
  • The intensity of an exercise program needs to be sufficient to improve bone mineralization.
  • Dietary calcium predicts 10 to 15% of skeletal calcium retention during adolescence, although interaction with vitamin D is still not well understood.
  • Men retain bone better than women; and black women better than non-black women.
  • After menopause, the utility of exercise to increase bone mass depends on adequate availability of dietary calcium.
  • Moderate consumption of alcohol (1 to 2 drinks/day) may be beneficial to bone in men and women. However, more than this may decrease bone mineral density.
  • Caffeine/coffee consumption has no effect on bone economy providing adequate intake of calcium and vitamin D are consumed.

Things That Work Against Bone Health

  1. Menopause and low estrogen status in women
  2. Low androgen and estrogen status in men
  3. Low-energy and low-nutrient density diets, especially protein, calcium and vitamin K
  4. Female triad – disordered eating, cessation of periods, bone loss (some women athletes, anorexics)
  5. Excessive dietary salt; excessive alcohol consumption
  6. Inadequate fruit and vegetables
  7. Being underweight and not exercising
  8. Smoking
  9. Inadequate vitamin D from sunlight, food or supplements

What You Need to Do About Bone Density

  1. Start before puberty with appropriate exercise and healthy eating habits.
  2. Maintain normal weight and protect muscle with sports and physical activity.
  3. Eat plenty of fruit and vegetables and vegetable protein..
  4. Ensure the recommended intake of protein and calcium, especially if you're vegan or vegetarian.
  5. Eat calcium, vitamin D and K rich foods and avoid carbonated drinks, especially cola drinks.
  6. Get appropriate sun exposure for safe vitamin D absorption.
  7. Supplement to get adequate calcium and vitamin D if necessary.

Exercise for Bone Health

  • Weight training - weighted lunges and steps, jump squats, clap pushups, overhead push-presses, pump classes
  • Plyometrics – bounds, box marches, skips, hops, step classes
  • Running, jogging, fast walking, jumping, basketball, volleyball

Don’t do very low-calorie dieting and always include exercise in weight loss plans. However, under-eating and weight loss, excessive exercising and cessation of periods is a warning cluster for bone less in active women.

Don't undertake a vigorous exercise program without consulting your doctor for a clearance to do so, especially if you are older than 40 or have a limiting health condition.

Sources

Borer KT. Physical activity in the prevention and amelioration of osteoporosis in women : interaction of mechanical, hormonal and dietary factors.Sports Med. 2005;35(9):779-830.
Weaver CM. The role of nutrition on optimizing peak bone mass. Asia Pac J Clin Nutr. 2008;17 Suppl 1:135-7.
Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr. 2006 Oct;84(4):936-42.
Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr. 2003 Feb;77(2):504-11.
Vandenput L, Ohlsson C. Estrogens as regulators of bone health in men. Nat Rev Endocrinol. 2009 Aug;5(8):437-43.
Leblanc ES, Nielson CM, Marshall LM, et al. The Osteoporotic Fractures in Men (MrOS) Study Group. The effects of serum testosterone, estradiol, and sex hormone binding globulin levels on fracture risk in older men. J Clin Endocrinol Metab. 2009 Jul 7.
Booth SL, Broe KE, Gagnon DR, et al. Vitamin K intake and bone mineral density in women and men. Am J Clin Nutr. 2003 Feb;77(2):512-6.

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