Winning the Battle with Osteoporosis

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Q: I have been advised to do weight-bearing exercises in my battle against osteoporosis. I enjoy walking but I also like my elliptical machine. I try to push my weight to the lowest point in the elliptical movement. Is this considered a weight-bearing activity? What are some exercises I can do to keep my bones and body strong?

A: Fortunately, the activities you enjoy are weight bearing and considered "a prescription for bone health" in the battle against osteoporosis. Both walking and elliptical training move your upright body against the forces of gravity, "working" your bone to gather strength and density. This in turn yields stronger bones that are better able to handle the physical stressors of everyday life (supporting your body weight, walking, going up or down stairs, the additional weight of carrying groceries, etc.). However, there's more to bone health than exercise, as your bones are living tissue that need good nutrition, including sufficient calcium and vitamin D.

Know your risks

Osteoporosis affects the structural integrity of the bones. Instead of being solid and strong, they may become weak and porous, kind of like a foundation with many cracks and holes. Over time and over the course of our daily routines, osteoporosis may lead to fractures, or broken bones, that seemingly occur from minor injuries such as a slight bump of the wrist against a cabinet. In more severe cases, a simple body reflex, a cough or sneeze may cause a fracture of a spinal bone. In fact, many people don't find out they have osteopenia (weakening of the bone and an early warning sign of osteoporosis) or osteoporosis until that first broken bone. This makes it important to know the risk factors, which include the following:

Family history of osteopenia or osteoporosis
Smoking and abuse of alcohol (no more than two drinks per day for men or one drink for women)
Female gender
History of broken bones
Early menopause and/or infrequent menses prior to menopause (indicates low estrogen levels)
Low testosterone levels in men
Eating disorder (bulimia, anorexia nervosa, etc.), especially before age 30
Medical conditions (celiac disease, hyperthyroidism, kidney disease, inflammatory bowel disease, lung disease requiring the long term use of corticosteroids, rheumatoid arthritis, multiple myeloma and others)
Medications (certain anti-seizure drugs such as Dilantin and Phenobarbital), long-term use of prednisone, overuse of aluminum-containing antacids, Lithium and some drugs used to fight cancer. Even antidepressants (selective serotonin reuptake inhibitors) and stomach medications known as proton pump inhibitors have the potential to affect your bones. However, before stopping any medication, please speak with your physician because the benefits of your treatment may far outweigh any risks to your bones.
High-protein diet (especially animal protein)
Thin body frame
Lack of calcium: (less than 1,000–1,500 mg per day for adults) and vitamin D (less than 400–1,000 IU of vitamin D3 per day for adults). Please check with your physician as amounts vary depending upon age and medical condition.
Older age (55 percent of those with osteoporosis are over age 50)
Inactivity from injury or illness (being bedridden, having an inability to engage in weight-bearing activities), or lack of a more active lifestyle

This last one is something that many of us who are physically able should correct.

But first, I need to add a caveat: Get clearance and exercise guidance from your physician prior to beginning any physical activity. That's because your current state of health will determine the exercise prescription that is right for you. For example, if your bone mineral density test (DXA or dual energy x-ray absorptiometry) reveals you already have osteopenia or osteoporosis, you would most likely avoid high-impact activities in favor of lower-impact activities like walking and swimming.

Mother Nature's prescription for healthier bones

That said, weight-bearing activities are a mainstay for healthier bones. There are a lot of choices, but the key is to enjoy what you do while staying within your "bone strength safety zone." Here are some options, broken into high and low impact exercises.

High impact exercises include the following:

Running or jogging
Hiking on rugged terrain
Jumping rope
Stair climbing on natural stairs or against resistance on moving stair climbing machines
Activities such as tennis, racketball or squash (remember to wear protective glasses)
Dancing (depending upon the dance form, this may be high or low impact)
Basketball, fencing and soccer

Low impact exercises include the following:

Walking
Using elliptical exercise machines
Gentle exercise movements known as low-impact aerobics (available on tapes and DVDs or from classes at fitness centers)
Stepping machines (may be high impact depending upon the resistance and your technique)
Ice-skating (without the athletic jumps and dance movements)

Another key type of activity that strengthens bones as well as muscles is resistance training. This may involve lifting weights, pulling against tubing (such as from a Thera-band, etc.), lifting your body (standing from squatting position exercises, etc.), gardening (pushing or pulling a lawnmower, movements involved in bending and squatting while pulling weeds), and even certain types of housework (moving furniture to clean, etc.).

Lastly, the ability to prevent falls is a very important form of exercise. This would include non-impact activities that increase muscle strength, while also improving balance, posture and the ability to perform everyday movements of daily life (getting up from a chair or in and out of a car, lifting your grandchild, etc.) without falling down and potentially breaking a bone. Suggestions for activities include but aren’t limited to these:

Tai Chi
Bike riding
Water aerobics and swimming
Flexibility exercises that maintain or expand your range of motion (consider an appointment with an exercise physiologist or physical therapist; this may be covered by your insurance)

For further information on reducing your risk for osteoporosis or osteoporosis-related fractures, speak with your physician and/or a registered dietitian. Additionally, check out the National Osteoporosis Foundation, American Dietetic Association, and Be Fit Over Fifty.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)