Understanding essential facts about osteoporosis and engaging in regular bone-building exercise are key to maintaining bone health as we age.
By Joan Pagano
A study conducted by the National Osteoporosis Foundation (NOF) revealed that most women over the age of 45 fail to recognize their personal risk of developing osteoporosis, the disease of “porous bones,” in which a lack of bone mineral, primarily calcium, causes the bones to deteriorate.1 Even though the majority of women have at least two risk factors for the disease by age 45—namely being female and reaching midlife—they do not perceive themselves to be at risk.
Step 1: Know the Facts about osteoporosis
Now is the time to debunk the myths and common misconceptions about osteoporosis and get on the right track.
“If I had osteoporosis, I would know it.”
NOT SO—the only way to be sure is to have a bone-density test.
Osteoporosis is a silent disease that progresses slowly and painlessly over time without symptoms. As the bone gradually diminishes in strength and structure, it becomes increasingly fragile. In fact, the first sign that you have it may be a bone fracture.
Certain people are more likely to develop osteoporosis than others. According to the NOF, factors that increase one’s risk of developing the disease include being female; having a small, thin frame; smoking; loss of menstruation when not pregnant; family history of the disease; and having a personal history of a fracture as an adult.2 Medical conditions like breast cancer, multiple myeloma, hyperthyroidism, rheumatoid arthritis, and premature menopause, among others, also increase the risk, as do some of the medications used to treat them.
The NOF recommends speaking to your healthcare provider about getting a bone-density test if you are a postmenopausal woman under the age of 65 with one or more risk factors for osteoporosis or if you are 65 or older even without any risk factors. If you have several risk factors, speak to your doctor to see if you should be tested.
“Osteoporosis affects only older women.”
Unfortunately, young women are also at risk of this disease. This is because the sex hormone estrogen protects bones; if you have low estrogen at an early age, you may be at risk of osteoporosis. One key reason why younger women may experience low estrogen—and related osteoporosis—is unhealthy, obsessive thought patterns about body, weight, and food, which can lead to disordered eating and excessive exercise. This scenario creates a stress condition in the body that alters hormonal levels, shuts down the reproductive system, disrupts the normal menstrual cycle, and begins silently destroying bone. The combination of amenorrhea (cessation of your period), disordered eating, and osteoporosis is known as the “female athlete triad.” An eating disorder and excessive exercise are both independent risk factors, as well. It is possible for a 20-year-old woman to have 60-year-old bones!
“Osteoporosis is not a very common or serious disease.”
According to the NOF, 54 million Americans over the age of 50 are affected by osteoporosis or osteopenia (low bone mass) and at greater risk of fracture. For women the incidence of fracture is greater than that of heart attack, stroke, and breast cancer combined.3
The consequences are life changing and include bone fractures of the hip, spine, and wrist. Hip fractures cause the most suffering to the individual and require the most extensive treatment and recovery. Vertebral fractures of the spine heal on their own but remain compressed, causing a loss of height, stooped posture, and in extreme cases difficulties in breathing and digestion. The wrist is the least debilitating fracture but still may require a cast and rehabilitation.
“Because osteoporosis runs in my family, I can’t do much about it.”
While it’s true that your ability to make bone is strongly influenced by genetics, lifestyle factors also play an important role, especially during childhood and adolescence. In these formative years, good nutrition (including adequate calcium) and regular physical activity have a positive effect on the growing skeleton.
Throughout your life your skeleton loses old bone and forms new bone. Children and teenagers form new bone faster than they lose old bone. By age 18 to 25, your peak bone mass— the highest bone content of your life—has been established.2 Unhealthy behaviors during the peak bone-building years, including smoking and excessive alcohol consumption, may override a genetic tendency toward higher bone mass.
Peak bone mass is a significant determinant for risk of fracture over a lifetime. As you mature, you hang on to the bone that you established during your youth. Although bone continues to renew itself, from this time on you will experience a natural decline in bone density, which accelerates at menopause. Because relatively little bone mineral can be added to the mature skeleton, it follows that the growing years are the key time to put bone “in the bank.” The higher the deposit, the more you have to draw out.
“All women in their eighties have this disease.”
Even though the risk of getting osteoporosis increases with age (a key factor being a lack of estrogen after menopause), a report conducted by researchers at the Centers for Disease Control and Prevention found that the disease does not affect all older women. The findings showed that 10 percent of women in their sixties, 27 percent of women in their seventies, and 35 percent of women age 80 and older have the condition.4
“If I don’t eat enough calcium, I can compensate by exercising harder to increase bone density.”
Adequate calcium plus regular exercise have an additive effect on bone. You cannot compensate for a lack of one by increasing the other. According to the NOF, calcium needs change over the course of a lifetime but are greatest (800 to 1,300 milligrams [mg]) during childhood and adolescence, and also during pregnancy and breastfeeding, and then again after age 50. From ages 19 to 49, the recommended intake for both men and women is 1,000 mg daily. If you are unable to consume enough calcium from food, you can make up the difference by taking a calcium supplement.
The NOF recommends five steps to improve bone health and prevent osteoporosis and broken bones:3
- Get the calcium and vitamin D you need every day.
- Do regular weight-bearing and muscle-strengthening exercises.
- Don’t smoke and don’t drink too much alcohol.
- Talk to your healthcare provider about your chance of getting osteoporosis, and ask when you should have a bone-density test.
- Take an osteoporosis medication when it’s right for you.
Step 2: Understand the Benefit of exercise
Now that you know the facts about osteoporosis, take action—if you haven’t already—with regular exercise.
OSTEOPOROSIS is not an inevitable part of the aging process. It is largely preventable and treatable. Current research on osteoporosis is focused on how exercise can help prevent and treat this condition.
Resistance is the key factor in both types of exercise that build bone: weight-bearing aerobic exercise and weight lifting. In weight-bearing exercise, your muscles resist the force of gravity to keep you in an upright position. In weight lifting, you apply resistance to the muscle to stimulate growth (hypertrophy) of the muscle fibers. In both cases, the pull of the muscle on the bone causes a parallel hypertrophy to the bone.
Exercise has a dramatic effect on the growing skeleton, which is why it is essential for children to be physically active. Once the skeleton stops growing, the effect of exercise on bone is more modest. If you do not develop adequate bone-mineral density at an early age, your risk of osteoporosis increases in the postmenopausal years. Some bone lost through inactivity may be restored, however, and major bone loss can be prevented before ages 30 to 35.
Step 3: Exercise for BONE HEALTH at Every Age
Ages 18 to 35
From ages 18 to 35, the goal is to achieve the highest peak bone mass. Activity should maximize the load to the bones with a progressive (i.e., gradual intensification) exercise program:
- High-impact exercise includes activities in which both feet are off the ground at the same time, as in running, jumping rope, and high-intensity aerobic dance; and also sports like basketball, volleyball, and gymnastics.
- High-intensity weight lifting uses the heaviest weights you can lift in good form. Aim for 8 to 12 repetitions, with the last few reps being challenging. Do one to three sets of each exercise. To target bones throughout the body, do 8 to 10 exercises for all the major muscle groups: hips and thighs, back, chest, shoulders, arms, and abdomen.
Ages 35 to 50
From ages 35 to 50, the goal is to maintain bone mass, offset or reduce bone loss, and improve coordination and balance.
- Follow the previous guidelines, using common sense. To protect your joints from injury, use good judgment regarding high-impact exercise and high-intensity weight training.
- Focus on strengthening the bony sites most vulnerable to fracture: the thighbone, spine, and wrist.
- Add balance training, such as stork stance and “tightrope walk.”
- To improve your stability, incorporate exercises using a stability ball, a BOSU ball, and foam rollers.
From age 50 onward (including post-menopausal), the goal is to conserve bone and reduce the risk of falls and fractures.
- Continue with strength training, balance, and stability exercises.
- If you are doing a walking program, be sure to vary your route to include hills and steps, adding intervals of increased speed or jogging, if appropriate.
- Focus on stretching exercises to maintain your height and spinal alignment. Changes in posture become more pronounced at this age and can cause a shift in your center of gravity, increasing the risk of falls.
Armed with the facts of bone health, you can make positive choices now that will serve you over a lifetime. If you have been diagnosed with osteoporosis, you need to protect your bones and avoid impact activities and movements that overload the spine. Consult your healthcare provider about specific exercise guidelines and restrictions.
Of course, this information should not take the place of guidance from your own healthcare provider. Always consult your doctor before beginning an exercise program or becoming much more physically active.
1. National Osteoporosis Foundation. Most women 45+ fail to recognize personal risk, survey from NOF and AoA highlights need to raise awareness. The Osteoporosis Report. 2004;20(2):1-2.
2. Boning Up on Osteoporosis, A Guide to Prevention and Treatment. Arlington, VA: National Osteoporosis Foundation; 2008:8-15.
3. NOF email bulletin, June 7, 2016; in response to article: Kolata G. Fearing drugs’ rare side effects, millions take their chances with osteoporosis. New York Times, June 1, 2016. Available at: http://www.nytimes. com/2016/06/02/health/osteoporosis-drugs-bones.html. Accessed July 22, 2016.
4. Looker AC, Borrud LG, Dawson-Hughes B, Shepherd JA, Wright NC. Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults: United States, 2005–2008. NCHS data brief no 93. Hyattsville, MD: National Center for Health Statistics. 2012. Available at: http://www.cdc. gov/nchs/data/databriefs/db93.htm. Accessed July 22, 2016.
Copyright © Joan Pagano 2016
Joan Pagano is the author of best-selling fitness books, including Strength Training Exercises for Women; a motivational speaker on health and fitness topics; and the owner of Joan Pagano Fitness in New York City. Former trainer to Jacqueline Onassis and Caroline Kennedy, Joan has specialized in strength training for women since 1988. She is an authority on the benefits of exercise for such women’s health issues as menopause, osteoporosis, and breast cancer, as well as strength training across the decades. For more information visit joanpaganofitness.com.