Osteoporosis/Osteopenia – The Importance of Strength Training

1. What is Osteopenia and Osteoporosis?
   • These are terms used to describe the strength and density of your bones. Bone is a living structure that is constantly being broken down and rebuilt. Osteopenia is a reduction in bone density that is less severe than osteoporosis, while osteoporosis represents a greater reduction in bone strength and density.
   • Having osteopenia or osteoporosis does not mean that your bones are extremely fragile or that a minor movement will cause a fracture. However, reduced bone strength does increase the risk of fracture, particularly following a fall. Bone loss is particularly common in females following menopause due to hormonal changes.
2. Why Does Bone Strength Matter?
   • Lower bone strength increases our risk of fractures. A fracture can then lead to a cascade of events, including a period of reduced activity and recovery, which can impact strength, independence and overall quality of life.
3. How Does Strength Training Help Your Bones?
   • As described above, bone is constantly being broken down and rebuilt. This means that bone responds to the mechanical loads placed upon it. If we do not provide our bones with enough mechanical loading, there can be greater bone breakdown compared to bone building over time.
   • The LIFTMOR study found that appropriately supervised, high-intensity resistance and impact training did not just slow changes in bone density, but actually improved bone mineral density (BMD), including an approximately 3% improvement in spinal BMD in postmenopausal women with low bone mass and 4% improvement in spinal BMD for low bone mass males.
4. Is Strength Training Safe With Osteoporosis?
   • The LIFTMOR trial investigated the effects of heavy, supervised resistance and impact training on bone health and physical function over eight months. No participants sustained a fracture during the training program, and there were no falls during the supervised exercise sessions. There were some minor training-related issues, such as temporary muscle and joint soreness, but no major training-related adverse events.
   • Therefore, when appropriately prescribed and supervised, strength training can be a safe form of exercise for people with osteoporosis.
5. Strength Training: More Than Just Building Muscle
   • This type of training is not just beneficial for our bones. It can also improve muscle strength, coordination and balance, which can help reduce falls risk. Improvements in measures such as the Timed Up and Go and five-times sit-to-stand tests are examples of improvements in physical function that can be associated with reduced falls risk.
   • Strength training can also make everyday activities easier, such as getting on and off the toilet, getting out of a chair and walking up and down stairs.
6. What Type of Exercise Is Most Beneficial?
   • Heavy resistance training – the LIFTMOR study used training at approximately 80–85% or more of one-repetition maximum. This represents a challenging load that allows only a limited number of repetitions to be completed with good technique.
   • Jumping and landing – there should also be an element of impact exercise where appropriate. Bones adapt to the loads placed upon them, and jumping and landing produce higher and faster loading compared with activities such as walking. This provides an additional stimulus for bone adaptation.
7. How Often Should You Strength Train?
   • From the available evidence, strength training does not need to be completed every day to provide a stimulus for bone health. The LIFTMOR program, for example, used two thirty-minute supervised sessions per week over eight months and demonstrated improvements in bone mineral density and physical function.
   • The most important factor is consistency and finding a trainer you enjoy working with and a training routine that you can maintain over the long term.
8. Are Exercises Hard?
   • The five main exercises that will be included in your program should be:
   • Squats
   • Deadlifts
   • Shoulder press
   • Chest press
   • Jumping and landing

9. The Key Message: Stronger Muscles, Stronger Bones, Greater Independence

• Completing strength training does not mean that you will never experience a fracture. However, appropriately prescribed strength and impact training can target several important factors associated with fracture risk. Heavy resistance training can improve BMD, while improving strength, balance and physical function can also help reduce falls risk.
• This information is not intended to scare you into doing strength training. Instead, it is about providing you with the information and understanding of how important strengthening can be for your long-term bone health, strength and independence.
• Strength and impact training should initially be completed under appropriate supervision to ensure you learn the correct technique and progress your weights and jumping safely. If you would like to get started, book an appointment with Finn and begin your journey towards stronger muscles, stronger bones, greater independence and increased confidence in your movement.