Bone Fit – The New Exercise and Treatment Guidelines for Helping People with Osteoporosis

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Osteoporosis is a silent condition that affects 2 million Canadians.  It is known as the “silent thief” because bone loss often goes unnoticed until someone gets a fracture.  Known as “low trauma” fractures, osteoporosis-related fractures can happen from a minor fall, sustained or repetitive postures, or even by turning on one’s leg.  Today, over 80% of all fractures in people older than 50 years of age are caused by osteoporosis. Even worse, 28% of women and 37% of men who suffer a hip fracture will die within one year.  Bone Fit is a professional education program that was developed jointly by the Ontario Osteoporosis Strategy and Osteoporosis Canada, to train health professionals on the most up to date knowledge for helping patients with osteoporosis.  Now updated for 2024, health and fitness professionals can get updated on the New Exercise and Treatment Practice Guidelines for the management of osteoporosis and fracture prevention.  The first BoneFit updated program was attended by John Gray, Registered Kinesiologist, demonstrating the Orthopaedic Therapy Clinic’s mission to stay at the leading edge of evidence to help our clients succeed.

The latest clinical guidelines aren’t filled with any new ground-breaking ideas, but instead comprehensively improve our understanding of the realistic risks of osteoporosis-related fractures.  Compared to previous guidance, they emphasize increased attention to functional exercises, and improving balance and mobility while decreasing the number of previous restrictions that have often left people feeling petrified to move in certain ways that might risk a fracture.  It’s probably good news to people trying to do those jarring “heel drops” that are often unpleasant and could actually cause other pains!

What exercises should be done to prevent falls and fractures?

The Bone Fit exercise guidelines recommend that you perform the following types of exercises at least twice per week for managing osteoporosis and reducing the risks of problems:

  1. Progressive Resistance Training
  2. Balance, Agility and Functional Training
  3. Postural Training

1.  Progressive Resistance Training for preventing osteoporosis fractures

Resistance exercises are important for reducing fracture risk and should include all the major muscles groups i.e. arms, legs, back, and even abdominals.  The amount and frequency of resistance training will depend on your risk but it should be done at least twice per week.

(reference: Bone Fit, 2024)

To build strength, the resistance you use needs to be challenging enough to grow your muscles and bones.  Bone Fit recommends making decisions based on a percentage of the highest weight you can *safely* lift for ten repetitions, which is called your 10RM (10 repetition maximum).  A safe starting point is at about 60% of this number, which can be increased as the exercise becomes easier.  This is the progressive part.  If you are unsure how to do this, or are worried about any risk of hurting yourself, then it would be a good idea to ask a Bone Fit training professional for guidance.

One widely used method for estimating the intensity of your exercises is based on your rate of perceived exertion (RPE).  The RPE is your personal estimate of “how hard” an exercise feels, and is normally done a scale out of 10, where 10 out of 10 would be your maximal possible effort level (in other words, 100% of your 10RM), and 1 out of 10 would be the lightest effort you could perceive.  This works with your repetitions in reserve in the following way: an RPE of 6 out of ten suggests that you were working at about 60% of your 10RM, which is a good starting point as suggested by Bone Fit.  If the weights you are using are not causing any pain or stiffness after the exercise, you should feel free to increase your RPE to get the best out of your workout.

This method is safer and easier than testing a 10-repetition maximum weight, especially for patients who are at high risk of fracture or are just beginning resistance training exercises for their health.

2.  Balance, agility and functional training for reducing risk of falls

Challenging your balance and flexibility are important to reduce your risk for falling.  These exercises improve your ability to react and maintain balance when you are in riskier situations like icy or uneven pavement.  The Bone Fit exercise guidelines advise that these types of exercises are recommended two or more times each week, as part of the warmup for your workout.  If this doesn’t apply to you, many of our busy patients have found that finding ways to do them individually at different times throughout your day can make scheduling exercise more manageable.  So, standing at your computer, or the kitchen counter, brushing your teeth, or during other normal daily activities are great opportunities to include some balance exercises into your day.

Effective balance exercises include more than reducing your base of support, like the traditional “standing on one foot” exercise, although it is still a good starting point.  Progressing balance exercises to make them more challenging also includes ideas such as:

  • Shifting your weight from side-to-side to challenge the limits of your stability
  • Throwing or catching a ball
  • Maintaining balance while moving, such as skipping or hopping
  • Removing visual cues, such as standing with eyes closed, or looking in a different direction than straight forward.

For specific examples, watch this YouTube video on Osteoporosis Canada’s channel.

Of course, you should always practice balance exercises in a safe and/or supervised environment to limit the risk of falling.


3.  Postural exercise to improve alignment and reduce osteoporosis related fractures

Reducing or avoiding a forward flexed posture is the most important factor in reducing or avoiding a spinal fracture.  Exercises that help to maintain good posture also allow more spine mobility, which helps to perform many functional tasks and activities.

Postural exercises strengthen the extensor muscles of the spine, but also help to increase the strength of your abdominals and glutes (buttock muscles).  Although these muscles are also strengthened during progressive resistance exercises, postural exercises are less intense but improve your postural awareness.  As a result, these exercises should be performed on a daily basis to build good postural habits.

A final component of treatment should also include teaching proper technique to protect the spine when lifting, reaching, or leaning forward.  Learn to lift with your legs, not your back.

Where to go for additional help and information:

The new Bone Fit osteoporosis exercise guidelines emphasize the importance of exercise as part of an integrated approach that may also include dietary or medical management.  However, even if you have “normal” Bone Mineral Density, you could still be at risk if: you have had fractures in the past, are managing a health condition that increases your risk, or have a familial history of osteoporosis and fractures.  You can get more information on these and other topics, as well as join a community of osteoporosis patients and leaders, by joining the Canadian Osteoporosis Patient Network

Managing osteoporosis and reducing your risk of fractures can be challenging since there is so much to include.  Contact us if you would like some help in putting together a program that addresses your needs and lifestyle, so you can be confident in your health journey.  An individualized exercise program is an important part of your treatment and management of osteoporosis, whether you are trying to prevent a future injury, or recover from a fracture.

This service pro­vides gen­eral infor­ma­tion and dis­cus­sion about therapy, health and related sub­jects. It is not meant to replace advice and/or treatment from your health care professional.