# Osteoporosis: The Silent Disease

Osteoporosis is a disease that causes the bones to become brittle and fragile due to a reduction in density and quality of bone matrix. These changes cause a large increase in the risk of fractures, there are often no signs of osteoporosis until the first fracture. This is why it is referred to as "The Silent Disease". Osteoporosis is a disease often seen among the elderly. This is due to the changes in bone remodeling as we age. During early adulthood bone matrix is at its most dense, as we age bone matrix is absorbed while new matrix is formed, this is normally an even equation. Unfortunately as we age this equation can become unbalanced leading to a greater pace of bone absorption compared to the formation of new matrix, this is the cause of osteoporosis.
Men and women over the age of 60 are at a higher risk of osteoporosis and while it is a disease associated with age it is still possible to develop at a younger age. Osteoporosis is diagnosed through a Bone Mineral Denisty (BMD) test. The most commonly used BMD test is DXA (dual-energy X-ray absorptiometry) which is similar to an X-ray but can detect changes in bone loss. A list of all types of tests can be found in the recommended readings. Osteoporosis is diagnosed against a set of threshold values created by the World Health Organisation (WHO). Osteoporosis is diagnosed when a person’s BMD is equal to or more than 2.5 standard deviations below this value.

## Connection Between Resistance Training and Osteoporosis

Resistance Training or weight lifting has been shown to provide benefits to many different types of athletes in regards to strength, power, endurance and hypertrophy gains although is not of common practice in the older population. It is a type of training normally undertaken by the younger population with association to specific sport development programs. Wolff's law states that stress or mechanical loading applied to the bone via the muscle and tendons has a direct effect on bone formation and remodeling. While resistance training has been shown to have an improvement on various athletic performances it can also extend into benefits with everyday life activities.
The goal of resistance training in regards to osteoporosis is to maintain or increase BMD and therefore reduce the chance of suffering a fracture. Resistance training has been shown to improve BMD in site specific areas and should therefore be targeted at areas that reduce the like hood of falls. Targeted muscle areas should include all major muscle groups of both lower and upper extremities in order to help increase BMD of all major bones such as hips and the lumbar spine which are at high risk of fractures and if fractured can lead to devastating consequences such as surgery, loss of function and death.

## Physical Activity Guidelines to Prevent/Manage Osteoporosis

When prescribing exercise programs for individuals with high risk of fractures such as those suffering from osteoporosis, with particular emphasis on the elderly, there are certain precautions and tests that should be conduced before undertaking exercise in avoid unforeseen calamities.

#### Precautions & Safety Concerns

* Ensure the individual has sought advice from a medical professional and has been cleared to undertake the program.
* Make sure the individual is under the supervision of a trained instructor to ensure proper use and technique of equipment and exercises are taking place.
* Reduce the risk factors of falls associated in physical activity environments such as dim lights, scattered objects and loose carpet or flooring.
* Depending on the additional needs of the individual in regards to vision and hearing the use of trochanteric pads may need to be arranged.
* Ensure that any medication taken will not effect or cause risk factors when physical activity is undertaken.

#### Recommended Physical Activity

When designing exercise programs for individuals with osteoporosis special attention and awareness of their like hood to suffer fractures needs to be kept in mind. Any resistance training session should start with a warm up and end with a cool down while incorporating some form of flexibility training. Increases in flexibility has been heavily linked with reduced falls risk.
Resistance training should be undertaken at a minimum of two sessions per week containing a variety of 8 to 10 different exercises per session. Three sets of each exercise should be performed with 8 to 12 repetitions. It is recommended that the individual begins the program starting at 50% of the 1 repetition max with the goal of obtaining 85% of their 1 repetition max through repetitions. Despite these recommendations the goal of any program should be long term adherence to the program, which will have the greatest benefit overall.

## Recommended Readings

For further information on osteoporosis and its effects please visit the following sources:
* http://www.nutritionaustralia.org/national/resource/osteoporosis
* http://www.osteoporosis.org.au/
* http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Osteoporosis
* http://www.abc.net.au/health/library/stories/2004/04/29/1831468.htm#.UIIsNsXMjVE
* http://www.osteoporosis.com.au/
* http://www.aihw.gov.au/media-release-detail/?id=6442464763