Osteoporosis and why we all need to be stronger
Quite a few of our WildStrong members have been talking about family histories of Osteoporosis so we thought we’d write a quick overview of what it is, what the risk factors are and how is can be prevented or mitigated. This by no means an in-depth look, but there are references to more information at the bottom.
Osteoporosis is often referred to as the ‘silent disease’ because, although 3.7 million people in the UK are estimated to have osteoporosis, 78% percent of those are women,(1) few know they have it until they break a bone.
What is osteoporosis?
Osteoporosis is a progressive condition that leads to more fragile bones as you get older. Fragile bones are more likely to break easily, and bones in your wrist, hip and spine are particularly vulnerable.
Bone is a living tissue and new bone replaces old bone throughout life. But in later life, the cells that build new bone can’t work as quickly as the cells that remove old bone. This leads to an overall loss of bone tissue, which makes bones weaker and more fragile.
What affects your risk of osteoporosis?
There is no single cause of osteoporosis. Your risk of developing it is linked to factors that can lead to weak bones, which include:
Family history – you are more likely to have osteoporosis if you have a family history of osteoporosis or if one of your parents has broken a hip
Being over 50 years old - Estrogen helps protect bone strength. The reduction in estrogen in the years following menopause causes a rapid bone loss, which can lead to osteoporosis.
Gender – osteoporosis is more common in women because they have smaller bones and lose oestrogen during menopause
Low body weight
Certain medical conditions – such as rheumatoid arthritis, hyperthyroidism and Crohn's disease
Certain medications
Unhealthy lifestyle – low physical activity, smoking, excessive alcohol, lack of calcium and vitamin D.(2)
Few people know they have osteoporosis until they break a bone.
There are more than 300,000 fractures every year due to osteoporosis. 1 in 2 women over the age of 50 will break a bone because of the disease. (2)
For women, the hormone oestrogen helps protect bone strength. The reduction in oestrogen in the years following menopause causes a rapid bone loss, which can lead to osteoporosis.
In 2013, falls were the ninth highest cause of disability-adjusted life years (DALYs) in England in 2013 and the leading cause of injury. Muscle strength of the lumbar spine and the presence of osteoporosis are intrinsic factors associated with the risk of falls. The prevalence of falls for women increases from the age of 40 onwards.
The fear of falling cycle is something we talk a lot about in WildStrong. Once you become frightened to fall, the fewer risk you take to put yourself in a position where you might fall. And as such, the opportunities available to you decrease gradually over time. Studies have shown that in women with osteoporosis or low bone mass increased fear of falling is associated with more falls, and balance confidence is related to measures of balance and mobility.(5, 6)
There are many ways to keep our bones healthy:
Strength training
Eating calcium rich foods
Ensuring adequate Vitamin D intake
Maintaining a healthy body weight
Limiting alcohol intake and stopping smoking.
HRT (hormone replacement therapy) has also been shown to keep bones strong and reduce the risk of getting osteoporosis. If you already have osteoporosis it can strengthen your bones and reduce your risk of breaking a bone.
If you have early menopause, where your periods stop before the age of 45, you'll usually be advised to take HRT or a hormonal contraceptive until at least age 51. This increases your level of oestrogen, which helps protect you from osteoporosis and other health conditions.
Strength training can be used as a way to prevent the onset of osteoporosis, but it is just as beneficial as a treatment strategy for those already diagnosed with osteoporosis due to the fact that strength training loads our bones and joints and this improves your bone density.
Within the WildStrong context, the findings support:
Strength training to improve bone density - particularly axial loading or big load bearing movements (e.g. loaded squats and deadlifts rather than bicep curls)
Time spent on and getting up and down from the ground regularly
Increasing our confidence with falling
More time working on balance and mobility.
Andrew Telfer, WildStrong’s Head Coach says “Most people need to be lifting heavier than they are, the 4kg dumbbell we bought from Aldi in lockdown is not going to cut it. Wolff's Law states that bones will adapt to the degree of mechanical loading subjected to them. We find that most people can lift much heavier than they think they can when they first arrive at WildStrong. As a rule thumb, you want to be working at about 80% of your one rep max. So if you can confidently push press a 24KG kettlebell once and then you need a rest, your working range should be around 80% of 24KG. If you can easily do 8 or 9 repetitions than you need to go up a weight.”
We really need “being strong” to become normal, particularly for woman and that needs to start in childhood. A lot of the women we meet find lifting heavy objects really frightening and it can takes months to move them up from a 12kg kettlebell. Mostly the barrier is confidence rather than strength or skill.
References if you’d like to read more:
From key findings for the UK, published in “Osteoporosis in Europe: A Compendium of country-specific reports”
Does osteoporosis predispose falls? a study on obstacle avoidance and balance confidence
Exercise to Prevent and Manage Frailty and Fragility Fractures
Interventions to improve osteoporosis care: a systematic review and meta-analysis
Review of Etiology, Mechanisms, and Approach to Management in the Aging Population
