Exercise therapy for osteoporosis: exercises and technique

Osteoporosis is a progressive disease characterized by changes in bone structure (fragility, friability) due to the destruction of the connective tissue structure. The danger of the disease is caused by an increased risk of fractures even with low loads on the bone. The progression of the disease leads to curvature of the spinal column, which is accompanied by a decrease in height.

Osteoporosis is a serious diagnosis; it ranks 4th on the list of diseases that most often lead to disability and, in some cases, death. The treatment of this disease should be approached comprehensively, complementing treatment with medications in other ways. Maintaining proper nutrition, massage and therapeutic exercises for osteoporosis have a positive effect on the condition of joints, bones and the body as a whole.

Systematic training exercises can prevent fractures, which often lead to immobilization and premature death.

Causes of the disease

About 99% of calcium in the body is concentrated in bone tissue. Since osteoporosis is defined by loss of bone mass, this is directly related to either insufficient calcium intake in the diet or abnormalities in the body that prevent it from being absorbed normally. The same culprit may be substances that promote calcium excretion.

Common sources of risk for the development and progression of the disease include:

• genetic predisposition. According to statistics, osteoporosis is much more common in women than in men. It is noted that the risk of the disease is higher among representatives of the Mongoloid and Caucasian races. Natural thinness of bones, short stature and low weight are important;
• hormonal imbalance (for example, menstrual irregularities);
• sedentary lifestyle;
• old age (usually the disease occurs in people over 60 years of age);
• hereditary factor;
• the presence of chronic diseases (renal failure, arthritis, type I diabetes mellitus, circulatory failure);
• strong physical activity;
• infertility;
• deficiency of vitamins A and D, phosphorus and other minerals;
• alcohol abuse (especially chronic alcoholism);
• insufficient consumption of meat and dairy products;
• long-term use of hormonal drugs;
• use of tobacco products.

Diagnosis of osteoporosis in women

Diagnosis of osteoporosis in women is based on the collection of complaints, medical history and illness, results of examination by a specialist and additional research methods.
General blood and urine tests are not specific. A biochemical blood test is necessary to determine calcium and phosphorus in the blood. Thanks to the development of modern medicine, there are several ways to diagnose osteoporosis at any stage of development. The gold standard for detecting the disease is densitometry. The study allows you to determine bone density. There are several diagnostic methods:

• X-ray. It is performed at standard points (femoral neck, radius, lumbar spine). The degree of osteoporosis is determined by the detected tissue density. The diagnosis is made at indicators of -2.5;
• Computed tomography. It is considered a more informative method compared to X-ray densitometry. The disadvantage of this method is considered to be radiation exposure to the body;
• Ultrasonic. The method is based on determining the speed of wave propagation through bone tissue. Osteoporosis is accompanied by loosening of bones. This makes it difficult for ultrasonic waves to pass through. The lower the speed, the lower the bone density. Ultrasound densitometry does not have a negative effect on the body. The procedure is permitted during pregnancy.
• Computed tomography and x-ray examination methods are informative already in the later stages, when bone mass has decreased by more than thirty percent.

Using laboratory research methods, the following indicators are determined:

• Sex hormones (for women);
• The amount of free testosterone (for men);
• Vitamin D;
• Ionized calcium;
• Parathyroid hormone.

Classification of osteoporosis

There are several classifications of this disease, the most common of which is based on the etiological factor (the origin of the disease).

Complications

According to statistics, osteoporosis is one of the leading causes of disability and mortality. The main complications of the pathology are fractures:

• femoral neck;
• radius bones;
• vertebrae

Bone fractures force patients to remain in bed for a long time.
As a result, the risk of bedsores and pneumonia increases. Severe stages of osteoporosis lead to external physical defects that contribute to impaired self-care. Therefore, it is important to diagnose the pathology in time and carry out correct treatment. If osteoporosis is detected, you must strictly follow your doctor's recommendations. Make an appointment

Therapeutic exercise for osteoporosis

Specialists often complement drug treatment with other conservative means. Gymnastics for osteoporosis is a productive approach and an important component of conservative treatment. Scientists have long proven that regular exercise has a positive effect on the body and helps in the treatment of osteoporosis. They help make muscles and bones stronger, improve body flexibility and overall coordination of movements. American experts identify 2 types of physical activity that help strengthen bones:

• exercises for muscle mass . These include all types of weight lifting with overcoming gravity in lying, standing and sitting positions. They increase bone density, reducing the risk of fractures;
• exercises focusing on the musculoskeletal system . These include exercises with overcoming gravity in a vertical position of the body. This could be dancing or walking every day. They allow you to increase the density of the hip bone and spinal column.

Before starting any training exercises, you should consult with a specialist to exclude the possibility of complications after exercise.

There is no universal set of physical exercises; a specialist must select and draw up an individual training plan, taking into account the state of health and the specifics of osteoporosis. Examination before starting physical activity includes identifying chronic diseases, forms of osteoporosis and the patient’s physical condition. For example, if you have high blood pressure or are overweight, many types of physical activity will be unavailable, and you should approach training with extreme caution. Throughout the entire exercise therapy, systematic medical supervision is required in order to assess the patient’s physical condition.

Treatment of osteoporosis in women and men

The main goals of osteoporosis treatment are:

• Pain relief;
• Suppression of bone tissue destruction;
• Stopping or slowing bone loss;
• Normalization of bone tissue restoration processes;
• Improving the patient's quality of life.

To treat patients suffering from osteoporosis, rheumatologists use drugs that, by increasing bone mass and improving bone quality, reduce the risk of fractures.
Monopreparations contain only calcium salts. In addition to calcium salts, the composition of combined medications includes vitamin C or vitamin D and minerals: zinc, boron, magnesium. There are multivitamins with calcium salts, but they are not considered as drugs for the treatment and prevention of osteoporosis due to the low concentration of the main ingredients. Some patients are prescribed the hormone calcitonin in parallel with mineralizing therapy. It stimulates the flow of calcium from the blood. Its action is carried out with the participation of parahormone and the activated form of vitamin D2. The drug, by reducing the elevated calcium content in the blood serum, suppresses the activity of osteoclasts and stimulates the formation and activity of osteoblasts, inhibits the resorption of the bone site. It increases the excretion of calcium, sodium, phosphorus in the urine by reducing their reabsorption in the renal tubules. When taking calcitonin, serum calcium concentration does not fall below normal values. Calcitonin is used subcutaneously, intramuscularly, intravenously and intranasally.

To treat osteoporosis in women who have entered menopause (over 45-50 years old), female sex hormones - estrogens - are used. If estrogen treatment is started during menopause, it reduces the risk of hip fracture by up to 50%. Modern estrogen drugs have a dual effect. On the one hand, they affect the receptors of bone tissue cells, leading to normal processes of bone formation and destruction. On the other hand, these drugs do not have a stimulating effect on the female reproductive system. Estrogens are prescribed in tablets and in patch form (Vivelle, Estraderm, Alora).

Many women who take estrogens note side effects of the drugs: breast tenderness, vaginal bleeding, weight gain. Endocrinologists at Yusupov Hospital reduce the side effects of estrogens due to the correct dosage and combination with other drugs. Estrogens are contraindicated in women whose uterus has been surgically removed. If patients cannot or do not want to take estrogens, they are prescribed selective estrogen receptor modulators (raloxifene, tamoxifen). The drug does not stimulate the mammary glands or uterus, which reduces the risk of the hormone therapy profile. Tamoxifen is commonly used to treat certain types of breast cancer. The drug also inhibits bone breakdown and preserves bone mass. A contraindication to the prescription of estrogens is the presence of breast cancer in the patient's relatives.

The first-line drugs in the treatment of osteoporosis in men, postmenopausal, glucocortico-induced osteoporosis are modern aminobisphosphonates. Several bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid) are used in clinical practice with different routes and modes of administration. Postmenopausal osteoporosis occurs due to accelerated bone loss in women after the cessation of menstruation, as a result of estrogen deficiency. Bisphosphonates have a greater effect on the process of reabsorption of bone tissue.

In patients with osteoporosis, regardless of age, calcium absorption in the intestine is reduced, which leads to a negative calcium balance. Vitamin D deficiency without significant clinical manifestations is widespread not only in older patients, but also in approximately half of people under sixty years of age. Adequate intake of vitamin D and calcium contributes not only to a rapid increase in bone mineral density, but also to a reduction in the incidence of hip and vertebral fractures.

All people over sixty years of age should consume 1200 mg of alimentary calcium and 800 IU of vitamin D per day. Rheumatologists recommend that people in this age group take additional calcium and vitamin D supplements per day. The dosage of medicines depends on dietary habits; doctors at the Yusupov Hospital select it individually for each person to the patient. For optimal treatment of all forms of osteoporosis with other anti-osteoporotic drugs, optimal doses of vitamin D and calcium are prescribed as basic therapy.

Treatment of osteoporosis with bisphosphonates (alendronate, risedronate) leads to a dose-dependent increase in bone mineral density and reduces the risk of fractures by 50% in patients with primary and glucocorticoid osteoporosis. Bisphosphonates bind strongly to bone mineral, inhibit bone resorption and remain in bone tissue for a long time.

Hormone replacement therapy is an effective method for the prevention and treatment of postmenopausal osteoporosis. Glucocorticoids are prescribed if the following indications exist:

• The onset of early menopause and premenopause;
• Postmenopause 10-12 years;
• Primary and secondary hypogonadism in women (with the exception of active hyperprolactinemia);
• Condition after removal of the ovaries.

Glucocorticoids stop the process of bone loss, prevent the development of new fractures, and eliminate vegetative and urogenital complications of menopause.
In the absence of contraindications and careful dynamic monitoring, patients take glucocorticoids for 5-7 years. Effective drugs for the treatment of osteoporosis are selective estrogen receptor modulators (raloxifene). They reduce the risk of spinal fractures. The drugs primarily affect bone tissue and do not have any undesirable effects on the endometrium (inner layer of the uterus) and mammary glands.

Calcitonins inhibit bone resorption due to the primary inhibition of osteoclast activity and a decrease in their number. Calcitonin has a pronounced analgesic effect, which is realized by the opioid systems of the brain. Rheumatologists prescribe salmon calcitonins (calsinar, miacalcic).

The ossein-hydroxyapatite complex (osteogenon) has a certain auxiliary value for normalizing calcium balance and improving bone metabolism. The mineral component of the drug stimulates bone formation with an organic component and suppresses active osteoclasts. This restores the balance between bone formation and destruction. As symptomatic therapy to reduce pain, along with pathogenetic agents (calcitonin), analgesics, non-steroidal anti-inflammatory drugs and muscle relaxants are used.

Doctors recommend that patients with osteoporosis use orthoses (corsets). They should be worn for back pain and compression fractures of the vertebral bodies. Wearing corsets is recommended either continuously or intermittently. You should get rid of them during the night's rest.

Rehabilitators at the Yusupov Hospital use physical therapy and massage as part of complex therapy for osteoporosis. Each patient receives an individual set of gymnastic exercises. Classes are conducted by a senior exercise therapy instructor. After treatment in a rehabilitation clinic, patients perform them independently at home.

Exercises for osteoporosis for all patients

Experts conditionally divide all training exercises into 3 groups:

• for people aged 30 to 49 years;
• for people aged 50 to 59 years;
• for people over 60 years old.

The general rule for performing all physical exercises is to distribute the load evenly. More attention is paid to exercises that put pressure on the muscles of the neck and back. This is due to the fact that vertebral osteoporosis is the main localization of the process. It is recommended to do exercise therapy about 3-4 times a week . Exclude those exercises that could lead to compression of the joints and spine, for example, lifting barbells and exercising with large dumbbells. Let's take a closer look at the specifics and technique of performing the exercise for each age group.

The first group (from 30 to 49 years old) represents the youngest patients, so the exercises for them are the most dynamic and varied. They are performed in different starting positions: sitting, lying or standing. For training, you need to choose comfortable clothes (preferably made from natural rather than synthetic fabrics) to increase their comfort. During warm periods, it is recommended to conduct classes outdoors. The approximate time of one workout is 20-40 minutes.

Exercises that can be done while standing:

1. Feet shoulder-width apart, hands on waist. Perform gentle turns of the head to the sides, forward, backward and in a circle. The whole complex is repeated 5 times.
   Read also:  We are not afraid of arthrosis of the hands: simple prevention
2. Feet together, arms down along the body. As you inhale, raise your arms up, and as you exhale, lower them to the starting position. The main thing is to concentrate on the quality of the exercises and not make sudden movements. Repeat about 5 times.

3. Hands clasped behind head, toes together. The weight is completely transferred to the toes and stretched (the higher, the better), and returned back. Repeat at least 5-6 times.

4. Squats: feet slightly wider than shoulder width, hands on waist. While inhaling, slowly squat, moving the pelvis back (so as not to damage the knee joint), hold for 3-5 seconds and come back as you exhale. Repeat at least 6-7 times.

5. Feet shoulder-width apart, hands on waist. In this position, rotate the body one by one in both directions (at least 5 times).

Exercises that can be done while sitting:

1. Sitting straight on a chair (with your paws pulled back), your hands are placed on your knees. As you inhale, raise your arms up, and as you exhale, lower them to the starting position. Repeat 5-6 times.

2. In a similar starting position, make circular movements with your shoulders forward and backward (12 times each).

3. Sitting on the floor in the “padmasana” pose (legs crossed on the hips), the left hand is placed on the palm (on the same side), resting, and the right hand is brought over the side and stretched towards the left hand. Same for the right hand. Perform 3 times in each direction.

Exercises that can be done while lying down:

1. Lying on your back, bend your legs and place them shoulder-width apart. As you exhale, raise the pelvis, hold it for 2 seconds and lower it while inhaling. Perform 5-6 times.

2. Lying on your back, stretch your arms along your body. Raising your head slightly (without straining your neck muscles), try to reach your stomach. Perform 6-7 times.
3. Lying on your back, pull both legs to the chest, clasp them with both hands and perform small rolls back and forth. The exercise is repeated for 20-30 seconds
4. Lying on your back, with your legs bent, perform the “bicycle” exercise for 2 minutes.

5. Lying on your back, raise one leg to 90° and make circular movements to the sides. Repeat similarly with the second leg, 5 times in each direction.
6. Lying on your stomach, stretch your arms along your body. Raise each leg in turn, fixing it in the air for 5-10 seconds, and lower it back. Perform 5-6 times on each leg.

If during or after training you experience severe pain or other negative symptoms (for example, nausea), you should stop exercising and report your condition to your doctor.

The second group includes people aged 50 to 59 years. Let's look at some general exercises for them:

1. Lying on your stomach, rise up, leaning on your elbows. From this position, raise the pelvis, linger in the air for 2-4 seconds, and lower down.
2. While standing or sitting, lower your chin to your chest, pause for 2-3 seconds and return to the starting position.
3. Lying on your back, perform stretching (you can also stand) about 5 times.
4. Lying on your back, stretch your arms along the body, strain your hands and feet, pulling them towards you. They linger in this position for a few seconds and return to the starting position. This manipulation is repeated with the arms bent into a fist.
5. Standing on all fours, they do a “cat” - they bend and arch their back.
6. Lying on your stomach, take turns raising your legs to 45 degrees, fixing them in the air for 10 seconds and lowering them to the floor.
7. Sitting straight on a chair, tense all your muscles. This position is fixed for 5-8 seconds, and then the muscles are relaxed.

Gymnastics for osteoporosis for older people contains exercises similar to the second group, differing only in a shorter duration and range of movements. The main thing is to remember not to overdo it and do the exercises to the best of your ability. After completing the entire set of exercises, you need to spend a few seconds in child’s pose (balasana) so that the muscles can relax.

Human skeleton

The human musculoskeletal system is formed by the skeleton and muscles.
Bones play the role of a kind of levers driven by muscle fibers. In addition, the bones of the skull, chest and pelvis protect internal organs from mechanical stress. Accessory structures of the musculoskeletal system: ligaments and tendons provide a strong connection between skeletal muscles and bones. Another important component is the various joints, which provide a movable connection of bones. Violation of the integrity of the musculoskeletal system can lead to a significant deterioration in a person’s quality of life. Bones consist of the densest tissue in the body. Young cells (osteoblasts) form the mineral component of the skeleton, providing strength. Bones also contain organic substances necessary for the flexibility and elasticity of the skeleton. The resistance of the skeleton to external influences depends on the ratio of inorganic and organic components of bone tissue. At the same time, against the background of continuous metabolism, bone tissue is constantly destroyed and renewed. Disruption of the metabolic balance in tissues often causes skeletal deformation.

Additional functions of bones:

• Deposition of red bone marrow, which forms components of the blood and immune system.
• Maintaining metabolism by forming reserves of calcium, phosphorus and other mineral components.
• Mitigation of physical stress with the help of cartilage and bone joints.

Bone tissue is constantly rebuilt throughout a person’s life in response to microtrauma. Orderly changes occur in individual areas of the bones, and the processes of tissue destruction always alternate with periods of regeneration. All these mechanisms are necessary to maintain the shape of the skeleton.

The development of bone tissue largely depends on the hormonal regulation of the body. During adolescence, a key period of development of the musculoskeletal system occurs precisely due to hormonal levels. Late endocrine changes, including menopause in women, can adversely affect the condition of the skeleton.

Normal bone metabolism

Bone strength is determined by the content of collagen proteins and mineral components. Collagen determines the tensile strength of tissue, while minerals determine the compressive strength of bone. The more calcium in the tissue, the more resistant the structure is to physical impact. As we grow older, the chemical composition of the human skeleton constantly changes. Organic components predominate in the bones of children, so fractures occur relatively rarely at this age. The bone tissue of older people contains little collagen proteins, which increases the risk of injury.

In addition to external influences, the regulation of bone health depends on two types of cells - osteoclasts and osteoblasts. As already mentioned, osteoblasts form the mineral and organic components of the organ. Osteoclasts ensure constant destruction of bone. The balance of tissue destruction and renewal depends on the interaction of these cells.

Osteocytes, which are terminally differentiated osteoblasts embedded in mineralized bone, determine the characteristics of tissue remodeling. It is believed that in osteoporosis, the mechanism of communication between osteoclasts and osteoblasts changes under the influence of constant trauma to the trabeculae. Osteoclasts take weeks to break down bone, while osteoblasts take months to regenerate tissue. Therefore, any process that increases the rate of bone conversion will result in tissue loss over time.

Prevention of osteoporosis

Basic preventive measures:

• lead a healthy lifestyle (minimize alcohol consumption);
• take regular walks;
• refrain from sudden movements (bending, running);
• maintain proper nutrition. Include in your diet foods that contain a lot of calcium and vitamins D. These include: fish (tuna and mackerel), herbs (parsley and dill), dairy products (kefir and milk), meat and cheese;
• Periodically stretch and do yoga;
• swimming (this helps strengthen bones and has a beneficial effect on all muscle groups);
• ride a bike.

Pathogenesis

Scientists include insufficient formation of bone mass at an early age, excessive skeletal resorption and deficiency of regeneration during tissue restructuring as the main mechanisms for the development of the disease. The interaction of these three mechanisms underlies the decrease in bone density in patients with osteoporosis. The trigger for such patterns of skeletal development may be hormonal disorders, hereditary factors, diseases of internal organs and natural processes during aging.

The spongy part of the bones provides the strength of the skeleton. It is this tissue that is primarily subject to destruction due to excessive activation of osteoclasts. In addition to a decrease in the density of spongy components, a change in the microarchitecture of bone tissue occurs. Thin trabeculae are destroyed with the appearance of small cracks. Gradually, the cracks are replaced by even more fragile tissue, unable to maintain the stability of the skeleton in relation to physical stress.

Diagnosis by a doctor

Complex diagnostics makes it possible to determine at what stage of skeletal destruction the patient is. It is a great success for the patient and the doctor to identify the disease before the first fractures occur, since fractures of the pelvic bones are difficult to treat, and even more so with osteoporosis.

There is a special technique for determining the percentage of bone tissue density, in addition, an X-ray machine helps to identify existing defects in the bones. A blood test is required to determine the content of minerals and hormones. The final picture of the disease is established by a tomograph.

What is the complexity of the combination of arthrosis and osteoporosis?

Even individually, each disease is very dangerous. If they complement each other, the clinical picture worsens. The bones that form the joint lose density, so the load on the cartilage increases - they wear out with triple the force. When experiencing pain due to arthrosis of the ankle, knee or hip joint, a person subconsciously moves less. Because of this, bone density rapidly decreases.

It turns out to be almost a vicious circle, which only an experienced orthopedist-rheumatologist can break. The earlier treatment is started, the better the prognosis, so you should seek help even if morning stiffness in the joint appears, without waiting for severe pain.

Arthrosis plus osteoporosis without treatment is almost certainly a rapid disability

Joint pain can indicate various diseases. How to react to it correctly and how to act in this case?