Getting to the bones of it
Most people hear the word “osteoporosis” and assume it relates to seniors. But I’m here to tell you otherwise.
While osteoporosis occurrence increases with age, as does the risk of an osteoporotic fracture, 66% of Australians aged 50 and over have osteoporosis or osteopenia (low bone mass that’s the precursor to osteoporosis).[1] [2] Considering that women lose up to 20% of their bone mass in the first 5-7 years after menopause (which occurs on average at age 51), the midlife stage is a key time to inquire if your clients have been screened for osteoporosis and even if they’ve experienced a fracture.[3]
It’s important to note that an individual is classified as having osteoporosis if they’ve experienced a fragility fracture, regardless of bone density testing. Especially interesting is the observational data published in the 2021 Journal of the American Medical Association finding that an initial fracture that’s traumatic (from above standing height or, say, in a car crash) and one that’s nontraumatic (occurring from standing heights or lower) are similarly associated with risk of subsequent fracture.[4] In other words, we need to take into account fracture history in general.
All of this matters for you as an exercise professional. Not only will a diagnosis of osteoporosis or osteopenia change and guide your programming, it offers you a unique opportunity for intervention and improvement in your clients’ health outcomes. This may be one of the most important ways you can help your clients and actually change their lives!
Now you may be thinking, “Oh boy, this means I’m now limited in what I can teach them and basically should have my clients practice little more than standing on one leg.”
Far from it.
The reason I created Buff Bones® back in 2009 was because I myself was diagnosed with osteoporosis 5 years earlier - at age 28 - and resented feeling excluded from classes that abounded with thoracic flexion, which is contraindicated for osteoporosis. My body at the time, like many in midlife as I am now at age 47, also wasn’t well suited to classes with certain high impact elements that hurt my joints. But any classes for osteoporosis were geared toward those like my elderly grandmother, and mostly seated in a chair.
Thus Buff Bones® was born, and it became my mission to guide others in ways to improve their bone health, using existing research findings, others not yet explored, and always through an inclusive and encouraging lens.
The Buff Bones method embraces a whole-body approach and the principles of Pilates, which many in the osteoporosis exercise world dismiss due to its limited loading of the bones. It’s true that Pilates alone lacks the necessary stimulation necessary to increase bone density in a postmenopausal population. Yet weight training, which has been shown at specific loads to be able to increase bone density in this population and is certainly key to at least maintaining current bone mass, is not sufficient in itself to provide the resilient and steady body necessary to meet life’s demands, overlooking mobility and balance training.
This is why we view Buff Bones as the centrepiece of the bone health formula. Rather than a number of exercises, it’s an entire method of movement that offers the solid foundation for any other exercise form that an individual wishes to or should layer on for their personalised programming. In addition to site-specific exercise targeting the most vulnerable bones, it combines key elements of motor control and fascia integration for healthy movement patterning and mobility, progressive overload for training strength, dynamic balance work for fall prevention and functional improvement, and impact for bone stimulation. Once the fundamentals are solid, we add in higher loads to build the bones as appropriate within a class format. And we certainly encourage high-intensity strength training and work in conjunction with personal trainers for a team approach to clientele and this population.
Understand that no one exercise or style is the entire answer to the osteoporosis dilemma. It demands a multimodal approach. And yet exercise must start with good movement habits and optimal joint health, not only to prevent injury but to contend with the hormonal shifts occurring at this midlife time and the tendon-related issues, often in the shoulders and hips.
Midlife clients can be among the most rewarding to work with, guiding them through what can be a challenging period of change, and turning it into an exceptional opportunity for improvement and fracture prevention for now and years to come.
[1] Australian Institute of Health and Welfare. (2014). Estimating the prevalence of osteoporosis in Australia. Canberra: AIHW.
[2] Healthy Bones Australia. (2023, February 19). About Bones. https://healthybonesaustralia.org.au/your-bone-health/about-bones/
[3] Bone Health & Osteoporosis Foundation. (2023, February 19). What Women Need to Know. https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/
[4] Crandall CJ, Larson JC, LaCroix AZ, et al. Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures. JAMA Intern Med. 2021;181(8):1055–1063.
Lisa Jackson, Australia faculty for Buff Bones® and frequent collaborator with Rebekah Rotstein, will be teaching the Instructor Training course in Melbourne March 18-19. For more information, visit www.buff-bones.com
Rebekah Rotstein, NCPT is an industry leader for Pilates, bone health and movement education. She is the founder of Buff Bones®, with trained instructors in more than 30 countries, is a frequent presenter on osteoporosis and works with several American bone health advocacy organisations.