In recent weeks I have had several discussions with people regarding the things they should do to prevent Osteoporosis. Some of these people had witnessed their parents succumb to this and were concerned that it would happen to them so they wanted to ensure they did everything they could to prevent it. Osteoporosis is a disease of the bone that makes a person’s bones weak and more likely to break and is often called a “silent disease” because you cannot feel your bones getting weaker.  Many people do not even know they have osteoporosis until after they break a bone. Once you have Osteoporosis you cannot reverse it so it is vital you do everything you can to prevent it from happening by making important lifestyle choices. If you do already have it you can still do things to prevent any further bone loss and also drastically reduce the likelihood of any future bone fractures. The sooner you start the better, for research shows that how likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. In this article, I will discuss what they key factors you need to start doing now to avoid this becoming a problem later in life.

How Prevalent Is This Osteoporosis?

Due to the fact that this disease is hard to detect it is difficult to determine the true prevalence of the condition (that is, the number of people with the condition). Until a minimal trauma fracture occurs, osteoporosis has no obvious symptoms and so many cases go undiagnosed.

Little clues that give you signs that this is beginning to take place are a recent back problem due to facet joint slippage, a loss of height, and most noticeably a stooped over posture. This is something I wrote about in the detailed article about kyphosis and the dowagers hump posture.

Muscle loss and noticeable weakness is another sign your bones may be getting weak. The loss of muscle mass is called sarcopenia and is an important factor to address because it can have a dramatic impact on functional capacity. You can read more about sarcopenia and see several examples of this in this article about arthritis.

I know first hand how destructive this can be as I have witnessed my mum's bones deteriorate over the last 5-10 years to a point where she was in hospital for over 6 months with a fracture in her femur caused by standing up! Her bones had become extremely weak due to chronic illnesses and side affects of medications she had been on for a long time. She also neglected exercise and strength training in her youth and now her body is paying a heavy price for her inactivity.

Muscle strength declines after the age of 50, and accelerated if strength training is not used consistently. Loss of strength with the legs, in particular the hip muscles and ankles has been shown to have a dramatic effect on dynamic balance. The only definitive way to know if you have osteoporosis for sure is via a DXS instrument used by Doctors.

In Australia based on a recent study by the AIHW measuring bone density in a population sample, the prevalence of osteoporosis among those aged 50 and over was estimated to be 23% of women and 6% of men. This estimate includes both diagnosed and undiagnosed cases of osteoporosis.

According to the National Osteoporosis Foundation in the US statistics show that 54 million Americans, half of all adults age 50 and older, are at risk of breaking a bone and should be concerned about bone health.

Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. After the early 20s this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it's created. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.

As bones lose their density they become weaker and the risk of fracture during regular activities increases. If this person were to fall they would likely break a hip, wrist or vertebrae in their spine! If bones become brittle enough (severe osteoporosis) they can break during even normal weight-bearing activities. In older populations broken bones are potentially lethal and the seriousness of this cannot be underestimated. Hip fractures are the number one cause of nursing home admission and approximately 50% of those who suffer a hip fracture never fully regain their mobility and independence and 50% of those die within the first year!

While bone density may not be the main cause of a fall it can cause a catastrophic consequence if present. The focus of this article is more to do with bone density which is not necessarily limited to older adults. You can read more about what really causes falls with seniors in this article – How to prevent falls in older adults

Women are more than three times more likely to develop osteoporosis than men and those who have gone through menopause are at the highest risk of osteoporosis as their bodies can no longer absorb calcium as well as it did when they were younger. However, this is not limited to women only as 20% of people with this disease are men!

Take a look at the picture below.

What Causes Osteoporosis?

There is no single cause of Osteoporosis, as there are a number of factors that contribute to this. Some factors are out of your control such as what sex you are, your age, race, and even how big you are! Men and women who have small body frames tend to have a higher risk because they might have less muscle mass and bone mass to draw from as they age.

Hormone problems can also contribute to the onset of this disease as seen with the fall in estrogen levels in women at menopause which is one of the strongest risk factors for developing osteoporosis. Also thyroid problems and medications used to treat various diseases like Rheumatoid arthritis, IBS, cancer, kidney, and liver disease can weaken bone leaving you vulnerable to developing osteoporosis later in life. Anyone who has been using corticosteroid medications like prednisolone to treat chronic pain for extended periods of time can also develop weak bones as one of the side effects is they interfere with bone rebuilding.

While you cannot change many of these factors you can still prevent this disease by focusing your attention on the things you can control. For the other factors that contribute greatly to the creation of this disease are all to do with good lifestyle choices, exercise, and nutrition.

There are several bad lifestyle habits that can increase your risk of osteoporosis. People who rarely exercise and spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. When you consider how many people now work in sedentary jobs compared with 50 years ago you can see how the modern lifestyle exposes our bodies to diseases like this more easily.

Poor diets that are devoid of calcium and important vitamins and nutrients can also expose bones to weakness and speeding up the rate of which osteoporosis takes place. This is something I have discussed many times before in articles about weight loss where people reduce calories too much in order to lose weight. Losing weight by drastically reducing calories does not automatically mean you are healthy. To see more read the article – Stop measuring your health by what the scales say

Other destructive habits that need no explaining are excessive drinking of alcohol and smoking which have also shown to dramatically increase your risk of osteoporosis. As opposed to genetics, sex, and age these lifestyle factors you do have control over and where you focus should be on preventing the disease. Even small changes can be the difference between strong bones and weak bones.

It is important that you recognize you must eat quality foods and exercise, but what are the best foods and what type of exercise is best?

To help you out we are going to take a detailed look at all of the things you need to do. Just as there is no one single factor that causes this, there is no one single factor that prevents it either. If you are female, over 50 years of age, have been taking medications for chronic pain the more important these following steps are. Long-term use of oral or injected corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process.

Let’s get started.

Make Sure You Eat Enough Calcium

Before getting stuck into exercise I think it is important to discuss your nutrition and in particular the role of calcium.

If you are a person who has a great variety in your diet you are likely to have this under control. However, if you eat the same foods all the time, or are a bit fussy and restrict your food variety too much, there is a good chance you are missing out on some important nutrients and vitamins you need as you age.

This is where people who are trying to lose weight may be restricting their diet so much that they become deficient in certain vitamins and nutrients leaving important parts of their body exposed to disease and injury. When this comes to protein and calcium deficiency this can be a disaster to your muscles and bones.

A study in 2003 by Brwonbill and Tamborini showed the postmenopausal women with calcium and energy intakes below that the recommended levels had lower bone mineral density than postmenopausal women with adequate levels.

We all know how important calcium is for infants to build strong bones, well the same is true for older adults. Calcium is needed to regulate heart rate and maintain bone mass, but unlike children where they soak it up like a sponge, absorption declines with age.

Older age brings with it special nutrition concerns and requirements. In older age, energy needs decrease but nutrition needs increase. In general, because of the physical and lifestyle changes that tend to go along with aging, the need for overall calories is decreased. However, the need for nutrition, in the form of nutrient-dense, well-absorbed foods and targeted supplementation, is more important than ever.

People aged 50 and over should aim to get 1200 mg of calcium per day.

What foods provide a stack of calcium?

The first thing people think of is milk and while it does provide calcium there are many other foods of equivalent value. Foods like sardines, Greek yoghurt, ricotta cheese & sardines have been shown to have higher levels of calcium than milk. Check out the full list of calcium-rich foods provided by the National Osteoporosis Foundation by clicking here.

It goes without saying that if you are eating a well balance diet that is loaded with a variety of plant foods, proteins and good fats you will have this area covered. Watch the video below to get a good idea of what foods are best to eat.

Do not underestimate the value of vegetables either. Studies have repeatedly shown that people with higher vegetable intake have:

• Lower risks of stroke & type 2 diabetes, high blood pressure, Alzheimer's disease and heart disease
• Lower risks of certain types of cancer, eye diseases and digestive problems
• Reduced risk of kidney stones and bone loss
• Higher scores on cognitive tests
• Higher antioxidant levels
• Lower biomarkers for oxidative stress

When we fail to take in enough antioxidants our body undergoes a greater degree of damaging oxidative stress. When we live in a constant state of oxidative stress it can lead to chronic inflammation and eventually disease. Green vegetables are useful in reducing the risk of cancer and heart disease since they are high in dietary fiber, and rich in folic acid, vitamin C, potassium and magnesium, as well as containing a host of other phytochemicals.

Make Sure You Get Enough Vitamin D

This next point is extremely important yet it is very rarely discussed and many people are completely oblivious to the damage it causes to your entire body if you are deficient.

Completing any kind of construction requires raw materials to build the structure and vehicles to deliver the raw materials. In this case calcium is the main material needed for building bone along with magnesium and phosphate but the vehicle to deliver them from the digestive system to the building site in the bones is where Vitamin D comes in.

Vitamin D facilitates the absorption of calcium, magnesium and phosphate through the intestinal wall and into the bloodstream.

Unfortunately, despite the importance of vitamin D, it’s estimated that anywhere from 30% to 80% of the population is vitamin D deficient!

Vitamin D levels can also be affected by age and body fat levels. As we age, our ability to make vitamin D is reduced by 75%. Furthermore, vitamin D can get trapped in body fat, leading to a 55% reduction in blood levels for those who are over-fat.

Interestingly vitamin D really isn’t a vitamin at all, but a potent neuro-regulatory steroidal hormone.

There are only 30,000 genes in your body and vitamin D has been shown to influence over 2,000 of them and is one of the primary reasons it influences so many diseases. Studies also reveal that low vitamin D levels in the body are associated with:

• Increased loss of muscle strength and mass as we age
• Increased risk of cancers
• Lower levels of immunity
• Higher blood pressure
• The development of neurological disorders
• The development of diabetes

If you are thinking all you need to do is pop some supplements and you will be fine, think again. Unfortunately it is not quite as easy as that as we do not all absorb Vitamin D as efficiently.

The best way to get the right amount of vitamin D is from the sunlight.

Sun exposure (without sunscreen) of about 10 to 15 minutes a day, with at least 40 percent of your skin exposed, is a general guide of how much you need, although people with dark skin will need to stay out significantly longer. Once you reach the maximum level any excess is deactivated automatically by the body so you cannot overdose on it as opposed to oral supplementation which you can overdose on!

Many studies show that vitamin D supplementation cannot reproduce sunlight’s health benefits. Moreover, excessive vitamin D supplementation can aggravate systemic sulfate deficiency, which will drive calcium build up in the arteries. Which is obviously not a good thing. If you take more than 10,000 IU per day of vitamin D orally for more than 6 months, you are definitely at risk of becoming vitamin D intoxicated.

It has been found that magnesium supplementation is recommended when taking vitamin D supplements. Magnesium helps activate vitamin D. All the enzymes that metabolize vitamin D seem to require magnesium, which acts as a cofactor in the enzymatic reactions in the liver and kidneys. The dose of magnesium should be in the range of 250–500 mg/d, along with twice that dose of calcium.

If you are thinking of taking supplements I would advise you to speak to your Doctor or a qualified nutritionist who can help guide you on the right amounts so you do not intoxicate your body with too much.

If you eat right and exercise, and in this case spend time out in the sunlight you will not need a pill or tablet.

Just remember, you cannot become vitamin D intoxicated from excessive sunlight.

You can read more about this in the article – Everything you need to know about Vitamin D

Now that we have covered nutrition, calcium, and Vitamin D we need to look at arguably the biggest factor, exercise.

It is important to understand that you can eat all the calcium and protein you like, but if you do not apply resistance to the bones you will not make any difference to the bone strength.

2 Exercise Mistakes Regularly Made

One hundred years ago we would not have needed to exercise for most jobs required extensive manual labour and even many daily activities were enough to keep our muscles and bones working as required for good health. Unfortunately, modern living has made our bodies weak and exposed to problems like osteoporosis due to a lack of physical stress. We need to devise exercise programs to keep all of our physical systems working correctly and one of the best ways to do this is with a strength training program.

Before you jump right into strength training it is vital you understand several important principles first. The two biggest mistakes I see people make are;

1. Ignorance to moving correctly first and applying strength methods too fast
2. Fear of using loads and not achieving anything for the load is too light.

These two mistakes are polar opposites, and both will result in poor outcomes and even make matters worse. Let me explain.

The first mistake is where people have heard they need to start strength training and use a quick-fire approach to getting it done. They believe that moving well will just automatically happen once they start exercising. All they have to do is get out there and get it done and the body will fix itself. Unfortunately it won’t. And movement problems will only get worse when compounded by frequency and volume of training.

Ignorance to exercise techniques and impatience to get to the “fun stuff” is a recipe for injury. As it takes considerable time to learn skills and earn the right to use heavy loads that produce big strength gains, some people will resort to machine training to speed up the process. All this does is set them up for joint and stability problems later on that will lead to injury and pain.

This is often where you see the early stages of osteoarthritis formed by learning poor movement strategies and adding load on top of them. In addition to this you will find that bone density responds much better to dynamic movement which is something I will discuss in much more detail shortly.

For this reason it is much more important to focus on learning good functional movement skills first and then gradually increasing loads as you improve. Machine training can be added in at times to complement the program but it should not be the first thing you do.

You can read more about this in the article – Why exercise technique is so important

The second big mistake is avoidance of using loads.

It is a real myth that mature adults should only use light dumbbells or easy resistance bands because they might become injured. It really annoys me when I see pictures shown above with older adults who are not wheelchair bound and able to walk around.

In order to force the muscles to grow and the bones to strengthen they must be exposed to resistance.

Unfortunately many people do not understand this concept. They either think that what they are doing is “good enough” or that working out harder will be dangerous for them. The muscles of older adults need to be challenged in order to grow just as the muscles of younger adults. If anything more so than younger adults!

This is also why walking, Yoga, and most forms of aerobic exercise will do very little to change your bone strength and structure. While walking and other forms of aerobic exercise are great for the cardiovascular system they do not pose much resistance to bones. The body becomes very efficient at using its muscles to complete these repetitive activities resulting in very little change to the body.

To force bones to grow they must have a physiological stress greater than normal placed upon it as seen in the graph below.

To help you understand this better let’s take a more detailed look at how to use strength training correctly to improve bone density.

Bone Responds Best To Dynamic Movement

When you understand how the three factors that affect bone strength you begin to see how important it is to use exercises that force a variety of angles and positions for it to grow. The three factors to affect bone strength are:

1. Bone density
2. Bone quality
3. Bone geometry

In the book “Bending The Aging Curve” the author uses a great analogy of a house to describe how this works.

Bone Density would be the equivalent to the wooden frame of studs and beams, bone quality is the knot holes, splits, and wooden flaws in the timber that weaken the wood, and the geometry is the architectural design of the building that provides that strongest structural strength of the house.

To be able to improve bone strength you need to move your body in a way that forces you to improve the quality of these three factors and the best way to do this is with dynamic movement with load. This is due to the fluid flow around the bone trabeculae that places a large strain on the bone itself that forces it to respond by improving its overall structure.

In plain English this means is that multi directional exercises with load improve bone density and bone strength faster due to the fact that they incorporate so many of the structural lines needed for everyday life moving. By forcing challenges with these exercises with either load or speed these lines adapt and create a structural change to the bones. This is one reason why machine training provides little to no effect.

Good examples of this are shown below.

Bone Responds Best When It Encounters A Load Different From The Usual

This is another mistake I see with strength training all the time, and not limited to older adults or those with osteoporosis, and that is doing the same exercises all the time. This is something I discussed in great detail in an article late last year (see how often should you change your program?) as it sets people up for poor results and injury.

However, with regards to bone density and osteoporosis continually challenging the body with a new exercise that requires different angles of resistance produces better results than doing the same exercise all the time with greater loads. This comes back to what we discussed with the first principle of dynamic movement, in that it is of more importance to continually hit the bone with variations of load to expose the structural lines and force adaptation. While it is good to spend some time developing your strength and skill with the same exercise until you have mastered it, you must not fall into the trap of doing the same thing all the time.

There is no shortage of exercise variations you can use and it is important to spend some time designing your workouts to constantly force your body with new challenges. Also do not disregard the value of changing the equipment you use.

I will often use a combination of dumbbells, barbells, cable machines, body-weight exercises, Swissballs, and even medicine balls and vibrations tools like body-blade to expose older adults to variations in resistance exercise.

Vibration training is a very unique type of exercise and has shown to increase significant amounts of bone and muscle mass and was used extensively by astronauts in space to maintain muscle in zero gravity conditions. The best part with tools like body-blade are they are very safe to use and easy to do anywhere.

You can watch a video of the body-blade in action below to see how you could use something like this. 

Vibration plates to stand on are other ways to do this but not many place have one and they also need to be used with caution as they can come with some risk. You should speak to your physical therapist before using something like that.

How Much Exercise Is Required?

This is an interesting question for while resistance is needed to force the bones to adapt there must be a period of rest and recovery.

Lifting weights and performing other strenuous exercise causes microscopic tears and other damage in the tissue of your muscles. Though this sounds bad, this damage is actually a good thing and essential for muscle development. The damage that your muscles receive while completing strength work triggers the healing process and also prompts the body to try and adapt itself to prevent this type of damage in the future.

As your body heals the damage from your strength workout caused in your muscles, specialized cells known as satellite cells begin fusing together and attach themselves to the damaged tissue to promote the healing process. These satellite cells begin fusing with the muscle fibres themselves, increasing their cross-section thickness. Eventually, these fused cells transition into new protein strands within the fibres, and components of the cells are used by the muscles to create additional strands as well. These strands increase both the size and the strength of the muscle fibres, resulting in the increase in muscle mass and muscular strength that you experience when lifting weights regularly.

For most people we would suggest to do 3 workouts per week with at least a day between sessions to allow the muscles and all the soft tissue time to recover and rebuild. Our muscles and bones get stronger during recovery as explained in our article about overtraining.

In order for the body to adapt, it must have a period of repair. If you cannot adapt to and cope with the physical and mental demands of training, you will quickly become exhausted.  Finding the perfect balance between working out and recovery can be tricky for these are the things you have to keep in mind.

• If the training stress is insufficient to overload the body's capabilities, NO adaptations will occur!
• If the workload is too great (progressed too quickly, performed too often without adequate rest), then fatigue follows and subsequent performance will be reduced. Again NO adaptations will occur!
• Work alone is not enough to produce the best results; you need time to adapt to training stress
• To encourage adaptation to training, it is important to plan recovery activities that reduce residual fatigue. See article - Best Foods & Methods To Promote Faster Recovery
• The sooner you recover from fatigue, and the fresher you are when you undertake a training session, the better the chance of improving and having positive adaptations.

Refer to the chart below to see how this works.

The more intense the training the longer the rest between workouts and if you remember from earlier in the article the stress placed upon the bones must be quite intense for any changes to occur. While low intensity training allows for faster recovery and more workouts, it may do very little to change the overall bone density and strength. Only the more strenuous workouts will make a difference but you will need to structure your training week more effectively to make any improvement.

Training Frequency For Improving Bone Density With Older Adults

Now just when you think it is all clear and makes perfect sense I am about to confuse you with contradictory information.

Research found that it may be better to workout more often and instead of one big workout, to do two small workouts two times in the same day!

A 2002 study by Robling and colleagues found that older adults completing 120 jumps per day showed a 50% improvement in overall bone structure by splitting the jumps into two sets of 60 sessions. The reason for this is that the cells responsible for bone growth respond better to smaller and more frequent bouts of stimulus.

They concluded the following:

“Short intensive exercise bout build bone more effectively than longer sessions do. If the goal is to reduce exercise time, it’s better to shorten each exercise session than to reduce the overall number of sessions performed.”

This might be where you could use split programs that allow you to work different parts of the body more often and something I discussed in great detail in the article – How long should a workout last?

You could have a full body strength day on Monday and Friday that consists of the big lifts like squats, deadlifts, lunges, pushing and pulling exercises. You could then have a lighter workout for the next workout that includes a agility exercises like skipping and jumping that do not demand the same type of muscular strength.

You could allow more time on the Monday and Friday, let's say 45-60mins to do your main strength workout that leaves your muscles sore and weary. The big workout will require longer resting times between sets and possibly 3-4 sets for some of the key exercises making the workout last a bit longer.

Some people like to break up the body into muscle parts like upper body on Monday and Thursday and legs on Tuesday and Friday. This can work out well in terms of muscle recovery, especially for the legs as they can get really sore if you designate an entire workout to them. (See the article about legs day for workout examples and more detail about how to do this).

Obviously, these are all hypothetical and perfect world scenarios and you will need to adjust exercises and workouts according to your specific needs. Some people may have an injury or a health concern that may require more rest between training so some of these ideas may not be best for you. However, by arming yourself with better knowledge as to what works is critical in achieving success especially if you know you have a bone density problem already and are trying to find a way to stop the ongoing loss.

Make Sure You Grab A Copy Of Our Special Report

There is a lot of information and great exercises I have not included in this article and I do suggest to grab a copy of our latest report that covers everything you need to know about older adults health. This report provides you with detailed pictures, instructions of over 50 exercises and some excellent workouts and tests to use for measuring your improvement. This report covers several of the important nutritional needs of older adults with clear and simple to follow information so you can implement this into your life immediately. Many of the exercise pictures shown in this report are of clients who in their 70’s and 80’s who currently train with us at No Regrets. We also feature several of their stories for you to see how they changed their life by adopting the methods explained in this report. I hope you enjoy reading this and it helps you to enjoy your golden years.

Summary

As with almost every disease it is so much easier to prevent it than to try and fix it after it has affected you. We all know that exercise and nutrition is important yet so many people still look at it as a luxury and our over-reliance on medical science leaves people ignorant to the danger that awaits.

Make sure you are getting the optimal levels of calcium, protein, magnesium and Vitamin D for it is impossible to build strong bones without it. But do not fall into the trap of thinking you can eat your way to strong bones, you are still going to need exercise. Walking and light activities will not cut it either. You MUST apply resistance.

Strength training is by far the best way to build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life.

If you would like to know more about our Stronger For Longer Older Adults Group Training program or any of our other services please click the image below and I will get back in touch with you within 24 hours.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 18 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Bending the Aging Curve -  Joseph Signorile
• Movement - By Gray Cook
• Functional Training for Sports - By Mike Boyle
• Corrective Exercise Solutions - by Evan Osar
• Athletic Body Balance by Gray Cook
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Stuart McGill
• Back Pain Mechanic - by Stuart McGill
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek