What is the safest exercise for people with osteoporosis?

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Elsevier ClinicalKey Clinical Overview

Treatment Recommended intakes: Calcium: 700 to 200 mg/day for females older than 50 years, obtained through diet, supplements, or both (preferably through diet) Vitamin D: guidelines vary from 17.5 to 50 mcg (600 to 2000 International Units)/day for adults older than 50 years, preferably through diet Supplementation may be needed for those with malabsorption or living in facilities Maintain serum 25-hydroxyvitamin D level of 20 nanograms/mL or more; the optimal range for 25-hydroxyvitamin D level is unknown but most experts suggest levels between 30 and 50 nanograms/mL Advise participation in weight-bearing, resistance, and balance exercises Aim for 30 to 40 minutes of walking (or other weight-bearing exercise) per session 3 to 4 days per week For people with osteoporosis who do not have history of vertebral fractures or multiple low-trauma fractures, moderate impact exercise (eg, stamping, jogging, low-level jumping, hopping) is recommended on most days For people with osteoporosis who have vertebral fractures or have had multiple low-trauma fractures, encouraging exercise on most days at level of intensity equivalent to brisk walking is recommended owing to theoretical risks of further vertebral fracture Recommend 2 to 3 sessions of muscle-strengthening exercise or activities per week to maintain bone strength Progressive muscle resistance training has greatest benefit; start at lower intensity and ensure good technique before increasing intensity level to maximum weight that can be lifted 8 to 12 times (building up to three sets for each exercise) Postmenopausal females who engage in strength training can be expected to have a 2% improvement in lumbar spine bone mineral density One meta-analysis determined that improvements in lumbar spine and femoral neck bone mineral density after exercise interventions could reduce the 20-year osteoporosis fracture risk at any site by approximately 10% Advise measures to reduce risk of falls

Treatment Advise measures to reduce risk of falls Activities such as tai chi, dance, pilates, and yoga may be helpful to improve balance, increase muscle tone, and reduce fall risk in older adults (eg, those aged 65 years or older); recommended at least twice a week For patients who are already having falls, professionally supervised, specific and highly challenging balance and muscle strengthening exercises are recommended (eg, Otago or Falls Management Exercise [FaME] programs) Identify hazards in home and remove them (eg, loose rugs, objects on floor); may be more effective when performed by occupational therapist Advise optimized nutritional status with balanced diet of macronutrients For patients who have experienced hip fractures, adequate protein intake is especially important to minimize bone loss; advise patients who have a history of hip fracture to consume the US recommended daily allowance of protein (0.8 g/kg) Encourage cessation of cigarette smoking Advise limitation of alcohol intake to 2 units (standard drinks) per day or less

Screening and Prevention Lifestyle measures to maximize peak bone mass and improve bone health are important to prevent osteoporosis: Participating in lifelong regular physical activity, particularly weight-bearing, resistance, and balance exercises Maintaining healthy body weight Optimizing nutritional status throughout childhood and adolescence, in particular Ensuring adequate intake of calcium and vitamin D, preferably through diet rather than supplements In community-dwelling, postmenopausal females, US Preventive Services Task Force recommends against daily supplementation with vitamin D and calcium for primary prevention of fractures To reduce fractures, encourage institutionalized older adults to increase their intake of dairy products or calcium-rich foods if dietary calcium intake is estimated to be less than 1200 mg per day Metaanalysis does not support calcium or vitamin D supplementation alone, or in combination, in healthy premenopausal women to improve bone mineral density in the total hip or lumbar spine Reducing risk of falls Avoiding tobacco use Avoiding excessive alcohol consumption Limit alcohol to no more than 2 drinks daily; 1 drink is equivalent to 120 mL of wine, 30 mL of liquor, or 260 mL of beer Pharmacotherapy Can consider bisphosphonates to prevent bone loss in postmenopausal females with low bone mineral density (T-score less than 1) and other risk factors for fracture who do not meet criteria for osteoporosis treatment Consider hormone therapy in patients within 10 years of menopause, or aged younger than 60 years, with low to moderate risk of fracture (for whom specific osteoporosis medications are not indicated) Base hormone therapy decisions on all clinical factors (eg, vasomotor symptoms, not skeletal considerations)

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Elsevier ClinicalKey Clinical Overview

Treatment In individuals with low bone mineral density aim for a 25-hydroxyvitamin D level of at least 30 ng/dL Correction of severe vitamin D deficiency can markedly improve bone mineral density and correct osteomalacia (which can be misinterpreted as osteoporosis on DXA scan) Other lifestyle modifications: Weight-bearing exercise for at least 30 minutes 3 times per week (eg, walking, jogging) Smoking cessation Limitation of alcohol intake (fewer than 3 drinks per day) Fall prevention through vision correction, balance exercises, avoidance of polypharmacy or of medications that increase the risk of falls (eg, blood pressure medications, sedatives), keeping rooms adequately lit and free of clutter, and avoidance of slippery and uneven surfaces