Dr. Arnan Sisson, PT / December 14, 2022

Want To Learn The Best Exercises For Osteoporosis?

Osteoporosis is a common problem in women after menopause. Fortunately, exercise can help prevent bone loss. Learn the best exercises for osteoporosis in this write up!

What Is Osteoporosis?

Osteoporosis is a decrease in your bone density far below the normal levels.

The test for osteoporosis is called a DEXA scan.

That's an acronym for Dual Energy X-ray Absorptiometry, but that's a big mouthful, so DEXA is a whole lot easier to say.

A DEXA scan x-rays through your tissues,  and it measures how much different tissues absorb that extra energy.

From that your bone density can be calculated, and it's interpreted in in respect to "normal" bone density of a young healthy person.  This measure is called your T-score.

There's also a Z-score, which compares your bone density to other people of the same age and gender.

However, the T-Score is the measure used to diagnose osteopenia and osteoporosis.

Osteopenia vs. Osteoporosis - What's The Difference?

Many people get osteopenia and osteoporosis confused.

Really, osteopenia and osteoporosis are just different degrees of the same problem - namely low bone density.

Osteopenia literally means a "deficiency of bone". 

Basically, it means your bone density has started to decrease a little bit.

Now, osteoporosis is 2.5 standard deviations below the norm for an average young person.

A score of -2.5 standard deviations puts your bone density in the lowest 1% of people (osteoporosis).

When it's just a number on a piece of paper that your doctor hands you and doesn't explain, it doesn't seem like that big of a deal.

However, when you consider what it actually means - that 99% of people have greater bone density than you - it becomes a little more real.

Osteoporosis is a problem that shouldn't be taken lightly.

When you reach a level of osteopenia,  you should really start to pay attention to improving your bone density.

If you've gotten to the degree of osteoporosis, it's really time to take action because something like a fall could cause a fracture. Hip fractures in older adults have negative health effects including being predictive of going into a nursing home and/or dying in the next 6 months.

At times, even at that point just the forces of gravity or carrying things can cause compression fractures in your spine.

Estrogen, Menopause, and Osteoporosis

Osteoporosis is particularly common in women in their the post-menopausal years.

Estrogen is protective of bones. As you start to lose, estrogen. your bone density has a greater risk of going down. In fact osteoporosis is four times more common in women than it is in men.

Estrogen regulates the relative balance between how much bone you build and how much bone your body breaks down and releases as calcium in the blood.

Throughout our life, we're always in a state of laying down new tissue and eating up old dead tissue.

If there's too much osteoclastic activity (breaking down bone), and not enough ostoeblastic activity (building bone), then your bone density will decrease over time.

Treatment For Osteoporosis

If you have osteopenia or osteoporosis, talk to your primary care physician about medical management for osteoporosis.

There are medicines that can help regulate the relative amount of bone building vs. bone resorption that occurs in your body.

However, the topic of this post is exercises for osteoporosis.

Before covering exercise though, it's important to briefly cover diet.

Calcium and Osteoporosis

Calcium is the raw material that your osteoblasts use to build bone, and if you're not getting enough dietary calcium, it doesn't matter how much exercise you do.  You're NOT going to increase your bone density without enough calcium.

Imagine you have these crew of brick layers, and that crew is tasked with building a house.

If the crew shows up to work but they have no bricks to lay down, how much work do you think they're really going to get accomplished?

Probably not very much.

Calcium is the brick that your osteoblasts uses to build bone.  If you don't have any calcium in your body or you don't have vitamin D which helps you to absorb the calcium, then you're not going to increase your bone density no matter how much exercise you do.

Your body uses calcium to contract your skeletal muscles and heart muscle.  If there's not enough calcium circulating in your blood, you're going to "steal" it from you bones.  This happens by breaking down bone and releasing the stored calcium into your blood.

What are dietary sources of calcium?

The obvious source that comes to mind is dairy foods such as milk, cheese, and yogurt.

However, some people can't tolerate either lactose or milk protein.

Other foods rich in calcium include green, leafy vegetables like spinach, or fish with bones in them such as canned salmon or sardines.

Calcium supplements for osteoporosis

If you don't get enough dietary calcium, you might consider taking calcium supplements.

The two common supplements that people buy are calcium carbonate and calcium citrate.

Calcium carbonate is a chalky type of calcium such as TUMS or other similar antacids.  Some types are made primarily as a calcium supplement as well.

It's a lot cheaper than calcium citrate and there's a lot higher proportion of calcium per gram, but it's also not absorbed very well. Therefore, even though you're taking it in, there's no guarantee that it's actually getting digested and being used to build bone.

Calcium citrate is a little more expensive and there's not as much calcium in proportionally, but your body can absorb it better.

Citrical has calcium citrate and vitamin D all in one supplement.

Vitamin D and Osteoporosis

Vitamin D helps you absorb calcium and phosphorous.  Most people can get enough vitamin D just being exposed to sunlight having for 20-30 minutes in the middle of the day along with eating vitamin D fortified foods such as milk and cereals.

Although it was once thought that supplementing vitamin D in high doses could prevent fractures, a recent study in the New England Journal of Medicine found no benefit to supplementing with high doses of vitamin D.

Now let's get on to exercises...

Best Exercises For Osteoporosis

So what are the best exercises to help you improve your bone density if you have osteopenia or osteoporosis?

Largely, weight-bearing exercises where your feet are on the ground are the best exercises for osteoporosis.

The reason for that is that your body adapts to the forces that are put on it that's a principle called the SAID principle - Specific Adaptations to Impose Demands.

A more specific version of the SAID principle with respect to bone is called Wolff's Law.

Wolff's Law states that your bones will adapt and change according to the stresses that they're subjected to.

If you're walking and you're creating compression in your joints every time your foot hits the ground then it stimulates osteoblasts to come to work and lay down new bone.

Conversely, if you're sitting on the couch all day, your body has no stimulus to lay down new bone.  However your osteoclasts are still at work breaking down bone, especially if you're calcium deficient.

So doing weight-bearing activities like walking are the best exercises for osteoporosis.

Other examples of weight-bearing exercises include squats or lunges.  If you've got osteoporosis already, you don't want to do squats with a heavy barbell on your back but bodyweight squats or squats using light dumbbells help to stimulate bone grown in in your spine and legs.

That's important because the lower back and the hips are the two most common places that post-menopausal women develop osteoporosis.

What About Upper Body Exercises For Osteoporosis?

You don't want to neglect your upper body either.  Although the hips and spine are the most common places to develop osteoporosis, it's also fairly common to see osteoporosis in the wrists.  Additionally, if you fall on an outstretched hand, you want to make sure your bones are strong enough that they don't break easily.

Just like in the lower body, weight-bearing exercises for your arms such as push-ups or wall push-ups can help develop bone density in the upper body.  Additionally doing pushing exercises such as overhead presses or bench presses can also increase bone density.

For overall fitness, you want to balance your pushing exercises with pulling exercises such as rows or lat pulldowns so that your chest muscles don't get too stiff.  Stiff chest muscles can pull your upper back into kyphosis, or a hunch-backed position.

Exercises To Prevent Osteoporosis Compression Fractures

In addition to stretching your chest muscles, you also want to strengthen your upper back extensor muscles.

When you have osteoporosis, the most common place you get fractures in your spine is in the front part of the vertebrae.

These "compression fractures" come from the compression of carrying things during everyday life, or in severe cases, just from the compression of gravity.

When you get compression fractures in the front of your spine, it creates a wedge-like deformity called "kyphosis".

It's normal to have kyphosis in your upper back, but you don't want it to be excessive.  Osteoporotic compression fractures are one thing that can cause you to develop a "hunchback".

Additionally, if you start getting a hunched back, it's common for people to compensate by hyperextending their lower back, which can create walking difficulty standing and walking, especially if you have spinal stenosis.

And the more you try to straighten up from your lower back, the worse the symptoms get.

That's why it's important to strengthen your upper back extensors if you have osteoporosis.

Seated Upper Back Extensor Exercise

One way to strengthen your upper back extensors is to sit in a chair and lean forward from your hips.

This locks out your lower back.

Then try to lift your chest up a just a little bit.

Your lower back should stay flexed with your belly down close to your thighs.  It's important to make sure you're ONLY lifting your chest and upper back and not moving too much in your lower back or excessively looking upward and hyperextending your neck.

Another way that you can do that just in your everyday life is trying to pull your shoulder blades back just slightly and lift your chest a little bit

The axis of rotation should be thorough your ribcage and thoracic spine.  You should NOT arch so much that you extend your lower back.

I know I've emphasized that a lot, but it's a very common mistake for people to do when trying to correct their posture. It's a very subtle movement. Don't overcorrect! 

Balance Exercises For Osteoporosis

Finally, you do want to prevent falls if you have osteopenia or osteoporosis, so working on your balance is really important.

Balance exercises don't necessarily build bone so to speak, but they do decrease your chance of falling and injuring yourself.

Again, falls in older adults are no laughing matter.  About 1 out of 4 older adults fall every year. 1 in 5 of those falls results in an injury or broken bone.  Finally there's about one fall-related death in the United States about every 20 minutes.

So fall prevention is important, especially if you have osteoporosis.

Most falls don't occur when you're standing on two legs though.  Most falls happen when walking, particularly when you have one leg off the ground.

Therefore, the best balance exercise for most people is simply standing on one leg.

If you've gotten to the point where you have osteopenia or osteoporosis, it's a good idea to hold on to something initially, or at least stand close to something sturdy where you can hold on if you need to.

You don't want to actually fall in the process of trying to prevent falls.

If you can work up to maintaining balance on one leg with minimal to no support from your hands for 10 seconds or more, you'll decrease your likelihood of falling and improve your life expectancy according to a 2022 study in the British Journal of Sports Medicine conducted on 1702 people aged 51–75.

Conclusion

Exercises can help prevent osteoporosis or prevent it's progression if you already have it.  The main categories of exercise to focus on are weightbearing exercises for both your lower and upper body, chest stretches, thoracic extensor muscle strengthening, and balance exercises.

Need help to start an exercise program for osteoporosis?

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