Osteoporosis

Bone is a living tissue that, like all tissues in our body, replaces itself over time. By the age of 30, the average person will have replaced the complete skeleton up to 5 times.  

The replacement of bone tissue is mainly carried out by two types of cells: osteoblast and osteoclasts, which are both variants of osteocytes, and perform different functions within the bone life cycle. Osteoblasts are the cells responsible for the bone cell production, while osteoclasts are the cells responsible for the breakdown and bone reabsorption. These cells work in tandem to continually remodel our bones as we grow at different rates through our lives. It is the relationship between these two cells that produce bone density as an outcome.  

Bone density is influenced by several factors, some of them are intrinsic (we cannot change them) like age, gender, race, and genetics, while some are extrinsic (can be changed) like calcium in diet, physical activity, tobacco, alcohol consumption, eating habits and medication.

Our peak of bone density occurs once the rate of new bone being remodel by the osteoblast is greater than the rate of breakdown by the osteoclast. However, with age and other factors, this relationship will shift, resulting in a decrease of bone density. When the bone density is too low, the risk of osteopenia, osteoporosis and eventually bone fractures will increase.  

Osteoporosis stages:

• Stage one: bone reposition rate slows down to equal the rate of breakdown.  
• Stage two: rate of bone loss reaches 0.25% per year influenced by genetics and health habits. (part of the normal ageing process)
• Stage three: for some women between the ages of 45-55, losing bone density at a common rate of 2% per year and up to 10-20% within the first 5 years of menopause is a real risk.
• Stage four: significant bone loss, fragility fractures and bone deformities that come associated with pain and movement difficulties to manage normal activities of daily living.

A combination of osteoporosis + poor balance + loss of muscle mass and strength = high risk of fracture

What can I do to keep my bones healthy?

Osteoblast, the cells responsible for remodelling the bone and increasing bone density, respond to mechanical stress through the axial plane and growth factors such as hormones. Weight bearing activities will cause the mechanical stress through the axial plane. Researchers from the Bone & Joint Injury Prevention & Rehabilitation Center at the University of Michigan have identified several characteristics of exercise that have an impact on bone density through mechanical stress:

• Strain magnitude refers to the force or impact of the exercise. Exercises such as gymnastics and weightlifting have a high strain magnitude.
• Strain rate refers to the rate of impact of the exercise. Exercises such as jumping or plyometrics have a high strain rate.
• Strain frequency refers to the frequency of impact during the exercise session. Exercises such as running have a high strain frequency.

How can LEAR help?

• Mat Pilates – a safe way to introduce low impact weight bearing exercise whilst improving  your overall movement
• Reformer Pilates – add resistance to your training while building on the basics of Pilates
• Hybrid and Hybrid Pro – supervised weight and resistance training in small groups
• Physiotherapy/Sports Rehabilitation/Sports Therapy – treatment plans and exercise prescriptions on a 1:1 basis and at home

However, exercise is not the only way to take care of your bones and maintain a healthy bone density:

• Include plenty of calcium in your diet. (almonds, broccoli, kale, canned salmon with bones, sardines).  
• Pay attention to vitamin D. Your body needs vitamin D to absorb calcium. Good sources of vitamin D include oily fish, such as salmon, trout, whitefish and tuna. Additionally, mushrooms and eggs are good sources of vitamin D. Sunlight also contributes to the body's production of vitamin D.  
• Include physical activity in your daily routine. Weight-bearing exercises, such as walking, jogging, and climbing stairs, can help you build strong bones and slow bone loss.
• Avoid substance abuse. Don't smoke. Avoid drinking too much alcohol.
• Enlist your doctor's help

References:

Jennifer Kellett, Oct 5, 2017, The stages of Osteoporosis, Hawker Place Physiotherapy and Pilates:

https://hawkerplacephysio.com.au/newsletter/the-stages-of-osteoporosis

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