Osteoporosis- understanding and managing bone health

Osteoporosis is a topic that affects millions worldwide. As I prepare to teach a donation-based workshop at Pilates Nosara in Costa Rica (with proceeds supporting the monkey 🐒bridges), I wanted to share essential information about this condition that particularly impacts women over 50.

What is Osteoporosis?

Osteoporosis, meaning "porous bone," is a serious condition where the body either loses too much bone, makes too little bone, or both. This leads to weakened, brittle bones that are more susceptible to fractures. A milder form, known as osteopenia, represents an early stage of bone density loss. When bone mineral density (BMD) decreases significantly (>25%), it's classified as osteoporosis, increasing fracture risk by 4-8 times.  The bones most commonly affected by osteoporosis are the hip, thoracic spine, and wrist.

The Global Impact

The International Osteoporosis Foundation reports alarming statistics:

• Worldwide, approximately 6.3% of men and 21.2% of women over the age of 50 have osteoporosis.  Based on the world population of men and women, this suggests that approximately 500 million men and women worldwide may be affected.

• 1 in 3 women and 1 in 5 men over the age of 50 will experience osteoporotic fractures in their lifetime.

• With an aging population and longer life span, osteoporosis is increasingly becoming a global epidemic.

• Although osteoporosis affects both sexes, it is more prevalent in women, particularly postmenopausal women, due to hormonal changes that lead to bone loss

• Most fractures occur in postmenopausal women and elderly men 

Understanding Risk Factors:

Several factors can increase the risk of developing osteoporosis:

• Aging

• Menopause induced hormonal changes (low estrogen)

• Chemotherapy or medicines such as steroids

• Body type: being slender or thin

• Race: higher risk in white and Asian women

• Diet: low calcium and vitamin D intake, excessive dieting or poor protein intake

• Other medical conditions: endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals

• Family history of osteoporosis

• Lifestyle choices: smoking, drinking excessive amounts of alcohol, low levels of physical activity, overall poor physical condition

What can we do to help prevent osteoporosis and fractures:

• Increase bone mineral density with weight-bearing exercises (walking, hiking, squats, lunges, resistance weight training)

• Eat a nutritious diet rich in calcium and vitamin D

• Quit smoking

• Drink alcohol only in moderation

• Practice good posture

• Work on balance and proprioception to prevent falls

• Avoid spinal flexion (e.g. poor sitting posture, bending over to touch toes, sit-ups, rollups, crunches)

• Avoid pressure on the rib cage

• Avoid weight bearing on the cervical or thoracic spine (headstand, plow pose, Pilates exercises such as short spine or rollover)

• Limit spinal rotation and lateral flexion

• Avoid forced external rotation of the hip

Bonus for Pilates Instructors and practitioners-

Pilates can help! 💪

As fitness professionals, we can make a significant impact through targeted Pilates exercises, so we need to know which exercises to focus on and which to avoid for optimal bone health.  Here are a few tips for instructors:

• Focus on thoracic extension to improve posture

• Work abdominals, but only in extension or neutral

• Improve balance and proprioception (to reduce risk of falls that lead to fractures)

• Increase core strength and core connection

• Increase overall muscular strength

• Teach neutral spine for functional movement (getting on/off floor and equipment, picking things up off floor, supine to sit)

• For those who already have a vertebral fracture – no regular jump board (only very light spring, straight leg variation)

Remember: If you have concerns about bone density, consult with your healthcare provider about getting a Bone Mineral Density (BMD) test. Early detection and intervention are crucial for maintaining bone health.

Stay strong and healthy!

With love, Sam

References:

• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH.gov)

• International Osteoporosis Foundation

• Bone Health and Osteoporosis Foundation

• Sozen, T., Ozisik, L., Basaran, N.C. 2017. An overview and management of osteoporosis. Eur J Rheumatol. 4(1):46-56.

• Zhu Z., Yu, Wu, et al. 2023. Sex Specific Global Burden of Osteoporosis in 204 Countries and Territories, from 1990 to 2030: An Age-Period-Cohort Modeling Study. J of Nutrition, Health, and Aging  27(9): 767-774.