What is Osteoporosis?

Osteoporosis occurs when our bones  gradually become fragile then break easily. Bones become honey combed when very osteoporotic. The struts within the honey comb mesh (trabecular bone) become thin causing the bones to become fragile and break easily. (Introduction to osteoporosis, National Osteoporosis Society)

Osteoporosis in its early stages is a silent, painless condition that signifies low bone density. This condition mainly affects women post menopause when oestrogen levels drop. However various drug medications and treatments can also pre dispose one to it and men, although not as commonly, can also be affected. Having low bone density though,does not mean you are going to have a fracture.

A DEXA scan (Dual Energy Xray Absorptiometry) is the most accurate method used to measure bone density.  The scan usually measures the bone density in your lumbar spine and  hip including the neck of the femur which is vulnerable.

(click on the dexa link image below this article)  The T score is the statistical measure which measures your bone density relative to that of a 30 year old. The Z score compares your bone density to other men and women of your age.

Interpreting the T Score

Above  -1 is normal

-1 to -2.5 is osteopenia (a mild stage of bone density loss)

-2.5 or lower is in the osteoporosis stage.

The main fracture sites are the spine, hip and wrist. Having osteoporosis means you have a greater risk of fracture if you fall.

The World health Organisation has developed a 10 year  assessment tool  FRAX (Fracture Risk Assessment Tool) to help predict a persons risk of fracture between the age of 40 and 90.

What can be done to stabilise or indeed reverse osteoporosis?

Research and National Osteoporosis Society guidelines strongly recommend the right kind of exercise which includes weight bearing, resistance, dancing and perhaps even careful jogging! In other words, staying active with controlled exercise which promotes and improves balance as part of a Falls Prevention Programme.

Some types of exercise are considered to be risky. This  includes excessive forward flexion, loaded flexion and pronounced sit ups. It is best to modify Pilates based exercises to be safe.

Appropriate exercise in conjunction with a healthy diet ( foods containing calcium and vitamin D) can certainly help but  may not  be enough to stabilise or halt the progression. Sunshine in moderation is good too!

Here is a graph below depicting the results of 6 dexa scans carried out between 2007 and 2018 showing a downward trajectory.

graph DXA Scans

Medical Treatment

If you have any concerns please do see your GP.  Commonly prescribed  drugs include Alendronate and Risedronate both bisphosphonates which are prescribed to  strengthen the existing bone and help to prevent or slow down further bone loss. However some people believe that this may interfere with bone quality.


So what is the alternative?

You may find that many GPs are reluctant to prescribe HRT to women at 60 years +. In a recently shown TV programme entitled The truth About the Menopause (BBC1 Nov 2018)  the research illustrates that the  risks of being on HRT from 60 years out weigh the benefits. There is the increased risk of breast cancer or having a stroke. HRT combined with alcohol intake (a regular glass of wine or two) and obesity has been shown to increase the risk even more!

To Conclude

Many people with a diagnosis of  osteoporosis are indeed fortunate to feel incredibly fit and healthy in advancing age (over 60) and may even have a  total absence of muscular aches and pains. They still enjoy an excellent quality of life and work!

However the reality is that at some point in time they may need to be on a type of bone medication to avoid the prospect of a vertebral or hip fracture which would undoubtedly be life changing with negative consequences. Osteoporosis is a natural part of the ageing process and many older people are likely to  have it but just not know it.

Keep exercising, develop and maintain muscle strength and continue to work on your balance! Pilates is great for maintaining and improving posture, balance and strength!

The following research article http://www.jfsf.eu/articles/v03i04_155.pdf recently published in the December 2018 Journal of Frailty, Sarcopenia and Falls, identifies safety issues associated with physical activity for exercise for adults with osteoporosis and osteopenia with reference to mind body exercises such as yoga and equestrian sporting activity.