The bare bones of osteoporosis

Let's talk about bones. We are very focused on the health of muscles and joints, but at least of equal importance are your bones. I'll start with a little anatomy. Your bones are made of compact and cancellous bone - a bit like a Crunchie bar. The compact bone (that's the chocolate) is really hard and strong, but also heavy and dense. Cancellous bone (the honeycomb) is light and porous, allowing blood vessels and marrow to be contained within it. 

Our bones experience a lifelong cycle of old bone getting cleared away and new bone being built. All being well, our bones develop increasing strength - or bone density - throughout childhood and young adulthood, up until our early 30s: building exceeds clearing (see the image "healthy bone").
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From middle-age onwards, bone density starts to decline. The more bone we lose, the more likely we are to experience fractures. Low bone density is known as osteopenia while very low bone density is known as osteoporosis (see the image "Osteoporosis"). Cancellous bone is the part that becomes vulnerable to fracture when bone density is lost. In some cases, osteoporosis fractures can occur without any obvious trauma, perhaps from an everyday activity such as hanging out washing. Falls also commonly cause fractures in later life. Although both men and women experience bone loss, women on average reach the threshold for fracture risk at an earlier age than men. 

There are many risk factors, but the big two lifestyle factors that you can influence are exercise and diet (not smoking goes without saying!).

Exercise is your friend when it comes to strong bones: particularly weight-bearing, muscle-strengthening, and impact exercise. The tuck jumps and star jumps that we do in STRONG Nation are considered high-impact, but lower impact exercises such as small jumps, vigorous walking, light jogging, and strength training have also been shown to be helpful. Whether mat-based Pilates is sufficient to increase bone density is uncertain, although a recent systematic review found that Pilates and Yoga appear to maintain bone density. 

In terms of diet, calcium and vitamin D play particularly important roles. It's worth taking a look at the NHS "food for healthy bones" website for more detailed guidance.

Many people with osteoporosis become fearful of exercise and physical activity. This is unfortunately counterproductive, as bone needs regular stimulation to help keep its strength. All adults, including people with osteoporosis, should follow the UK Chief Medical Officer physical activity guidelines, which can be summarised as:

• Physically activity every day. 
• Muscle-strengthening activities on at least two days a week
• Accumulate at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity; or (for under 69s) even shorter durations of very vigorous-intensity activity per week; or a combination.
• Minimise the amount of time spent being sedentary.

If you do have osteoporosis, there are certain precautions that need to be taken to ensure that your exercise regime is safe, as certain exercises are not recommended for people with osteoporosis and the environment should be arranged to reduce the risk of falling. A general exercise class is not suitable. I have completed a specialist bone health qualification which qualifies me to teach adults with osteoporosis and osteopenia - this is necessary for safety, and also to develop programmes specifically designed to help build stronger bones. If you are diagnosed with osteoporosis it is essential that you your fitness instructor know.

There are medicines available to help rebuild bone density. You would need to consult your GP for advice on these.

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