Diet & Exercise in Managing Osteoporosis
What is osteoporosis?
Osteoporosis is a condition where your bones lose strength due to reduced density. Weakened bones have a higher risk of breaking (or fracturing) and certain bones (the wrists, hips and spine) are more susceptible to breaks than others. It’s estimated 3.5 million people aged over 50 in the UK have osteoporosis, that is 7% of men and 22% of women (International Osteoporosis Foundation, accessed June 2019)
While weak bones are more likely to be detected in your 50s, it is what you do until your 30s that really counts. In our late 20s we build bone strength through physical activity and good nutrition, but equally we can inhibit its growth through low body weight, the use of steroids, smoking and drinking too much alcohol. It is during our late 20s that we reach our peak bone mass. After that, we cannot increase the strength of our bones any further.
How do you know if you have low bone density?
Unless you are having routine scans to look at your bone mass, the first thing you might know about it is if you fracture a bone. Your health professional will arrange for a dual energy X-ray absorptmetry (DEXA) scan to measure your bone density. DEXA scans compare the density of your bones with that of an average, healthy young adult and a healthy adult of your own age, gender and ethnicity. You are therefore likely to be given two scores after your scan; The T-Score and the Z-Score. T-Scores compare your bone reading with that of a healthy, young person and Z-Scores compares your bone density with that of someone who is a similar age to you. (NHS.UK)
It’s expected that your bones will be more fragile than those of a young person with healthy bones, so a variance (or standard deviation) of -1 is regarded as normal. Therefore, a T-Score of -.05 suggests your bones are considered to be suitably strong. However, if your T-Score (or comparison with the peak bone mass of a healthier, younger person) varies by -1 or more you may be told you have reduced bone mineral density. A reading of between -1 to -2.5 is classified as osteopenia, whereas a reading of -2.5 or below is classified as osteoporosis.
Z Scores are not usually used to diagnose osteoporosis or osteopenia, but if your Z score (how your bone density compares to someone of the same age) is below -2, your bone density is lower than average.
How to manage your lifestyle if you have osteoporosis and osteopenia
If you are diagnosed with osteoporosis or osteopenia your health professional may prescribe you medication or food supplements. There are also a number of modifications you can make to your lifestyle, including adapting your diet.
Diet for fragile bones
Calcium and vitamin D play an important role in keeping bones healthy. Calcium is an essential mineral that builds and maintains our bones, as well as helping with other essential functions like muscle contraction. The majority of the body’s calcium is stored in the bones and it is constantly being used and replaced . It is therefore vitally important to keep your calcium store well stocked!
Most people need 700g of calcium per day, but if you have osteoporosis or osteopenia your health professional may recommend you take 1000 mg. They may also prescribe a supplement.
Foods rich in calcium include;
dairy products, like milk and cheese
green leafy vegetables
fortified foods and drink, like breakfast cereal and alternative milks
To measure how much calcium you are getting through your diet you can use this calculator.
A portion of oily fish with bones like sardines or pilchards = 350mg
¼ pint low fat milk = 150mg
A portion of cheese = 320mg
According to The Vegan Society if you have a plant-based diet you can also get adequate calcium from your diet.
100g calcium set tofu =350mg
⅓ pint of calcium fortified plant milk = 240g
Approx.20 almonds =72g
Vitamin D helps the body to absorb calcium from foods, so is a key ingredient in strengthening our bones. Most of our vitamin D is made by the action of sunlight on the skin. Between April and September, going outside for 15 minutes, two or three times a week between 11am and 3pm without sunscreen should be enough to produce sufficient vitamin D. However, with the British weather as it is, is is also worth looking at food sources rich in vitamin D. Good sources include oily fish, eggs and fortified breakfast cereals. However, be aware, but you cannot get sufficient vitamin D from food alone. (British Dietetic Association)
Exercise for osteoporosis
Exercise can increase and maintain your bone mineral density, but knowing what type of exercise to do can be tricky. A clinical exercise specialist can prescribe specific weight-bearing and resistance training that can help you maintain your bone strength and may even improve it. However, in post-menopausal women, it is difficult to build bone density back up. In this situation it would be a case of preventing the bones from deteriorating any further.
According to the Royal Osteoporotic Society the evidence suggests that the benefits of physical activity far outweigh the any potential harm, especially in causing vertebral fractures. If you have been active all your life then the advice is to keep going! If you use a fitness trainer then make sure they are trained in how to adapt exercises to be most beneficial for people with osteoporosis.
If you haven't had a vertebral fracture or multiple other fractures, the recommendations is to do 50 impacts per day which could be ‘stomps’, jumps or jogging.
If you have had a vertebral fracture or multiple fractures, the recommendation is to keep active by doing lower level impact exercises and brisk walking up to 15 minutes per week. Advice from a qualified fitness instructor or physiotherapist is recommended so that you maintain the correct technique and alignment and progress resistance exercises at a suitable rate.
If you do not exercise regularly and your balance could do with improving then Pilates is one of the exercises recommended to do twice a week.
For people who have lost their balance which resulted in a fracture, programmes such as those run by a Postural Stability Instructor, for 3 hours per week are recommended.
Pilates for Osteoporosis
Pilates has a multitude of benefits for reducing the risk of bone fractures and is generally very safe to perform if you have osteoporosis.
It can help train you to improve your balance in a safe environment
It can help with pain and posture
It can increase muscle strength and maintain bone strength, particularly at fracture risk sites
But there are a few things to be aware of, especially if you are new to Pilates.
Avoid exercises that cause you to bend forward excessively, such as the roll down. Instead, you can support your hands on your thighs, or do the cat stretch
Some of the more advanced levels of scissors, double leg stretch, one leg stretch or the 100s may not be suitable. You can adapt these exercises by keeping your head on the mat
Avoid exercises such as rolling like a ball or the roll up
If doing a forward flexion stretch, such as the spine stretch, ensure you hinge from the hip
Other forms of exercise to help bone strength
If you want to maintain your bone health you might also want to consider the following exercise;
Weight-bearing exercise classes
While exercises such as swimming and cycling will not help strengthen your bones, as you are not exerting sufficient force through the body, they are still important for improving your heart and lung function and your overall health.
In conclusion, being diagnosed with weak bones can be a scary prospect. However, with the right guidance and suitable lifestyle modifications, you can continue to be active and live a full and healthy life.
Carol Clark is a Clinical Exercise Specialist who is qualified to prescribe exercise on referral, work with cardiac patients and help people improve their balance in later life. She has taught on the ‘bonewise’ programme at the Royal Free Hospital in Hampstead, is a qualified Pilates teacher and has recently completed the APPI course in Pilates for Osteoporosis. She currently has a private practice in north Hertfordshire.