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By: Gold Coast Sports & Spinal Physio  18-Feb-2012

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-deterioration of bone tissue leading to bone fragility and increased risk of fracture.  It is estimated that there are over 1.5 million fractures per year in this high risk group.  The health care costs associated with fractures in this group of Caucasian women are estimated to be as high ad $45.2 billion over the next ten years. Some of the most common sites for fracture are the wrist, spine and hip with hip fractures being the most devastating.  The loss of independence, prolonged immobility and death due to multi-system failure are some of the complications of hip fractures.  Only one-quarter of hip fracture patients regain full independence. The biggest focus is looking at how to prevent osteoporosis and to decrease the incidence of fractures.  Preventative measures include lifestyle changes, such as altering nutrition and exercise. Bone mass density changes across the lifespan of females with a gradual loss throughout adult years and a steeper decline with menopause. Research suggests that athletes involved in activities requiring high impact loads have higher bone mass than those involved in endurance training. Those activities that involve muscular involvement without gravitational forces, for example, swimming, are associated with lower bone mass density than those with a weight bearing component. The impact of training should be at the bone site of interest since loading has a localized effect.  Overload means that the training stimulus must include forces much greater than that afforded by habitual activity and reversibility indicates that in the absence of the training stimulus, the positive effect will be lost. Studies show that there is improvement in spinal bone mass density in postmenopausal women with a program consisting of vigorous, progressive exercises including walking, jogging, stair climbing and rowing.  Discontinued participation showed reversal in bone mass, confirming that the benefits of training only persist as long as the stimulus is applied. Intervention which includes dynamic resistance training 2 days/week on pneumatic machines demonstrates improvements in muscle strength, muscle mass, bone mass and dynamic balance in oestrogen-deplete postmenopausal women. It takes about 9 – 12 months to detect significant change in bone mass.  The change may be a > 1% increase, since the average rate of loss is 0.5 – 1% per year. The program should include squats, lunges, chair raises and jumping which helps with strengthening the hip abductors and extensors.  It also helps with lateral stability and decreases the risk of falls.  Balance exercises are an important part of the exercise program, as a common reason for the fractures is due to falls.  Physical activity that involves twisting, bending or high impact should be avoided for those already diagnosed with a low bone mass density and sports like golf and tennis apply torsional stresses to weakened bones.  Therefore, patients at risk should be involved in swimming, water aerobics, dancing, low impact aerobics, walking, cycling and light resistance weight training. Get out there and stimulate those bones and have some fun! By Melanie Roberts

The information in this article was current at 16 Feb 2012

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