Looking for input on best training options to build up bone density to prevent future hip and slow future spinal fractures. I have a post menopausal women in her mid 60s with kyphosis who was on Fosamax but stopped taking several years ago on her own due to side effect concerns. I am going to require her to get physician’s clearance. But looking for input from anyone with hands on experience with this population.
Osteoporosis and osteopenia are more common than most people realize. I have worked with several women with issues of bone density after physician clearnance. And I did meet and briefly train a man with low bone density which apparently was common in his family. At the center at which I instructed. a body scan mobile unit came around every 4 months or so. A lot of people were screened and a fair percentage were found to have bone density issues. Several patrons that I knew well and had been working out for some time were surprised to find that they had moderate bone loss. The fact is that if you are not loading the skeletal system, you won’t be reaping bone density benefits. Many of these people were not resistance training properly and none of them were training with an instructor. And progressive loads are needed to continue to improve bone density. The bones will only adapt to the stress imposed. Once that stress is reduced by an accomodating increase in bone density, the bone density will not continue to increase. You will need to utilize resistance in planes of motion that load the skeletal system.
That said, you still must start clients off conservatively and gradually increase loads as tolerated. The initial focus needs to be on posture, core stabiization, balance, and the recommendations of the physician (which usually include posture, core, etc.). Lower body exercise is very useful in promoting all of these things. Aerobic exercise is not the focus for this population, but I feel it needs to be include in some way. I found that most clients tolerated short intense cardio bouts (not quite HIIT) and this type of exercise does fit with the current recommendation for some impact form of stimulation. Again, introduce this conservatively and clear it with the physician if it was not in the recommendations. If you receive recommendations that you do not understand, make sure you get clarification.
Regular bone density screenings are a topic of debate, but with the mortality from hip fractures in older populations related to bone density, I feel the potential down side is out weighed by the definite risk of fracture and debilitation. Follow physician guidelines closely and ask how often the client will be retested for bone density. Make sure you stay connecting with the clients healthcare team.
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Most research shows that it is very hard to build up bone density without drugs (at least after someone reaches his or her late 20’s). Weight training can help reduce bone loss, but do not look to it to increase much bone mass. Martin is right that stress to the bones (weight training and impact exercises in particular) are needed to help bone remodel, but they can be very tricky with osteoporosis. Usually squats, twisting and any type of spinal flexion, as well as high impact exercises are all contraindicated, so you do need to discuss it with her physician. Some sources recommend walking with a weighted vest as a good way to stress the bones with less impact, but other sources nix the vest. Swimming and walking are generally well tolerated, but they do little to help bone density. Once you have clearance I would focus on strength training exercises that do not involve spinal flexion, trying to gradually increase the weight. Machines (sorry pure functional people) such as the leg press and leg extension may be helpful. I would also focus on balance and core work (planks and bridges and warding moves that do not use spinal flexion). One other caveat; even though you are consulting her physician I have found many who seem clueless about osteoporosis and exercise; they give their clients a blanket response to “exercise” and do not seem aware of the contraindications. If you adhere to the strict guidelines (and I have clients who do not, but that is their choice) that means golf and tennis are out if the osteoporosis is in the spine, many doctors seem unaware of this.