Exercising with osteoporosis

[Wishimaywishimight]

I was recently diagnosed with osteoporosis and have been reading up on how best to exercise but finding there is lots of conflicting information.

My doctor is lovely, very calm and pragmatic and helped lessen the panic. She is of the view that the more exercise the better - walking (uphill / on stairs preferably) and pretty much anything else I am happy to do which is skipping, cardio (youtube vids), handweights, kettlebells, pilates etc. (bearing in mind avoiding things like crunches, bending at the waist, rolling the spine upwards etc). Her only 'no's' were golf and tennis until I have been on the medication for a while (and presumably had a repeat DEXA scan).

However, when I read up on the best exercise to do with osteoporosis, I am coming across articles saying 'no' to jumping, skipping, jogging i.e. anything that 'jars' the spine whereas other articles say that this sort of force is necessary to help bone strength / density.

I am planning on making an appointment with a physiotherapist to see if they can give me some definitive advice but, in the meantime, I wondered if anyone here has any expertise and can offer any advice?

Hi there. This is certainly something I have expertise in and am very happy to help on this. May I ask how you were diagnosed with osteoporosis and what your T score is?
In terms of the specifics of the exercises, if you are happy to share either here on messages, what were your T scores in the specific areas - lumbar, spine etc? This would help cater what exercise is best.
The main overall advise would be to do a mixture of cardio, flexibility and strength training - based on what you are doing at present. If you mainly walk right now, continue doing this and try and increase it somewhat. Increasing the pace and distance incrementally will mean your bones adapt to the load gradually.
Tennis interestingly has the best evidence for balance - I wonder if your doctor was concerned about lumbar fractures from serving? Otherwise if you are playing at leisurely pace it should be fine. I think the concern would be going into an extended position through your back. Balance is important so to ensure you reduce risk of falls and thus reduce the risk of getting a fracture.
Finally, with regards to strength training - doing your core muscle groups - shoulders, chest, legs, abdominal muscles - twice a week. You dont need to do more than 30 minutes at a time. This will help strengthen the bones.

Just for your reference, this is the NICE guidance - it isnt really too specific, but this is where speaking to a specialist can be helpful.

• Take regular exercise (tailored to the person) to improve muscle strength. Encourage:
• Walking, especially outdoors, as this will increase exposure to sunlight, increasing vitamin D production.
• Strength training (such as weight training) of different muscle groups (for example hip, wrist, and spine).
• A combination of exercise types, for example balance, flexibility, stretching, endurance, and progressive strengthening exercises.

@SportsAndExerciseMedicineDoc thank you so much for replying.

My T-score are as follows;

L1: -2.3 L2: -3.3 L3: -1.6 L4: -1.7

Femur neck left: -2.1 Femur neck right -2.0
Femur total left: -1.7 Femur total right: - 1.7

I had a DEXA scan as I have a strong family history - mother, grandmother, sister, aunts all have osteopenia and/or osteoporosis so while I got a shock at the diagnosis it was not really surprising.

At the moment I do the following:

Walking: Once a day - can be anywhere from 20 minutes to 45/50 minutes depending on what day / time of day I'm walking.

Mornings: I do youtube videos so 30 minutes generally of cardio or weights (light handweights) or kettlebells or pilates. To be honest I have stopped the pilates as I am so unsure about the movements - lots of the moves involve flexing the spine which is a no-no. With the other activities I am just wary about bending at the waist or twisting at the spine so I am probably not getting the full value out of these workouts.

To finish up I will do perhaps 5 rounds of 50 skips then 1 minute plank and perhaps some squats and calf raises.

During the day I get up from my desk several times a day to do squats, calf raises, marching on the spot and walking up/down stairs a number of times.

In the evenings I usually do 20 minutes hoola hooping and another 4/5 rounds of 50 skips.

So, mostly I am continuing activities as previously (with the exception of pilates) but modifying where I am unsure and have added in a few exercises during the day - squats, going up and down the stairs a few times.

The doctor hesitated when I mentioned tennis and suggested I wait until I have been on the medication (Alendronic Acid) for a while so I will re-visit this in perhaps 6 months. I don't play regularly but I do enjoy it however it does involve a lot of bending at the waist picking up balls!

I am just so confused now as to whether I should be skipping and jumping and doing cardio or not!!

Get a mini trampoline. It’s very low impact exercise. NASA uses them to strengthen the bones of astronauts after they come back from being in space.

HI @Spodey I hadn't thought of that. Will bear it in mind although not sure it would be my first port of call while I am still feeling a bit nervous - I can picture myself falling off and breaking something!!

So the key thing for me is you have been doing all these things and despite having a low T score you have been fine. Doing some skipping should be fine. Your femur T score is actually fine - which is where most of the force would be taken. You should definitely be doing some cardio. One thing is getting your bones used to the load, but also you need to maintain your muscles and build them ideally. Muscles work as shock absorbers - so if you imagine when you run, you are putting roughly 3 times your body weight through each limb on each stride. Your muscles absorb this shock. So if you were to stop doing cardio for example you would decondition and increase the force through your bones. And of course, there is the overall benefit of cardio to your health.

The T spine of most concern is at L2 and next L1. Its not so much bending, but going into extension which causes pressure into these areas. But, you need to be comfortable with what you are doing. You must try and avoid getting the muscles around these areas weak, so perhaps doing pilates to keep your core strong would be worthwhile.

Overall, I think you are doing the right things. I would perhaps look at just increasing bits - such as the amount you are walking, and increasing the weights you are doing as well.

Re: Trampolining - the Nasa study is around rebounding - I think the way they performed that at Nasa was much more controlled to ensure no injuries. Trampolining has very high injury rates and I would just be a little careful with this.

Hope this helps and let me know your thoughts.

You can’t hurt yourself on a mini trampoline. It’s only six inches off the floor. Mine lives behind the sofa and I pull it out and clip the legs on when I want to bounce.

What do people think about the vibration plates for bone strengthening? I have osteopenia and have been wondering about getting one of these.

OP if you have audible Dr Lani's no nonsense bone health guide is currently free in the Plus Catalogue and has chapters on exercise and diet. When I get a chance I will try to review what she said about exercise types.

How old are you, OP?

I've never heard of fractures from pilates and I did a lot of gerries jobs as a junior. All Osteoporotic fractures ive seen have been from significant falls in little old women (the type that would never be able to play tennis in a million years) so I'd try not to worry too much and definitely don't let it limit you as you need your strength and flexibility to protect you

try turmeric milk for osteoporosis .. curcuminoids really helps in calcium level

@SportsAndExerciseMedicineDoc Your comment about how I have been doing these exercises with no issues has actually uplifted me! Since the diagnosis I feel like I am moving a little more gingerly, feeling a little more frail etc and I don't want to behave that way as I know that will do more harm than good!

I am driving myself nuts, to be honest, with reading up so much information and trying to fit so many exercises into my day (thankfully I work from home so taking 5 minutes out to do a few squats / planks every now and again is possible!).

I have a couple of questions;

1. Re weighs - I usually use 1.5 or 2kg which I appreciate is quite light. I do have 3kgs so will aim to move up to these. I think I would find anything heavier a bit of a struggle. Is 2 / 3kg sufficient for my needs?

2. Just to clarify the difference between "bending" and "going into extension" - do you mean I am fine to, say, bend while cleaning the bath whereas going into extension is repeatedly doing a movement bending at the waist, such as russian deadlifts, is bad?

I am planning on making some amendments to my schedule such as;

Walking - increasing to some longer walks and carrying light weights (1kg) while I walk for extra resistance.

Adding in some balancing exercises - what do you think about balance boards?

Core exercises - I have downloaded a 'planks' app and plan on working hard to strengthen my core.

Thank you again for your advice and expertise, I hugely appreciate you taking the time to respond.

@doubly436 I have never heard or, or seen, turmeric milk so I am adding that to my 'diet' sheet and will see if I can find it. I presume Holland and Barrett or some sort of health shop will stock it!

@lljkk I am 54. Far too young (in my own head!!) for this.

@Bubbles254 Thanks for that. I will have a listen.

@Destiny123 Apparently with osteoporosis in the spine there can be small fractures that are not even noticed until you start to lose height so I want to avoid those! Definitely it seems that crunches / curls are out and lots of pilates moves are lying on your back with legs in tabletop position and raising the shoulders / curling up. I do love it however so I am going to do what I can while avoiding those movements.

Just go gently and you'll be fine. You've probably had it for years and not yet known it. Just take the meds and keep active, try not to worry hundreds of post menopausal women have it, few get fractures

@Destiny123 Thanks so much for that reassurance. I have been a bit of a nervous Nelly since receiving the diagnosis and tempted to wrap myself in cotton wool (I won't!!)

I enjoy exercise so intend to continue very much as I have been doing but with modifications in respect of movements which would flex my spine.

I am trying now to dial things back a bit in terms of research / reading / watching youtube videos etc and just live with it without letting it take over!

I found this summary really useful about what to incorporate;

https://theros.org.uk/information-and-support/osteoporosis/living-with-osteoporosis/exercise-and-physical-activity-for-osteoporosis/?_gl=11nxzq31_upMQ.._gaNzIyMTA2NjQxLjE2OTU4MTMwNjM._ga_LE28KHFKJD*MTY5NTgxMzA2My4xLjEuMTY5NTgxMzEwMy4wLjAuMA..&gclid=Cj0KCQjwpc-oBhCGARIsAH6ote_OPYYGuiyraHM6MRr5SL4ALuMCehSyN2A2523onSRHZypUzfwtdIwaAtZmEALw_wcB

I also strongly recommend the website and YouTube videos from Margaret Martin. She is a Canadian physical therapist who has written several books and does an email newsletter you can sign up for.

https://melioguide.com/about/margaret-martin/
A PP was asking about vibration plates - Margaret Martin wrote an article about this - basically the ones in gyms are too strong/fast and are dangerous for many people, but smaller ones with lower speeds would be safer. There is little evidence that they have any effect other than in the lower legs because the vibrations don't travel into your spine.

https://melioguide.com/osteoporosis-exercise-equipment/whole-body-vibration-therapy/

and as you said OP - it's important to avoid spine extension positions involved in pilates movements such as crunches, roll downs, etc - these can cause compression fractures to the inner side of the vertebrae.

@fernsandlilies I have actually been watching the Margaret Martin free videos - I'm up to Lesson 6! I have incorporated some of her exercises into my schedule although I do feel that some of them are perhaps a little too 'gentle' and perhaps geared to older / less mobile people. I may get her book however and have a proper read.

Thank you so much for that link to the UK Osteoporosis Society - the factsheet on exercise is fantastically helpful so I have downloaded that. It really makes things pretty clear and I am feeling a lot better about being able to do the exercising that i want to do.

I am still cautious about tennis as it would involve a lot of bending so I am going to hold off on that but otherwise I am going to keep going and (carefully) ramp things up a little.

Thanks so much for all of your responses / advice.

@fernsandlilies Yes, absolutely, there seems to be no ambiguity in that regard so I will be really careful to avoid these types of movements.

I don't know how to do the link thing but here is an article I sent to my mum earlier today

www.womenshealthmag.com/uk/fitness/a45205205/anne-somauroo-strength-training/

It got my attention as I do strength training, and am likely to soon get an arthritis diagnosis, so was interested to see how strength training helps with conditions like this as we get older

@florenceandthemac Wow, that is inspirational!!

Amazing article!

I realised that I used the wrong word previously- the movements to avoid are spinal flexion not spinal extension (just in case this helps anyone coming to the thread later).