{"id":11420,"date":"2024-12-20T06:00:55","date_gmt":"2024-12-20T05:00:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11420"},"modified":"2024-12-19T13:36:05","modified_gmt":"2024-12-19T12:36:05","slug":"the-fear-of-fractures-how-to-exercise-safely-with-osteoporosis-part-1","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2024\/12\/20\/the-fear-of-fractures-how-to-exercise-safely-with-osteoporosis-part-1\/","title":{"rendered":"The Fear of Fractures: How to exercise safely with Osteoporosis Part 1"},"content":{"rendered":"<p><b>Key words: <\/b><span style=\"font-weight: 400\">Exercise, Osteoporosis, Prevention<\/span><\/p>\n<p><strong>Introduction<\/strong><\/p>\n<p><span style=\"font-weight: 400\">The aim of this blog piece is to give an overview of the disease process of Osteoporosis and the importance of exercise prescription in the management of this condition. This can make patients feel more comfortable discussing exercise and alleviate\u00a0 concerns of sustaining fractures from being active.<\/span><\/p>\n<p><span style=\"text-decoration: underline\"><i><span style=\"font-weight: 400\">Osteoporosis<\/span><\/i><\/span><\/p>\n<p><span style=\"font-weight: 400\">Osteoporosis is a condition of reduced bone mineral density that has an estimated prevalence of 10% in those over 50 years old and rising with age [1]. It is more common and occurs earlier in females due to reduced oestrogen circulating after the menopause [2]. The condition does not infrequently go undiagnosed until a low impact fragility fracture occurs. Common locations for these include the hip, spine and humerus [3]. These fractures can have a significant impact on morbidity and mortality \u2013 16-36% 1 year mortality rate in hip fractures [4]. Additional complications range from chronic pain to mental health disorders with an impact on quality of life [5].<\/span><b>\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">The diagnosis may<\/span><i><span style=\"font-weight: 400\">\u00a0 <\/span><\/i><span style=\"font-weight: 400\">stem from an initial fracture, which can occur from activity and abnormal loading activity, including low impact trauma. \u00a0<\/span><span style=\"font-weight: 400\">A DEXA scan may be requested where a T-score is calculated which measures bone density [5].<\/span><\/p>\n<p><span style=\"font-weight: 400\">Given the mechanism of injury, <\/span><i><span style=\"font-weight: 400\">patients may lose confidence and be concerned to exercise due to fear of further injury<\/span><\/i><span style=\"font-weight: 400\">\u00a0leading to further morbidity due to inactivity [3].\u00a0 However, evidence points to controlled and safe activity for these patients promotes bone health through increasing turnover, developing strength and balance to help protect bones as well as reducing falls [6].<\/span><\/p>\n<p><span style=\"text-decoration: underline\"><i><span style=\"font-weight: 400\">How to Exercise<\/span><\/i><\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">One of the key takeaways for patients and practitioners is that bones need to be both stimulated to strengthen, but also protected. This comes from safe weight bearing activity as well as strengthening exercise [1].<\/span><\/li>\n<li><span style=\"font-weight: 400\">Impact exercise is safe, with higher impact being better for bones. This may be something patients can build towards from initially starting with hydrotherapy, progressing walking\/running\/jumping. It is important to consider relevant risk factors including any previous spinal fractures, other injuries or medical co-morbidities that impact exercise tolerance [8].\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Muscle strengthening exercise stimulates bone regrowth but also gives the bones more protection. There are multiple ways to do this, including body weight exercises, resistance bands or moving to free weight training. This can also be built up slowly with exponential benefit to patients [8].\u00a0\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">In line with chief medical officer guidelines, adults should aim for 150 minutes of moderate intensity exercise per week. It is recommended to incorporate strength and balance training 2 to 3 days per week. Each session should last 30 minutes, aiming for lower weights with higher repetitions for the most physiological benefit. Avoiding prolonged sedentary periods is recommended [7].<\/span><\/li>\n<li><span style=\"font-weight: 400\">It is recommended for patients looking to initiate activity, do so with the guidance of a trained practitioner\/trainer<\/span> <span style=\"font-weight: 400\">[9]<\/span><b>. <\/b><span style=\"font-weight: 400\">This would be following a holistic clinician review by optimising chronic health conditions, sensory impairment and medication review.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Read part 2 of our blog in January for an example\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline\"><i><span style=\"font-weight: 400\">Benefits to patients\u00a0<\/span><\/i><\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improved balance thus reducing falls and subsequent injury [10]\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improvement in overall quality of life by finding enjoyment in new activities and improving social support<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improved confidence<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Reduction in severity and progression of overall frailty in the context of a comprehensive geriatric assessment [1]\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improvement in management\/prevention of co-morbidities e.g. diabetes<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improvements in posture and subsequent improvements in pain control[7]<\/span><\/li>\n<\/ul>\n<p><strong>Conclusions<\/strong><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Being physically active brings a huge range of benefits to the health of those with osteoporosis<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Bone health and turnover significantly improves with safe and appropriate prescription of exercise<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Taking a holistic approach to reviewing patients in relation to the cause of their falls is paramount. Optimising chronic health conditions, nutrition and medications is crucial alongside exercise prescription.<\/span><\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11421\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/PA-and-osteoporosis-1-300x300.png\" alt=\"\" width=\"526\" height=\"526\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/PA-and-osteoporosis-1-300x300.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/PA-and-osteoporosis-1-150x150.png 150w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/PA-and-osteoporosis-1-768x768.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/PA-and-osteoporosis-1-640x640.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/PA-and-osteoporosis-1.png 1080w\" sizes=\"auto, (max-width: 526px) 100vw, 526px\" \/><\/p>\n<p><strong>Authors:<\/strong><\/p>\n<p><i><span style=\"font-weight: 400\">Dr Callum Innes MBChB, MFSEM (UK) \u2013 University of Bath<\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">Dr Andrew Shafik \u2013 Professional Development Advisor, University of Bath<\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">Dr Malin Farnsworth &#8211; Frailty Consultant, Epsom and St Helier University Hospitals NHS Trust<\/span><\/i><\/p>\n<p><strong>References<\/strong><\/p>\n<ol>\n<li><a href=\"https:\/\/www.osteoporosis.foundation\/sites\/iofbonehealth\/files\/2022-10\/exercisebrochure_web_1.pdf\"><span style=\"font-weight: 400\"> Sabri, S.A., et al., <\/span><i><span style=\"font-weight: 400\">Osteoporosis: An Update on Screening, Diagnosis, Evaluation, and Treatment.<\/span><\/i><span style=\"font-weight: 400\"> Orthopedics, 2023. <\/span><b>46<\/b><span style=\"font-weight: 400\">(1): p. e20-e26.<\/span><\/a><\/li>\n<li><a href=\"https:\/\/www.osteoporosis.foundation\/sites\/iofbonehealth\/files\/2022-10\/exercisebrochure_web_1.pdf\"><span style=\"font-weight: 400\"> Cosman, F., et al., <\/span><i><span style=\"font-weight: 400\">Clinician&#8217;s Guide to Prevention and Treatment of Osteoporosis.<\/span><\/i><span style=\"font-weight: 400\"> Osteoporosis Int, 2014. <\/span><b>25<\/b><span style=\"font-weight: 400\">(10): p. 2359-81.<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"><a href=\"https:\/\/www.osteoporosis.foundation\/sites\/iofbonehealth\/files\/2022-10\/exercisebrochure_web_1.pdf\"> Brooke-Wavell, K., et al., Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine, 2022. 56(15): p. 837-846.<\/a><\/span><\/li>\n<li><span style=\"font-weight: 400\">Morri, M., et al., <\/span><i style=\"font-size: 1rem\">One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study.<\/i><span style=\"font-weight: 400\"> Scientific Reports, 2019. <\/span><b style=\"font-size: 1rem\">9<\/b><span style=\"font-weight: 400\">(1): p. 18718.<\/span><\/li>\n<\/ol>\n<ol start=\"5\">\n<li><a href=\"https:\/\/www.osteoporosis.foundation\/sites\/iofbonehealth\/files\/2022-10\/exercisebrochure_web_1.pdf\"><span style=\"font-weight: 400\"> Clynes, M.A., et al., <\/span><i><span style=\"font-weight: 400\">The epidemiology of osteoporosis.<\/span><\/i><span style=\"font-weight: 400\"> Br Med Bull, 2020. <\/span><b>133<\/b><span style=\"font-weight: 400\">(1): p. 105-117.<\/span><\/a><\/li>\n<li><a href=\"https:\/\/www.osteoporosis.foundation\/sites\/iofbonehealth\/files\/2022-10\/exercisebrochure_web_1.pdf\"><span style=\"font-weight: 400\"> Suzuki, N., O. Ogikubo, and T. Hansson, <\/span><i><span style=\"font-weight: 400\">The course of the acute vertebral body fragility fracture: its effect on pain, disability and quality of life during 12 months.<\/span><\/i><span style=\"font-weight: 400\"> Eur Spine J, 2008. <\/span><b>17<\/b><span style=\"font-weight: 400\">(10): p. 1380-90.<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Foundation, I.O. <\/span><i><span style=\"font-weight: 400\">Exercise for Bone Health and Osteoporosis<\/span><\/i><span style=\"font-weight: 400\">. 2020\u00a0 16\/08\/24]; Available from: https:\/\/www.osteoporosis.foundation\/sites\/iofbonehealth\/files\/2022-10\/exercisebrochure_web_1.pdf<\/span><span style=\"font-weight: 400\">.<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Society, R.O. <\/span><i><span style=\"font-weight: 400\">Exercise and Physical Activity for Osteoporosis and Bone Health<\/span><\/i><span style=\"font-weight: 400\">. 2024\u00a0 15\/08\/24]; Available from: <\/span><a href=\"https:\/\/theros.org.uk\/information-and-support\/osteoporosis\/living-with-osteoporosis\/exercise-and-physical-activity-for-osteoporosis\/\"><span style=\"font-weight: 400\">https:\/\/theros.org.uk\/information-and-support\/osteoporosis\/living-with-osteoporosis\/exercise-and-physical-activity-for-osteoporosis\/<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li><span style=\"font-weight: 400\"> O&#8217;Halloran, P.a.B., Gurjit, <\/span><i><span style=\"font-weight: 400\">Exercise Prescription in Health and Disease<\/span><\/i><span style=\"font-weight: 400\">. 2012. p. 98.<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Medicine, M. <\/span><i><span style=\"font-weight: 400\">Evidence Finder: Falls and Frailty<\/span><\/i><span style=\"font-weight: 400\">. 2024\u00a0 16\/08\/24]; Available from: <\/span><a href=\"https:\/\/scotland.movingmedicine.ac.uk\/why-movement-matters\/evidence-finder\/\"><span style=\"font-weight: 400\">https:\/\/scotland.movingmedicine.ac.uk\/why-movement-matters\/evidence-finder\/<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<\/ol>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key words: Exercise, Osteoporosis, Prevention Introduction The aim of this blog piece is to give an overview of the disease process of Osteoporosis and the importance of exercise prescription in the management of this condition. This can make patients feel more comfortable discussing exercise and alleviate\u00a0 concerns of sustaining fractures from being active. Osteoporosis Osteoporosis [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2024\/12\/20\/the-fear-of-fractures-how-to-exercise-safely-with-osteoporosis-part-1\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":11421,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[655,16068,16232],"class_list":["post-11420","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-exercise","tag-featured","tag-osteoporosis"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The Fear of Fractures: How to exercise safely with Osteoporosis Part 1 - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=11420\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Fear of Fractures: How to exercise safely with Osteoporosis Part 1 - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Key words: Exercise, Osteoporosis, Prevention Introduction The aim of this blog piece is to give an overview of the disease process of Osteoporosis and the importance of exercise prescription in the management of this condition. 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This can make patients feel more comfortable discussing exercise and alleviate\u00a0 concerns of sustaining fractures from being active. 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