What the hell is Osteoporosis?

Written by: Adam Luther
Published: October 23, 2023

The International Osteoporosis Foundation reports that Osteoporosis affects 2.2 million Australians aged 50 and above (1). Osteoporosis is a condition characterized by weakened bone strength, making individuals more susceptible to fractures (2). Throughout our lives, bones undergo a process of generating new bone cells (bone formation) and removing old ones (bone resorption), known as bone remodeling. In osteoporosis, there is an accelerated rate of bone resorption compared to bone formation. This results in a higher disposal of old bone cells compared to the creation of new ones, ultimately altering the overall structural integrity of bones and increasing the risk of fractures and breaks.

Another term associated with osteoporosis is Osteopenia, which involves a lesser degree of bone loss. Osteopenia is considered the initial stage in the development of osteoporosis. This condition can be categorized into two groups based on “Bone Mineral Density (BMD).” A bone mineral density scan provides a T-score, representing bone density. The classification system is as follows:

  • A score of -1 or higher indicates normal bone density.
  • A score between -1 and -2.5 suggests moderately low bone density and may indicate osteopenia (early stages of osteoporosis).
  • A score of -2.5 or lower signifies low bone density, indicating the presence of osteoporosis.

The American College of Sports Medicine (3) has outlined several risk factors for osteoporosis, which include:

  • Gender, with females being at higher risk.
  • Race.
  • Family history.
  • Menopause.
  • Low calcium levels.
  • Low vitamin D.
  • Certain medications like glucocorticoids.
  • Low physical activity.

Regarding the relationship between osteoporosis and exercise, along with pharmacological interventions, seeking guidance from an Exercise Physiologist for a customized exercise regimen can significantly assist in managing osteoporosis. Specifically, resistance training, which applies greater stress to the skeletal system, has demonstrated the ability to stimulate overall bone formation (4) and improvements in Bone Mineral Density (BMD) (5). Although aerobic exercise is not as effective as resistance training in enhancing BMD, it should still be integrated into the overall training plan, as it aids in weight management, subsequently reducing stress on lower limb joints.

The American College of Sports Medicine (3) suggests the following exercise recommendations:

  • Strength training should be performed 2-3 times per week, lasting 30-40 minutes, with resistance set at 75% of one’s Repetition Maximum (1RM).
  • Aerobic training should be conducted 3-5 times per week, lasting 30-60 minutes, with intensity set at 40-70% of maximum heart rate.
  • It’s crucial to understand that these prescriptions are general guidelines. An Exercise Physiologist can assess the initial frequency, duration, and intensity of exercise, as well as plan subsequent training phases to facilitate progressive overload.

Once the initial loads and movement patterns have been comfortably tolerated and established under the guidance of an Exercise Physiologist, the incorporation of plyometric training can serve as a natural progression for progressive overload. Research has shown that plyometric training, which combines jumping with resistance exercises, yields greater improvements in BMD compared to strength training alone (6).

Key Considerations:

  • Consulting with your Exercise Physiologist in conjunction with your pharmacological treatment will enable you to develop a tailored plan for managing your osteoporosis. Here are some important factors to take into account
    • Seek guidance from a qualified professional for personalized exercise advice. Starting with a generic program may not be the most effective way to initiate your strength training. Having a strength program customized to your specific assessment results can greatly benefit your osteoporosis. Incorporating a pilates reformer can be an excellent starting point.
    • Set clear exercise goals that you aim to accomplish.
    • Determine appropriate resistance training loads that allow for safe and effective strength training. This can be based on a rating of perceived exertion scale (RPE).
    • Use feedback from a patient wellness tracker to identify muscle and joint soreness, helping establish the right training loads.
    • Gradually increase the demands on your skeletal system to enhance your muscular strength.
    • Integrate a balance component to assist in preventing falls and reducing the risk of osteoporotic fractures.

(1) https://www.iofbonehealth.org (International Osteoporosis Foundation)
(2) Beck, B., & Taaffe, D. (2016).  Exercise and sport science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis.  
(3) Durstine, J., Moore, G., Painter, P., & Roberts, S. (2009).  ACSM’s exercise management for persons with chronic disease and disabilities.  (3rd ed.).  Mitcham, South Australia: Human Kinetics.
(4) Zhao, R., Zhao, M., & Zhang, L. (2014).  Efficiency of jumping exercise in improving bone mineral density among premenopausal women: a meta-analysis.  Journal of Sports Medicine.
(5) Calatayud, J., Borreani, S., Moya, D., Colado, J., & Triplett, T. (2013).  Exercise to Improve Bone Mineral Density.  Journal of Strength & Conditioning.
Hinton, P., Nigh, P., & Thyfault, J.  (2015). Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: a 12-month randomized, clinical trial.  Journal of Bone