Physical Activity and Bone Health
Author: Desiree Dutton, MPT
Marcus Daly Rehabilitation
A service of Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
Physical Activity and Bone Health
Physical activity is an important tool for staying healthy in aging. Older
adults who are physically active have a lower risk of developing heart
disease, type 2 diabetes, stroke, hypertension, depression and some cancers.
Weight bearing physical activity also has positive effects on bone health
and is essential in both the prevention and treatment of osteoporosis.
Regular exercise can also improve muscle strength, flexibility and balance.
Osteoporosis is a common disease characterized by low-bone density (thickness
of the bone), decreased bone strength, and a change in bone structure
- all which can lead to an increased risk of fracture. The normal bone
structure may become more porous and lessens the ability of the bone to
withstand typical forces. Fractures from osteoporosis and osteopenia can
be very serious. The National Osteoporosis Foundation (NOF) estimates
that 54 million Americans have either osteoporosis or low bone mass. The
NOF reports that studies suggest 1 in 2 women and up to 1 in 4 men age
50 and older will break a bone due to osteoporosis.
Bone is a living tissue. In osteoporosis, bones weaken when not enough
new bone is formed and/or too much bone is lost. Women have the greatest
risk of developing osteoporosis and it commonly begins in women during
the first 5 years of menopause, but it can also occur in men and in children.
There are many factors that can cause a person to be more at risk for
developing osteoporosis. Non-controllable risks include female gender,
small build, hormone levels and predisposing medical conditions. Some
medical conditions such as rheumatoid arthritis, multiple sclerosis, inflammatory
bowel disease and spinal cord injuries can increase the likelihood of
osteoporosis. Controllable risks (which we can prevent and treat) include
cigarette smoking, excessive alcohol intake, an inactive lifestyle, lack
of weight-bearing exercises, poor health and low vitamin D levels and
calcium-poor diet. It is important to know your risks, so you can be proactive
in your treatment.
The American College of Sports Medicine and the National Osteoporosis
Foundation agree that weight bearing physical activity has beneficial
effects on bone health across the age spectrum.
Peak bone mass is typically reached in ones 20s to 30s, so optimizing
peak bone mass and strength is a primary strategy to reduce the risk of
osteoporosis and related fractures later in life. The exercise component
for bone building or slowing bone loss is specific and similar for all
ages. Bone grows when it is sufficiently and appropriately stressed, just
as muscle grows when challenged. Two types of exercise are optimal for
bone health, weight-bearing and resistance exercises.
Be sure your child is physically active - childhood and young adulthood
are the critical bone building years. Bone mass is higher in children
who are physically active than those who are less active. In children
and adolescents, physical activities such as gymnastics, plyometrics and
resistance training augment bone mineral accrual. Participation in sports
that involve running and jumping such as soccer and basketball are likely
to be of benefit. And, there is some evidence to suggest the exercise-induced
gain in bone mass in children is maintained into adulthood. Children should
strive for 60 minutes of moderate intensity activity each day. The NOF
position statement also points to the positive effects of calcium intake,
especially during late childhood and puberty. Good evidence also supports
the positive role of vitamin D and a detrimental effect of carbonated
soft drink consumption on building bone.
During adulthood, the primary goal of physical activity should be to maintain
bone mass density through weight bearing exercises. Weight bearing exercises
may include tennis, stair climbing, jogging, dancing and activities that
involve jumping. Physical activities that help preserve muscle mass such
as resistance exercise may also be effective in preserving bone mass.
Resistance exercises may include weight lifting, use of exercise bands
and gravity resistance such as yoga poses. If you are middle-aged and
older, it is important to improve your posture, improve the strength of
your back muscles and improve your hip strength and flexibility.
Typically exercises are performed for 30-60 minutes, 2 to 3 times per
week as part of an overall fitness program. The recommendation that adults
maintain a level of weight-bearing and resistance activities for bone
health does not have an upper age limit. But, as age increases, so does
the need for ensuring that the activities can be performed safely.
Due to the association of osteoporosis and fracture risk, it is also important
to include exercises that improve dynamic balance and reduce the risk
of falls. The most common site of fractures occurs at the hip, spine or
wrist. According to the American College of Sports Medicine, there is
considerable evidence that physical inactivity is a risk factor for hip
fracture and the incidence of hip fracture has been found to be 20-40%
lower in individuals who report being active than those who report a sedentary
lifestyle. Many factors may contribute to falling including poor posture,
poor vision, decreased muscle strength, impaired balance, and cognitive
impairment as well as external factors such as medications or tripping
hazards. Balance training is a crucial element of exercise interventions
for older adults. A home safety evaluation with an Occupational Therapist
can also be an important piece in reducing the risk of falls from external
If you are diagnosed with osteoporosis or low bone density, a physical
therapist can develop a specific program based on your individual needs
to help improve your bone health. A physical therapist will prescribe
weight bearing and resistance exercises to build bone or lessen the amount
of bone loss at the regions most vulnerable to fracture. A PT will also
recommend dynamic balance exercises to improve your balance to reduce
your risk of falling. Osteoporosis can also affect the vertebrae in your
spine leading to a stooped or hunched posture. Improving posture and your
work and living environment are also an important piece of the physical
therapy plan of care.
Healthy bone is built and maintained through a healthy and active lifestyle.
Contact your physician for a referral to a physical therapist who specializes
in the treatment of osteoporosis to get started on a more active and healthy
Questions and or comments regarding this week's health column please
contact, Marcus Daly Rehabilitation Center and Services, a service of
Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840.