Exercise prescription for patients with osteoporosis
September 02 12:32:41, 2025
Osteoporosis is a condition characterized by reduced bone mineral density (BMD) and changes in bone microstructure, increasing the risk of fractures. It is commonly diagnosed in postmenopausal women over 50 years old or men over 50, particularly when the T-score of BMD at the lumbar spine, hip, or femoral neck is 2.5 standard deviations below that of young adults. Some individuals may still be at high risk for fractures even if their bone density is above this threshold, especially as they age. Hip fractures are particularly severe, often leading to high mortality and long-term disability.
According to statistics, about 10 million Americans over the age of 50 suffer from osteoporosis, with another 34 million at high risk. The condition is becoming increasingly common among the general fitness population, highlighting the need for awareness and prevention.
Regular physical activity plays a crucial role in preventing and managing osteoporosis. Exercise can help increase peak bone mass, slow down age-related bone loss, reduce the risk of falls by improving muscle strength and balance, and promote higher bone density in children, adolescents, and young adults, which can be maintained into adulthood.
Other treatment options include dietary adjustments, calcium supplementation, vitamin D intake, and sun exposure. Hormone replacement therapy with estrogen and progesterone is also sometimes used, though it carries its own risks and benefits.
When designing an exercise plan for patients with osteoporosis, certain precautions must be taken. There are currently no strict contraindications, but it's generally advised to avoid movements that cause pain or could worsen symptoms. Spinal torsion, flexion, and compression should be avoided, along with high-impact or explosive activities. Patients with severe osteoporosis should not engage in maximum testing, as even mild flexion can lead to fractures.
For those with spinal osteoporosis, walking exercises may be more suitable. Patients with vertebral compression fractures should focus on balance training to reduce fall risks. Even the most vulnerable elderly should receive tailored exercise prescriptions to prevent further bone loss.
Exercise prescriptions for osteoporosis typically include:
- **Frequency**: 3–5 times per week for weight-bearing aerobic exercises and 2–3 times per week for resistance training.
- **Intensity**: Moderate to high intensity for strength training (8–12RM to 5–6RM), and moderate intensity (40%–60% of target heart rate) for aerobic activities.
- **Duration**: 30–60 minutes per day, combining aerobic and resistance exercises.
- **Type**: Weight-bearing activities such as walking, jogging, climbing stairs, or playing tennis. Sports like volleyball and basketball can also help stimulate bone growth. Back strengthening exercises (avoiding spinal flexion) can improve spinal support and reduce fracture risk.
However, high-intensity resistance training should be approached with caution. Jumping and running should be avoided, even if the patient is physically capable. Non-weight-bearing activities like swimming and cycling can still provide health benefits by improving muscle strength, which indirectly supports bone health through muscle contraction.