Osteoporosis

As it is helpful for a personal trainer to understand conditions that their clients may have – and to help prevent them – our blog this week focuses on osteoporosis.

Osteoporosis is a disease characterised by low bone mineral density, or low bone mass. It causes microarchitectural deterioration of the bone, which leads to the bone becoming more fragile, increasing the risk of developing a fracture.

AREAS MOST COMMONLY AFFECTED BY OSTEOPOROSIS

Although it can occur anywhere in the body, it is most commonly seen in the following areas:

• the thoracic spine – as there’s a large range of movement in this area
• the lumbar spine – as a lot of force is transmitted through this area
• the distal radius – being at the end of the wrist, it often gets broken when people put a hand out to break a fall
• the proximal femur – a prominent bone at the hip joint, it often gets broken when people have a fall

WHAT CAUSES OSTEOPOROSIS?

Osteoporosis occurs when osteoclasts, which clear away bone, are more active than osteoblasts, which deposit new bone.

The three types of osteoporosis are:

Primary Type 1 Most commonly occurring in women after the menopause when oestrogen levels decrease, it is also referred to as post-menopausal osteoporosis. Here, the reduction in oestrogen causes the osteoblasts to slow down, while the osteoclasts continue to work at the normal rate.

Primary Type 2 Also known as senile osteoporosis, this occurs after the age of 75 and is seen in both men and women, but at a ratio of 2:1 female to male. As older people tend to be less active and don’t produce as many new cells, again the osteoblasts slow down, while the osteoclasts continue to clear away bone at the usual speed.

Secondary osteoporosis This can occur at any age and affects men and women equally. It normally occurs because of a pre-disposing medical condition or as a result of taking medication such as glucocorticoids, a steroid that can reduce bone mineral density.

THE DIAGNOSIS OF OSTEOPOROSIS

Osteoporosis is diagnosed using a DXA (Dual X-ray Absorptiometry­) machine, which measures bone mineral density using two types of X-rays. A person is classed as having osteoporosis when the measurement is more than 2.5 standard deviations below the normal mean.

THE PREVALENCE OF OSTEOPOROSIS

Osteoporosis is more prevalent  in women:

10% of women aged 60

20% of women aged 70

40% of women aged 80

66% of women aged 90

In the UK, one in two women and one in five men will suffer a fracture after the age of 50 due to osteoporosis.

HOW TRAINING IN THE GYM CAN REDUCE THE LIKELIHOOD OF DEVELOPING OSTEOPOROSIS

If an individual trains with a fitness instructor or personal trainer on a regular basis, they will build up their bone mass density. When they age and their peak bone mass starts to deteriorate, they will be starting from a higher level of bone density than someone who hasn’t exercised regularly.

Conversely, if someone is inactive through their life, or has poor nutrition – for example by following extreme diets – this can affect their peak bone mass and, as they age, they will be starting from a level of low bone density.

THE PRESENTATION OF OSTEOPOROSIS

Any of the following can be signs of osteoporosis:

• A bone fracture after a slight fall
• A loss of height
• Persistent back pain
• Stooping or bent posture

LIFESTYLE INTERVENTIONS

A variety of lifestyle interventions can reduce the likelihood of developing osteoporosis. These include:

• Stopping smoking – if someone is smoking, they are less likely to be exercising and eating healthily; also, women who smoke are likely to have an earlier onset of the menopause.

• Following a diet high in calcium and vitamin D. A high intake of dairy products and green leafy vegetables is beneficial, as is moderate exposure to sunlight. Alcohol intake should be moderated as it can affect the absorption of calcium and vitamin D.

• Weight-bearing exercises – these put stress and force through the joints, promoting the activation of osteoblasts. This can be anything from walking or running to resistance training.

These interventions can be beneficial at any age. For a younger person, it allows them to build up bone mineral density, which will be beneficial in later life. For someone showing signs of osteopenia – reduced bone mass – they can help increase osteoblast activity. Even after someone is diagnosed with osteoporosis, it is possible to slow down the progression of the disease by following the above recommendations.

A personal trainer working with a client who has osteoporosis will have to be aware of the severity of the disease as well as the client’s general level of fitness. They will need to adapt the training exercises accordingly, avoiding high-impact training, which could lead to a bone fracture.