Osteoporosis: Exercising the Bone in Menopause
By Jacky Forsyth
Osteoporosis is often referred to as a ‘silent disease’. This is because individuals are not likely to realise that they have the condition until they experience a break or fracture, as a result of something minor like a fall or trip. is a disease characterised by low bone mass or weakened bones.
Osteoporosis is a disease characterised by low bone mass or weakened bones. A fracture can have devastating consequences to a person’s health and wellbeing. For instance the risk of mortality increases threefold in those who have had a fracture compared to those who have not had a fracture. Following a wrist fracture, around 50% of people report continued pain and functional impairment. Fractures, as a result of osteoporosis are, therefore, something that we really need to avoid, owing to the increased mortality and decreased health and wellbeing, not to mention the financial burden on the NHS.
Osteoporosis is much more common in women than it is in men, especially once women reach the menopause, partly due to the natural ageing process, but also because of the decrease in oestrogen that occurs around this time. The number of women over the age of 50 years in the UK is projected to increase, with most women spending more than one third of their lifetime in a menopausal state. Strategies for increasing or maintaining bone health for women in the menopausal period are, therefore, required, in order to prevent the risk of fracture as a result of low bone mass.
Exercise to treat osteoporosis is about being specific and targeted – so not the usual 150 minutes per week of moderate intensity, aerobic-type of exercise – but something that requires loading on the bone. For instance, for the lower body, impact exercise, such as jumping, has been found to be particularly beneficial. However, following menopause, women are less likely to engage in jumping type activity. Sports, such as netball or basketball, where there are high jumping forces as well as twisting actions and sudden changes in pace and direction, are extremely good for bone strength, but often sports such as these are replaced by more gentler forms of exercise as a person ages – yoga, jogging, walking, Pilates – which are not as beneficial for the bone. Adding jumping, which can be as little as 10 jumps per day on three days per week, can have a significant improvement in bone strength. Balance exercises are also important, as improved balance can reduce the risk of falls, which then reduces the risk of fracture as a result of a fall. A combination of jumping and balance exercise can, therefore, help to improve bone strength and decrease fall risk.
The upper body should not be neglected when it comes to improving an individual’s bone health, especially as there are 69,000 wrist fractures that occur every year in the UK. In a recent meta-analysis, where several studies were reviewed, we found that exercise of the upper body was effective for improving bone strength in a menopausal population. In particular, we found that circuit-style exercise, with low weights and high repetitions was beneficial, but largely because the exercises that were conducted as part of the circuit were novel and so created an unusual loading pattern on the bone. Another important aspect of improving bone health, as well as putting strain on the bone through impact, is to ensure that the strain that is loaded is unusual. This is one of the reasons why repetitive types of exercise, such as jogging and walking, are not so good for bone compared to exercise that is sudden, dramatic and novel, since the bone very quickly gets used to the load being placed on it. Exercise should, therefore, be different, and could include things like squeezing a tennis ball, rotating a broom handle, or squeezing out water from a towel. These actions will improve upper body bone health. Impact exercise for the upper body can also be undertaken. For instance, impact exercise includes wall drops, which involves standing a little over an arm’s-distance away from a wall and dropping onto the wall with an outstretched arm. Generally though, any exercise for the upper body, including weights at the gym, actions like wrist rolling and impact exercises, will improve bone health of the forearm and will hence reduce the risk of wrist fracture.
Often, exercises for improving bone health are neglected, since priority is given to improving cardiovascular health by doing exercises of a moderate intensity for a longer duration. Bone exercise requires short bouts of impact or unusual exercise, alongside exercises to improve balance. Balance exercises can be as simple as balancing on one leg, with eyes open or eyes closed, then reaching out to touch objects and regaining balance to extend the challenge. It is highly likely that menopausal women are at risk of osteoporosis, since around 50% of women over the age of 50 years have osteopaenia, which is an indication that bone has already become weak. Exercises, such as jumping for the lower body, and unusual resistance training for the upper body, alongside balance exercises should, therefore, be incorporated into a menopausal women’s exercise programme.
We are currently conducting a study on the effect of exercise – both jumping and balance – on bone health. We are trying to find out whether exercise can improve bone health in the menopause. This information might be useful for deciding what type of exercise is beneficial for bone health and for preventing osteoporosis. Participants will be required to take part in an exercise intervention lasting 8 months, in which they will be required to exercise for just 10 minutes on three occasions per week. All the exercises can be done at home, although once a month, we will invite participants to come into the University to check on their progress. Participants will also be required to attend the sport and exercise physiology laboratory at Staffordshire University, Stoke Campus, on three separate occasions, once before the intervention starts, once at the end of the 8 months, then a third time, three months after the intervention has finished. On these occasions, we will assess bone health using a foot bone scanner, balance, leg power and ask questions about current health and medical history.
We are looking for a total of 134 volunteers who are over the age of 50 and who are postmenopausal. If you meet these criteria and are also not using any HRT or have no medical or health condition preventing you from taking part, please contact Jacky Forsyth, j.j.forsyth@staffs.ac.uk, or phone 01782 294057.
