Thursday, July 21, 2005

Osteoporosis Prescription: The Other "E" Pill

By Shelly DeRuiter, PT (Work Systems Rehab & Fitness; Pella, Iowa)

Estrogen is an important supplement for individuals with osteoporosis. But, there is another option to fight against osteoporosis, another “E” pill – exercise prescription! Sifting through the research on the prevention and treatment of osteoporosis yields a wealth of information. Much evidence exists that supports the use of exercise to increase bone density in premenopausal women and at least maintain bone density when combined with nutrition and/or medication in postmenopausal women.

But increasing bone density is not the only reason for exercise prescription for these patients. Exercise prescription teaches safe body mechanics and activities of daily living (ADL) modification to prevent flexion forces through a weakened spine. It also includes postural stretching and strengthening to ensure that walking allows for weightbearing activity at the appropriate portion of the hip, the neck of the trochanter. Stretching to increase mid-back extension and decrease rounded shoulders is progressively introduced to improve tolerance for lying on the back without support. Exercises to enhance balance reeducation can also be included to decrease the risk of falls, decreasing fracture incidence.

In his book, Stand Tall! Every Woman’s Guide to Preventing and Treating Osteoporosis, Morris Notelovitz, MD outlines multiple research projects that investigated the potential benefits of exercise in the treatment of osteoporosis. Some of the results are amazing:

· Bone mass increases with walking, jogging, and stair climbing;
· Spinal bone density increases more noticeably when estrogen is combined with muscle strengthening;
· Hip and spine density increases with muscle strengthening; and
· Exercise combined with medication and nutrition is more effective at maintaining and improving bone mass than any one factor alone.

Granted, nutrition and medication can also increase bone density, BUT appropriate exercise can do what estrogen, calcium, and other bone-building medications can’t – improve balance and strength, reducing the risk of falls and fractures and improving posture.

Including health professionals with knowledge of both osteoporosis and appropriate exercise prescription enhances the potential that individuals with osteoporosis can increase bone density and decreases the potential for fractures from falls and unsafe positions with ADL’s. Consider the other “E” pill to address not only loss of bone density, but risk for falls, and posture restrictions.

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