Prevention of osteoporosis Dr Z.Bonakdar Rheumatologist
Assessing the risk of developing OP •Family history: Parental history of hip fracture • Medical history: Advanced age; frailty; hyperthyroidism; hyperparathyroidism; celiac and other malabsorption syndromes; BMI < 20 kg/m2 or weight loss; long-term glucocorticoids, > 3 months of prednisone ≥ 7.5 mg; rheumatoid arthritis; or chronic liver or kidney disease
• Gender risks: For men, androgen deficiency (primary or secondary); For women, estrogen deficiency, menopause age < 45 years, or cessation of menstruation for 6-12 consecutive months • Lifestyle: Smoking (current or former), daily alcohol > 3 units, caffeine > 4 cups/day, inadequate calcium / vitamin D intake, lack of sunlight, prolonged immobility / lack of weight-bearing exercise
Assessing the risk of falls and fracturing within 10 years • Previous fragility fracture (hip, vertebra, humerus, wrist) or fall in the past year • High risk of falling, physical frailty or significant weight loss; poor strength, balance, gait, vision
Bone accretion occurs during adolescence and peak bone mass is normally achieved after puberty and into the third decade of life • Bone mass declines with age, about 0.3- 0.6% in cortical bone and 0.8- 1.2% in trabecular bone annually • At menopause, an acceleration of bone loss occurs over approximately 5 to 8 years, with an annual 2 to 3 percent loss of trabecular and 1 to 2 percent loss of cortical bone
Over lifetime, women lose approximately 50 percent of trabecular and 30 percent of cortical bone, where as men lose two thirds of these amounts • After 50 years of age, there is an exponential rise in fractures such that 40 percent of women and 13 percent of men develop one or more osteoporotic fractures
We lose so much muscle as we age that by the time we're 70, we only have about 50% to 55% of our muscle mass left. • If you persist with your weight training, even a 1% change in bone density every year adds up to a 10% difference after ten years. That's a lot of bone. • If you have osteoporosis in your spine, don't lift more than 20 to 25 pounds with your arms or against your trunk, and avoid movements that have you twisting your trunk or bending forward extensively.
Three types of exercise for osteoporosis are: • Weight-bearing • Resistance • Flexibility All three types of exercise for osteoporosis are needed to build healthy bones.
Weight-bearing exercise for osteoporosis are: Walking Hiking Dancing Stair climbing Racquet Sports Sports like bicycling and swimming are great for your heart and lungs. However, these are not weight-bearing exercise for osteoporosis. At least half an hour of moderate to vigorous exercise five times a week. Walking four hours a week cause a 41% lower risk of hip fractures.
Resistance exercise for osteoporosis includes: Free weights or weight machines at home or in the gym Resistance tubing that comes in a variety of strengths Water exercises, any movement done in the water makes your muscles work harder. For best results, do resistance exercises two or three times a week. Resistance helps with osteoporosis because it strengthens muscle and builds bone.
For best results, do resistance exercises two or three times a week. the exercise more challenging by gradually adding weight or repetitions. • Work all your different muscles -- including arms, chest, shoulders, legs, stomach, and back. • Give each muscle group time to recover.
Flexibility exercise for osteoporosis include these: Regular stretches T'ai chi Yoga Flexibility is another important form of exercise for osteoporosis. Having flexible joints helps prevent injury.
Tai Chi • Tai chi a form of slow, graceful moves builds both coordination and strong bones. • A study reported in Physician and Sports medicine found that tai chi could slow bone loss in postmenopausal women. • The women, who did 45 minutes of tai chi a day, five days a week for a year, enjoyed a rate of bone loss up to three and a half times slower than the non tai chi group.
Yoga • yoga can build bone health in your hips, spine, and wrists -- the bones most vulnerable to fracture. • Yoga also sharpens your balance, coordination, concentration, and body awareness and thus helps prevent falls.
In a study of healthy, postmenopausal women, a 24-week whole body vibration program was shown to improve muscle strength, balance and hip bone density. The Bone Mass Density (BMD) of the hip increased by 1% . Research indicates that the highest muscle reflex response may occur between 30Hz and 40Hz. The duration of the vibration exercise programs was between 20-30 minutes.