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21/Jun/2023

We all know regular exercise is essential for good health. It can improve the fitness of your heart and lungs, sleep quality, energy levels and mental wellbeing. And it can reduce your risk of developing conditions such as diabetes.

Exercise is also vital for the health of your bones.

Like muscle, bone is living tissue that responds to exercise by becoming stronger. People who exercise regularly have stronger bones and higher bone density than those who don’t. This reduces the risk of developing osteoporosis.

Exercise also increases your balance, coordination and flexibility, which improves your ability to prevent trips and falls. DYK, falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths? More than half of the hospitalisations were due to broken bones (fractures).(1)

Bones need exercise.

To understand why exercise is important for bone health, it helps to know how bones work.

Throughout your life, your bones are constantly changing. This is called ‘remodelling’. Bone cells called osteoblasts build new bone, while other bone cells (osteoclasts) break down and remove old bone. This process is controlled by hormones such as calcitonin, parathyroid hormone, oestrogen (in women), testosterone (in men), and vitamin D.

From birth to about 25, you build more bone than you lose. Your bones are not only getting bigger as you grow, but they’re also developing their density. This determines how strong they are.

From about 25 to 50, your bones break down and rebuild at about the same rate. They’re in a state of balance. This is when you’ve achieved your ‘peak bone mass’. Your bones are at their strongest.

After about 50, you break down more bone than you rebuild. While this means everyone will experience some bone loss as they age, it doesn’t mean everyone will develop osteoporosis.

Women commonly experience a period of rapid bone loss after menopause. This is due to a drop in oestrogen levels. It’s estimated that the average woman loses up to 10% of her bone mass in the first five years after menopause.(2)

For good bone health, exercise is vital for everyone – from the very young to the very old.

A combination of different exercises is best for bone health.

Different exercises challenge and strengthen your bones and muscles in different ways, so you should include the following in your exercise plan:

Weight-bearing exercises or activities where your body carries its own weight. These exercises put stress on your bones, making them stronger and denser. It also strengthens the muscles around your bones, providing support and reducing the risk of fractures. Weight-bearing exercises include brisk walking, climbing stairs, tennis, and netball.

High-impact exercises such as jogging, running, jumping, and skipping rope. They’re also weight-bearing exercises, but they place greater stress on the bones of the spine and legs as your feet hit the ground. This can provide more bone-strengthening benefits; however, these exercises aren’t suitable for everyone.

Resistance training, also known as strength training, uses resistance or weights to strengthen your muscles by working them harder than you do in everyday life. The strong muscle contractions required to move a heavy weight place stress on the bone where the muscle attaches. When bone feels this strain repeatedly, it responds by becoming stronger. Resistance training uses equipment like free weights (e.g. dumbbells), gym machines, elastic resistance bands or your body weight (e.g. push-ups, squats).

Balance and flexibility exercises such as tai chi and yoga improve balance and mobility and can reduce your risk of falling. This is important for preventing fractures.

Before beginning an exercise program, speak with your health professional. Not all types of exercise are suitable for everyone. This is especially important if you have other health conditions, including osteoporosis. A physiotherapist or exercise physiologist can assist you with a safe exercise program that targets your specific needs and reduces your risk of injury.

Exercise must be regular and ongoing.

You need to exercise regularly to have a significant benefit, so you should choose activities you enjoy. This will make it easier to exercise consistently.

Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. This includes at least two sessions of strength training every week. However, when you’re just beginning, this can seem daunting.

That’s why it’s good to know you don’t have to do all your exercise in one session. For example, a 30-minute brisk walk can be broken up across your day into shorter, more achievable sessions, such as three 10-minute or six 5-minute walks.

You can do other things to make exercise a regular, ongoing activity.

Exercise with a group or a partner. This can improve your motivation to exercise and provides an opportunity for socialising with others.

Exercise SMART and set goals. A clear goal can motivate you to stay on track with your exercise program. But they must be realistic and specific to your abilities, needs, and health issuehttps://msk.org.au/goals/s. So, ensure your goal is SMARTSpecific, Measurable, Achievable, Realistic and has a Timeframe.

For example, a good SMART goal for resistance training for stronger bones and muscles could be: “I will perform resistance exercises, such as lifting weights or using resistance bands, for 30 minutes, twice a week, for the next three months.”

This goal is Specific (focuses on resistance training), Measurable (30 minutes, twice a week), Achievable (realistic for most people), Relevant (aimed at improving bone and muscle strength), and has a Timeframe (three months).

Constantly evaluate your goals, adjust them as needed and reward yourself for your successes.

Add variety. Vary where you exercise and the type of exercise you do. Include recreational activities such as bushwalking or dancing. This will help keep your mind fresh and your motivation high. Find activities that are enjoyable to you so that you’ll be motivated to continue doing them.

Exercise within your capabilities. Often, people drop out of exercise programs because they exercise at a level beyond their current capabilities. Ensuring your exercise program suits your current abilities will decrease your risk of injury and increase your enjoyment and motivation to continue your exercise program.

Challenge yourself. Increase the intensity of your exercise as your fitness improves. It’ll make your exercise more interesting and also has greater health benefits.

Stop if you have pain. Don’t continue exercising if you experience pain or severe discomfort. Talk with your fitness professional for advice to ensure you’re not doing an exercise incorrectly.

Bone health doesn’t happen in a vacuum.

As well as exercise, you need to also to eat a nutritious diet with calcium-rich foods, get sufficient sun exposure for vitamin D, take medicines or supplements as prescribed by your doctor, quit smoking, and moderate your use of alcohol, caffeine, and salt intake, as they can impact bone density.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

References

(1) Falls. Australian Institute of Health and Welfare.
(2) Osteoporosis, Australasian Menopause Society


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16/Nov/2022

We talk a lot about musculoskeletal conditions being invisible. With current treatments, most people diagnosed with a musculoskeletal condition will have no outward signs of their condition. However, someone living with these conditions can feel the pain and fatigue associated with them.

Osteoporosis is a different story. It really is invisible. There are no obvious signs when a person develops osteoporosis, and importantly, they don’t feel any different. Until they break a bone. Then it becomes obvious that something has happened.

So what is osteoporosis?

Osteoporosis is a condition that causes bones to become weak and lose their strength, making them break more easily than healthy bones. It’s more common in women, but men do get it too.

Another condition, osteopenia, is also associated with weak bones. A person with osteopenia has lower than average bone density but it’s not low enough to be diagnosed as osteoporosis.

Your bones

To understand how osteoporosis affects your bones, it’s helpful to know how they work.

Although we often think of them as dry and lifeless, bones are living tissue. They’re made of the protein collagen and are strengthened with the mineral calcium phosphate. They’re constantly changing throughout life. Specialised bone cells (osteoblasts) create new bone, while others (osteoclasts) break down and remove old bone. The rate at which this occurs changes as we age.

From birth to about 25 years of age, you build more bone than you lose. Your bones are not only getting bigger as you grow, but they’re also developing their density. This determines how strong they are.

From about 25 to 50, your bones break down and rebuild at about the same rate. Your bones are at their strongest.

After about 50 years of age, you break down more bone than you rebuild. While this means everyone will experience some bone loss as they age, it doesn’t mean everyone will develop osteoporosis.

Women commonly experience a period of rapid bone loss after menopause. This is due to a drop in oestrogen levels.

Causes of osteoporosis

Osteoporosis is caused by a loss of bone density. Many things can cause you to lose bone density; some you can change, and others you can’t.

Risk factors you can’t change:

  • Family history of osteoporosis
  • Being female
  • Getting older
  • Early menopause (before 45) which results in reduced levels of oestrogen
  • Use of certain medicines, including long-term use of glucocorticoids (e.g. to treat rheumatoid arthritis or asthma), some chemotherapy drugs, epilepsy drugs, and proton pump inhibitors
  • Other health conditions including rheumatoid arthritis, coeliac disease, inflammatory bowel diseases, and diabetes.

Risk factors you can change:

  • Low levels of calcium in your diet
  • Not getting enough vitamin D
  • Being inactive or sedentary
  • Excessive alcohol intake
  • Smoking
  • Being underweight
  • Poor nutrition.

The International Osteoporosis Foundation has an online risk test you can use to check your risk factors. This isn’t a diagnostic tool, but it can help you understand your potential risks so you can discuss them with your doctor.

Symptoms of osteoporosis

For most people, there are no symptoms that you have osteoporosis. Bones becoming weaker has no visible signs until they become so weak that they break. This can cause pain from a fracture – for example, breaking the wrist or hip after a fall. If the bones in the spine (vertebra) have fractured or collapsed, it can cause back pain, loss of height and a stooped posture.

Diagnosing osteoporosis

If you’re concerned that you may have osteoporosis or be at risk of developing it, you should see your doctor.

Your doctor will assess your risk factors for developing osteoporosis and look at your medical history – including your family history.

Family history is significant because having a parent or sibling with osteoporosis puts you at greater risk of developing osteoporosis.

After assessing your risk factors, your doctor will decide whether you need a bone scan. This scan will measure the density of your bones. The best scan for assessing your bone density is a dual-energy x-ray absorptiometry – often referred to as a DEXA or DXA scan.

A DEXA scan is short and painless. While you lie on your back on a padded table, a scanning arm passes over your body to take images of your hips, spine, and in some cases, the forearm. It takes about 15-30 minutes. A report is sent to your doctor, who will discuss the results with you.

Treating osteoporosis

If you’re diagnosed with osteoporosis, or osteopenia, your doctor will work with you to develop a treatment plan to reduce your risk of fractures by protecting and strengthening your bones. This may include calcium, vitamin D, exercise, medicines and self-care.

Calcium

Most of your body‘s calcium is stored in your bones. That’s why we associate calcium with healthy bones and teeth. But your heart, muscles and nerves also need calcium to function properly.

Because your body can’t make calcium, you need to get it from the foods you eat each day. If you don’t have enough calcium to keep your body functioning properly, it will take it from your bones. Over time, this can lead to bones becoming weaker.

The amount of calcium you needs every day varies depending on your age. Find out about the recommended dietary intake of calcium you and your family need every day.

Calcium is found in many foods, including dairy, oranges, sardines and salmon, almonds, tofu, baked beans, and green leafy vegetables.

Vitamin D

Vitamin D is produced when your skin is exposed to the sun. It’s essential for strong bones because it helps increase calcium absorption, regulates the amount of calcium in your blood, helps strengthen your skeleton, assists with muscle function and reduces your risk of falls.

The main source of vitamin D is sunlight. Exposing your hands, face and arms to the sun daily is essential. But the amount of time you need to do this depends on where you live, the time of the year and your skin’s complexion. You also need to be careful that your exposure to the sun is safe. Healthy Bones Australia has developed a chart to help you work all this out.

Vitamin D can also be found in small quantities in foods such as fatty fish (salmon, herring, mackerel), liver, eggs and fortified foods such as low-fat milk and margarine.

However, it’s unlikely that adequate quantities of vitamin D will be obtained through diet alone.

Exercise

Besides having a calcium-rich diet and ensuring you get enough vitamin D, regular exercise is essential for maintaining healthy bones.

The types of exercise that benefit bone health include:

  • Weight-bearing: such as brisk walking, climbing stairs, tennis, and netball. Your body is carrying its own weight, and gravity exerts a force. Bones become stronger because they’re coping with the force placed on them.
  • High-impact: such as tennis, dancing, jumping or skipping. These exercises place high stresses on the bones of the spine and legs as your feet hit the ground.
  • Resistance training: also known as strength training. This involves using machines (e.g. leg press) or free weights (e.g. dumbbells). The strong muscle contractions required to move a heavy weight place stress on the bone where the muscle attaches. When bone feels this strain repeatedly, it responds by becoming stronger.
  • Balance training: exercises such as tai chi and yoga improve balance and mobility and reduce your risk of falling. This is essential for preventing fractures.

Before beginning an exercise program, speak with your health professional. Not every type of exercise will be suitable for all people.

If you’ve been diagnosed with osteoporosis, it’s especially important that you discuss any kind of exercise with your health professional before you begin. Some high/moderately high intensity exercises may be unsafe for certain levels of osteoporosis.

Medicines

If you have osteoporosis, your doctor will consider your age, general health, and fracture risk before deciding on the most appropriate medicine.

Most osteoporosis medicines slow down bone loss by reducing the ability of osteoclasts to remove bone and allowing osteoblasts to continue to build bone.

In Australia, the following medicines may be prescribed for osteoporosis:

  • oral bisphosphonates – e.g. alendronate and risedronate – weekly or monthly tablets
  • zoledronic acid – once a year infusion given through a needle into the vein
  • denosumab – twice a year injection into the fat just under the skin
  • teriparatide – daily injection for people with severe osteoporosis.

Other medicines:

  • Menopausal hormone therapy (MHT) – also known as hormone replacement therapy or HRT – is a synthetic version of the hormones oestrogen and progesterone and may be an option for some women around menopause.
  • Selective oestrogen receptor modulators (SERMS) – act on bones in a similar way to oestrogen. Because oestrogen levels drop at menopause, they may be prescribed for postmenopausal women who are at increased risk for osteoporosis or already have it.
  • Supplements – calcium and vitamin D are important for bone health. Your doctor may prescribe a supplement if you’re not getting enough through diet or exposure to sunlight.

What else can I do to manage my condition?

You can do many other things to reduce your risk of developing osteoporosis or the impact it has if you do develop it.

  • Learn about your bone health and osteoporosis.
  • Prevent slips, trips and falls, which can lead to broken bones. Falls are most commonly caused by poor muscle strength, poor vision, problems with balance, and home hazards that lead to tripping. Talk with your doctor for information about falls prevention.
  • Quit smoking – it’s linked to reduced bone density.
  • Consume in moderation (if at all) – alcohol, caffeine and salt, as they can all affect your bone density. Alcohol also increases the risk of falling and the chance of fractures.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

 


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27/May/2018

Do you get enough calcium and vitamin D? Along with regular exercise, they’re important for bone health.

Calcium

Almost every cell in your body uses calcium in some way.

Most of the calcium is stored in your bones. They act as your calcium bank. You need to make regular ‘deposits’ to cover the ‘withdrawals’. The rest is found in your blood and body fluids.

If you don’t have enough calcium in your diet to maintain adequate levels in the blood, then your body withdraws calcium from your bones. If calcium is constantly taken from your bones, they’ll become weaker over time.

For adults the amount of calcium required each day is between 1000 – 1300mg – the exact amount depends on your age and gender.

Calcium can be found in lots of foods – including dairy food, oranges, sardines and salmon, almonds, tofu, baked beans, green leafy vegetables.

Calcium is listed on the nutrition panel of packaged foods – so check to see how much is in the foods you buy.

If you can’t get enough calcium in your diet, talk with your doctor about whether a calcium supplement may be necessary.

Vitamin D – the sunshine vitamin

Vitamin D is essential for strong bones for many reasons. It helps increase the absorption of calcium and phosphorous from the small intestine, helps regulate the amount of calcium in your blood and helps strengthen your skeleton. It can also assist with muscle function and reduce your risk of falls.

The main source of vitamin D is sunlight so you need to expose your hands, face and arms to the sun every day. The amount of time you need to do this depends on where you live, the time of the year and the complexion of your skin. Osteoporosis Australia has developed a chart to help you work this out.

In Australia we have high levels of skin cancer, so you also need to make sure you expose your skin to the sun safely. SunSmart has developed an app which will help work out when it’s safe.

Vitamin D can also be found in small quantities in foods such as: fatty fish (salmon, herring, mackerel), liver, eggs and fortified foods such as low fat milks and margarine, but it’s unlikely that you’ll be able to get enough vitamin D through your diet alone.

If you aren’t able to expose your skin to the sun regularly (e.g. you’re a shift worker, you have a condition that makes your skin sensitive to sunlight), you may be deficient in vitamin D. It’s important to discuss this with your doctor. Vitamin D supplements may be needed.

Take action for the health of your bones and find out more about calcium, vitamin D and osteoporosis.

Contact our MSK Help Line on 1800 263 265 and speak with a nurse or our trained volunteers for information.




Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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