Osteoporosis is one of the most significant health problems facing medicine in general and sports medicine specifically today.  It is estimated that about 30% of post-menopausal women and 70% of women over the age of 80 are afflicted with osteoporosis.  The costs of treating this disease in not only dollars but in pain and suffering are immeasurable.

Although most people have some idea of what osteoporosis is, a bit of clarification would seem to be in order.  One recent definition of the disease states “osteoporosis is a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue that renders bone more susceptible to fracture”.

One thing that people may not understand about osteoporosis is that having lower bone mass is not, in and of itself, pathological.  The problem is that having a decrease in bone mass from the optimal level increases the risk of fracture.

So how much risk do people with osteoporosis have?  Well, the annual risk of an fracture in a person with osteoporosis is about three times as high as for a heart attack.  It is estimated that the overall lifetime risk of a fracture due to osteoporosis is 39.7% for women and 13.1% for men. And, although men have a lower risk of fracture, they have a much higher mortality rate following hip fracture (21% for men versus 8% for women).

Now that everyone is convinced that osteoporosis is a significant problem, lets look at some of the risk factors for developing the disease.  As you’ve noticed from reading above, women are at more risk than men.  Patients with a family history of osteoporosis are more likely to develop the condition themselves.  Since bone density is lost over time, the older you are, the more your risk for developing the disease.  Women who are post-menopausal and are not treated with hormone replacement therapy are at significantly higher risk of developing osteoporosis.  And, people whose diets are deficient in calcium and/or vitamin D are at risk for bone density loss.

Aside from the obvious fracture risk associated with osteoporosis, the sports medicine angle on this disease has to do with exercise.  People who do not perform weight bearing exercises place themselves at risk for developing osteoporosis.  It is very clear that one of the best ways to prevent bone loss is the regular and sustained performance of weight bearing exercises.

Unfortunately, it is very difficult to significantly put bone density back.  Although it is true that several of the preventative therapies detailed below may produce modest increases in bone density, the best way to keep bone healthy is to prevent its loss.

Bone density loss is prevented primarily by minimizing many of the risk factors for osteoporosis.  One of the most important is for post-menopausal women to consider hormone replacement therapy.  Although this is not right for everyone, women who replace hormones following menopause remarkably reduce their risk of developing osteoporosis.

A second very important key to the prevention of osteoporosis is exercise.  Weight bearing exercise has been proven to slow or stop the loss of bone density.  However, there are several things that one should keep in mind when exercising to prevent osteoporosis.

First, only weight bearing exercise is effective in preventing bone density loss.  Swimming and other non-weight bearing exercises, while good for you in other ways, do little to help preserve bone.

Secondly, the bone must be overloaded.  Although walking is a weight bearing exercise and is the only tolerable one to many people, there are many more exercises like aerobics and weight training that overload the bones beyond what they are accustomed to.

Also, the effects of exercise on bone are not systemic.  For example, if you jog to help preserve bone density in your legs, your arms get little if any benefit.  Likewise, if you do upper body weight exercises, your legs will not benefit.  To maintain optimal bone density throughout the entire body, all areas must be stressed.

One other way that exercise can help prevent the negative side effects of osteoporosis is to prevent and/or cushion falls.  When the muscles become more accustomed to handling the body’s weight, they can do a more effective job of stabilizing the body when it gets off balance.  And, if you should fall, the muscles can serve as a sort of cushion between the ground and bone.

Obviously, people should keep in mind their own abilities and aptitudes when choosing exercises to perform.  If its been a while since you’ve worked out, start slow and gradually increase the intensity to an acceptable level.  People with health problems should talk to their doctor before starting an exercise program.

Along with exercise in general and hormone replacement for women, vitamin and mineral supplementation can be helpful in preserving bone.  Adequate consumption of both calcium and vitamin D can help to reduce the risk of bone loss.  Your personal doctor will have specific guidelines regarding appropriate doses for you, however most post-menopausal women require 1500 milligrams of calcium daily.  Vitamin D recommendations are different at different ages but 400-600 IU per day is adequate for most people.  Talk to your doctor or pharmacist for a specific dose that is right for you.

Osteoporosis is a largely preventable medical condition.  With a few simple and smart prevention strategies you can preserve bone density and dramatically decrease your risk of a bone fracture secondary to osteoporosis.  Your doctor or pharmacist is always happy to answer any questions you have regarding osteoporosis or its prevention.