Osteoporosis and exercise

Osteoporosis is the loss of calcium and other minerals from a person’s bones, which makes the bones susceptible to fracturing (breaking). In Australia, around half of all women and one third of men over 60 years of age have osteoporosis. Women are more likely to have osteoporosis because the hormonal changes of menopause make bone loss worse.

A nutritious diet including calcium-rich foods and regular exercise throughout a person’s life (including during childhood and adolescence) will reduce the risk of osteoporosis in later years.

People with existing osteoporosis can also benefit from exercise. This is because a sedentary lifestyle (little exercise) encourages the loss of bone mass. Exercising regularly can reduce the rate of bone loss and specific types of exercise can improve bone health.

Most bone fractures occur because of a fall. You can reduce your chances of falling by exercising to build your muscle strength and improve your balance. Exercise can also slow the rate of bone loss, which reduces the risk of fractures from osteoporosis.

Exercise also brings other benefits to people who have osteoporosis or want to prevent osteoporosis. These include reduced need for some medications that can contribute to the risk of falls, and better management of other health problems.

Benefits of exercise for people with osteoporosis

A sedentary lifestyle, poor posture, poor balance and weak muscles increase the risk of fractures. A person with osteoporosis can improve their health with exercise in valuable ways, including:

• reduction of bone loss
• improved bone mass
• conservation of remaining bone tissue
• improved physical fitness
• improved muscle strength
• improved reaction time
• increased mobility
• better sense of balance and coordination
• reduced risk of bone fractures caused by falls
• reduced pain
• better mood and vitality.

Deciding on an exercise program for people with osteoporosis

Always consult with your doctor, physiotherapist, exercise physiologist or health care professional before you decide on an exercise program. Factors that need to be considered include:

• your age
• the severity of your osteoporosis
• your current medications
• your fitness and ability
• other medical conditions such as cardiovascular or pulmonary disease, arthritis, or neurological problems
• whether improving bone density or preventing falls is the main aim of your exercise program.

A combination of weight-bearing impact loading, aerobic and muscle-building (resistance) exercise is best, together with specific balance exercises.

Recommended exercises for people with osteoporosis

Exercises that are good for people with osteoporosis include:

• weight-bearing, impact loading exercise such as dancing
• resistance training using free weights such as dumbbells and barbells, elastic band resistance, body-weight resistance or weight-training machines
• exercises to improve posture, balance and body strength, such as tai chi.

Ideally, weekly physical activity should include something from all three groups.

Swimming and water exercise for people with osteoporosis

Swimming and water exercise (such as aqua aerobics or hydrotherapy) are not weight-bearing exercises, because the buoyancy of the water counteracts the effects of gravity. However, exercising in water can improve your cardiovascular fitness and muscle strength.

People with severe osteoporosis or kyphosis (hunching of the upper back) who are at high risk of bone fractures may find that swimming or water exercise is their preferred activity. Consult with your doctor or healthcare professional.

Walking for people with osteoporosis

Even though walking is a weight-bearing exercise, it does not greatly improve bone health, muscle strength, or balance. However, for people who are otherwise inactive, walking may be a safe way to introduce some physical activity.

Exercises that people with osteoporosis should avoid

A person with osteoporosis has weakened bones that are prone to fracturing. They should avoid activities that:

• involve loaded forward flexion of the spine such as abdominal sit-ups and toe touches
• increase the risk of falling
• require sudden, forceful movement, unless introduced gradually as part of a progressive program
• require a forceful twisting motion, such as a golf swing, unless the person is accustomed to such movements.

The best amount of exercise for people with osteoporosis

The exact amount of exercise required for people with osteoporosis is currently unknown. However, guidelines suggest:

• weight-bearing impact loading exercises a minimum of three days per week – each session should contain 50 impacts
• resistance training two to three times per week– each session should include two to three sets of five to eight exercises
• balance exercises – minimum three sessions a week to accumulate at least three hours of any type of progressive and challenging balance activities. For safety reasons, always make sure you can hold on to something if you overbalance
• stretching exercises to promote flexibility.

You need to continue your exercises over the long term to reduce your chances of a bone fracture. Please consult with a physiotherapist or exercise physiologist for further advice.

Professional advice for people with osteoporosis

Regular exercise is an essential part of any osteoporosis treatment program. See your doctor before starting a new exercise program. Physiotherapists and other exercise professionals can give you expert guidance.

Always start your exercise program at a low level and progress slowly. Exercise that is too vigorous too quickly may increase your risk of injury, including fractures. Also, consult your doctor or a dietitian about ways to increase the amount of calcium, vitamin D and other important nutrients in your diet. They may advise you to use supplements.

Avoid smoking and excessive alcohol, which are bad for your bones.

Where to get help

• Your GP (doctor)
• Physiotherapist
• Healthy Bones Australia
• Jean Hailes for Women's Health