Exercise for fragility fractures introduction Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility...
Exercise for fragility fractures introduction Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Exercise is well known to improve or maintain bone mineral density and reduce the likelihood of fragility fractures and injurious falls. This post will review the evidence and updated recommendations for exercise programs for prevention of fragility fractures.
It is recommended that individuals participate in regular weight-bearing exercise, and be prescribed an exercise program according to their individual abilities and needs. This is an important point when prescribing exercise programs for primary or secondary prevention and some physical therapists may be trained specifically in osteoporosis exercise. Benefits of supervision include improved adherence, appropriate intensity progression, and safety.
It is well known that the optimal exercise prescription for fragility fracture prevention should include weight-bearing (impact) exercise. It is less known that progressive resistance training (PRT) paired with a challenging balance and mobility program should also be included in an ideal program. Weight bearing exercise is needed to provide adequate mechanical loading (strain) on the skeletal system from which improvements in BMD can occur across all age groups.
Whilst the optimal weight-bearing load is not clear, guidelines recommend that exercise eliciting loads (peak ground reaction forces) that are twice one’s body weight (BW) are needed for those at moderate to high-risk and four times BW for those at low risk of fracture. In recent years, there has been an emerging body of research investigating the effects of different types of exercise loads on changes in BMD. A 2020 Australian ‘Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation’ (LIFTMOR) trial focused on 8 months of supervised, ‘bone-focused’, high intensity progressive resistance and impact training (HiRIT) across various population groups.
The LIFTMOR program involved five sets of five repetitions (at 80–85% of one repetition maximum) for three exercises (overhead press, deadlift, and squat) with 1 min rest interval between sets. The LIFTMOR trial involved 93 men aged ≥ 45 years with low BMD and found significantly greater BMD (mean 2.8% and 4.1% improvement in trochanteric and lumbar spine BMD and greater lean (muscle) mass (1.5%) compared with matched controls. Multimodal exercise has also shown promise for reducing the risk of osteoporosis.
If you are experiencing symptoms that may be related to exercise for fragility fractures, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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