Have you ever noticed why your bones easily break by a sudden jerk? It is because you are suffering from Osteoporosis. 

 OSTEOPOROSIS 

Osteoporosis is a disease of bone  that leads to decreased mineral content and weakening of the bone. This weakening may lead to fractures, especially of the spine, hip and wrist. Approximately 10 million Americans have osteoporosis, 80% of them women, and an additional 34 million individuals are at increased risk due to decreased bone mass. The diagnosis of osteoporosis is determined by T-score of a bone mineral density (BMD) scan. The T-score is the number of standard deviations above or below a reference value (young, healthy Caucasian women). The World Health Organization has established the following criteria:

-Normal:- 1.0 or higher
-Osteopenia:- 1.0 to -2.4
-Osteoporosis :- -2.5 or less


A decrease of 1 standard deviation represents a 10% to 12% loss of BMD. 

RISK FACTORS OF OSTEOPOROSIS 

Primary Osteoporosis - Risk factors for developing primary osteoporosis include:-
-Caucasian or Asian descent
-Family history
-Low body weight
-Little or no physical activity 
-Diet low in calcium and vitamin D
-Smoking
- Prolonged bed rest
- Advanced age

Secondary Osteoporosis:- Secondary osteoporosis develops owning to other medical conditions i.e.,
-Gastrointestinal diseases
-Hyperthyroidism
-Chronic renal failure 
-Excessive alcohol consumption and use of certain medications such as glucocorticoids. 

Regardless of etiology, osteoporosis is detected by cortical thinning, osteopenia (increased bone radiolucency), trabecular changes, and fractures.


PREVENTION OF OSTEOPOROSIS 



The National Osteoporosis Foundation (NOF) recommends four ways to prevent osteoporosis.
1- Eating foods that are good for bone health, such as fruits and vegetables 
2- Maintaining a balanced diet that is rich in calcium and vitamin D
3- Performing regular weight-bearing exercise 
- Following a healthy lifestyle with moderate alcohol consumption ( limit 2-3 drinks per day)  and no smoking

Bone is a living tissue that is continually replacing itself in response to the daily demands placed on it. 
Normally, this continual replacement keeps our bone at its optimum strength.
Cells in bone called osteoclasts resorb bone, especially if calcium is needed for particular body functions and not enough is obtained in the diet. 
Another type of cell, the osteoblast, builds bone. This cycle is usually kept in balance with bone resorption equaling bone replacement until the third decade of life. 
With increasing age, there is a shift to greater resorption.
For women , resorption is accelerated during menopause owing to the decrease in estrogen. Both exercise and pharmacological therapy have been shown to be effective in the prevention of decreased bone mass density.
Bleicher et al tracked the bone density of 1100 men, aged 70 to 97 years, for 2 years. They concluded that walking, improved balance, and the use of beta blockers were found to retard the bone resorption process. 

Physical activity 

Physical activity has been shown to have a positive effect on bone remodelling. In children and adolescents, this activity may increase the peak bone mass. In adults, it has been shown to maintain or increase bone density, in the elderly, it has been shown to reduce the effects of age related or disuse- related bone loss. 
Maintenance of, or an increase in, bone density is important for preventing fractures associated with osteoporosis. 
Weak bones due to osteoporosis have been attributed to causing more than 1.5 million fractures per year at a cost of $19 billion dollars. Many of these individuals never return to their previous functional level.

Effects of exercise 

Muscle contraction (e.g., strengthening exercises and resistance training) and mechanical loading deform bone. This deformation stimulates osteoblastic activity and improves BMD. 


RECOMMENDATIONS FOR EXERCISE 

The NOF recommends weight-bearing exercise in the prevention of osteoporosis but does not specify what type of exercise or how often it should be done. Based on current research, the following recommendations are made. 
- Weight- bearing exercise, such as walking, jogging, climbing stairs and jumping
- Nonweight- bearing exercise, such as with a bicycle ergometer
- Resistance ( strength) training of 8 to 10 exercises that target major muscle groups. 

Mode: Aerobic 

Frequency. Five or more days per week. 
Intensity. Thirty minutes of moderate intensity (fast walking) or 20 minutes of vigorous intensity (running). Doing three short bouts per day of 10 minutes of activity is acceptable. 

Mode: Resistance 

Frequency. Two to three days per week with a day of rest in between each bout of exercise. 
Intensity. Eight to 12 repetitions that lead to muscle fatigue. 

FOCUS ON EVIDENCE 

Weighted vests or backpacks have been shown to improve bone mass density. The increased weight has been shown to alter the spinal muscle imbalance and focus more weight bearing to the osseous structures of spine. If there is a history of vertebral fracture, recommendations are that up to 1 kg can be carried on the back or up to 2 kg on the front. 
A study by Roghani et al followed three groups of women for 6 weeks that exercised 3 times per week. The groups included a control population and two exercise groups, one with and one without a weighted vest (4% - 8% of body weight). It was reported that while both exercise groups had increased bone synthesis and decreased bone resorption, the weighted exercise group exercise also demonstrated improved balance. 

PRECAUTIONS AND CONTRAINDICATIONS OF OSTEOPOROSIS 

-Because osteoporosis change the shape of the vertebral bodies (they become more wedge shaped), leading to kyphosis, flexing activities and exercise, such as supine curl-ups and sit-ups, as well as the use of sitting abdominal machines, should be avoided. Stress into spinal flexion increases the risk of a vertebral compression fracture. 


-Avoid combining flexion and rotation of the trunk to reduce stress on the vertebrae and the intervertebral discs. 
- When performing resistance exercise, it is important to increase the intensity progressively but within the structural capacity of the bone. 

Check out the video and follow these exercises so that you can also treat osteoporosis by your self.