Osteoporosis and Exercise: Part Two

If you haven’t read part one, click here! Osteoporosis is one of the most common things we get asked about when a client begins their journey at Paragon. We will be providing a multi-part blog series to dive deeper into the topic!

How is osteoporosis diagnosed and what are the risk factors?

How do we test for bone health?

Testing for bone density before someone has experienced any symptoms of bone density loss has become common for individuals who are at the greatest risk of getting osteoporosis.  The most common test of bone density is done using a type of X-ray known as dual-energy X-ray absorptiometry (DXA).  This is a completely non-invasive procedure that your health care provider may order and involves relatively low levels of radiation.  A DXA scan will provide you and your health care provider a t-score value for your bone mineral density.  If it’s been a while since you’ve taken statistics, a t-score represents the number of standard deviations away from the mean of a distribution of data.  

In the case of bone mineral density, your t-score represents how much your bone mass differs when compared to a healthy 30 year old.  If your bone mineral density is exactly equal to that of the average 30 year old, your t-score will be 0.  If your t-score comes back as +1, this would mean that your bones are 10% more dense than those of the average 30 year old.  A t-score greater than -1 is considered normal bone mineral density, while osteoporosis is defined as a t-score of less than -2.5.  Therefore, the bones of an individual with osteoporosis are at least 25% less dense than those of the average 30-year-old.  

You’ll notice on the chart below that there is a third category for bone mineral density known as osteopenia.  Osteopenia is not a medical condition in and of itself, but it represents a “yellow flag,” where we don’t want to immediately begin medication but we do want to develop strategies to help prevent this number from getting any worse.  It is estimated that for every 10% drop in bone mineral density, risk of fracture increases two to three times.  

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Who’s at the greatest risk?

The American Bone Health organization provides a 10-year fracture risk calculator, which you can access by clicking here.  There are some risk factors which you cannot change, and some risk factors which are very modifiable through health and lifestyle influence:

Non-modifiable risk factors:

  1. Gender: Due to hormonal and body size differences, women are at a greater risk than men.
  2. Age:  The reason that t-scores for bone mineral density represent the difference between an individual and an average 30 year old is that once we reach peak physical maturity, our bone density will naturally decrease with time.  
  3. Body size: We’ll talk more about this when we get to how exercise can help prevent osteoporosis, but for now we’ll leave it at this: the smaller you are, the less your bones are forced to remodel and therefore the greater your risk of bone density loss.  You cannot change your structure as a whole, as this is genetically determined.  You can, however, impact your skeleton in some amazing ways as we’ll see below.
  4. Ethnicity:  Caucasian and Asian people seem to be at the highest risk of developing osteoporosis.

Modifiable risk factors:

  1. Sex hormones: Low estrogen in women and low testosterone in men are associated with greater risk of bone density loss.  For this reason, maintenance of regular hormonal cycling, specifically menstrual cycles in young women, can have an impact on your bone mineral density.  We’ll dive deeper into these topics in section two of this article.
  2. Calcium and Vitamin D:  Diets deficient in calcium and Vitamin D tend to lead to diminished bone health.  Before you go buy a calcium and Vitamin D supplement however, I’d suggest reading section two of this article where we’ll dive into a lifestyle action plan.
  3. Substance use:  Excessive use of alcohol, certain drugs, and tobacco may lead to a higher incidence of osteoporosis.
  4. Physical activity: Being physically active in general seems to help delay the onset of osteoporosis and in section two of this article I’ll get into the specific types of physical activity that you should consider in order to make your bones as strong as possible.

In part three, we will be discussing the impacts of plyometrics on our bone health.

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